Yes / British Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda. Methods: A two‐step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n= 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n= 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system. Results: Survey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well‐being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population. Conclusion: Actively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population. Patient or Public Contribution: Participants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into are search agenda. / NIHR, Grant/Award Number: NIHR200166;UKPRP, Grant/Award Number:MR/S037527/1

In the first part of the present study, samples of 13 native Turkish sheep breeds (n=628) were examined, individually and comparatively, with respect to their 19 microsatellite loci to characterize them by employing various statistical analyses. Low FST values, high mean number of alleles and allelic richness as well as results of Factorial Correspondence Analysis and Structure analyses showed the degree of admixture between native sheep breeds of Turkey, IVE and SAK were observed as the most distincts of the breeds and possible introgressions were detected in other breeds. The 2- BAD, a software to examine the admixtures, was employed to estimate the time of the admixtures and the MSVAR software was employed to detect past demographic histories. In the second part, evaluations based on their genetic characteristics were made in relation to their prioritization in conservation studies. By employing four different approaches, it has been concluded that IVE, SAK, KRY, KIV, HEM and breed from Central Anatolia should be included in a conservation program for the preservation of optimum genetic diversity. In the last part of the thesis breeds were also characterized with respect to their relative risk of extinctions and their merits, which were used to estimate the utilities of the breeds. Non-genetic factors, collected based on the existing literature and surveys throughthe questionnaires filled by the field specialists, were incorporated into genetic factors to estimate the utilities of the breeds under different scenarios. In this approach, it is concluded that NOR, AKK, SAK, IVE and HEM should be included in the conserved set of breeds. By the present study, it is believed that specific genetic features of the native Turkish sheep breeds were documented, effects of sampling on the population genetic studies was discussed, the need for a reliable data (genetic and nongenetic, for characterizing the risks and merits of the breeds) for the prioritization of the breeds in the long term sustainable conservation ofthem was emphasized.

In Lübeck fand 2010 eine Bürgerkonferenz zum Thema Priorisierung im Gesundheitswesen statt. 20 Bürger unterschiedlichen Alters und mit heterogenen Bildungshintergründen informierten sich über das Thema Priorisierung im Gesundheitswesen, diskutierten ihre Überzeugungen und Erfahrungen und verfassten am Ende ein gemeinsames Votum. Priorisierung im Gesundheitswesen war bei den Bürgern definiert als ein Gedankenkonstrukt darüber, welche Werte und Kriterien in der medizinischen Versorgung als wirklich wichtig empfunden werden, und welche weniger wichtig erscheinen. Aus diesen Überlegungen können Rangfolgen medizinischer Interventionen und Therapien erarbeitet werden. Diese Konferenz betreffend beantwortet diese Arbeit die Forschungsfragen, ob Bürger in der Lage sind ein solch komplexes Thema wie Priorisierung im Gesundheitswesen sinnvoll und weiterführend zu diskutieren, zu welchen inhaltlichen Ergebnissen sie dabei kommen und welche Bedeutung diese Ergebnisse für die Gesamtdebatte haben können. Die Lübecker Bürger haben einen gelungenen Diskurs geführt, was in dieser Arbeit anhand von Kriterien des Diskursethikers Jürgen Habermas herausgearbeitet wird. Mit dieser Methode eine Bürgerkonferenz zu analysieren wurde dabei innerhalb dieser Arbeit ein neuer Weg beschritten. Außerdem wird bezüglich der inhaltlichen Diskussion gezeigt, welche wichtige Bedeutung der Bürgerdiskurs für die Gesamtdebatte hat. Die Bürger haben einzelne neue Aspekte angesprochen, aber vor allem zeigt sich in der Analyse, dass die Lübecker Bürger einen Schwerpunkt bei Werten und Kriterien setzen, die das einzelne Individuum betreffen. Der Vergleich der inhaltlichen Ergebnisse der Lübecker Bürgerkonferenz mit den inhaltlichen Ergebnissen einer kanadischen citizens jury zu diesem Themenkomplex zeigt viele Parallelen und gibt damit den Hinweis darauf, dass ein länderübergreifender gemeinsamer Bürgerwille besteht.

The expectations of patients have dramatically changed since the introduction of the first public health services more than a decade ago, as have the surrounding conditions a health system has to tackle. The grown health systems of the industrialised countries counter the challenges of an ageing society, technological advancement and chronic disease by a state of constant reform, which has been present for the last few years, without the abolition of the basic principles of affordability, accessibility and solidarity. One solution to answer all these expectations and requirements is so-called "integrated care", a patient-centred model, which propagates better processes, coordination and cooperation between the different service providers and sectors in health care. Based on a comprehensive discussion of the existing theories on health systems analysis, decision making and performance measurement in health as well as the trade-offs emerging therefrom, the first part of this thesis examines the changing conditions and expectations as well as problem areas of organisation and restructuring in health care systems. This analysis serves as a foundation for the introduction of the integrated care concept, an international expert questionnaire on the decision making in integrated care and conclusions on priority setting of decision makers in health. The analysis of the results demonstrates the high value that is placed on a clear political framework and incentives for the promotion of integrated care, as well as the substantive demand for improved communication, coordination and information structures. (author's abstract)

Japan is one of the world’s 34 biodiversity hotspots, according to Conservation International (CI). The methods used by various organisations to define priorities differ, however, and all have weaknesses when trying to identify hotspots at finer resolutions. The goal of this thesis is to investigate how biodiversity hotspots in Japan could be revealed and mapped in order to encapsulate conservation elements of biodiversity in practical ways and at various scales. Bioquality is a term that emphasises the concentration within a community of elements of biodiversity with high conservation value. It evaluates the global rarity and taxonomic distinctiveness of plant species or infra-specific taxa using four Star categories. At a plant community level, the Genetic Heat Index (GHI), which is a standardised global range size rarity score, is calculated using weighted Star statuses of species in the community. Bioquality hotspots are assessed here for the first time for the flora and vegetation in Japan – and for temperate Asia – by categorising the Japanese flora into Stars and by applying GHI to survey data and literature-based sources. Keys to Stars are developed for the Japanese flora, with adjustments for variability in species geographic range size information and for taxonomic relatedness. A Flora of Japan (FOJ) database was compiled as a BRAHMS database, containing 8,262 accepted names (30,656 taxon names in total, including synonyms) in 258 families – the first full database of Japanese vascular plants. A total of 7,145 taxa are assigned Stars; from the rarest to the widespread class, there are 884 Black, 756 Gold, 833 Blue, and 4,672 Green Star taxa, confirming that Japan as a whole contains a high proportion of globally rare taxa (23% taxa in Black or Gold). A protocol for calibrating the weight of Stars based on species geographic range is developed based on fine-resolution distribution maps within Japan and coarse–resolution Taxonomic Database Working Group (TDWG) code information. The protocol optimises calculation for temperate regions. The first ever bioquality hotspot maps of Japan are produced using two independent data sources on species distribution at national level: 1) 50 botanical prefectures using 4,830 species from the FOJ database; 2) 1,418 Horikawa ‘geoquadrats’ (0.1° latitude by 0.15° longitude grid) maps covering 829 species. The Ryukyu Islands and Ogasawara Islands are identified as bioquality hotspots, and high mountain ranges in mainland Japan are predicted to contain areas potentially high in GHI; the spatial patterns of GHI are generally concordant between maps of different resolutions. These findings highlight that bioquality assessment can be applied meaningfully at various spatial resolutions. Using field sampling data and existing literature, three study sites are further investigated on a local level: 1) the satochi-satoyama landscape, the current national priority area for biodiversity conservation; 2) various vegetation types of Okinawa-jima Island, the Ryukyu Islands; and 3) the Utaki sacred groves within the predicted hotspot of the Ryukyu Islands. The Ryukyu Islands are confirmed to contain bioquality hotspots within many individual sites, while there was generally low GHI across the satochi-satoyama landscape. The field study outcomes, together with a gap analysis of the existing coverage of protected areas, highlight three important points that are directly relevant to national biodiversity conservation planning: 1) the Ryukyu Islands urgently need newly designated protected areas; 2) the satochi-satoyama landscape conservation should redirect its focus on cultural benefits to the public; 3) the existing protected areas, particularly on mountain areas, need re-evaluation in terms of upgrading their status in light of the bioquality assessment.

This study explored how nurses in acute and nurse-led gynaecology wards prioritised patient caseloads ranging in diversity and number of patient conditions. Statistics show that since the introduction of medical termination of pregnancy (MTOP) procedures into the National Health Service (NHS) in 1991, the number of women having this procedure is increasing year on year. To date very little is known about the impact this procedure may have had on nursing practice. The focus of this study was to explore the nursing care when this included, and did not include, caring for women having MTOP. The study was conducted in two parts. The first qualitative study employed non-participant observation and semi-structured interviews of nurses in gynaecology and surgical wards at two hospital sites to examine the external context in which nursing decisions were made. This found that nurses in gynaecology focused on emotional or psychosocial aspects more so than surgical nurses who focused on physical aspects of patient care. The second quantitative study involved a cross-sectional survey of nurses from both ward types in two hospitals sites in Scotland. Internal constructs were examined using personality and thinking styles measures. Nurses were assessed on their emotionality, that is, the numbers of times an emotional care aspect was prioritised. This found that nurses who prioritised the emotional aspects of the task tended to be more conscientious and elected preference for a ‘people-centred’ thinking style. The context in which women have TOP is also important since the findings suggest women may benefit from being cared for in nurse-led rather than in acute wards. Knowing how a person thinks about emotional and physical aspects of care also has implications for those involved in education, and career planning.

Prioritätensetzung in der Agrarforschung ist ein komplexes Entscheidungsproblem angesichts der Unsicherheit in der Abschätzung der erwarteten Wirkungen von Forschung und Technologien und den vielfältigen sozialen und wirtschaftlichen Zielen, die mit der Generierung von Wissen und neuen Technologien in landwirtschaftlichen Forschungsinstitutionen in Entwicklungsländern verbunden sind. Diese Arbeit versucht durch die Anwendung von formalen und quantitativen Evaluierungs- und Entscheidungsmethoden mit der besonderen Berücksichtigung von Unsicherheit und multiplen Zielen einen Beitrag zur Methodenverbesserung in der Prioritätensetzung zu leisten. Zur Darstellung dieser Methoden wurde als Fallstudie das nationale Milchviehforschungsprogramm des "Kenyan Agricultural Research Institute" (KARI) ausgewählt. Gegenstand der Analyse sind 19 geplante Forschungsprojekte, die anhand eines stochastischen Evaluierungsansatzes ("Economic Surplus" und Monte Carlo Simulation) hinsichtlich ihrer ökonomischen Wirkungen auf den kenianischen Milchmarkt untersucht wurden. Die Evaluierungsergebnisse der Forschungsprojekte und anschließende Bewertung anhand verschiedener stochastischer Dominanztests zeigen, daß die Ableitung einer klaren Präferenzstruktur und Rangordnung innerhalb der Projekte nach ökonomischen Kriterien, z.B. Gegenwartswert und Kosten-Nutzenrelation, in vielen Fällen nicht möglich ist, sondern vielmehr von den unterstellten Risikopräferenzen abhängt. Dies bedeutet, daß aus der Sicht eines Planers eine differenzierte und vorsichtige Interpretation und Beratung des Forschungsmanagements vorzunehmen ist. Dies steht im Gegensatz zu einer deterministischen Investitionsanalyse. Mehrere mathematische Programmierungsmodelle wurden zur Analyse von multiplen Zielen, der Untersuchung der Wirkungen von Verteilungsaspekten und unterschiedlicher Risikopräferenzen auf die Zusammensetzung eines optimalen Forschungsportfolios entwickelt und angewandt. Obwohl in den meisten Fällen eine Änderung der Risikoeinstellung auch eine Änderung des optimalen Portfolios bewirken würde, sind die ökonomischen Unterschiede gemessen am Gegenwartswert der alternativen Portfolios unbedeutend. Die Analyse der Zielkonflikte zwischen Effizienz- und Verteilungsziel wurde unter zwei unterschiedlichen Blickwinkeln für das Verteilungsziel untersucht: zum einen als räumliche und regionale Allokation des Forschungsnutzens, und zum anderen zwischen kenianischen Konsumenten und Produzenten von Milch. Aus den Modellergebnissen wird deutlich, daß eine spezielle Förderung von Produzenten- sowie Konsumenteninteressen nur beschränkt möglich ist, d.h. die jeweiligen Planungsoptionen nur geringe Umverteilungswirkungen erzielen. Ganz anders stellt sich die Situation bei einer regionalen Differenzierung dar. Dort würden je nach relativer Bedeutung einzelner Regionen starke Umverteilungswirkungen in den regionalen Einkommen auftreten. Allerdings sind diese Optionen im Vergleich zu einer "neutralen", d.h. regional indifferenten Ausrichtung mit großen Effizienzverlusten verbunden. / Priority setting in agricultural research is a complex decision making problem due to the inherent uncertainty surrounding the impact of research activities and the multiple social and economic research objectives under which research institutions in developing countries have to operate. This study attempts to apply formal and quantitative evaluation and decision making methods for a more rigorous and explicit analysis of the uncertainty and multiple research objectives. These methods are illustrated by applying them to a priority setting exercise for the National Dairy Research Program of the Kenyan Agricultural Research Institute (KARI) conducted in 1996. A set of 19 planned dairy research projects was proposed and specified by KARI scientists and the economic impact assessed based on a stochastic evaluation framework using economic surplus methods and Monte Carlo simulation. Results show that comparing these projects by stochastic dominance criteria with respect to the expected net present value and cost-benefit ratio the final rank order is very much subject to assumed risk preferences of the decision- makers. Thus, decision advice on the type of prioritised projects for implementation and fund raising is much less clear-cut than a deterministic evaluation would suggest. Mathematical programming techniques were applied to analyse the trade-off between multiple research objectives, to examine the distributional consequences of research, and to explore how different risk strategies (from risk aversion to risk proneness) would affect the selection of a optimal research portfolio from the planned dairy research projects. Although risk has a strong bearing on the composition of a research portfolio for various different funding levels the economic implications are not significant in terms of net present value. In a Multiple-objective programming framework the trade-off between efficiency and equity was examined. Equity concern was looked at two different angles: first, by a spatial distribution of the research benefits, and second by the distributions among consumer and producer groups. Results show a limited scope of directing the dairy research plan either for the sake of consumers or producers while the scope of targeting different production zones in Kenya is much larger although the trade-offs in terms of foregone welfare between different zones are very pronounced.

The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Canada highlights a broad range in ethical challenges, particularly in priority setting. Presently, a leading theory in ethical priority setting is Daniels’ and Sabin’s Accountability for Reasonableness (A4R), which enhances fair and legitimate procedural decision making in typical healthcare settings. A4R attempts to mitigate conflicting interests and facilitate fairness in deliberations over priority setting issues. Whether this framework may be applied to public health emergencies has yet to be examined. This qualitative study describes the outbreak through the lens of A4R and explores the applicability of A4R in atypical or emergent circumstances. Findings from 25 structured key informant interviews of public health officials suggest refinements to the framework may be required for emergency events. The presence of such a framework may minimize collateral damage during and after a response. The lessons may guide future preparedness efforts such as pandemic planning.

The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Canada highlights a broad range in ethical challenges, particularly in priority setting. Presently, a leading theory in ethical priority setting is Daniels’ and Sabin’s Accountability for Reasonableness (A4R), which enhances fair and legitimate procedural decision making in typical healthcare settings. A4R attempts to mitigate conflicting interests and facilitate fairness in deliberations over priority setting issues. Whether this framework may be applied to public health emergencies has yet to be examined. This qualitative study describes the outbreak through the lens of A4R and explores the applicability of A4R in atypical or emergent circumstances. Findings from 25 structured key informant interviews of public health officials suggest refinements to the framework may be required for emergency events. The presence of such a framework may minimize collateral damage during and after a response. The lessons may guide future preparedness efforts such as pandemic planning.

In March 2002 the Western Australian Minister for Environment and Heritage adopted a policy framework to guide investment decisions on salinity management. Promoted as Western Australia's Salinity Investment Framework (or the SIF), it offered a set of principles for prioritising investment decisions that were generally grounded in economic theory. This represented a significant landmark in terms of the government's appreciation of the scale of salinity problem and its acknowledgement that a full turnaround in the situation was beyond the reach of both volunteers and the public purse. The evolution of the SIF policy, including an initial trial in the Avon Basin, provided an opportunity to evaluate pre-policy processes; observe policy on the run; and test stakeholder reactions to the investment principles embodied in the the SIF, as well as their reaction to its implied outcomes. The intention of the study was to highlight any barriers standing in the way of effectively implementing a policy to prioritise investments in salinity management and identify any novel approaches developed in an attempt to overcome them. The evaluation was multifaceted to incorporate retrospective and prospective modes of inquiry. The retrospective investigation involved the construction of a series of policy narratives using evidence from notes and minutes taken at SIF meetings, as well as other formal and informal documents. It systematically captured the influence of key people, events and decisions on the SIF up until June 2008. This evaluation highlighted the impact of (1) policy entrepreneurs; (2) time lags; (3) vertical silos, and (4) priority setting hierarchies. The prospective investigation involved the execution of a community survey featuring attitudinal questions, paired comparisons and a choice modelling experiment. The survey involved 269 personal interviews with rural landholders, townspeople and landcare officers across the Avon Catchment. It captured perceptions towards past funding strategies and proposals for future allocations and explored the nature of priority setting decisions in relation to trade-offs between: (1) the mix of assets protected; (2) the degree of risk; (3) the level of community involvement in the decision, and (4) the distribution of benefits. This evaluation highlighted the importance of (1) incentives and disincentives for change; (2) awareness of priority setting concepts; (3) the capacity of regional bodies; and (4) elements perceived to be crucial in priority setting.