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Many commercial reproductive genetic carrier screening (RGCS) panels include genes associated with non‐syndromic hearing loss (NSHL), however little is known about the general acceptability of their inclusion. Although some couples wish to avoid having a deaf child, there are effective interventions and supports available for deafness, and no consensus on whether it is appropriate to reproductively screen NSHL genes. This study explored views of people with personal experience of deafness regarding carrier screening for genes associated with NSHL. We interviewed 27 participants; 14 who identified as deaf and 13 hearing parents of a deaf child. Thematic analysis was undertaken on transcripts of interviews. The findings reveal the complexity of attitudes within these groups. Some vacillated between the wish to support prospective parents' reproductive autonomy and concerns about potential harms, especially the expression of negative messages about deafness and the potential loss of acceptance in society. While some participants felt carrier screening could help prospective parents to prepare for a deaf child, there was little support for reproductive screening and termination of pregnancy. Participants emphasized the need for accurate information about the lived experience of deafness. The majority felt deafness is not as severe as other conditions included in RGCS, and most do not consider deafness as a disability. People with personal experience of deafness have diverse attitudes towards RGCS for deafness informed by their own identify and experience, and many have concerns about how it should be discussed and implemented in a population wide RGCS program. [ABSTRACT FROM AUTHOR]

Abstract Mental illnesses comprise the single largest source of health-related economic burden globally and low-and middle-income countries (LMICs) are disproportionately affected. Many individuals with schizophrenia do not receive evidence-based, psychosocial interventions as these are largely unavailable, undeveloped, and under-researched in LMICs. Involving service-users and carers in the design of interventions is crucial to ensure stakeholder needs are adequately addressed by the intervention and to aid successful implementation. We aimed to explore the views and perspectives of different stakeholder groups about the delivery, format, and content of family interventions for people living with schizophrenia in Indonesia as a first step towards developing evidence-based, acceptable family interventions. This study used a qualitative design comprising single stakeholder focus groups. Data were analysed separately using the framework approach incorporating deductive and inductive coding within an existing heuristic framework. 51 participants consented to take part in this study comprising six stakeholder consultation groups including service-users (n = 15), caregivers (n = 15) and healthcare professionals (n = 21). Service users were diagnosed with schizophrenia. Caregivers comprised parents (n = 10, 67%), brothers (n = 2, 13%), sister (n = 1, 7%) and husbands (n = 2, 13%). Healthcare professionals were working as nurses (n = 6, 29%), doctors (n = 5, 23%) or cadre’s (n = 10, 48%). Caregiver and service-user respondents had limited knowledge or experience of structured family interventions. There was strong support for such interventions, however, for effective delivery a number of challenges exist in terms of widespread stigmatised views, low expectations for involvement in sharing decisions about care and treatment, views that healthcare professionals are expert and have the authority to delegate tasks to families such as responsibility for ensuring medication adherence and understanding the need to balance the needs of both service-users and families when there are conflicting agendas for treatment. These findings can support the development of evidence-based family interventions for families of those with schizophrenia in Indonesia, as user-informed interventions enhance engagement, satisfaction, and adherence to family interventions.

Background: Cognitive communication disorder (CCD) following traumatic brain injury (TBI) is well documented and these communication problems impede successful re‐integration into community living. While there is growing evidence for intervention to both detect and treat the impact of these deficits across the rehabilitation continuum, there are barriers to accessing services. Cognitive communication impairments may be missed because the person can talk, and this may mask the subtle but debilitating impact of a CCD. Referral to a speech and language therapist (SLT) may be overlooked or not timely, which prevents the individual accessing evidence‐based interventions. Inadequate treatment provision and an under‐ or overestimation of communication capability can potentially undermine the effectiveness of wider team assessment and intervention. Aims: To report stakeholder views on specialist SLT input for CCD within a multidisciplinary team intervention for a community‐dwelling individual with severe TBI. The investigation explored perspectives on understanding of CCD, on practice and on outcomes, in order to inform professional groups on perceived impacts of the evidence‐to‐practice gap. Methods and Procedures: A semi‐structured interview methodology was employed with 11 stakeholder participants involved in a single case. Data were evaluated using a thematic framework method. Themes were inductively derived from the stakeholder narratives. Outcomes: Stakeholders reported the following outcomes from specialist SLT input for CCD within a collaborative team approach: improved engagement with rehabilitation and support teams, improved health‐related quality of life and well‐being, and increased client participation in community activities of personal relevance. Stakeholders also reported inequities in wider service provision where limitations in professional understanding of CCD and knowledge of best practice recommendations preclude access to specialist SLT services. Conclusions: CCDs are under‐recognised and this can have a devastating effect on people with CCD and on those around them. Stakeholder reports provide evidence for the effectiveness of SLT practice recommendations for the treatment of CCD following TBI. They also provide additional evidence of persisting barriers to accessing treatment. Future research to explore ways to close this evidence‐to‐practice gap is required. What This Paper Adds: What is already known on this subject: Cognitive communication difficulties are a well‐documented consequence of TBI. There is evidence for the effectiveness of person‐centred interventions for CCD across the recovery continuum. International evidence‐based practice recommendations are in place for CCD assessment and management. Barriers to accessing SLT expertise for CCD have previously been reported. What this paper adds to existing knowledge: This investigation explores the views of a diverse group of stakeholders involved in a single case of a community‐dwelling individual with severe TBI. Stakeholders report positive real‐world outcomes from SLT interventions for CCD within a coordinated multidisciplinary rehabilitation team. Stakeholder reports also indicate inequities in wider service provision and CCD knowledge gaps amongst professional groups providing rehabilitation services for people with TBI. What are the potential or actual clinical implications of this work?: CCDs are under‐recognised, with devastating effect for people with CCD and those around them. These findings underscore the importance of raising professional awareness of CCD and best practice recommendations, in order to improve access to SLT expertise for people with CCD following TBI. [ABSTRACT FROM AUTHOR]

Abstract Background The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders. Methods A pre-implementation rapid qualitative evaluation of stakeholder interviews. One hundred eight UK stakeholders participated in the study including 34 consumers, 24 manufacturers and retailers, 22 local authority enforcement officers and 28 academic and charitable health representatives. A participatory conference was used to enable policy recommendations to be confirmed by stakeholders. Results Stakeholders perceived the legislation to be a ‘good first step’ towards improving population diet but recognised this needed to be considered amongst a range of long-term obesity policies. Areas of further support were identified and these are presented as six recommendations for government to support the successful implementation of the legislation: (1) provide a free central HFSS calculator, (2) refine legislation to enhance intent and clarity, (3) conduct a robust evaluation to assess intended and unintended outcomes, (4) provide greater support for smaller businesses, (5) provide ring-fenced resources to local authorities and (6) create and communicate a long-term roadmap for food and health. Conclusions This legislation has the potential to reduce impulse HFSS purchases and makes a solid start towards creating healthier retail outlets for consumers. Immediate government actions to create a freely accessible HFSS calculator, support smaller businesses and provide additional resources to local authorities would support successful implementation and enforcement. Independent evaluation of the implementation of the legislation will enable monitoring of potential unintended consequences identified in this study and support refinement of the legislation. A long-term roadmap is necessary to outline strategies to support equal access to healthier and sustainable food across the whole food system within the next 20–30 years.

Background: The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders. Methods: A pre-implementation rapid qualitative evaluation of stakeholder interviews. One hundred eight UK stakeholders participated in the study including 34 consumers, 24 manufacturers and retailers, 22 local authority enforcement officers and 28 academic and charitable health representatives. A participatory conference was used to enable policy recommendations to be confirmed by stakeholders. Results: Stakeholders perceived the legislation to be a 'good first step' towards improving population diet but recognised this needed to be considered amongst a range of long-term obesity policies. Areas of further support were identified and these are presented as six recommendations for government to support the successful implementation of the legislation: (1) provide a free central HFSS calculator, (2) refine legislation to enhance intent and clarity, (3) conduct a robust evaluation to assess intended and unintended outcomes, (4) provide greater support for smaller businesses, (5) provide ring-fenced resources to local authorities and (6) create and communicate a long-term roadmap for food and health. Conclusions: This legislation has the potential to reduce impulse HFSS purchases and makes a solid start towards creating healthier retail outlets for consumers. Immediate government actions to create a freely accessible HFSS calculator, support smaller businesses and provide additional resources to local authorities would support successful implementation and enforcement. Independent evaluation of the implementation of the legislation will enable monitoring of potential unintended consequences identified in this study and support refinement of the legislation. A long-term roadmap is necessary to outline strategies to support equal access to healthier and sustainable food across the whole food system within the next 20–30 years. [ABSTRACT FROM AUTHOR]

Introduction. Primary care research is critical to address Aotearoa New Zealand’s (NZ) health sector challenges. These include health inequities, workforce issues and the need for evaluation of health system changes. Internationally, primary care data are routinely collected and used to understand these issues by primary care research and surveillance networks (PCRN). NZ currently has no such infrastructure. Aim. To explore health sector stakeholders’ views on the utility of, and critical elements needed for, a national PCRN in NZ. Methods. Twenty semi-structured interviews and a focus group were conducted with key stakeholders, representing different perspectives within the health sector, including Hauora Māori providers. Data were analysed thematically. Results. Six themes were identified that included both challenges within current primary care research and ideas for a future network. The themes were: disconnection between research, practice and policy; desire for better infrastructure; improving health equity for Māori and other groups who experience inequity; responding to the research needs of communities; reciprocity between research and practice; and the need for data to allow evidence-informed decision-making. Improving health equity for Māori was identified as a critical function for a national PCRN. Discussion. Stakeholders identified challenges in conducting primary care research and translating research into practice and policy in NZ. Stakeholders from across the health sector supported a national PCRN and identified what its function should be and how it could operate. These views were used to develop a set of recommendations to guide the development of a national PCRN. [ABSTRACT FROM AUTHOR]

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The ethics of returning nonactionable genetic research results to individuals are unclear. Apolipoprotein L1 (APOL1) genetic variants are nonactionable, predominantly found in people of West African ancestry, and contribute to kidney disease disparities. To inform ethical research practice, we interviewed researchers, clinicians, and African American community members (n = 76) about the potential risks and benefits of returning APOL1 research results. Stakeholders strongly supported returning APOL1 results. Benefits include reciprocity for participants, community education and rebuilding trust in research, and expectation of future actionability. Risks include analytic validity, misunderstanding, psychological burdens, stigma and discrimination, and questionable resource tradeoffs. Conclusions: APOL1 results should be offered to participants. Responsibly fulfilling this offer requires careful identification of best communication practices, broader education about the topic, and ongoing community engagement. [ABSTRACT FROM AUTHOR]

Processed foods are increasingly under the spotlight since the development of classification systems based on proxies for food processing. Published critical reviews and commentaries suggest different views among professional disciplines about the definition and classification of processed food. There is a need to further understand perspectives of professionals on the conceptualisation of processed food and the agreements and disagreements among experts, to encourage interdisciplinary dialogue and aid communication to the public. The aim of this research was to elicit views and understandings of professionals on processed food, their perceptions of lay people's perceptions of the same, and their perspectives on the challenges of communicating about processed foods to the public. The online discussion groups brought together a range of professionals (n = 27), covering the fields of nutrition, food technology, policy making, industry, and civil society, mixed in 5 heterogenous groups. Through thematic analysis the following themes relating to the conceptualisation of processed food and challenges for communication were identified: (1) Broad concepts that need differentiation; (2) Disagreements on scope and degree of processing; (3) The role of food processing within the food system: the challenges in framing risks and benefits; and (4) The challenge of different perspectives and interests for risk communication. Throughout the discussions blurred lines in the characterisation of processing, processed foods, and unhealthy foods were observed. Participants agreed that consensus is important, but difficult. Participants identified a need for further interdisciplinary dialogue, including public engagement, to break down the observed issues, and work towards a mutual understanding and develop clear communication messages.

[Display omitted] • LDA topic model is used to analyze the stakeholders' views based on news texts. • The production capacity of plastic alternatives cannot meet with consumption. • National standards for plastic substitutes urgently need to be improved. • Opaque information hinders the process of material recycling. With the massive use of plastic products, plastic pollution has increasingly attracted worldwide attention. To deal with the problem of plastic pollution, the Chinese government issued the " Opinions on Further Strengthening the Control of Plastic Pollution " (Abbreviated as OFSCPP), which is known as "plastic restriction policy" by the public, in January 2020. It stipulates the timetable and main tasks for restricting the production, sales, and use of certain plastic products, such as plastic bags, disposable straws and agricultural mulch. Since the policy was officially implemented on January 1, 2021, people's lives in China have been considerably affected, and it has also attracted widespread attention from news media. In this study, 310 pieces of news items and information about the OFSCPP published in the first quarter of 2021 from the Baidu News website from which 44, 94, 90, 26, and 49 statements from producers, retailers, consumers, managers, and experts were extracted. The extracted words and expressions were then analyzed using the Latent Dirichlet Allocation topic model. Text analysis results showed that the production efficiency of plastic substitutes in China cannot meet market demand, consumers' experience on plastic substitutes is poor, and recycling and disposal processing information is opaque. To achieve the policy goals, the government should encourage the innovation of high-quality and inexpensive plastic alternatives, the national standards for plastic substitutes should be urgently improved, consumers' concept of green consumption should be gradually cultivated, and terminal recycling and disposal should be promoted. [ABSTRACT FROM AUTHOR]

Background Medication reviews are recognised as essential to tackling problematic polypharmacy. Domiciliary medication reviews (DMRs) have become more prevalent in recent years. They are proclaimed as being patient-centric but published literature mainly focuses on clinical outcomes. However, it is not known where the value of DMRs lies for patients who participate in them. Objective To determine the value of domiciliary medication reviews to service users. Setting Interviews took place with recipients of domiciliary medication reviews residing in the London boroughs of Islington and Haringey. Method Semi-structured interviews analysed using thematic analysis. Main outcome measure Themes and sub-themes identified from interview transcripts. Results Five themes were identified: advantages over traditional settings, attributes of the professional, adherence, levels of engagement and knowledge. Conclusion For many patients, the domiciliary setting is preferred to traditional healthcare settings. Patients appreciated the time spent with them during a DMR and felt listened to. Informal carers felt reassured that the individual medication needs of their relative had been reviewed by an expert. [ABSTRACT FROM AUTHOR]

This research aims to reveal stakeholder views on early literacy and reading and writing acquisition in the preschool period. It is a case study conducted with the descriptive survey model. The research participants consisted of academics, primary school teachers, early childhood education teachers, primary school teaching students, and prospective early childhood education students. Five semi-structured interview forms were used as the data collection tool. The data were analyzed through content analysis method. The results indicate that stakeholders have a flexible approach to teaching reading and writing in the preschool period and support early literacy education. The roles that early childhood education teachers, preschool education institutions, and parents should play, are presented. It is recommended to increase the cooperation of stakeholders having an essential role in literacy skills development and to reshape the pre-service and in-service training related to early literacy.

This study examines knowledge, attitudes, and communication practices toward genomic data sharing among principal investigators and research coordinators engaged in cancer and non-cancer studies. We conducted 25 individual semi-structured interviews and conducted a qualitative thematic analysis. Most interviewees had basic knowledge of data sharing requirements, but lacked specific details of recent changes to NIH policy. Principal investigators perceived more risks to participants for data sharing than the research coordinators who generally obtained consent. Interviewees perceived a trend toward providing fewer data sharing options to participants in the consent process, and had observed that parents of pediatric patients asked more questions than adult patients. Our findings highlight potential areas for improvement related to data sharing during consent processes. [ABSTRACT FROM AUTHOR]

• We surveyed UK stakeholders views on Natural Flood Management (NFM) • If, how and who pays for NFM is the most contested topic. • We find widespread interest in NFM but as yet little evidence of a paradigm shift. • Views on NFM highlight challenges for this and other Nature-Based Solutions (NBS). • There is a need to debate rights/responsibilities linked with land management. An exemplar of nature-based solutions (NBS) is natural flood management (NFM), for which interest is growing worldwide. As with many NBS, implementing NFM requires the participation of support of multiple stakeholders. However, we lack understanding about the views and expectations of the many stakeholders who might be expected to enable or implement it. Understanding such views may offer insights regarding whether and how the dominant flood risk management protection paradigm is really being challenged. Using the first survey (N = 118) across a range of water and environmental management stakeholders in the United Kingdom (UK), this research explores whether there is support for a paradigm shift to "work with nature" as intended with NBS. We find evidence that some stakeholders view NFM as a "no-brainer"; a judgement based on perceived cost-effectiveness, social and environmental benefits and the failure of the protection paradigm exposed in recent floods. Others, typically farmers and landowners, have more cautious views about change. All our respondents generally agree that responsibility to enable, implement, and fund NFM should be shared across society, but disagreements remain about the detail and the basis for any enabling payments. We argue that the shared perception of roles and responsibilities provides a foundation for further work to facilitate NFM, explicitly considering principles and specific contractual details. In the UK, the possibilities of post-Brexit agri-environment policy make such a debate particularly pertinent. It is also likely to be productive in many other cases and places, since the paradigm shift entailed by ideal visions of NBS often entails new relationships between stakeholders and new activities 'on the ground'. [ABSTRACT FROM AUTHOR]

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens (n = 2259) and poultry farmers (n = 100) judged three practical cases, which illustrate the dilemma of improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. [ABSTRACT FROM AUTHOR]

Highlights • Cost of Compliance is proposed as a useful statistic for assessing any proposed change in management in any fishery. • A way to calculated it is shown for the Atlantean roundfish fisheries. • A summary is provided of the response of Atlanterro Stakeholders to this approach. • It suggests how Atlanterro expertise could be transfered to other areas. • It addresses the problems of including Atlanterro and other Stakeholders in the fisheries management process. Abstract Fisheries Stakeholders are understandably most concerned with immediate problems. Often these problems are related to proposed rule changes. This short term focus is in itself a serious problem for introducing Ecosystems Based Fisheries Management (EBFM), which is typically seen as a long-term approach. However, the short-term response of fishers to rule changes may well have long-term consequences by either changing their fishing patterns or by changing the extent to which fishers obey the rules. Either response could have a long-term impact on achieving EBFM. This is a difficult area to study because it involves fishers' unrecorded behaviour, but it is probably the case that many of the responses of fishers may be influenced by how much it costs them to change their behaviour to comply with new rules. Changes in behaviour may include changes in fishing gear, fishing grounds or fishing effort. To examine these possibilities requires that a short-term area based model is available that can consider the costs and consequences of changes in fishing gear or fishing ground. There can be technical difficulties with doing this, but this paper attempts to show how these might be overcome. However, given the sensitive nature of compliance issues, these approaches are applied to the mythical fisheries of Atlantis rather than to real life fisheries. Initial results of the model applied to the important Atlantean Fishing fleets are shown, and most importantly how much compliance might cost in these cases is indicated (i.e. the profit forgone by complying). Pursuing this scientific parable further also allows an open discussion of ways to mitigate non compliance. It suggests how stakeholders and managers might be able to improve trust and compliance by adding fishers' information to the scientific information used in models of compliance. This would increase transparency and help with identifying and encouraging responsible behaviours that improve compliance and thus the chances of EBFM being successful. The purpose of the parable is to spark discussion and wider thinking about fisheries management and compliance in an EBFM context. [ABSTRACT FROM AUTHOR]

Highlights • This paper presents the evolution of the decision support framework for the North Sea during the MAREFRAME project. • This evolution was from a multi-criteria Analysis (MCA) to the N Dimensional Potato Approach. • It presents an initial classification of the stakeholder subgroups and quantifies unacceptable levels of the major concerns. • It shows how the conflicting views of these stakeholder subgroups can be communicated clearly to senior managers. Abstract Any ecosystem based fisheries management system is necessarily faced with the problem of multiple objectives that trade-off against one another. Typically, objectives such as the maximization of yield, employment or profit or minimizing environmental impacts will be optimized in different parts of the decision space, which is formed of the fishing mortality rates that can be applied to the various species, given the constraints imposed by the mixed species nature of many fishing fleets. Since objectives cannot be simultaneously achieved, managers need to consider how such objectives trade-off against one another in order to choose a balanced strategy. Normally, they also have to consider the views of different groupings of stakeholders, who often favour widely different and conflicting objectives. This is particularly difficult if stakeholders are reluctant to expose their negotiating positions. This article explores two possible approaches to developing a Decision Support Framework for the North Sea. The first is a classic Multi- Criteria Analysis (MCA) approach that was developed in cooperation with North Sea stakeholders. The implementation went smoothly for the definition of suitable scenarios, decision trees and criteria, but failed in facilitating consensus on how to set priorities at the stakeholder level. However, it remains a possible approach for higher level management to adopt. Consequently, to aid effective decision-making a simpler approach was designed to visualise stakeholders concerns both to themselves and to the managers in charge of actual decision-making. Rather than trying to achieve some joint optima of the objectives that stakeholders wish to achieve this approach seeks to avoid the solutions various stakeholder groups resent the most. This 'N dimensional potato approach' proposed here treats the decision space as analogous to a partially rotten potato that has to be prepared for the table: each group of stakeholders cut away those parts of the decision space that they consider unacceptable. Ideally, this would leave a decision space where somewhat acceptable compromise solutions exist. But, if no decision space is left after all have made their cuts, this approach will still inform managers about the consequences of different solutions in terms of which group will be disappointed and by how much. Making this approach operational requires both uncovering various stakeholders' views of the unacceptable areas, and also displaying these areas in a convenient fashion together with areas of stakeholder consent. The article describes the steps taken to address these two tasks by the North Sea case study of the MareFrame research project. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate South African stakeholder views of the content of the recently developed postgraduate course in Facilities Management at the University of the Witwatersrand in South Africa. The study was done using a questionnaire survey of a cross-section of professionals registered with the South African Facilities Management Association (SAFMA). It covers technical, personal, interpersonal and professional skills as well as the ability to conceive, design, implement and operate business systems. It also highlights the degree of importance of these skills. The findings of this research will enable those designing FM programmes of study to ensure that their curricula are current and relevant to the needs of the relevant stakeholders within their contexts. The paper goes beyond previous research in the built environment in specifying the requisite proficiency levels in terms of the relevant skills and competencies.

The aim of this study is to evaluate South African stakeholder views of the competency requirements of graduates of facilities management programmes. The study was done using a questionnaire survey of a cross-section of professionals registered with the South African Facilities Management Association (SAFMA). The responses cover graduates' technical, personal, interpersonal and professional skills as well as their ability to conceive, design, implement and operate business systems. Respondents also offered opinions on the degree of importance of these skills. The findings of this research will enable those designing FM degree programmes of study to ensure that their curricula are current and relevant to the needs of the relevant stakeholders within their respective contexts. The paper goes beyond previous research in the built environment in specifying the requisite proficiency levels in terms of the relevant skills and competencies. [ABSTRACT FROM AUTHOR]

The concept of ‘Sustainable Intensification’ (SI) has been promoted as a potential solution to the many contemporary challenges facing agriculture, but has also received widespread criticism for being too narrow in scope and failing to address all aspects of sustainability. Despite this, there are few suggestions in the literature as to what a holistic, broad-based approach to SI should comprise and what issues and trade-offs are likely to arise in the adoption and operation of such a broadly-based approach. We report a suit of SI indicators suggested by UK stakeholders, evaluate the plausibility of these in terms of the commonly established principles of sustainability, and identify the critical issues that may arise in the adoption and operation of these indicators. The purpose of this paper is not to recommend a specific blueprint for SI but to raise issues and questions for dialogue amongst stakeholders. Data were collected via semi-structured interviews with 32 stakeholders from throughout the UK agrifood system. The data were analysed thematically and organised using a Social-Ecological Systems (SESs) framework. The interviewees suggested a total of 110 SI indicators, of which the most frequently suggested related to agricultural production and ecological considerations. There was less emphasis placed on social and cultural dimensions of agricultural systems. A number of the indicators suggested were poorly-defined and it was difficult to determine what particular aspects of sustainability they addressed. Many potential trade-offs between the indicators were also evident. The findings raise a number of questions. Is it appropriate to continue referring to SI as Sustainable Intensification when it fails to give equal consideration to all accepted aspects of sustainability? Would it be more appropriate to refer to the SI concept as ‘Ecological Intensification’? Is a broad-based and all-encompassing definition of ‘sustainability’ always desirable, or should ‘sustainability’ be considered as context specific, with the weighting of the different dimensions varying according to operational circumstances? We argue that these questions need to be resolved through stakeholder dialogues in order for the concept of SI to become more widely accepted and implementable in practice. [ABSTRACT FROM AUTHOR]

How do professionals working in pre-implantation genetic diagnosis (PGD) reflect upon their decision making with regard to ethical challenges arising in everyday practice? Two focus group discussions were held with staff of reproductive genetic clinics: one in Utrecht (The Netherlands) with PGD-professionals from Dutch PGD-centres and one in Prague (Czech Republic) with PGD-professionals working in centres in different European countries. Both meetings consisted of two parts, exploring participants' views regarding (1) treatment requests for conditions that may not fulfill traditional indications criteria for PGD, and (2) treatment and transfer requests involving welfare-of-the-child considerations. There was general support for the view that people who come for PGD will have their own good reasons to consider the condition they wish to avoid as serious. But whereas PGD-professionals in the international group tended to stress the applicants' legal right to eventually have the treatment they want (whatever the views of the professional), participants in the Dutch group sketched a picture of shared decision-making, where professionals would go ahead with treatment in cases where they are able to understand the reasonableness of the request in the light of the couple's reproductive history or family experience. In the international focus group there was little support for guidance stating that welfare-of-the child considerations should be taken into account. This was different in the Dutch focus group, where shared decision-making also had the role of reassuring professionals that applicants had adequately considered possible implications for the welfare of the child. [ABSTRACT FROM AUTHOR]

The global demand for renewable energy continues to increase rapidly and with it the necessity to develop and test new technologies to deliver the power. Offshore renewable energy sources that harness wind, wave or tidal power are of major interest. Technological advances in these directions have not been matched by a clear understanding of the environmental impacts of the new devices, with most existing research concentrated on the impacts of offshore wind farms. Decisions often continue to be made without the support of a clear evidence base. Here we use an underwater tidal turbine, SeaGen, constructed and operated within the Strangford Lough marine protected area in Northern Ireland, as a case study to explore the potential impacts of the turbine as points of concern and argumentation in the decision-making processes. We use information obtained from official documents and one-to-one interviews with the main stakeholders. Our results demonstrate that during the construction and operation of the turbine the perceptions and views of different stakeholders sometimes disagreed but were often surprisingly similar in relation to both likelihood and intensity of the potential impacts of the turbine on marine biodiversity, ecosystem services and human well-being in general. The overall consensus of views was refined and evolved under an adaptive management approach over the 10 years of the discussions and decision-making processes. The results are discussed in relation to cumulative gains in knowledge, future arrays of many underwater turbines and multiple use of oceans within social ecological systems to maintain the conservation of marine biodiversity. [ABSTRACT FROM AUTHOR]

This paper assesses EU nature conservation and EU climate protection policies within the context of their local implementation in Vienna/Austria in order to gain insights into the decision-making process as well as to show the extent of achievements and experienced difficulties. In this connection, this paper also investigates based on published knowledge and the perceptions of stakeholders the awareness of nature conservation measures as climate-change adaptation and possibly ways of improvement. In order to address these issues, additionally to an in-depth literature review, 16 experts working in Vienna in the field of either nature conservation or climate protection were interviewed. The transcriptions of these interviews were then used in a qualitative content analysis. The findings show that the vast majority of the interviewed stakeholders see EU climate policy and nature conservation policy separately. Furthermore, the implementation of EU climate and nature conservation policy in Vienna is indicated as a “learning by doing” process. There the currently limited cooperation between stakeholders can be improved. Our study also finds that the awareness of different stakeholder groups of the possibility to use nature conservation as a measure against climate change is limited. [ABSTRACT FROM AUTHOR]

This study examines how technology is perceived by different stakeholder groups in The Language Flagship programs.2 We administered questionnaires to three stakeholder groups: 14 directors, 34 instructors, and 100 learners at a variety of institutions with three goals: (a) to investigate what technologies the directors, instructors, and learners find useful for language instruction; (b) to explore how and to what degree the perceptions of the directors, instructors, and learners agree about technologies they use; and (c) to study how learners' views vary with regard to the value of various technologies for language learning inside and outside the classroom. [ABSTRACT FROM AUTHOR]

Health research in resource-limited, multi-cultural contexts raises complex ethical concerns. The term ‘over-researched community’ (ORC) has been raised as an ethical concern and potential barrier to community participation in research. However, the term lacks conceptual clarity and is absent from established ethics guidelines and academic literature. In light of the concern being raised in relation to research in low- and middle-income countries (LMICs), a critical and empirical exploration of the meaning of ORC was undertaken. Guided by Emanuel et al.’s (2004) eight principles for ethically sound research in LMICs, this study examines the relevance and meaning of the terms ‘over-research’ and ‘over-researched community’ through an analysis of key stakeholder perspectives at two South African research sites. Data were collected between August 2007 and October 2008. ‘Over-research’ was found to represent a conglomeration of ethical concerns often used as a proxy for standard research ethics concepts. ‘Over-research’ seemed fundamentally linked to disparate positions and perspectives between different stakeholders in the research interaction, arising from challenges in inter-stakeholder relationships. ‘Over-research’ might be interpreted to mean exploitation. However, exploitation itself could mean different things. Using the term may lead to obscured understanding of real or perceived ethical concerns, making it difficult to identify and address the underlying concerns. It is recommended that the term be carefully and critically interrogated for clarity when used in research ethics discourse. Because it represents other legitimate concerns, it should not be dismissed without careful exploration. [ABSTRACT FROM AUTHOR]

To select appropriate fire protection options for buildings during their design stage, economic, safety, environmental, and societal criteria need to be accounted for. The divergent and sometimes conflictual desires from different fire design stakeholders involved in the process present a multicriteria decision problem. Design decision criteria and fire protection options can be interdependent, and so there is a need to manage these desires with an advanced decision analysis technique, thereby reducing uncertainties in the complex decision-making process. The aim of this paper is to use the weighted/geometric mean method-analytic network process (W/GMM-ANP) to balance the opinions of fire design stakeholders extracted from 42 structured stakeholder interviews on selecting the most suitable fire protection option for buildings constructed of steel frames. Different categories of interdependent decision elements were developed from 22 design decision criteria and 5 proposed fire protection options to produce a network of decision clusters for multicriteria decision analysis. In the synthesis and ranking of fire protection options, the W/GMM-ANP accounted for the multiple interdependencies of weighted and unweighted stakeholder desires and managed the complexity of the decision-making problem. The technique is proposed for approaching suitable group decisions in structural fire design of steel-framed buildings as well as other performance-based engineering decision making that may involve multidisciplinary stakeholders. [ABSTRACT FROM AUTHOR]

Background: Schools are key settings for childhood obesity prevention, and the location for many intervention studies. This qualitative study aims to explore parent and child experiences of the WAVES study obesity prevention intervention, in order to gain understanding of the mechanisms by which the intervention results in behaviour change, and provide context to support interpretation of the main trial results.Methods: Focus groups were held with 30 parents and 62 children (aged 6-7 years) from primary schools in the West Midlands, UK. Data analysis (conducted using NVivo 10) was guided by the Framework Approach.Results: Three over-arching themes were identified: 'Impact', 'Sustainability' and 'Responsibilities', under which sub-themes were determined. Participants were supportive of the school-based intervention. Parental involvement and the influential role of the teacher were seen as key ingredients for success in promoting consistent messages and empowering some parents to make positive behavioural changes at home. Parents recognised that whilst they held the primary responsibility for obesity prevention in their children, they faced a number of barriers to healthier lifestyles, and agreed that schools have an important role to play.Conclusions: This study enabled us to better understand aspects of the WAVES study intervention programme that have the potential to initiate positive behaviour changes in families, and indicated that a combination of pathways influenced such changes. Pathways included: increasing capability through improving knowledge and skills of children and parents; increasing motivation through parental empowerment and role modelling; and the direct provision of opportunities to lead healthier lifestyles. Strategies to sustain behaviour changes, and the school role in supporting these, are important considerations. [ABSTRACT FROM AUTHOR]

Background: Clinical networks have been established to improve patient outcomes and processes of care by implementing a range of innovations and undertaking projects based on the needs of local health services. Given the significant investment in clinical networks internationally, it is important to assess their effectiveness and sustainability. This qualitative study investigated the views of stakeholders on the factors they thought were influential in terms of overall network success.Method: Ten participants were interviewed using face-to-face, audio-recorded semi-structured interviews about critical factors for networks' successes over the study period 2006-2008. Respondents were purposively selected from two stakeholder groups: i) chairs of networks during the study period of 2006-2008 from high- moderate- and low-impact networks (as previously determined by an independent review panel) and ii) experts in the clinical field of the network who had a connection to the network but who were not network members. Participants were blind to the performance of the network they were interviewed about. Transcribed data were coded and analysed to generate themes relating to the study aims.Results: Themes relating to influential factors critical to network success were: network model principles; leadership; formal organisational structures and processes; nature of network projects; external relationships; profile and credibility of the network.Conclusions: This study provides clinical networks with guidance on essential factors for maximising optimal network outcomes and that may assist networks to move from being a 'low-impact' to 'high-impact' network. Important ingredients for successful clinical networks were visionary and strategic leadership with strong links to external stakeholders; and having formal infrastructure and processes to enable the development and management of work plans aligned with health priorities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to explore the views of the primary and the secondary stakeholders on the current functioning of the fish quality and safety regulatory system in Oman. Design/methodology/approach -- The views on the fish quality and safety regulatory governance mechanism were elicited using a questionnaire survey. Findings -- Although specific benefits derived from the quality control (QC) regulations were recognized by both groups a number of key factors were highlighted for improvement such as funding, being more proactive, literacy, quality of fish received. Originality/value -- The paper has identified some weaknesses and constraints that hinder the effective and efficient functioning of the quality and safety regulatory systems and provided appropriate policy recommendations to make the governance of the QC regulatory system in the seafood sector efficient and effective and to mitigate public health risk. [ABSTRACT FROM AUTHOR]

• We inventorized the legacy soil surveys for two provinces of Zambia. • Over 60% of surveys could not be traced. • Map effort and texture were consistent with smaller scales than published. • Stakeholders elicted stated that legacy information was potentially useful. • Legacy surveys can be more accessible than single property maps. Soil information is essential for agricultural research and development. In developing countries like Zambia, the availability of soil information is limited by the cost of new soil surveys. Legacy soil information could be useful to fill this gap. This study evaluated the availability of legacy soil information in Southern and Eastern Provinces of Zambia. We also examined the survey scales, legends, boundary density and map texture. We examined a number of exemplar transects undertaken by C.G. Trapnell from 1932 to 1942 in the region, evaluating the information provided on soil, vegetation, landscape and farming systems. An overview of this legacy was presented to a workshop of varied stakeholders in Lusaka, and their opinions on its utility were elicited. More than 60% of large-scale surveys known to have been conducted in the two provinces could not be traced and among those traced some map-sheets were not available. Most of the survey reports exist as hard copies and some are in poor condition, while only 7 are available online on the ISRIC website as scanned copies. The map scale and texture were not entirely consistent with general expectations, with map texture consistent with a smaller publication scale in assessed map-sheets. Stakeholders regarded the legacy information as a valuable resource, despite some limitations, suggesting that some of its features could usefully be reproduced in modern soil information. The holistic assessment provided for soil map units may be more accessible than single-property maps. Accessibility and understanding of soil information is seen as a limitation. There is an urgent need to preserve the legacy soil survey reports and maps that are still available in Zambia, and in other countries. This entails physical preservation of material, making it available, and studying it closely with current and retired soil surveyors to preserve their recollection of how it was produced and their understanding of how it should be interpreted. The preservation should include scanning of hardcopy reports and storage in national, regional, and global soil survey data hubs with links provided for easy access. Stakeholder enthusiasm for the format of legacy soil surveys suggests that renewed systematic soils surveys would be valuable. [ABSTRACT FROM AUTHOR]

Background International medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population. Methods This was an explanatory sequential, mixed methods study. All students in First Year Medicine, National University of Ireland Galway 2012 were eligible to sit a previously validated 10 station MMI. Quantitative data comprised: demographics, selection tool scores and First Year Assessment scores. Qualitative data comprised separate focus groups with MMI Assessors, EU and Non-EU students. Results 109 students participated (45% of class). Of this 41.3% (n=45) were Non-EU and 35.8% (n=39) did not have English as first language. Age, gender and socioeconomic class did not impact on MMI scores. Non-EU students and those for whom English was not a first language achieved significantly lower scores on MMI than their EU and English speaking counterparts (difference in mean 11.9% and 12.2% respectively, P<0.001). MMI score was associated with English language proficiency (IELTS) (r=0.5, P<0.01). Correlations emerged between First Year results and IELTS (r=0.44; p=0.006; n=38) and EU school exit exam (r=0.52; p<0.001; n=56). MMI predicted EU student OSCE performance (r=0.27; p=0.03; n=64). In the analysis of focus group data two overarching themes emerged: Authenticity and Cultural Awareness. MMI was considered a highly authentic assessment that offered a deeper understanding of the applicant than traditional tools, with an immediate relevance to clinical practice. Cultural specificity of some stations and English language proficiency were seen to disadvantage international students. Recommendations included cultural awareness training for MMI assessors, designing and piloting culturally neutral stations, lengthening station duration and providing high quality advance information to candidates. Conclusion MMI is a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background. [ABSTRACT FROM AUTHOR]

Noninvasive prenatal testing (NIPT) allows for highly sensitive detection of Down syndrome early in pregnancy with no risk of miscarriage, therefore potentially increasing the number of pregnancies identified with Down syndrome. This study assesses how mothers of children with Down syndrome perceive NIPT, especially the impact they think it will have on their families and other families with children who have Down syndrome. Seventy-three self-reported mothers of children with Down syndrome responded to an anonymous online survey emailed to, and posted on, message boards of various Down syndrome support groups and networks. Data analysis included chi-square tests and thematic analysis. Fifty-nine percent of respondents indicated they would use NIPT in the future; respondents who had not used prenatal testing in the past were significantly less likely to report interest in using NIPT in the future than those who had prenatal testing previously ( p < .001). Many respondents felt NIPT could lead to increased terminations (88 %), increased social stigma (57 %), and decreased availability of services for individuals with Down syndrome (64 %). However, only 16 % believed availability of new noninvasive tests would be the most important factor in determining the number of pregnancies with Down syndrome terminated in the future. Additionally, 48 % believed health care providers give biased or incorrect information about Down syndrome at the time of diagnosis, and 24 % felt this incorrect information leads to terminations of pregnancies affected with Down syndrome. Results suggest although mothers of children with Down syndrome believe new noninvasive testing will lead to an increase in termination of pregnancies with Down syndrome, they do not think it is the MOST important factor. They also highlight the need to provide a diagnosis of Down syndrome in a balanced and objective manner. [ABSTRACT FROM AUTHOR]

Accessible summary Prescribing medication was previously the monopoly of medical doctors but in recent years suitably qualified mental health nurses among others, have been authorized to prescribe., The nurse-patient relationship is considered paramount in mental health nursing but some mental health nurses are concerned that prescribing may somehow conflict with this relationship. However there has been little reported on the views of mental health nurse prescribers and their clients., In this study clients and other stakeholders from one National Health Service Foundation Trust were interviewed or participated in a focus group regarding their experiences of nurses prescribing medication., Clients in this study believed that nurse prescribing was working well and they were satisfied having their medication prescribed by their nurse. Nurse prescribers believed that their prescribing was well received by their clients and by other professionals., Abstract Nurse prescribing has been embraced in many areas of nursing, but less so in mental health. Relatively few studies have been published in this field with even fewer asking clients who have their medication prescribed by a mental health nurse about their views. This paper reports findings concerning the mental health nurse prescriber-patient relationship. It draws on data from a qualitative study, which was undertaken in one mental health National Health Service Foundation Trust in England to ascertain the views of clients and other stakeholders (nurse prescribers, pharmacist prescribers, nurse managers and doctors) about nurse prescribing. Data were collected by interview (either face to face or telephone) or focus group. Following Framework analysis, findings revealed that clients liked to have their nurse prescribe for them as they valued the pre-established relationship. They also valued the consistency of seeing the same person and the relative ease of access to appointments. Doctors and nurse managers were aware of positive feedback from clients. Nurse prescribers believed that nurse prescribing provided an enhanced service to clients. [ABSTRACT FROM AUTHOR]