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Few novel or emerging infectious diseases have posed such vital ethical challenges so quickly and dramatically as the novel coronavirus SARS‐CoV‐2. The World Health Organization declared a public health emergency of international concern and recently classified Covid‐19 as a worldwide pandemic. As of this writing, the epidemic has not yet peaked in the United States, but community transmission is widespread. President Trump declared a national emergency as fifty governors declared state emergencies. In the coming weeks, hospitals will become overrun, stretched to their capacities. When the health system becomes stretched beyond capacity, how can we ethically allocate scarce health goods and services? How can we ensure that marginalized populations can access the care they need? What ethical duties do we owe to vulnerable people separated from their families and communities? And how do we ethically and legally balance public health with civil liberties?

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic.

The ability to analyse online user-generated content related to sentiments (e.g., thoughts and opinions) on products or policies has become a de-facto skillset for many companies and organisations. Besides the challenge of understanding formal textual content, it is also necessary to take into consideration the informal and mixed linguistic nature of online social media languages, which are often coupled with localised slang as a way to express ‘true’ feelings. Due to the multilingual nature of social media data, analysis based on a single official language may carry the risk of not capturing the overall sentiment of online content. While efforts have been made to understand multilingual sentiment analysis based on a range of informal languages, no significant electronic resource has been built for these localised languages. This paper reviews the various current approaches and tools used for multilingual sentiment analysis, identifies challenges along this line of research, and provides several recommendations including a framework that is particularly applicable for dealing with scarce resource languages.

This paper proposes a novel method for phrase-based statistical machine translation based on the use of a pivot language. To translate between languages$L_{s}$and$L_{t}$with limited bilingual resources, we bring in a third language,$L_{p}$, called the pivot language. For the language pairs$L_{s}$-$L_{p}$and$L_{p}$-$L_{t}$, there exist large bilingual corpora. Using only$L_{s}$-$L_{p}$and$L_{p}$-$L_{t}$bilingual corpora, we can build a translation model for$L_{s}$-$L_{t}$. The advantage of this method lies in the fact that we can perform translation between$L_{s}$and$L_{t}$even if there is no bilingual corpus available for this language pair. Using BLEU as a metric, our pivot language approach significantly outperforms the standard model trained on a small bilingual corpus. Moreover, with a small$L_{s}$-$L_{t}$bilingual corpus available, our method can further improve translation quality by using the additional$L_{s}$-$L_{p}$and$L_{p}$-$L_{t}$bilingual corpora.

The fast growth of Internet-connected embedded devices demands new system capabilities at the network edge, such as provisioning local data services on both limited network and computational resources. The current contribution addresses the previous problem by enhancing the usage of scarce edge resources. It designs, deploys, and tests a new solution that incorporates the positive functional advantages offered by software-defined networking (SDN), network function virtualization (NFV), and fog computing (FC). Our proposal autonomously activates or deactivates embedded virtualized resources, in response to clients’ requests for edge services. Complementing existing literature, the obtained results from extensive tests on our programmable proposal show the superior performance of the proposed elastic edge resource provisioning algorithm, which also assumes an SDN controller with proactive OpenFlow behavior. According to our results, the maximum flow rate for the proactive controller is 15% higher; the maximum delay is 83% smaller; and the loss is 20% smaller compared to when the non-proactive controller is in operation. This improvement in flow quality is complemented by a reduction in control channel workload. The controller also records the time duration of each edge service session, which can enable the accounting of used resources per session.

Background Inter-hospital patient transfers to hospitals with greater resource availability and expertise may improve clinical outcomes. However, there is little guidance regarding how patient transfer requests should be prioritized when hospital resources become scarce. Objective To understand the experiences of healthcare workers involved in the process of accepting inter-hospital patient transfers during a pandemic surge and determine factors impacting inter-hospital patient transfer decision-making. Design We conducted a qualitative study consisting of semi-structured interviews between October 2021 and February 2022. Participants Eligible participants were physicians, nurses, and non-clinician administrators involved in the process of accepting inter-hospital patient transfers. Participants were recruited using maximum variation sampling. Approach Semi-structured interviews were conducted with healthcare workers across Michigan. Key Results Twenty-one participants from 15 hospitals were interviewed (45.5% of eligible hospitals). About half (52.4%) of participants were physicians, 38.1% were nurses, and 9.5% were non-clinician administrators. Three domains of themes impacting patient transfer decision-making emerged: decision-maker, patient, and environmental factors. Decision-makers described a lack of guidance for transfer decision-making. Patient factors included severity of illness, predicted chance of survival, need for specialized care, and patient preferences for medical care. Decision-making occurred within the context of environmental factors including scarce resources at accepting and requesting hospitals, organizational changes to transfer processes, and alternatives to patient transfer including use of virtual care. Participants described substantial moral distress related to transfer triaging. Conclusions A lack of guidance in transfer processes may result in considerable variation in the patients who are accepted for inter-hospital transfer and in substantial moral distress among decision-makers involved in the transfer process. Our findings identify potential organizational changes to improve the inter-hospital transfer process and alleviate the moral distress experienced by decision-makers.

Background: Stark gaps exist between projected health needs in a pandemic situation and the current capacity of health care and medical countermeasure systems. Existing pandemic ethics discussions have advocated to engage the public in scarcity dilemmas and attend the local contexts and cultural perspectives that shape responses to a global health threat. This public engagement study thus considers the role of community and culture in the ethical apportionment of scarce health resources, specifically ventilators, during an influenza pandemic. It builds upon a previous exploration of the values and preferences of Maryland residents regarding how a finite supply of mechanical ventilators ought to be allocated during a severe global outbreak of influenza. An important finding of this earlier research was that local history and place within the state engendered different ways of thinking about scarcity. Objective: Given the intrastate variation in the themes expressed by Maryland participants, the project team sought to examine interstate differences by implementing the same protocol elsewhere to answer the following questions. Does variation in ethical frames of reference exist within different regions of the United States? What practical implications does evidence of sameness and difference possess for pandemic planners and policymakers at local and national levels? Methods: Research using the same deliberative democracy process from the Maryland study was conducted in Central Texas in March 2018 among 30 diverse participants, half of whom identified as Hispanic or Latino. Deliberative democracy provides a moderated process through which community members can learn facts about a public policy matter from experts and explore their own and others’ views. Results: Participants proposed that by evenly distributing supplies of ventilators and applying clear eligibility criteria consistently, health authorities could enable fair allocation of scarce lifesaving equipment. The strong identification, attachment, and obligation of persons toward their nuclear and extended families emerged as a distinctive regional and ethnic core value that has practical implications for the substance, administration, and communication of allocation frameworks. Conclusions: Maryland and Central Texas residents expressed a common, overriding concern about the fairness of allocation decisions. Central Texas deliberants, however, more readily expounded upon family as a central consideration. In Central Texas, family is a principal, culturally inflected lens through which life and death matters are often viewed. Conveners of other pandemic-related public engagement exercises in the United States have advocated the benefits of transparency and inclusivity in developing an ethical allocation framework; this study demonstrates cultural competence as a further advantage.

Central Asian states, where freshwater is a strategic resource, are oriented towards regional conflict rather than cooperation. First, the article analyses the role of the unequal distribution of freshwater that has been generating conflicts in Central Asia in the post-Soviet period. Next, these conflicts are examined. Finally, we provide some recommendations on the non-conflictual use of water.

PurposeThe purpose of this paper is to critically explore how context as an antecedent to entrepreneurial digital competencies (EDCs) influences digital entrepreneurship in a resource-scarce environment.Design/methodology/approachThe data comprises semi-structured interviews with 16 digital entrepreneurs, as owner-managers of small digital businesses in Cameroon.FindingsThe results reveal the ways in which EDCs shape the entry (or start-up) choices and post-entry strategic decisions of digital entrepreneurs in response to context-specific opportunities and challenges associated with digital entrepreneurship.Research limitations/implicationsThe data comes from one African country and 16 digital businesses thus the research setting limits the generalisability of the results.Practical implicationsThis paper highlights important implications for encouraging digital entrepreneurship by focussing on institutional, technology and local dimensions of context and measures to develop the entrepreneurial and digital competencies. This includes policy interventions to develop the information and communication technology (ICT) infrastructure, transport and local distribution infrastructure, and training opportunities to develop the EDCs of digital entrepreneurs.Originality/valueWhereas the capabilities to adopt and use ICTs and the internet by small businesses have been examined, this is among the first theoretically sensitised study linking context, EDCs and digital entrepreneurship.

•The 201 identified studies evaluate strategies to reducing demand for healthcare, optimizing existing resources, augmenting resources, and adopting crisis standards of care.•Most research exists for countermeasures to reduce demand. Of 15 COVID-19 studies, five higher quality studies reported on combinations of policy interventions and benefit of community-wide mask policies.•In pandemics like COVID-19, the need for medical resources quickly outpaces available supply.•The review provides policymakers with a comprehensive overview of the effects of strategies to allocate resources and provides critical appraisal to direct them to the best available evidence. In pandemics like COVID-19, the need for medical resources quickly outpaces available supply. policymakers need strategies to inform decisions about allocating scarce resources. We updated a systematic review on evidence-based approaches and searched databases through May 2020 for evaluation of strategies for policymakers. The 201 identified studies evaluated reducing demand for healthcare, optimizing existing resources, augmenting resources, and adopting crisis standards of care. Most research exists to reduce demand (n = 149); 39 higher quality studies reported benefits of contact tracing, school closures, travel restrictions, and mass vaccination. Of 28 strategies to augment resources, 6 higher quality studies reported effectiveness of establishing temporary facilities, use of volunteers, and decision support software. Of 23 strategies to optimize existing resources, 12 higher quality studies reported successful scope of work expansions and building on existing interagency agreements. Of 15 COVID-19 studies, 5 higher quality studies reported on combinations of policies and benefits of community-wide mask policies. Despite the volume, the evidence base is limited; few strategies were empirically tested in robust study designs. The review provides a comprehensive overview of the effects of strategies to allocate resources and provides critical appraisal to identify the best available evidence.