UNASSIGNED: In Canada, one out of five people lives with chronic pain, a condition frequently co-occurring with other chronic illnesses. As with most chronic illnesses, successful engagement in symptom management is key. In the context of multiple illnesses, self-management involves daily prioritization of symptoms and conditions and decision-making, which can be challenging. Self-management of chronic illnesses can require more complex competence and tasks to address the different implications of each condition.
UNASSIGNED: Our research objective was to explore types and processes of self-management symptom prioritization among adults living with chronic pain and other chronic illnesses.
UNASSIGNED: This research was carried out as part of a larger study that adopted an explanatory sequential mixed-methods design. This study focused more specifically on the qualitative part of the study.
UNASSIGNED: Participants recruited for the qualitative component took part in a semi-structured individual interview online or in-person at the center hospitalier de l\'Université de Montréal.
UNASSIGNED: In total, 25 participants were interviewed, including 18 women and 7 men.
UNASSIGNED: To participate in the qualitative part of the study, participants were selected from the larger study and were eligible if they were 18 years old or older and experiencing pain for more than 3 months and had at least one other chronic illness for which they were receiving treatment or engaged in symptom management. Semi-structured interviews were conducted in-person or virtually and were transcribed verbatim. Reflexive thematic analysis was used to explore patients\' narratives, and an open and iterative approach was adopted to code interviews and generate themes.
UNASSIGNED: The first theme, focus on symptom prioritization, showed different prioritization processes, including prioritizing a dominant illness, prioritizing multiple illnesses to avoid undesirable consequences, and finally absence of or automatic processes of prioritization. In the second theme, we identified several characteristics of an illness, in this case chronic pain that made it a self-management priority: uncontrollable and disabling nature, omnipresence, unpredictability, unpleasantness, and invisibility to others. In the last theme, we highlighted that some psychosocial factors influenced levels of engagement in self-management and prioritization processes, including social support and the patient-physician relationship.
UNASSIGNED: Chronic pain was the medical condition most often prioritized by participants in their self-management tasks. Because of its characteristics, it was the medical condition that had the most negative impact on day-to-day functioning.

BACKGROUND: Prioritization decision-making arises when nurses encounter intricate situations that demand ethically challenging judgments about care. This phenomenon has rarely been studied in nursing homes. Prioritization decision-making may lead to instances where individuals in social and healthcare may not receive all services they need. Making prioritization decisions and awareness of their consequences can increase nurses\' workload.
OBJECTIVE: To describe prioritization decision-making regarding unfinished nursing care in nursing homes.
METHODS: A qualitative descriptive study conducted through individual theme interviews. Participants were recruited through social media. The data was analyzed using inductive content analysis.
METHODS: Nurses (n = 23) working in nursing homes for the elderly people in Finland. Data were collected between June 2022 and February 2023.
METHODS: Finnish legislation does not mandate an ethical review or research permits, as the participants took part as private individuals. [ask authors to make reference here to informed consent process and anonymity].
RESULTS: Nurses stated that the need for prioritization decision-making arises from challenges associated with nurses\' engagement with person-centered care, the culture of the work community, the burden due to workload and challenges associated with the leadership. Prioritization decision-making was based on the interests of residents, striving for an efficient workflow and nurse\'s personal interests. Nurses did not receive support for decision-making regarding unfinished care, and protocols for prioritization had not been established in their work communities. Prioritization decision-making and unfinished care were concealed and left unspoken.
CONCLUSIONS: Nursing leaders should address this hidden phenomenon, making it visible through discussions with nurses and by involving them in the development of protocols. The findings can be utilized for developing new approaches to support nurses and reduce their workload and for enhancing the quality and person-centeredness of nursing care in nursing homes.

The biodiversity conservation needs recent high-quality data and efficient methods for prioritizing species and sites for conservation. Here we prioritized Orthoptera habitats of the Aggtelek National Park, based on revised and actualized distribution data of 69 Orthoptera species living at 98 sites. The simple ranking and complementary areas methods were used with species richness (S), rarity weighted species richness (SR), and number of rare species (SQ). Additionally, the Grasshopper Conservation Indexes (GCI\" and GCIn\") combining European and local rarity and dispersal capacity of the species were also tested. Contrary to simple ranking the complementary areas method represented the whole fauna and significant part of the species-site data records. All the used indices performed similar except the standardized GCIn\" which is highly affected by the differences in study intensity of sites. High-priority areas of the Aggtelek National Park were designated in the plateau above Jósvafő and Aggtelek villages and in the small, isolated hill near Jósvafő (Szőlő-hegy) covered with remained mosaic of former vineyards, orchards and hayfields. The combined use of the efficient indices provides additional ranking that allows the best selection of hotspots to support efficient use of limited resources in nature conservation.

Ultraviolet (UV) filters are emerging contaminants that have been found in high concentrations in human tissues. Food intake is generally considered to be the primary route of human exposure to contaminants. In this study, 184 composite food samples, prepared from 4268 individual samples in eight categories collected from 23 Chinese provinces for the sixth Chinese total diet study, were analyzed. The total and median UV filter concentrations in food samples were 1.5-68.3 and 7.9 ng/g wet weight, respectively. The highest median concentrations were found in decreasing order in meat, cereals, and legumes. In total, 15 UV filters were analyzed. 2-Ethylhexyl salicylate, homosalate, and 2-ethylhexyl-4-methoxycinnamate were dominant and made median contributions of 34.1%, 22.6%, and 14.5%, respectively, and 2-(2H-benzotriazol-2-yl)-4,6-di-tert-pentylphenol contributed the median of 0.03%, of the total UV filter concentrations. The estimated total daily UV filter intake in animal-origin foods and total UV filter concentration in human milk from the same province were significantly correlated (r = 0.44, p < 0.05). Predicted absorption, distribution, metabolism, and elimination properties led to 10 UV filters being prioritized as most likely to be retained in human tissues. The prioritization results and toxicity assessments indicated that octocrylene and 2-ethylhexyl-4-methoxycinnamate have stronger effects in vivo and therefore require more attention than others.

BACKGROUND: There is a lack of consensus about how to prioritize potential implementation strategies for HIV pre-exposure prophylaxis (PrEP) delivery. We compared several prioritization methods for their agreement and pragmatism in practice in a resource-limited setting.
METHODS: We engaged diverse stakeholders with clinical PrEP delivery and PrEP decision-making experience across 55 facilities in Kenya to prioritize 16 PrEP delivery strategies. We compared four strategy prioritization methods: (1) \"past experience surveys\" with experienced practitioners reflecting on implementation experience (N = 182); (2 and 3) \"pre- and post-small-group ranking\" surveys before and after group discussion (N = 44 and 40); (4) \"go-zone\" quadrant plots of perceived effectiveness vs feasibility. Kendall\'s correlation analysis was used to compare strategy prioritization using the four methods. Additionally, participants were requested to group strategies into three bundles with up to four strategies/bundle by phone and online survey.
RESULTS: The strategy ranking correlation was strongest between the pre- and post-small-group rankings (Tau: 0.648; p < 0.001). There was moderate correlation between go-zone plots and post-small-group rankings (Tau: 0.363; p = 0.079) and between past-experience surveys and post-small-group rankings (Tau: 0.385; p = 0.062). For strategy bundling, participants primarily chose bundles of strategies in the order in which they were listed, reflecting option ordering bias. Neither the phone nor online approach was effective in selecting strategy bundles. Participants agreed that the strategy ranking activities conducted during the workshop were useful in prioritizing a final set of strategies.
CONCLUSIONS: Both experienced and inexperienced stakeholder participants\' strategy rankings tended to prioritize strategies perceived as feasible. Small group discussions focused on feasibility and effectiveness revealed moderately different priorities than individual rankings. The strategy bundling approach, though less time- and resource-intensive, was not effective. Future research should further compare the relative effectiveness and pragmatism of methodologies to prioritize implementation strategies.

Disconcerting reports from different EU countries during the first wave of the COVID-19 pandemic demonstrated the demand for supporting decision instruments and recommendations in case tertiary triage is needed. COVID-19 patients mainly present sequentially, not parallelly, and therefore ex-post triage scenarios were expected to be more likely than ex-ante ones. Decision-makers in these scenarios may be highly susceptible to second victim and moral injury effects, so that reliable and ethically justifiable algorithms would have been needed in case of overwhelming critical cases.To gather basic information about a potential tertiary triage instrument, we designed a three-dimensional instrument developed by an expert group using the Delphi technique. The instrument focused on three parameters: 1) estimated chance of survival, 2) estimated prognosis of regaining autonomy after treatment, and 3) estimated length of stay in the ICU. To validate and test the instrument, we conducted an anonymous online survey in 5 German hospitals addressing physicians that would have been in charge of decision-making in the case of a mass infection incident. Of about 80 physicians addressed, 47 responded. They were presented with 16 fictional ICU case vignettes (including 3 doublets) which they had to score using the three parameters of the instrument.We detected a good construct validity (Cronbach\'s Alpha 0.735) and intra-reliability (p < 0.001, Cohens Kappa 0.497 to 0.574), but a low inter-reliability (p < 0.001, Cohen\'s Kappa 0.252 to 0.327) for the three parameters. The best inter-reliability was detected for the estimated length of stay in the ICU. Further analysis revealed concerns in assessing the prognosis of the potentially remaining autonomy, especially in patients with only physical impairment.In accordance with German recommendations, we concluded that single-rater triage (which might happen in stressful and highly resource-limited situations) should be avoided to ensure patient and health care provider safety. Future work should concentrate on reliable and valid group decision instruments and algorithms and question whether the chance of survival as a single triage parameter should be complemented with other parameters, such as the estimated length of stay in the ICU.

Rehabilitation service providers must take into account prognostic factors when making clinical decisions, which includes using these factors as prioritization criteria. The goal of this study was to establish consensus on patient prioritization criteria based on prognostic factors related to persistent symptoms for patients with mild traumatic brain injury (mTBI) waiting for outpatient specialized rehabilitation services.
We conducted a Delphi survey involving clinicians, researchers, decision makers, and patients. Before the survey, we presented the results of an overview of systematic reviews summarizing the evidence on prognostic factors related to post-concussion symptoms.
After two rounds, the 17 experts reached consensus on the inclusion of 12 prioritization criteria: acute stress disorder, anxiety and depression, baseline mental and physical health, functional impacts and difficulties in performing daily habits after the trauma, motivation to receive services, multiple concussions, prior neurological problems, PTSD, quality of sleep, return to work failures, somatic complaints, suicidal ideation.
Healthcare stakeholders must consider a wide range of factors to guide clinical decision-making, including about access to care and patient prioritization. This study shows that the Delphi technique can be used to reach consensus on such decisions regarding patients with mTBI who are waiting for outpatient specialized rehabilitation services.

We aimed to combine Global Burden of Disease (GBD) Study data and local data to identify the highest priority intervention domains for preventing cardiovascular disease (CVD) in the case study country of Aotearoa New Zealand (NZ).
Risk factor data for CVD in NZ were extracted from the GBD using the \"GBD Results Tool.\" We prioritized risk factor domains based on consideration of the size of the health burden (disability-adjusted life years [DALYs]) and then by the domain-specific interventions that delivered the highest health gains and cost-savings.
Based on the size of the CVD health burden in DALYs, the five top prioritized risk factor domains were: high systolic blood pressure (84,800 DALYs; 5400 deaths in 2019), then dietary risk factors, then high LDL cholesterol, then high BMI and then tobacco (30,400 DALYs; 1400 deaths). But if policy-makers aimed to maximize health gain and cost-savings from specific interventions that have been studied, then they would favor the dietary risk domain (e.g., a combined fruit and vegetable subsidy plus a sugar tax produced estimated lifetime savings of 894,000 health-adjusted life years and health system cost-savings of US$11.0 billion; both 3% discount rate). Other potential considerations for prioritization included the potential for total health gain that includes non-CVD health loss and potential for achieving relatively greater per capita health gain for Māori (Indigenous) to reduce health inequities.
We were able to show how CVD risk factor domains could be systematically prioritized using a mix of GBD and country-level data. Addressing high systolic blood pressure would be the top ranked domain if policy-makers focused just on the size of the health loss. But if policy-makers wished to maximize health gain and cost-savings using evaluated interventions, dietary interventions would be prioritized, e.g., food taxes and subsidies.

Characterized by the incomplete development of the germinal epithelium of the seminiferous tubules, Testicular hypoplasia (TH) leads to decreased sperm concentration, increased morphological changes in sperm and azoospermia. Economic losses resulting from the disposal of affected bulls reduce the efficiency of meat production systems. A genome-wide association study and functional analysis were performed to identify genomic windows and the underlying positional candidate genes associated with TH in Nellore cattle. Phenotypic and pedigree data from 207,195 animals and genotypes (461,057 single nucleotide polymorphism, SNP) from 17,326 sires were used in this study. TH was evaluated as a binary trait measured at 18 months of age. A possible correlated response on TH resulting from the selection for scrotal circumference was evaluated by using a two-trait analysis. Thus, estimated breeding values were calculated by fitting a linear-threshold animal model in a Bayesian approach. The SNP effects were estimated using the weighted single-step genomic BLUP method. Twelve non-overlapping windows of 20 adjacent SNP that explained more than 1% of the additive genetic variance were selected for candidate gene annotation. Functional and gene prioritization analysis of the candidate genes identified genes (KHDRBS3, GPX5, STAR, ERLIN2), which might play an important role in the expression of TH due to their known roles in the spermatogenesis process, synthesis of steroids and lipid metabolism.

OBJECTIVE: The aim of this project was to identify gaps and research waste in the dissemination of gynecology evidence in Cochrane systematic reviews (CSRs).
METHODS: A cross-sectional study of the Cochrane Gynecology and Fertility (CGF) Group\'s specialized register of randomized controlled trials (RCTs). We included trials on benign gynecological conditions, published in 2010 and 2011. These trials were matched, by the condition and treatment, to existing Cochrane reviews. Unmatched trials were analysed to prioritize new review titles.
RESULTS: After exporting 740 trials from the CGF specialized register, we found that 192 (26%) could be included in an existing CSR if it was updated, whereas 230 trials (32%) were not matched to any review title, and from these, we developed 21 new review titles. The topic with the largest number of associated \'unused\' trials was \'Plant and herbal extracts for symptoms of menopause\'.
CONCLUSIONS: We found that a third of the benign gynecology trials published in 2010 and 2011 had no associated CSR. After identifying new topics from unmatched trials, we developed new CSR titles. This study identified the gaps in the evidence for women with gynecological problems.