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Introduction: The COVID-19 pandemic generated overflow of healthcare systems in several countries. As the ethical debates focused on prioritisation for access to care with scarce medical resources, numerous recommendations were created. Late 2021, the emergence of the Omicron variant whose transmissibility was identified but whose vaccine sensitivity was still unknown, reactivated debates. Fears of the need to prioritise patients arose, particularly in France. Especially, a debate began about the role of vaccination status in the prioritisation strategy. Material and methods: The Ethics Committee (EC) of the University Hospital of Bordeaux (UHB), France, identified prioritisation criteria in the literature (some recommended, such as being a healthcare worker (HCW) or having consented to research, while others were discouraged, such as age with a threshold effect or vaccination status). A survey was sent within the institution in January 2022 to explore frontline physicians' adherence to these prioritisation criteria. The decision making conditions were also surveyed. Results: In 15 days, 78/165 (47.3%) frontline physicians responded, and more widely 1286/12946 (9.9%) professionals. A majority of frontline physicians were opposed to prioritising HCWs (54/75, 72%) and even more opposed to participating in research (69/76, 89.6%). Conversely, the results were very balanced for non-recommended criteria (respectively 39/77, 50.7% and 34/69 49.3% in favour for age with a threshold effect and for vaccination status). Decisions were considered to be multi-professional and multi-disciplinary for 65/76, 85.5% and 53/77, 68.8% of frontline physicians. Responders expressed opposition to extending decision-making to representatives of patients, civil society or HCWs not involved in care. Discussion: Prioritisation recommendations in case of scarce medical resources were not necessarily approved by the frontline physicians, or by the other HCWs. This questions the way ethical recommendations should be communicated and discussed at a local scale, but it also questions these recommendations themselves. The article also reports the experience of seeking HCWs opinions on a sensitive ethical debate in a period of crisis. [ABSTRACT FROM AUTHOR]

With the impact and cost of continued river degradation and climate changeinduced extreme rainfall and floods, there is growing urgency to achieve and maintain good river health to meet global sustainable development goals. Upscaling and working with nature-based solutions at regional, catchment and fluvial corridor scales is critical. One way to achieve this is to work within a recovery-enhanced approach to river rehabilitation, incorporating processes of geomorphic and vegetative recovery to build fluvial corridors in areas where they have become fragmented. Geomorphologically-informed cost-benefit analysis has not previously been applied in a riverine or riparian context, at the catchment or regional scale needed. We applied Marxan in a novel manner to undertake the first cost-benefit analysis for geomorphologically-informed rehabilitation of river systems. We estimated that to rehabilitate 75,500 km of streams in coastal catchments of NSW will cost $8.2 billion, comparing favourably to recent single flood event insurance losses, and projected future losses. We developed Marxan scenarios based on three broad approaches to river management: ad hoc and reactive, working with recovery and corridors, across current and future time periods. We found there are considerable current and flow-on future financial and non-financial benefits, and lower initial total and per-hectare rehabilitation costs, by fully adopting working with recovery or corridors approaches and moving away from the ad hoc and reactive approaches which dominate current practice. Implementing targeted rehabilitation based on a rolling sequence over time of corridors scenarios provides optimal holistic solutions to improve geomorphic condition and enhance recovery potential at landscape-scale. Our study demonstrates the use of Marxan as an accessible tool to address prioritisation complexity, and to run and cost landscape-scale rehabilitation scenarios over time. Our study also demonstrates the positive offsite feedbacks that occur through multiplier effects, as recovery occurs, and corridors are built. Geomorphologically-informed decision making becomes more robust, transparent, cost-effective, consistent across catchments, and adaptive to local situations and evolving river management priorities. [ABSTRACT FROM AUTHOR]

Background: Decentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level. Methods: Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software. Findings: The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs. Conclusion: The findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support. [ABSTRACT FROM AUTHOR]

Community assembly provides the foundation for applications in biodiversity conservation, climate change, invasion, restoration and synthetic ecology. However, predicting and prioritising assembly outcomes remains difficult. We address this challenge via a mechanism‐free approach useful when little data or knowledge exist (LOVE; Learning Outcomes Via Experiments). We carry out assembly experiments ('actions', here, random combinations of species additions) potentially in multiple environments, wait, and measure abundance outcomes. We then train a model to predict outcomes of novel actions or prioritise actions that would yield the most desirable outcomes. Across 10 single‐ and multi‐environment datasets, when trained on 89 randomly selected actions, LOVE predicts outcomes with 0.5%–3.4% mean error, and prioritises actions for maximising richness, maximising abundance, or removing unwanted species, with 94%–99% mean true positive rate and 10%–84% mean true negative rate across tasks. LOVE complements existing mechanism‐first approaches for community ecology and may help address numerous applied challenges. [ABSTRACT FROM AUTHOR]

Aim: Efficient mitigation of the biodiversity crisis requires targeted conservation actions in locations with high species richness, the presence of endangered species and unique species communities. However, prioritising sites remains challenging because of sparse knowledge on biodiversity, limiting the possibility of communicating efficiently with local decision makers. We examine easy‐to‐replicate, yet robust, methods to identify areas with high conservation values on large spatial scales using data filtering and complementary biodiversity indicators based on species records from a biodiversity information facility. Location: Finland, Europe. Methods: We illustrate the protocol by focusing on Lepidoptera in Finnish municipal districts. We mobilised over 3 million species records on 878 native Lepidoptera (2001–2020) from the Finnish Biodiversity Information Facility. We estimated the richness of overall and endangered species using species accumulation curves, as well as the uniqueness of species communities, using measures of local contribution to beta diversity (LCBD). After testing for multiple thresholds and their effect on indicator accuracy, 97 districts with >5000 records were included in the analyses. Results: Estimated overall species richness was highest on the southern coast and significantly decreased in the North, following a known pattern with Lepidoptera in Finland. Species richness was not the highest in the districts with the greatest number of records and the ranking differed from the raw data, demonstrating the importance of correcting for sampling intensity. The estimated number of endangered species correlated with overall species richness, except in northernmost districts, where the proportion of endangered species was exceptionally high. High LCBD replacement (i.e. unique species communities) was concentrated in the Southwest (hemi‐boreal) and North (northern boreal) of the country. Main Conclusions: We provided an example and interpretations of how scalable biodiversity indicators based on accumulation curves and LCBD analyses, and careful data filtering (thresholds) can be used to identify sites with conservation priorities from multi‐sourced species records. [ABSTRACT FROM AUTHOR]

Abstract Introduction The COVID-19 pandemic generated overflow of healthcare systems in several countries. As the ethical debates focused on prioritisation for access to care with scarce medical resources, numerous recommendations were created. Late 2021, the emergence of the Omicron variant whose transmissibility was identified but whose vaccine sensitivity was still unknown, reactivated debates. Fears of the need to prioritise patients arose, particularly in France. Especially, a debate began about the role of vaccination status in the prioritisation strategy. Material and methods The Ethics Committee (EC) of the University Hospital of Bordeaux (UHB), France, identified prioritisation criteria in the literature (some recommended, such as being a healthcare worker (HCW) or having consented to research, while others were discouraged, such as age with a threshold effect or vaccination status). A survey was sent within the institution in January 2022 to explore frontline physicians' adherence to these prioritisation criteria. The decision making conditions were also surveyed. Results In 15 days, 78/165 (47.3%) frontline physicians responded, and more widely 1286/12946 (9.9%) professionals. A majority of frontline physicians were opposed to prioritising HCWs (54/75, 72%) and even more opposed to participating in research (69/76, 89.6%). Conversely, the results were very balanced for non-recommended criteria (respectively 39/77, 50.7% and 34/69 49.3% in favour for age with a threshold effect and for vaccination status). Decisions were considered to be multi-professional and multi-disciplinary for 65/76, 85.5% and 53/77, 68.8% of frontline physicians. Responders expressed opposition to extending decision-making to representatives of patients, civil society or HCWs not involved in care. Discussion Prioritisation recommendations in case of scarce medical resources were not necessarily approved by the frontline physicians, or by the other HCWs. This questions the way ethical recommendations should be communicated and discussed at a local scale, but it also questions these recommendations themselves. The article also reports the experience of seeking HCWs opinions on a sensitive ethical debate in a period of crisis.

Abstract Background Decentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level. Methods Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software. Findings The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs. Conclusion The findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support.

Abstract Background Healthcare triage policies are vital for allocating limited resources fairly and equitably. Despite extensive studies of healthcare equity, consensus on the applied definition of equity in triage remains elusive. This study aimed to investigate how the principles of equity are operationalised in Australian hospital physiotherapy triage tools to guide resource distribution. Methods A retrospective, qualitative content analysis of 13 triage policies from 10 hospitals across Australia was conducted. Triage policies from both inpatient and outpatient settings were sourced. Data were coded deductively using the five discrete domains of the multi-faceted operational definition of health equity posited by Lane et al. (2017): 1) point of equalisation in the health service supply/access/outcome chain, 2) need or potential to benefit, 3) groupings of equalisation, 4) caveats to equalisation, 5) close enough is good enough. Descriptive summative statistics were used to analyse and present the frequency of reported equity domains. Results Within the included triage tools, four out of five domains of equity were evident in the included documents to guide decision making. Allocation based on perceived patient need and overall health outcomes were the central guiding principles across both inpatient and outpatient settings. Equal provision of service relative to patient need and reducing wait times were also prioritised. However, explicit inclusion of certain equity domains such as discrimination, ensuring equal capability to be healthy and other patient factors was limited. Conclusions Physiotherapy triage policies consider various domains of equity to guide resource allocation decisions. Policymakers and service providers can use the insights gained from this study to review the application and operationalisation of equity principles within their healthcare systems through mechanisms such as patient triage tools.

Several attempts to eradicate invasive alien species have been initiated in South Africa and despite no formal eradication declaration, several species have been brought down to low levels or are now absent from the country. Based on an expert workshop with South African implementing agencies on best nationwide eradication practices, we recommend that eradication programmes should be well coordinated, and characterised by collaboration between implementing agencies, researchers and practitioners. Countries should have a list of eradication targets informed by the best available science, with targets ranked according to priority. The best eradication model should be used consistently until eradication is achieved. While most of these priority areas are not novel, it does provide a perspective from a biodiverse African country with limited funding, based on 16 years of experience in implementing eradication programmes. It corroborates challenges experienced elsewhere in the world and contributes to enhancing eradication outcomes globally. [ABSTRACT FROM AUTHOR]

Background: Nurses play an important role in the prevention and management of delirium episodes. However, some studies have reported that not all interventions recommended are applied due to time and resource constraints, resulting in patients receiving less care than required because other patients and/or interventions are prioritised. The concept of prioritization is part of the broader concept of decision-making as the ability to choose between two or more alternatives to ensure patient safety. Understanding the reasons influencing the prioritization process in patients at risk or with delirium may inform interventions to prevent and/or minimise the unfinished nursing care. Aim: The purpose of this study was to explore the reasons that inform the prioritisation process among nurses when they are challenged to make decisions for patients at risk and with delirium. Methods: A descriptive qualitative study performed according to the COnsolidated criteria for Reporting guidelines, in 2021. An intentional sample of nurses working full-time with older patients in medical, geriatric, and post-acute care facilities affiliated with the National Health System was involved. Semi-structured interviews were conducted and narratives thematic analysed. Results: A total of 56 nurses (55.4% in internal medicine, 26.8% in geriatrics and 17.8% in post-acute/intermediate care) participated with an average age of 31.6 years. The reasons informing the prioritisation process while providing preventive or managerial interventions towards a patient at risk of or with delirium are set at three levels: (1) unit level, as reasons belong to the inadequacy of the 'Environment', the 'Human Resources', and the 'Organisation and Work Processes', (2) nurse's level, as issues in 'Competencies' and 'Attitudes' possessed, and (3) patient level, due to the 'Multidimensional Frailty'. Conclusion: Nurses caring for patients at risk of and with delirium face several challenges in providing care. To prioritise preventive and managerial interventions, it is essential to implement multilevel and multifaced organizational and educational strategies. [ABSTRACT FROM AUTHOR]

Background: Healthcare triage policies are vital for allocating limited resources fairly and equitably. Despite extensive studies of healthcare equity, consensus on the applied definition of equity in triage remains elusive. This study aimed to investigate how the principles of equity are operationalised in Australian hospital physiotherapy triage tools to guide resource distribution. Methods: A retrospective, qualitative content analysis of 13 triage policies from 10 hospitals across Australia was conducted. Triage policies from both inpatient and outpatient settings were sourced. Data were coded deductively using the five discrete domains of the multi-faceted operational definition of health equity posited by Lane et al. (2017): 1) point of equalisation in the health service supply/access/outcome chain, 2) need or potential to benefit, 3) groupings of equalisation, 4) caveats to equalisation, 5) close enough is good enough. Descriptive summative statistics were used to analyse and present the frequency of reported equity domains. Results: Within the included triage tools, four out of five domains of equity were evident in the included documents to guide decision making. Allocation based on perceived patient need and overall health outcomes were the central guiding principles across both inpatient and outpatient settings. Equal provision of service relative to patient need and reducing wait times were also prioritised. However, explicit inclusion of certain equity domains such as discrimination, ensuring equal capability to be healthy and other patient factors was limited. Conclusions: Physiotherapy triage policies consider various domains of equity to guide resource allocation decisions. Policymakers and service providers can use the insights gained from this study to review the application and operationalisation of equity principles within their healthcare systems through mechanisms such as patient triage tools. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the rate of inflammatory rheumatic diseases (IRDs) in a cohort of initial referrals and the efficacy of prioritising appointments to the early arthritis clinic (EAC) based on symptom duration. Methods: In the present study, we used algorithm-based telephone triage to assign routine care appointments according to the time between symptom onset and request for an appointment (cut-off criterion: 6 months). This retrospective, monocentric analysis evaluated the effectiveness of our triage in identifying patients with IRDs as a function of the assigned appointment category (elective, EAC, or emergency appointment). Results: A total of 1407 patients were included in the study (34.7% male; 65.3% female). Of the 1407 patients evaluated, 361 (25.7%) presented with IRD. There were significant differences in the frequency of inflammatory diagnoses between appointment categories (p < 0.001): elective 13.8%, EAC 32.9%, and emergency 45.9%. The sample without the emergency category included a total of 1222 patients. The classification into "inflammatory" or "non-inflammatory" in this subsample was as follows: Sensitivity was 37.7%, and specificity was 92.6%. The positive predictive value (PPV) was 59.8%, and the negative predictive value (NPV) was 83.6%. Overall, 80.2% of patients were correctly assigned using the appointment category and C-reactive protein (CRP). Conclusions: The algorithm-based triage system presented here, which focuses on the time between symptom onset and request for an appointment, allows for the prioritisation of appointments in favour of patients with IRDs and thus earlier initiation of therapy. [ABSTRACT FROM AUTHOR]

Purpose: The work on bridge resilience assessment includes quantitative and qualitative approaches to compare the multiple bridges based on their resilience. But still, the bridge resilience obtained by these assessment approaches is inefficient when prioritising multiple bridges to improve their resilience. Therefore, this study aims to develop a methodology for prioritising the bridges to improve their resilience. Design/methodology/approach: The research methodology follows three sequential phases. In the first phase, criteria importance through intercriteria correlation (CRITIC) technique is used to compute the criteria weights. The criteria considered are age, area, design high flood level, finish road level FRL and resilience index of bridges. While 12 river-crossing bridges maintained by one bridge owner are considered as alternatives. Then, in the second phase, the prioritisation of each bridge is evaluated using five techniques, including technique for order of preference by similarity to ideal solution, VIKOR (in Serbian, Visekriterijumska Optimizacija I Kompromisno Resenje), additive ratio assessment, complex proportional assessment and multi-objective optimisation method by ratio analysis. Finally, in the third phase, the results of all five techniques are integrated using CRITIC and the weighted sum method. Findings: The result of the study enables bridge owners to deal with the particular bridge that requires resilience improvement. The study concluded that it is not enough to consider only the bridge resilience index to improve its resilience. The prioritisation exercise should consider various other criteria that are not preferred during the bridge resilience assessment process. Originality/value: The proposed methodology is a novel framework based on the existing multi-criteria decision-making (MCDM) techniques for contributing knowledge in the domain of bridge resilience management. It can efficiently overcome the pitfall of decision-making when two bridges have the same resilience index score. [ABSTRACT FROM AUTHOR]

Value capture refers to the process of capturing a portion of the increase in property value resulting from public investments in infrastructure projects. It is an important tool for financing and sustaining urban development. This research paper presents a qualitative approach for value capture mechanism (VCM) in context to urban project. This study consists of parameter prioritisation with respect to revenue generation is studied using fuzzy analytic hierarchy process (FAHP), a multi-actor multi-criteria analysis approach is adopted. It is found that, administrative parameters, infrastructure parameters, geographical parameters, business parameters have criteria weights 0.38, 0.22, 0.19, 0.13 respectively. The research aims to propose appropriate VCM which can potentially contribute towards the investment cost of the urban project. [ABSTRACT FROM AUTHOR]

Background: Semi‐urgent surgery where surgical intervention is required within 48 h of admission and the patient is medically stable is vulnerable to scheduling delays. Given the challenges in accessing health care, there is a need for a detailed understanding of the factors that impact decisions on scheduling semi‐urgent surgeries. Aim: To identify and describe the organisational, departmental and contextual factors that determine healthcare professionals' prioritising patients for semi‐urgent surgeries. Methods: We used the Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for scoping reviews (PRISMA‐ScR) checklist. Four online databases were used: EBSCO Academic Search Complete, EBSCO Cumulative Index to Nursing and Allied Health Literature, OVID Embase and EBSCO Medline. Articles were eligible for inclusion if they published in English and focussed on the scheduling of patients for surgery were included. Data were extracted by one author and checked by another and analysed descriptively. Findings were synthesises using the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework. Results: Twelve articles published between 1999 and 2022 were included. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework highlighted themes of emergency surgery scheduling and its impact on operating room utilisation. Gaps in the management of operating room utilisation and the incorporation of semi‐urgent surgeries into operating schedules were also identified. Finally, the lack of consensus on the definition of semi‐urgent surgery and the parameters used to assign surgical acuity to patients was evident. Conclusions: This scoping review identified patterns in the scheduling methods, and involvement of key decision makers. Yet there is limited evidence about how key decision makers reach consensus on prioritising patients for semi‐urgent surgery and its impact on patient experience. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

This article analyses and discusses how to develop contemporary methods to conduct democratic and sustainable planning in rural landscapes based on place-making, collaborative planning and strategy-making. The analysis is based on a Danish regional strategy-making case, the Nørreådalen river valley (NRV), which is used to explore how to democratically incorporate local values and establish sustainable development priorities. The NRV case highlights the significance of cultivating a shared frame of reference to foster inclusive and informed landscape strategies, which underscores the importance of understanding diverse values and their holders in landscape governance. Collaborative strategy-making may serve as a powerful method for addressing complex challenges and fostering sustainable development in rural landscapes provided it is tailored to the specific contextual considerations and nurtures a comprehensive understanding of shared landscape values. [ABSTRACT FROM AUTHOR]

Acute healthcare providers operate large, diverse medical equipment inventories. Resources for managing these inventories is frequently scarce so must be prioritised such that maximum benefit is conferred per unit of expenditure.This review identifies publications which have discussed the clinical value conferred by mechanical ventilation (MV) and by extra corporeal membrane oxygenation (ECMO). Respectively, mechanical ventilators and ECMO units are necessary to deliver these therapies. Systematic searches for publications which discuss the clinical value conferred by MV and by ECMO were conducted.The identified articles included reviews, prospective studies, retrospective studies, and models. Most presented findings in terms of the cost-effectiveness ratio. The patient populations studied, and analytical methods used varied widely. The clinical value conferred by MV varied with dependencies on several factors including the age- and disease- profile of the patient population. It was not possible to infer these dependencies from the literature which exists for ECMO.More relevant literature existed for MV, the more mature technology, than did for ECMO. The ECMO literature also tended to be more recent and included more modelling studies and fewer prospective studies. The data extracted could inform estimates of the clinical value likely to be delivered by mechanical ventilators operated by a specific institution. Estimates for ECMO are likely to carry greater uncertainty than those for MV.

AbstractManufacturing industries implement lean production tools to improve their production efficiencies. Improving production efficiency is vital in the apparel industry because product cycles and lead times are getting shorter and shorter. The purpose of this study was to improve the performance of a shirt manufacturing company through the implementation of value stream mapping (VSM) along with some other lean tools. Data were collected through stop-watch-based time studies and structured questionnaires. On the one hand, the current state value stream map was created and its performance was examined. On the other hand, the ranks of the seven lean wastes were determined, and process activity mapping was used to analyse the wastes furthermore. Then, layout improvement and 5S were implemented to reduce the main wastes, and the future state value stream map was developed. Analysis of the wastes resulted in motion, inventory and overproduction as the main wastes, while materials and machines were found to be the main sources of lean wastes. The main results of lean implementation showed 74.30%, 30.95%, 71.1% and 27.02% reductions in work-in-process inventory, value-added time, lead time and standard minute value, respectively. The findings of this study support the applicability of VSM in the apparel industry.

This paper provides a composite analysis of children's academic development grounded on the capability approach. The study utilises a panel dataset comprising 8,422 Chinese children and adolescents aged 6 to 16, observed between 2012 and 2018. It introduces a series of innovative indicators, including a parent advantage index to capture how parents influence their children and a ranking indicator for spending priorities to reify the value of children's education that families have reasoned. To address unobserved heterogeneity, we adopted fixed-effects models, multilevel modelling, and heteroskedasticity-based instrumental variables. Our primary results show that a 1% increase in the parent advantage index yields an increase of 13.85% to 21.31% in children's academic development, and the biggest leap in prioritising education-relevant spending increases the child outcomes by 2.88% to 6.57%. By highlighting the influence of parents' beings and doings, particularly the value they assign to education, this research contributes to the existing literature on child development, which often focuses predominantly on material dimensions. In sum, it expands the frontiers of the capability approach and related research on parental practices. It offers novel insights into how policies can be reinforced to equalise educational opportunities and to boost human capital. [ABSTRACT FROM AUTHOR]

This study explores the lived experience of both in-service and pre-service apprentices studying Level 7 apprenticeship programmes. Using qualitative questionnaires, this article facilitates a thematic analysis exploring how aspects such as: rationale for enrolment; study habits; prioritisation of workload; resilience and wellbeing are experienced by educators studying either an Academic Professional Apprenticeship or a Senior Leaders Apprenticeship programme. Results demonstrate a mixed landscape is apparent for Level 7 apprentices, with tangible differences, both within and between groups, exhibited regarding reason for enrolment and study habits. The challenge around balancing work-life priorities and the encroachment of work commitments on study time (and vice versa) are a common theme for both cohorts, with those who have better established working patterns and relationships more resilient to the challenges of Level 7 apprenticeship study. [ABSTRACT FROM AUTHOR]

Early detection of any disease is half cured but the vaccination process is likewise vital for the control of spread of diseases. Great efforts and initiatives are being made by researchers for the development of COVID-19 vaccines. Looking at the current scenario, the demand of COVID-19 vaccine surpasses the supply. It is very important to formulate the priorities of individuals for the vaccination drive at various stages. In this article, analytic hierarchy process is applied to develop a decision-making system to decide the priority of an individual to be vaccinated depending upon the unique features they might possess. The various characteristics are decided based on research and consultation from academicians, peer researchers and medical professionals. This study supports the prioritisation of vaccination to individuals with low immunity levels, which is followed by the presence of comorbidity, then followed by occupation, age and then area of their stay. This article may help countries to set up the priorities during their various stages' vaccination drive. Countries that have not yet started with the vaccination process may follow the mentioned priorities in various stages. [ABSTRACT FROM AUTHOR]

Context: The response of most native plant species in New South Wales (NSW) to infection by the oomycete pathogen Phytophthora cinnamomi Rands is unknown, which makes decisions about disease management difficult. Aims: We aim to improve knowledge about the potential threat from P. cinnamomi by testing a further 32 threatened species for their response to the pathogen and developing a method for prioritising management and susceptibility testing. Methods: Susceptibility to infection and host response were evaluated in glasshouse experiments where the pathogen was introduced to pots containing the threatened species, and the results were compared with control uninoculated pots. Our prioritisation used modelled habitat suitability for P. cinnamomi , proximity to known P. cinnamomi occurrences, and numbers of plant species populations at least 1 km apart to rank 928 rare and threatened plant species native to NSW for either management or susceptibility testing. Key results: Phytophthora cinnamomi was re-isolated from the roots of 10 of the 32 species assessed, most of which also showed significant mortality or disease symptoms. Darwinia peduncularis B.G.Briggs, Hibbertia circinata K.L.McDougall & G.T.Wright , Isopogon fletcheri F.Muell., Phebalium speciosum I.Telford , Pultenaea baeuerlenii F.Muell. and Pultenaea parrisiae J.D.Briggs & Crisp were the most severely affected species. The effect of P. cinnamomi is known for only 63 rare and threatened species in NSW. The Greater Sydney region is a hotspot for rare and threatened plant species with a high priority for susceptibility testing. Conclusions: The prognosis in the wild for rare and threatened plant species affected by P. cinnamomi depends on (1) habitat suitability for the pathogen, with subalpine and arid-zone species unlikely to be affected, (2) the number of unaffected populations, with two severely affected species that occur only on infested sites (Hibbertia circinata and Prostanthera marifolia R.Br.) facing extinction in the near future and (3) climate, with some species (e.g. Pomaderris delicata N.G.Walsh & Coates) apparently affected only in unusually wet years. Further susceptibility testing of rare and threatened species is required. This should be supported by taxonomic studies of genera (e.g. Hibbertia , Pultenaea) commonly affected by the pathogen. Implications: Many more plant species in NSW are likely to be severely affected by P. cinnamomi than currently known, and may require active management of the disease for their long-term survival. The root pathogen Phytophthora cinnamomi is a major threat to Australia's native plants. Little is known about its effect on plants in New South Wales. We found that some rare and threatened species can be severely affected by this pathogen but the threat is unknown for many rare species in areas such as the Blue Mountains where the habitat is highly suited to P. cinnamomi. Image by Keith McDougall. [ABSTRACT FROM AUTHOR]

This paper describes the design and build of a pilot Natural Sciences Collections Digitisation Dashboard (CDD). The CDD will become a key service for the Distributed System of Scientific Collections Research Infrastructure (DiSSCo) and aims to improve the discoverability of natural science collections (NSCs) held in European institutions, both digitised and undigitised. Furthermore, it will serve as a dynamic visual assessment tool for strategic decision-making, including the prioritisation of digitisation. The CDD pilot includes high-level information from nine European NSCs, covering the number of objects, taxonomic scope, storage type, chronostratigraphy (Earth Science Collections), geographical region and level of detail in digitisation. This information is structured through a standardised Collection Classification Scheme, which uses high-level categorisation to describe physical natural science collections. [ABSTRACT FROM AUTHOR]

Context: The International Union for Conservation of Nature (IUCN) Red List categories and criteria are a widely accepted standard for assessing extinction risk and have been adopted by many countries, including Australia. Tasmania is globally renowned for its biodiversity, and yet very few of its plant species have been evaluated using IUCN criteria, exposing a significant gap in conservation prioritisation. Aims: This study aimed to undertake a regional IUCN assessment of Tasmania's vascular flora and highlight gaps and discrepancies in accepted lists of threatened species. Methods: The R package ConR was used to automatically generate preliminary IUCN assessments for 1885 taxa based on Criterion B (geographic range). This was compared to current listing status to identify potentially misaligned or at-risk taxa. Protected areas were incorporated into the analysis, and heatmaps were used to show the distribution of threatened flora in Tasmania based on their preliminary IUCN category. Key results: One-third of Tasmania's vascular flora (570 taxa) were categorised as threatened by ConR , of which only 47% are currently listed under legislation. We identify 301 non-listed taxa that are potentially threatened and can now be prioritised for full IUCN assessments. Taxa categorised as threatened are more likely to occur near cities and towns, often outside of formal protected areas. Conclusion and implications: Automated IUCN assessments are a useful means of systematically refining lists of threatened species. The adoption of IUCN categories and criteria is likely to have a substantial effect on current lists of threatened species and could shift the focus of conservation efforts. Tasmania is globally renowned for its biodiversity, but many of its plant species are at risk of extinction. Using rapid IUCN Red List assessments, we identify 570 threatened plant species, equivalent to 30% of the island's flora. Less than half of these species are currently listed as threatened under legislation. We find that threatened plants are concentrated near urban areas, and outside of protected areas. [ABSTRACT FROM AUTHOR]

Children born in Sub-Saharan Africa (SSA) have an 85 % risk of requiring surgical care by the age of 15 [1,2]. Yet, children's surgery has been largely neglected by global health policies. National Surgical Obstetric and Anaesthetic Plans' (NSOAPs) reflect countries' strategic health priorities, policies, and targets related to surgical care. This study assessed the prioritisation of children's surgical care in national surgical care policies in SSA. This systematic review of national surgical care policies in SSA conducted in December 2022, analysed NSOAPs developed in SSA electronically for search terms "child∗", "pediatric∗", "paediatric∗" and evaluated manually for children's surgical care in relation to the NSOAP domains, health system building blocks, and surgical care. Policies were evaluated for collaboration. Eight policies met the inclusion criteria. In the 797 (M = 99.63; SD = 34.83) text-containing pages analysed, there were 258 (15.5; 0–164) mentions of children's surgery search terms. Twenty-five percent (n = 2) of the NSOAPs dedicated sections to children's surgical care, 62.5 % (n = 5) mentioned children's surgery, and 12.5 % (n = 1) did not mention children's surgery. Children's surgery received citations in 25 % (n = 2) of backgrounds, 37.5 % (n = 3) of situational analyses, 87.5 % (n = 7) of strategic frameworks, 37.5 % (n = 3) of monitoring and evaluation, and 25 % (n = 2) of the costing sections. Overall, 62.5 % (n = 5) of countries included a children's surgery stakeholder. NSOAPs are a pragmatic measure of national surgical care priorities. Our findings suggest children's surgery is not widely recognised even where commitments to improving surgical care exist. Greater prioritisation of children's surgery is needed in surgical policy development. • NSOAPs are strategic entry-points for integrating children's surgery into national health programs. • Improved children's surgical care research is needed at country-level. • Diverse stakeholder engagement improves NSOAP representativeness. • Purposeful inclusion of children's surgery is needed in future NSOAPs to promote health equity. [ABSTRACT FROM AUTHOR]

Introduction: Triage is a dynamic and complex decision-making process to determine fair access to medical care in mass casualty situations. Triage takes place through healthcare settings including Intensive Care Units (ICUs). Triage governing principles have been subject to ethical debates for a long time specifically with the recent global pandemic of COVID-19. This study aims to revisit the ethical principles guiding patient prioritisation during recent COVID-19 disaster triage in the Indian subcontinent and attempts to look for principles with consideration of social justice. Methods: Key electronic databases such as WHO, EMBASE, and DOAJ were used to access published literature relating to ICU triage in the Indian subcontinent. Literature on and from 2015–2022 were included in this study. The SPICE framework was used to identify the literature. The Inclusion criteria were as follows: Literature with ethical connotations focusing on India and neighbouring countries, and in an ICU setting during pandemics. The Exclusion criteria were as follows: Literature focusing on other countries, without ethical foundations, hospital admissions, and non-COVID-19 ICU admissions. The PRISMA standard was applied to screen the appropriate literature. The BOOLEAN operator "OR" was used to enhance the literature search. Finally, six papers were found suitable for this study and thus were included in the literature review. Additionally, for the second time, the frequency of certain ethical phrases was reassessed in the plans and guidelines to check the changed awareness of ethical pandemic planning, if any. A thematic analysis was applied to analyse the data and generate findings and new knowledge. Results: The findings highlight gaps in knowledge around ICU triaging in the region which indicates the scope of better ethical pandemic preparation at the regional level. The findings show that there is a debate between researchers on prioritisation from available resources and ethical perspectives and principles associated with fair access to healthcare even during pandemic times. The literature also highlights enhancing the regional capacity and building equitable approaches to reduce existing health inequities and the need of the social justice framework for ICU triaging during a pandemic. Conclusions: ICU triaging in five South Asian neighbour nations was studied for the presence of a guided ethical framework. Additionally, for the second time, certain ethical phrases were reassessed in the plans and guidelines; however, usage of those terms was found to be significantly low. The discussion shows that the plans and guidelines have the scope to improve ethical ICU triaging in these countries and in the specific region. After analysing different ethical guidelines, this study emphasises that there is a need for a just and fair framework, specifically a social justice framework in ICU triage in the subcontinent to address the underlying health inequities. [ABSTRACT FROM AUTHOR]

Manufacturing industries implement lean production tools to improve their production efficiencies. Improving production efficiency is vital in the apparel industry because product cycles and lead times are getting shorter and shorter. The purpose of this study was to improve the performance of a shirt manufacturing company through the implementation of value stream mapping (VSM) along with some other lean tools. Data were collected through stop-watch-based time studies and structured questionnaires. On the one hand, the current state value stream map was created and its performance was examined. On the other hand, the ranks of the seven lean wastes were determined, and process activity mapping was used to analyse the wastes furthermore. Then, layout improvement and 5S were implemented to reduce the main wastes, and the future state value stream map was developed. Analysis of the wastes resulted in motion, inventory and overproduction as the main wastes, while materials and machines were found to be the main sources of lean wastes. The main results of lean implementation showed 74.30%, 30.95%, 71.1% and 27.02% reductions in work-in-process inventory, value-added time, lead time and standard minute value, respectively. The findings of this study support the applicability of VSM in the apparel industry. [ABSTRACT FROM AUTHOR]

Abstract Background Demonstrating safety and efficacy of new medical treatments requires clinical trials but clinical trials are costly and may not provide value proportionate to their costs. As most health systems have limited resources, it is therefore important to identify the trials with the highest value. Tools exist to assess elements of a clinical trial such as statistical validity but are not wholistic in their valuation of a clinical trial. This study aims to develop a measure of clinical trials value and provide an online tool for clinical trial prioritisation. Methods A search of the academic and grey literature and stakeholder consultation was undertaken to identify a set of criteria to aid clinical trial valuation using multi-criteria decision analysis. Swing weighting and ranking exercises were used to calculate appropriate weights of each of the included criteria and to estimate the partial-value function for each underlying metric. The set of criteria and their respective weights were applied to the results of six different clinical trials to calculate their value. Results Seven criteria were identified: ‘unmet need’, ‘size of target population’, ‘eligible participants can access the trial’, ‘patient outcomes’, ‘total trial cost’, ‘academic impact’ and ‘use of trial results’. The survey had 80 complete sets of responses (51% response rate). A trial designed to address an ‘Unmet Need’ was most commonly ranked as the most important with a weight of 24.4%, followed by trials demonstrating improved ‘Patient Outcomes’ with a weight of 21.2%. The value calculated for each trial allowed for their clear delineation and thus a final value ranking for each of the six trials. Conclusion We confirmed that the use of the decision tool for valuing clinical trials is feasible and that the results are face valid based on the evaluation of six trials. A proof-of-concept applying this tool to a larger set of trials with an external validation is currently underway.

This study was undertaken in the Himalayan basin, in the river Lohawati, Uttarakhand, to study its hydro-morphological characteristics and prioritise the watersheds using geospatial tools. Advanced Spaceborne Thermal Emission and Reflection (ASTER-30 m) data and the Survey of India’s topographic sheets were used to analyse the study area comprehensively. Nine watersheds were identified within the basin in order to calculate the hydro-morphological characteristics in terms of basic, shape, texture, and relief aspects. The basin was identified as being elongated, with a total drainage area of 337.48 km2. The interaction between the terrain, rock formations, and precipitation levels produced a branching structure in the areas drainage system that ranged from dendritic to sub-dendritic. The basin had been classified as a fifth-order basin, comprising a network of 500 stream segments spanning a total length of 492.41 km. In each of the watersheds, the primary streams are of the first order, followed by those of the second order, and so forth. The physiography and lithology of the basin have a significant influence on this pattern. The calculated elongation ratio, circulatory ratio, form factor, shape index, and shape factor ranged from 0.57 to 0.80, 0.35 to 0.64, 0.26 to 0.50, 1.98 to 3.89, and 0.57 to 1.77, respectively. These values indicate that watersheds are elongated, suggesting moderate lag times. The parameters, including drainage density (0.98 to 1.62), stream frequency (1.07 to 1.59), infiltration number (1.04 to 2.59), drainage texture (0.67 to 2.82), and drainage intensity (0.93 to 1.12), pointed towards the coarser drainage texture, higher infiltration, and minimal runoff characteristics of the basin. In light of the relief characteristics of the basin, a higher basin relief, relief ratio, and relative relief were observed for the watersheds, indicating the possibility of higher erosion and deforestation rates. Using the Weighted Sum Analysis (WSA) method, the computed factors were utilised to rank the watersheds based on their potential for erosion. Based on the WSA approach, watersheds were classified into high-, moderate-, and low-prioritisation zones. This further indicates that 36.14% (121.95 km2) of watersheds are in the high-priority zone, and that 48.84% (164.91 km2) and 15.00% (50.62 km2) of watersheds are in the moderate- and low-priority zones, respectively. The WSA is a practical strategy to prioritise watersheds when making appropriate decisions.

A care pathway is defined as “a complex intervention for the mutual decision-making and organisation of care processes for a well-defined group of patients during a well-defined period.” The European Haemophilia Consortium (EHC) established a Think Tank Workstream on Future Care Pathways to identify and address key challenges in shaping future pathways that meet the needs of people with rare diseases while remaining practicable and affordable to healthcare providers in countries with different budgets and resources. This workstream is particularly timely as the introduction of innovative therapies is adding to the complexity of care pathways in some rare conditions.

Human behaviour is at the centre of unsustainable consumption and production. Responsible consumption behaviours must therefore be at the centre of the solution. However, because it is inefficient for policymakers and practitioners, and ineffective for users, to attempt to target all responsible consumption behaviours simultaneously in a given initiative, some form of prioritisation is necessary. Through a combination of collaborative workshops and surveys with key stakeholders, this study applied established methods of prioritisation to identify a ‘long list’ of 84 responsible consumption behaviours across three material streams – fashion, electronics and furniture. The ‘long list’ was then taken to a prioritisation summit with government, academic, business, and community stakeholders. The behaviours were rated against explicit prioritisation criteria related to likelihood of adoption, timing, impact and potential system reach. This yielded a final ‘short list’ of seven prioritised behaviours, including a mixture of achievable consumer behaviours that can be realised in the short-term, as well as larger-scale and longer-term manufacturer- and government-related behaviours supporting fundamental design and policy shifts. By drawing on the collective knowledge and expertise of academic and non-academic experts, the study identified and prioritised behaviours to reduce material resource consumption in Australia that are impactful and transformative, while also being practical and realistic to implement.

In this study I investigated the involvement of top management and teachers in the strategic planning process in 5 district schools located in the Bulawayo Metropolitan Province guided by the Take Stock Analysis (TSA) model. The constructivist/interpretivist paradigm was the qualitative methodology adopted for the study using a case study research method. The participants were 5 education managers and 5 focus groups of 4 teachers, each purposively selected from each school as an in-depth analysis of the phenomenon was sought through face-to-face interviews. Interview data were inductively and thematically analysed while strategic plans provided were inspected using content analysis and supplemented with interview data. The findings were reported following the concept of strategic planning, the formulation, monitoring and evaluation process. The results reveal that some schools used the centralised or decentralised strategic planning process while others hired strategists with minimal involvement from the teachers and the top management of the school. I recommend that stakeholders are actively involved in the entire strategic planning process to enhance ownership and commitment at the operational level. Most importantly, joint periodic evaluations are needed for modification purposes and relevance. [ABSTRACT FROM AUTHOR]

This study was undertaken in the Himalayan basin, in the river Lohawati, Uttarakhand, to study its hydro-morphological characteristics and prioritise the watersheds using geospatial tools. Advanced Spaceborne Thermal Emission and Reflection (ASTER-30 m) data and the Survey of India's topographic sheets were used to analyse the study area comprehensively. Nine watersheds were identified within the basin in order to calculate the hydro-morphological characteristics in terms of basic, shape, texture, and relief aspects. The basin was identified as being elongated, with a total drainage area of 337.48 km2. The interaction between the terrain, rock formations, and precipitation levels produced a branching structure in the areas drainage system that ranged from dendritic to sub-dendritic. The basin had been classified as a fifth-order basin, comprising a network of 500 stream segments spanning a total length of 492.41 km. In each of the watersheds, the primary streams are of the first order, followed by those of the second order, and so forth. The physiography and lithology of the basin have a significant influence on this pattern. The calculated elongation ratio, circulatory ratio, form factor, shape index, and shape factor ranged from 0.57 to 0.80, 0.35 to 0.64, 0.26 to 0.50, 1.98 to 3.89, and 0.57 to 1.77, respectively. These values indicate that watersheds are elongated, suggesting moderate lag times. The parameters, including drainage density (0.98 to 1.62), stream frequency (1.07 to 1.59), infiltration number (1.04 to 2.59), drainage texture (0.67 to 2.82), and drainage intensity (0.93 to 1.12), pointed towards the coarser drainage texture, higher infiltration, and minimal runoff characteristics of the basin. In light of the relief characteristics of the basin, a higher basin relief, relief ratio, and relative relief were observed for the watersheds, indicating the possibility of higher erosion and deforestation rates. Using the Weighted Sum Analysis (WSA) method, the computed factors were utilised to rank the watersheds based on their potential for erosion. Based on the WSA approach, watersheds were classified into high-, moderate-, and low-prioritisation zones. This further indicates that 36.14% (121.95 km2) of watersheds are in the high-priority zone, and that 48.84% (164.91 km2) and 15.00% (50.62 km2) of watersheds are in the moderate- and low-priority zones, respectively. The WSA is a practical strategy to prioritise watersheds when making appropriate decisions. [ABSTRACT FROM AUTHOR]

This paper reports on a quantitative study of prioritisation of biodiversity amongst small‐ to medium‐sized enterprise (SME) leaders. Existing research indicates that value orientation impacts propensity for pro‐environmental behaviours. However, as biodiversity loss remains inadequately addressed, this study employs the value‐belief‐norm framework to explore how leaders with strong biospheric and altruistic (collectively termed 'bigger‐than‐self') value orientations perceive their responsibility for biodiversity loss in comparison with climate change and, using an adaptation of the Global Reporting Initiative standards, how biodiversity is prioritised against other areas of environmental sustainability in their businesses. Surveying 61 SME leaders, primarily in the South‐West UK, it was found that biodiversity is often considered of low priority compared with factors such as energy, waste, materials and emissions. Analysis also indicates that these leaders feel less responsibility for biodiversity than for climate change demonstrating that, even where bigger‐than‐self values dominate, there is a need for higher prioritisation of biodiversity amongst SMEs. [ABSTRACT FROM AUTHOR]

Background: Demonstrating safety and efficacy of new medical treatments requires clinical trials but clinical trials are costly and may not provide value proportionate to their costs. As most health systems have limited resources, it is therefore important to identify the trials with the highest value. Tools exist to assess elements of a clinical trial such as statistical validity but are not wholistic in their valuation of a clinical trial. This study aims to develop a measure of clinical trials value and provide an online tool for clinical trial prioritisation. Methods: A search of the academic and grey literature and stakeholder consultation was undertaken to identify a set of criteria to aid clinical trial valuation using multi-criteria decision analysis. Swing weighting and ranking exercises were used to calculate appropriate weights of each of the included criteria and to estimate the partial-value function for each underlying metric. The set of criteria and their respective weights were applied to the results of six different clinical trials to calculate their value. Results: Seven criteria were identified: 'unmet need', 'size of target population', 'eligible participants can access the trial', 'patient outcomes', 'total trial cost', 'academic impact' and 'use of trial results'. The survey had 80 complete sets of responses (51% response rate). A trial designed to address an 'Unmet Need' was most commonly ranked as the most important with a weight of 24.4%, followed by trials demonstrating improved 'Patient Outcomes' with a weight of 21.2%. The value calculated for each trial allowed for their clear delineation and thus a final value ranking for each of the six trials. Conclusion: We confirmed that the use of the decision tool for valuing clinical trials is feasible and that the results are face valid based on the evaluation of six trials. A proof-of-concept applying this tool to a larger set of trials with an external validation is currently underway. [ABSTRACT FROM AUTHOR]

There are approximately 1.5 billion specimens kept in European Natural History Collections. The mission for the Distributed System of Scientific Collections (DiSSCo) is to unite all these specimens into a one-stop e-science infrastructure of digital specimens. This is a monumental digitisation task and criteria for how to prioritise this effort are, therefore, crucial for the success of the project. In this report, we have reviewed the literature and designed and conducted surveys of the digitisation plans and criteria used by DiSSCo Partners to understand the prioritisation criteria used in the digitisation of natural history collections. As an attempt to provide some guidance for the digitisation of specimens, we suggest that an organisation (e.g. DiSSCo or an individual institution) that is planning to digitise natural history collections considers four categories of prioritisation criteria: Relevance, Data quality, Cost and Feasibility. [ABSTRACT FROM AUTHOR]

The increase in global trade and traffic networks contributes to the introduction and spread of invasive alien species, posing a threat to biodiversity. EU Regulation 1143/2014 addresses the prevention and management of invasive alien species and requires an action plan on the priority pathways of unintentional introduction and spread of invasive alien species by each member state. To this end, the first German action plan was developed for the German government in cooperation with relevant Ministries and authorities, scientists, administrative experts, stakeholder working groups and political as well as public deliberation processes. As a result, 14 priority pathways of unintentional introduction, escape or release and spread were identified, resulting in 24 targeted measures. Nineteen sectors will be involved in the implementation of these measures. Here we describe the development process and outcome of Germany's first action plan. By this, we aim making the process public and transparent, which can facilitate a revision of the action plan required at least every six years, and trigger broader European as well as national cooperation in the future. [ABSTRACT FROM AUTHOR]

Recent studies have identified many potential climate change impacts on bridges. Considering the sheer number of these potential impacts, how can a bridge owner prioritise which impacts to consider, and for which bridges? This paper proposes a risk-based multi-criteria decision analysis method for systematically addressing these two questions simultaneously. The proposed method can be used to address both extreme and non-extreme impacts as opposed to focussing solely on extreme impacts as has been done in previous prioritisation studies related to climate change risks. The proposed method is based on four main components of risk: hazard, impact, vulnerability and consequences. Several indices characterising these components are used to address the previous two questions. To reflect the uncertainty in the analysis, the different indices are assessed optimistically and pessimistically. Additionally, to ensure a more transparent decision-making process the inclusion of a strength of evidence assessment is also proposed. The applicability of the method is then demonstrated on three illustrative case studies for three different potential climate change impacts. It is concluded that the proposed method is both feasible and appropriately fulfils its purpose. Nevertheless, the proposed method should be more elaborately tested on practical bridge case studies to further establish its applicability. [ABSTRACT FROM AUTHOR]

Abstract Background Lately scientific and societal concern has emerged about persistent (P), mobile (M) and toxic (T) chemicals. Such chemicals, like some polyfluoroalkyl acids (PFAAs), are of concern due to their high mobility and persistence in aquatic compartments which relates to long-term biotic exposure and difficult removal from drinking water. In this study, a screening approach for identification of PMT chemicals was developed and applied to 6158 diverse chemicals. Results Chemicals are given a continuous score for P, M and T potential based on the modelled indicators (low to moderate potential is a score of 0–0.33, high potential is a score of 0.33–0.5 and very high potential a score of 0.5–1). The P score was based on the estimated aquatic environmental half life and the M score on the chemical’s organic carbon/water partition coefficient (K oc) using respectively the BIOWIN3 and KocWIN QSAR models of EPISuite™. The T score was based on the indicators for five human health endpoints: carcinogenicity (c), mutaganicity (m), reprotoxicity (r), endocrine disruption (ED) and general repeated dose systemic toxicity. Structural alerts for these endpoints taken from the OECD QSAR Toolbox™ and Toxtree™ were used as indicators of potential (human) toxicity. Chemical similarity values to Substances of Very High Concern (SVHC) with c, m and/or r properties were also included. Value functions were developed to translate the presence of alerts and similarity to the existing SVHCs to values between 0 and 1. Subsequently, all values were also aggregated to an overall PMT score, again ranging from 0 to 1. Applying the approach to chemicals from the Inventory of Existing Commercial chemical Substances, which are also REACH registered, resulted in 15% of the chemicals receiving high scores (≥ 0.33) for all three (P-, M- and T-) indicators and 4% getting very high scores (≥ 0.5) for both the P- and M-indicators. Conclusions The approach confirmed the properties of chemicals classified as SVHC due to PMT properties (e.g. 1,4-dioxane), illustrating the ability of the approach to identify PMT chemicals of concern. Water regulators, drinking water suppliers and others can use this approach to identify potential PMT/vPvM chemicals that need further investigation.

Abstract Background The prioritisation of updating published systematic reviews of interventions is vital to prevent research waste and ensure relevance to stakeholders. The consideration of health equity in reviews is also important to ensure interventions will not exacerbate the existing inequities of the disadvantaged if universally implemented. This study aimed to pilot a priority setting exercise based on systematic reviews of interventions published in the Cochrane Library, to identify and prioritise reviews to be updated with a focus on health equity. Methods We conducted a priority setting exercise with a group of 13 international stakeholders. We identified Cochrane reviews of interventions that showed a reduction in mortality, had at least one Summary of Findings table and that focused on one of 42 conditions with a high global burden of disease from the 2019 WHO Global Burden of Disease report. This included 21 conditions used as indicators of success of the United Nations Universal Health Coverage in attaining the Sustainable Development Goals. Stakeholders prioritised reviews that were relevant to disadvantaged populations, or to characteristics of potential disadvantage within the general population. Results After searching for Cochrane reviews of interventions within 42 conditions, we identified 359 reviews that assessed mortality and included at least one Summary of Findings table. These pertained to 29 of the 42 conditions; 13 priority conditions had no reviews with the outcome mortality. Reducing the list to only reviews showing a clinically important reduction in mortality left 33 reviews. Stakeholders ranked these reviews in order of priority to be updated with a focus on health equity. Conclusions This project developed and implemented a methodology to set priorities for updating systematic reviews spanning multiple health topics with a health equity focus. It prioritised reviews that reduce overall mortality, are relevant to disadvantaged populations, and focus on conditions with a high global burden of disease. This approach to the prioritisation of systematic reviews of interventions that reduce mortality provides a template that can be extended to reducing morbidity, and the combination of mortality and morbidity as represented in Disability-Adjusted Life Years and Quality-Adjusted Life Years.

AbstractThe aim of this study is to combine the Analytic Hierarchy Process (AHP) with sensory analysis for assessing the quality of stone fruits, such as peaches and nectarines. To this end, a multicriteria model based on the AHP is proposed, which could be used in any process of evaluation or selection of these fruits. It is compared with the Quantitative Descriptive Analysis (QDA) performed by trained panellists. The AHP results showed that gustatory phase was the most important attribute in both the positive (54%) and negative (80%) models. In the next level of attributes, the most important were sweetness and juiciness (63.1% of the weight for nectarines and 55.1% for peaches), while for rejection the most important attributes were the bitter, sour or astringent sensation of the gustatory phase (around 25% each attribute). The prioritisation obtained for the samples of fruits was the same as the QDA. AHP also provided the tasting profile of every panellist. With the AHP, time and costs are saved and accuracy of the results is improved. In the case of stone fruits, where variability is high throughout the season, the combination of QDA and AHP can help the food industry by matching consumer’s expectations better and faster.