Priority Setting Research Articles

Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review.

Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.

Assessing coastal vulnerability and climate resilience for Caribbean small island states using ecological principles

Climate Change challenges small island developing nations (SIDS) whose economies are heavily dependent on touristic coastal development. Climate change, as a driver of coastal impacts, is manifested by increased storm intensity as well as sea level rise. The intersection of climate hazards, exposure and vulnerability is the overall risk of coastal impacts. Ecological principles can be applied to simple Coastal Indices (CVI) to establish priorities for mitigation focused on risky development areas to direct population growth to lower risk areas. This research examines one island within the Bahamian archipelago to demonstrate how ecological principles can be applied to quantify vulnerability and recommend high-priority sites for restoration or remediation. This study aims to quantify vulnerability of coastlines through an assessment of coastal vegetation setbacks, intact wetlands and coastal geomorphology. The aim is to produce a tool to identify highly vulnerable/highly exposed coastlines that can be specifically targeted for risk reduction through cost-benefit analyses of response options. The vulnerability assessment was quantitative and allowed the ranking of coastal environments on one island to set priorities for remediation of highly vulnerable sites. Tools that identify at-risk coastal areas allow small Caribbean nations more time to adapt their infrastructure and relocate populations.

Preparing popular views for inclusion in a reflective equilibrium: A case study on illness severity

Principles for priority setting in health care are typically forged by experts influenced by the normative literature on priority setting. Meanwhile, their implementation is subject to democratic deliberation, political pressures, and administrative bureaucracy. Sometimes expert proposals are democratically rejected. This points towards a problem: on the one hand, the fact that a majority shares a moral belief does not inherently validate this belief. On the other hand, when justifying a position to others, we cannot expect much success without engaging with their moral judgments. In this work we examine the possibility of including so-called popular views in a reflective equilibrium process. In reflective equilibrium processes, we are usually interested in considered judgments rather than mere intuitions. Popular views, arguably, often do not meet this standard. To mitigate this, we propose to bolster popular views by linking them with theoretical frameworks echoing similar moral perspectives. We use illness severity as a case study and show that a set of popular accounts can provide considered judgments that merit inclusion in a publicly informed reflective equilibrium process. This is plausibly a way forward in the search for priority setting principles that are both normatively sound and acceptable to the public. Our method provides a general framework for refining available data on popular views on moral questions, including when we cannot assess the consideredness of such views.

Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities - the PROMPt Study.

A barrier to hepatitis C virus (HCV) cure is conventional testing. The aim of this study was to evaluate the effect of HCV antibody and RNA point-of-care-testing (POCT) on testing rates, linkage to care, treatment and acceptability of testing in three priority settings in Australia. Participants were enrolled in an interventional cohort study at a reception prison, inpatient mental health service (MHS), and inpatient alcohol and other drug (AOD) unit-between October 2020 and December 2021. HCV POCT was performed using SD Bioline HCV antibody fingerstick test and a reflexive Xpert® HCV Viral Load Fingerstick test using capillary blood samples. A retrospective audit of HCV testing and treatment data was performed at each site for the preceding 12-month period to generate a historical control. 1,549 participants received a HCV antibody test with 17% (264/1,549) receiving a positive result, of which 21% (55/264) tested HCV RNA positive. Across all settings the rate of testing per year significantly increased between the historical controls and the study intervention period by three-fold (RR:2.57 95% CI: 2.32, 2.85) for HCV antibody testing and four-fold (RR:1.62; 95% CI:1.31, 2.01) for RNA testing. Treatment uptake was higher during the POCT intervention (86%, 47/55; P=0.010) compared to the historical controls (61%, 27/44). This study demonstrated across three settings that the use of HCV antibody and RNA POCT increased testing rates, treatment uptake linkage to care. The testing model was highly acceptable for most participants. ACTRN-12621001578897.

Multi-actor system dynamics in access to disease-modifying treatments for multiple sclerosis in Southeast Asia: A regional survey and suggestions for improvement

BackgroundDespite the global availability of multiple sclerosis (MS) treatments, accessing and financing them in Southeast Asia (SEA) remains a challenge. This descriptive survey-based study aimed to describe the current state of MS treatment access and local access dynamics within this region. MethodsThe survey questionnaire, comprising of 15 closed-ended and five open-ended questions, was developed by three neurologists with expertise in MS and routine MS patient management, or had training in neuroimmunology. Questionnaire development was guided by the recent Atlas of MS and in alignment with the Access to Treatment framework, focusing on MS diagnosis and treatment issues in SEA. Fifteen neurologists experienced in managing MS across the region were identified as key informants for this study. ResultsAll fifteen neurologists participated in the survey via email and videoconferencing between January 2020 and February 2023, which included the following countries: Brunei, Cambodia, Indonesia, Malaysia, Myanmar, Lao PDR, Philippines, Singapore, Thailand, Timor-Leste, and Vietnam. All had at least five years of experience in managing MS patients and six had previously completed a neuroimmunology fellowship programme. SEA countries showed disparities in healthcare financing, availability of neurologists, MS treatments, and investigative tools. Access to MS disease-modifying treatments (DMTs) is hindered by high cost, lack of MS specialists, and weak advocacy efforts. On-label DMTs are not listed as essential medicines regionally except for interferon beta1a and teriflunomide in Malaysia. On-label monoclonals are available only in Malaysia, Singapore, and Thailand. Generic on-label DMTs are unavailable due to lack of distributorship and expertise in using them. Off-label DMTs (azathioprine, methotrexate, and rituximab) predominate in most SEA countries. Other challenges include limited access to investigations, education, and knowledge about DMTs among general neurologists, and absence of registries and MS societies. Patient champions, communities, and MS organisations have limited influence on local governments and pharmaceutical companies. Despite its increasing prevalence, there is a lack of concerted priority setting due to MS being perceived as a rare, non-communicable disease. ConclusionThis study highlights the distinct dynamics, challenges, and research gaps within this region, and provides suggestions to improve MS diagnosis, education, and medicine access.

Estimation of the Population Size of Street- and Venue-Based Female Sex Workers and Sexually Exploited Minors in Rwanda in 2022: 3-Source Capture-Recapture.

HIV surveillance among key populations is a priority in all epidemic settings. Female sex workers (FSWs) globally as well as in Rwanda are disproportionately affected by the HIV epidemic; hence, the Rwanda HIV and AIDS National Strategic Plan (2018-2024) has adopted regular surveillance of population size estimation (PSE) of FSWs every 2-3 years. We aimed at estimating, for the fourth time, the population size of street- and venue-based FSWs and sexually exploited minors aged ≥15 years in Rwanda. In August 2022, the 3-source capture-recapture method was used to estimate the population size of FSWs and sexually exploited minors in Rwanda. The field work took 3 weeks to complete, with each capture occasion lasting for a week. The sample size for each capture was calculated using shinyrecap with inputs drawn from previously conducted estimation exercises. In each capture round, a stratified multistage sampling process was used, with administrative provinces as strata and FSW hotspots as the primary sampling unit. Different unique objects were distributed to FSWs in each capture round; acceptance of the unique object was marked as successful capture. Sampled FSWs for the subsequent capture occasions were asked if they had received the previously distributed unique object in order to determine recaptures. Statistical analysis was performed in R (version 4.0.5), and Bayesian Model Averaging was performed to produce the final PSE with a 95% credibility set (CS). We sampled 1766, 1848, and 1865 FSWs and sexually exploited minors in each capture round. There were 169 recaptures strictly between captures 1 and 2, 210 recaptures exclusively between captures 2 and 3, and 65 recaptures between captures 1 and 3 only. In all 3 captures, 61 FSWs were captured. The median PSE of street- and venue-based FSWs and sexually exploited minors in Rwanda was 37,647 (95% CS 31,873-43,354), corresponding to 1.1% (95% CI 0.9%-1.3%) of the total adult females in the general population. Relative to the adult females in the general population, the western and northern provinces ranked first and second with a higher concentration of FSWs, respectively. The cities of Kigali and eastern province ranked third and fourth, respectively. The southern province was identified as having a low concentration of FSWs. We provide, for the first time, both the national and provincial level population size estimate of street- and venue-based FSWs in Rwanda. Compared with the previous 2 rounds of FSW PSEs at the national level, we observed differences in the street- and venue-based FSW population size in Rwanda. Our study might not have considered FSWs who do not want anyone to know they are FSWs due to several reasons, leading to a possible underestimation of the true PSE.

Perspectives on the timing of ecosystem collapse in a changing climate.

Climate change is one of the most important drivers of ecosystem change, the global-scale impacts of which will intensify over the next 2 decades. Estimating the timing of unprecedented changes is not only challenging but is of great importance for the development of ecosystem conservation guidelines. Time of emergence (ToE) (point at which climate change can be differentiated from a previous climate), a widely applied concept in climatology studies, provides a robust but unexplored approach for assessing the risk of ecosystem collapse, as described by the C criterion of the International Union for Conservation of Nature's Red List of Ecosystems (RLE). We identified 3 main theoretical considerations of ToE for RLE assessment (degree of stability, multifactorial instead of one-dimensional analyses, and hallmarks of ecosystem collapse) and 4 sources of uncertainty when applying ToE methodology (intermodel spread, historical reference period, consensus among variables, and consideration of different scenarios), which aims to avoid misuse and errors while promoting a proper application of the framework by scientists and practitioners. The incorporation of ToE for the RLE assessments adds important information for conservation priority setting that allows prediction of changes within and beyond the time frames proposed by the RLE.

Aligning organisational priorities and implementation science for cancer research

BackgroundThe challenge of implementing evidence into routine clinical practice is well recognised and implementation science offers theories, models and frameworks to promote investigation into delivery of evidence-based care. Embedding implementation researchers into health systems is a novel approach to ensuring research is situated in day-to-day practice dilemmas. To optimise the value of embedded implementation researchers and resources, the aim of this study was to investigate stakeholders’ views on opportunities for implementation science research in a cancer setting that holds potential to impact on care. The research objectives were to: 1) Establish stakeholder and theory informed organisation-level implementation science priorities and 2) Identify and prioritise a test case pilot implementation research project.MethodsWe undertook a qualitative study using semi-structured interviews. Participants held either a formal leadership role, were research active or a consumer advocate and affiliated with either a specialist cancer hospital or a cancer alliance of ten hospitals. Interview data were summarised and shared with participants prior to undertaking both thematic analysis, to identify priority areas for implementation research, and content analysis, to identify potential pilot implementation research projects. The selected pilot Implementation research project was prioritised using a synthesis of an organisational and implementation prioritisation framework – the organisational priority setting framework and APEASE framework.ResultsThirty-one people participated between August 2022 and February 2023. Four themes were identified: 1) Integration of services to address organisational priorities e.g., tackling fragmented services; 2) Application of digital health interventions e.g., identifying the potential benefits of digital health interventions; 3) Identification of potential for implementation research, including deimplementation i.e., discontinuing ineffective or low value care and; 4) Focusing on direct patient engagement e.g., wider consumer awareness of the challenges in delivering cancer care. Six potential pilot implementation research projects were identified and the EMBED project, to support clinicians to refer appropriate patients with cancer for genetic testing, was selected using the synthesised prioritisation framework.ConclusionsUsing a theory informed and structured approach the alignment between strategic organisational priorities and implementation research priorities can be identified. As a result, the implementation research focus can be placed on activities with the highest potential impact.

Multi-objectives optimization can contribute to conservation and restoration priority setting in dryland region

The ecological conservation and restoration of drylands is a global challenge, which is always under resources constraints and in competition with land developments. Here, we aim to identify ecological conservation and restoration priority areas based on the objectives of maximizing ecological values and minimizing opportunity costs with zonation as a heuristic spatial optimization tool. We take the Inner Mongolia (IM) of China as a typical dryland region. Results reveal that the efficiency of multi-objectives for ecological restoration is often better than a single objective. IM should focus on ecological conservation supplemented by restoration. Conserving 36.9% and restoring 13.1% of IM can provide an average of 72% of ecosystem functions while consuming 20% of opportunity costs. Our framework aligns with the need for nature-based solutions and rationalizes the allocation of resources for ecological conservation and restoration projects in complex dryland regions.

Pakistan's Progress on Universal Health Coverage: Lessons Learned in Priority Setting and Challenges Ahead in Reinforcing Primary Healthcare.

Pakistan developed an essential package of health services at the primary healthcare (PHC) level as a key component of health reforms aiming to achieve universal health coverage (UHC). This supplement describes the methods and processes adopted for evidence-informed prioritization of services, policy decisions adopted, and the lessons learned in package design as well as in the transition to effective rollout. The papers conclude that evidence-informed deliberative processes can be effectively applied to design affordable packages of services that represent good value for money and address a major part of the disease burden. Transition to implementation requires a comprehensive assessment of health system gaps, strong engagement of the planning and financing sectors, serious involvement of key national stakeholders and the private health sector, capacity building, and institutionalization of technical and managerial skills. Pakistan's experience highlights the need for updating the evidence and model packages of the Disease Control Priorities 3 (DCP3) initiative and reinforcing international collaboration to support technical guidance to countries in priority setting and UHC reforms.

Incidence, mortality and survival rates of lip, oral cavity and salivary glands cancers in Singapore: A half-century time trend analysis (1968-2017).

To examine trends in incidence and mortality and evaluate overall survival (OS) of oral cancer in Singapore between 1968 and 2017. All diagnosed oral cancers by anatomical sites and population size were extracted from the Singapore Cancer Registry and the Department of Statistics Singapore. The trend of age-standardized incidence rate (ASIR) and mortality rate (ASMR) (per 100 000 person-years) of the lip, oral cavity and salivary gland cancers were evaluated by Prais-Winsten regressions for each ethnicity and gender. Kaplan-Meier curves were performed to evaluate the OS by anatomical sites in each age group by ethnicity and sex. Overall, 49, 3494 and 1066 people were diagnosed, and 28, 2310 and 476 died from lip, oral cavity and salivary gland cancers, respectively. The oral cavity cancer ASIR and ASMR reduced from 3.07 (1968-1972) to 2.01(2008-2012) and from 2.06 (1978-1982) to 1.21 (2013-2017) per 100 000 person-years, respectively, with both highest in Indians throughout the whole period. Male:Female ratio ranged from 3.43 (1973-1977) to 1.75 (2013-2017) and from 3.41 (1978-1982) to 2.40 (2013-2017) for ASIR and ASMR, respectively. However, both salivary gland cancer ASIR and ASMR increased from 0.50 (1968-1972) to 0.80 (2008-2012) and from 0.18 (1968-1982) to 0.42 (1988-1992) per 100 000 person-years, respectively, with both higher in males since 1993. Oral cavity cancer ASIR decreased for males aged ≥60, and Indian females ≥25, but increased among Chinese females aged ≥60. Oral cavity cancer ASMR decreased among Chinese aged 25-59, and among Malay males and Indian females. Salivary gland cancer ASIR increased among Chinese males aged ≥60 and Malay males aged 25-59; while ASMR increased among Chinese males aged ≥60. The median OS for oral cavity, lip and salivary gland cancers were 3.0, 9.3 and 18.1 years, respectively, with females surviving longer than males. Singapore has experienced a decline in the incidence and mortality of lip, oral cancer, an increase in in the incidence and mortality of salivary gland cancer, with an increase in the median overall survival rate. Monitoring the magnitude of oral cancer burden and the demographic, and temporal variations is necessary for tailoring health planning and setting priorities for future clinical care and research.

Graduate medical education well-being directors in the United States: who are they, and what does the role entail?

BackgroundInstitutional Graduate Medical Education (GME) Well-being Director (WBD) roles have recently emerged in the United States to support resident and fellow well-being. However, with a standard position description lacking, the current scope and responsibilities of such roles is unknown. This study describes the scope of work, salary support, and opportunities for role definition for those holding institutional leadership positions for GME well-being.MethodsIn November 2021, 43 members of a national network of GME WBDs in the United States were invited to complete a cross-sectional survey that included questions about job responsibilities, percent effort, and dedicated budget, and a free text response question about unique leadership challenges for GME WBDs. The survey was analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data.Results26 members (60%) responded. Most were physicians, and the majority identified as female and White. Median percent effort salary support was 40%. A small minority reported overseeing an allocated budget. Most respondents worked to improve access to mental health services, oversaw institution-wide well-being programs, designed or delivered well-being content, provided consultations to individual programs, met with trainees, and partnered with diversity, equity, and inclusion (DEI) efforts. GME WBDs described unique challenges that had implications for perceived effectiveness related to resources, culture, institutional structure, and regulatory requirements in GME.DiscussionThere was high concordance for several key responsibilities, which may represent a set of core priorities for this role. Other reported responsibilities may reflect institution-specific needs or opportunities for role definition. A wide scope of responsibilities, coupled with limited defined budgetary support described by many GME Well-being Directors, could limit effective role execution. Future efforts to better define the role, optimize organizational reporting structures and provide funding commensurate with the scope of work may allow the GME Well-being Director to more effectively develop and execute strategic interventions.

A material world: how can materiality assessments be used to define organizational sustainability priorities, while taking into account the United Nations’ SDGs?

Purpose This paper aims to contribute to existing academic work and business practice by presenting original empirical findings and by providing insights into priority setting on Sustainable Development Goals (SDGs) in organizations. From an academic viewpoint, it not only adds to previous work on the topic of SDG materiality (e.g. Van Tulder and Lucht, 2019) but also aims to contribute new insights into the steps that are crucial and influence the adoption of the SDGs in materiality assessments. It may also add to the literature by providing new knowledge on the strategic considerations that organizations may make and institutional dynamics that encourage organizations to implement the SDG materiality method. Design/methodology/approach By executing a national survey research in Belgium through a collaboration between academics of Antwerp Management School, Louvain School of Management (UCLouvain) and the University of Antwerp, and supported by Belgium’s Federal Institute of Sustainable Development, the authors have obtained several insights into the SDG landscape in Belgium for various types of organizations, including companies, governmental and nongovernmental organizations and educational institutions. This research builds further on a first national survey (SDG Barometer Belgium, 2018) on the adoption and implementation of the SDGs. However, an important aim of this research is to shift the emphasis to more prominent new elements, such as whether or not organizations use the SDGs in materiality assessments. While the main part of the data for this research were collected through an online questionnaire, document analyses were conducted based on the sustainability reports of BEL 20 companies, the benchmark stock market index of Euronext Brussels consisting of 20 companies traded at the Brussels Stock Exchange, and seven interviews were held to obtain additional insights. Findings A total of 386 organizations across sectors responded to the question “Does your organization perform a materiality analysis”, of which 210 organizations completed the question “Does your organization align the materiality analysis with the SDGs,”after an “exit route” based on a positive answer to the first question. When diving into the survey results, the authors see that no more than 12% of the 210 organizations performing a materiality analysis align their materiality analysis with the SDGs, while 14% indicate that they do not account for the SDGs at all in their materiality analyses. The results show that 41% of the organizations take into account the SDGs to a certain degree when performing their materiality analysis. Speculating on an explanation for these results, it may be the case that organizations do not yet think about coupling the SDGs to their materiality assessment, experience difficulties in practice or generally lack the knowledge for relating the SDGs to the sustainability topics that are relevant to them. This seems in line with other research (e.g. Van Tulder and Lucht, 2019), as the results of this study indicate that it seems to be difficult for organizations to relate the SDGs to the existing sustainability priorities or materiality analyses of companies. Originality/value The real contribution of this paper essentially lies in the description of the Janssen Pharmaceuticals case. The company recognized that today’s internally focused approach to goal setting is not enough to address global challenges. Hence, looking at what is needed externally from a global perspective, taking into account sustainability thresholds and setting ambitions accordingly, is needed to bridge the gap between current performance and required performance. From the Janssen Pharmaceuticals case, the authors learned that external stakeholders are an extremely useful source of information to address the required performance by using the SDG framework. For sure, SDG materiality analyses are still in an early phase of development and knowledge on how to conduct such an analysis may be lacking. Future efforts – or the lack thereof – may indicate whether or not companies consider such analyses as sufficiently relevant. Although the uptake of the SDGs is in progress, it remains to be seen which, if any, materiality method will eventually turn out as a new dominant way of defining material issues. The findings presented in this study hopefully serve as a basis for further investigation of the topic.

Community-based palliative care in two primary care settings - nursing homes and home care: a national survey.

Based on selected themes from a national survey, the study aims to describe and analyse similarities and differences in community-based palliative care provided to people living at home in two different care settings - the nursing home setting and the home care setting. Responses from four palliative care themes covered by a national survey sent to 717 managers in municipality-based care units were used. The themes were: (a) target groups in palliative care; (b) wishes for end-of-life care; (c) tools/guidelines in palliative care; and (d) palliative care provided to relatives. The response rates were 53% in the nursing home setting and 69% in the home care setting (69%). Both settings had target groups for palliative care, in which significantly more units in the home care settings cared for people with other cultural backgrounds or children. Wishes for end-of-life care were addressed by more than 90% of the units in both settings. There were significantly more nursing home units that addressed questions regarding resuscitation, decision making when you are incapable of making decisions for yourself, and the level of medication. In both settings, around half of the units did not use or did not know if they used tools/guidelines to identify palliative care needs. Half of home care and 65% of nursing home settings did not/were unaware of providing palliative care to relatives. Both settings serve target populations for palliative care with few differences. Identifying palliative care needs seemed to be a low priority in both settings. A difference was found between the settings regarding end-of-life care questions and palliative care promotion to relatives.

Identifying the top 10 research priorities for the school food system in the UK: a priority setting exercise

IntroductionThe school food system varies widely between schools and across the UK. There is a need to understand evidence gaps in school food research to allow the development, implementation and...

Future research priorities for soft-tissue knee injuries.

To identify unanswered questions about the prevention, diagnosis, treatment, and rehabilitation and delivery of care of first-time soft-tissue knee injuries (ligament injuries, patella dislocations, meniscal injuries, and articular cartilage) in children (aged 12 years and older) and adults. The James Lind Alliance (JLA) methodology for Priority Setting Partnerships was followed. An initial survey invited patients and healthcare professionals from the UK to submit any uncertainties regarding soft-tissue knee injury prevention, diagnosis, treatment, and rehabilitation and delivery of care. Over 1,000 questions were received. From these, 74 questions (identifying common concerns) were formulated and checked against the best available evidence. An interim survey was then conducted and 27 questions were taken forward to the final workshop, held in January 2023, where they were discussed, ranked, and scored in multiple rounds of prioritization. This was conducted by healthcare professionals, patients, and carers. The top ten included questions regarding prevention, diagnosis, treatment, and rehabilitation. The number one question was, 'How urgently do soft-tissue knee injuries need to be treated for the best outcome?'. This reflects the concerns of patients, carers, and the wider multidisciplinary team. This validated process has generated ten important priorities for future soft-tissue knee injury research. These have been submitted to the National Institute for Health and Care Research. All 27 questions in the final workshop have been published on the JLA website.

Exploring equity in global health collaborations: a qualitative study of donor and recipient power dynamics in Liberia

IntroductionGlobal health collaborations between individuals from high-resource and low-resource settings are complex and often built on hierarchical structures and power differentials that are difficult to change. There have been many...

Coastal vulnerability level and beach handling priorities in Serang District Banten Province

Coastal erosion and accretion have altered the shorelines of various Indonesian coastal areas, endangering the lives and livelihoods of coastal populations. Damage to beaches in coastal areas affects the community’s daily activities, the transportation system, industry, and trade, as well as the environment and public health. Based on this occurrence, the initial stage of disaster management study resulting from coastal damage is to identify the coast’s vulnerability to threatening harm. To assess coastal vulnerability, field observations and measurement from the research location were carried out to obtain visual damage observation, land use, lithology, tidal range, and beach slope. Coastline data from satellite imagery and wind data from the government agencies were carried out to obtain the rate of shoreline change, width of damage, length of damage, and wave height. The purpose of this research is to look at changes in the coastline of Serang, Banten Province, and analyse the amount of beach damage to set priorities for coastal management. The beaches explored were Karangantu Beach, Domas Beach, Lontar Beach, and Tengkurak Beach. Karangantu Beach’s level of vulnerability is classified as very high, so dealing with it is a top priority. Domas and Lontar Beaches are extremely vulnerable, so dealing with them is a key priority. Tengkurak Beach has a moderate level of vulnerability, hence the priority for managing is rather high. This can be utilized as a model for overcoming coastal damage in Serang District, Banten Province, by constructing coastal protection buildings based on the shore’s vulnerability and management priority.

크로아티아 ‘언어 순수주의’에 나타나는 인종적 우스타샤 언어 이데올로기

Croatian is the common language of the Republic of Croatia, the national language representing the Croatian people, and the core national symbol. After independence in 1991, Croatia sets priorities to complete the identity of pure Croatian people, which is different from Serbian, and to recreate the Croatian language for this purpose. The core of Croatian language policy is generally described as ‘Croatian purism’. Croatian purism, led by only fighting spirit, is, in principle, to remove all elements that undermine Croatian purity. The ideology that extremely emphasized the purity of the Croatian people in Croatian history comes from Ustasia. The Croatian Independent State (Nezavista Država Hrvatska: NDH), which was a practical aspect of Ustasia, implements ‘language purism’ according to the principle of ‘blood and language’. The situation and development method of the two-lingual purism are very different, but in ‘Croatian purism’ unique to fighting spirit, some aspects of NDH's ‘blood and language’ ideology appear. This study studies NDH's linguistic purism based on Ustasia’s racial ideology and ‘Croatian purism’ based on the romantic nationalism of ‘one language = one territory’ from an ethnolingustic perspective.

Setting S&T perspective priorities in an era of complexity and uncertainty: a case for megacities

PurposeThe purpose of this study is to create a methodological approach for identifying priority areas for science and technology (S&T) development and its empirical application within the city of Moscow. This research uncovers a wide range of multicultural and multidisciplinary global trends that will affect the development of major cities in an era of complexity and uncertainty, including the inherent complexity of urban contexts, demographic and socioeconomic trends, as well as scientific and ecological factors.Design/methodology/approachThe methodological approach is based on classic foresight instruments. Its novelty lays in the blending of qualitative and quantitative methods specially selected as the most appropriate for the identification of S&T areas in an era of complexity and uncertainty, including horizon scanning, bibliometric analysis, expert surveys and the construction of composite indexes with respect to the scope and resources of the research and the selected object for empirical application – Moscow, which is one of the world’s largest megacities. The analysis was performed for the period of 2009–2018 and expert procedures took place in 2019.FindingsAs a result, 25 global trends were identified, evaluated and discussed over the course of an expert survey and subsequent expert events. Ten priority areas of S&T development were determined, including 62 technological sub-areas within them and the most important market niches for all identified technological sub-areas, which could be useful for the world’s megacities. The results of this study are illustrated using the construction sector. Based on the conducted research and results, a list of recommendations on S&T policy measures and instruments were suggested, including the creation of the Moscow Innovation Cluster, which by the end of 2023 contained more than 6,000 projects and initiatives, selected using the findings of this investigation.Originality/valueThis research contributes to the existing literature and research agenda of setting priorities for S&T development and shows how it can be done for a megacity. The blended foresight methodology that was created within the study satisfies the criteria of scientific originality, is repeatable for any interested researcher, is applicable to any other city in the world and demonstrates its high efficiency in empirical application. It could be used for creating new agenda items in S&T policy, setting S&T priorities for a megacity and integrating the results into decision-making processes. This study provides recommendations on the further implementation of the designed methodology and results into a policymaking system. Moreover, the example of the Moscow Innovation Cluster, which was created based on the results of our research, demonstrates these recommendations’ practical significance in real life, which is quite valuable. The limitation of this study is that it is not devoted to urban planning issues directly or the promotion of R&D areas; it is about setting promising S&T priorities in an era of complexity and uncertainty for megacities.