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How to Order Authors in Scientific Papers

It’s rare that an article is authored by only one or two people anymore. In fact, the average original research paper has five authors these days. The growing list of collaborative research projects raises important questions regarding the author order for research manuscripts and the impact an author list has on readers’ perceptions.

With a handful of authors, a group might be inclined to create an author name list based on the amount of work contributed. What happens, though, when you have a long list of authors? It would be impractical to rank the authors by their relative contributions. Additionally, what if the authors contribute relatively equal amounts of work? Similarly, if a study was interdisciplinary (and many are these days), how can one individual’s contribution be deemed more significant than another’s?

Why does author order matter?

Although an author list should only reflect those who have made substantial contributions to a research project and its draft manuscript (see, for example, the authorship guidelines of the International Committee of Medical Journal Editors ), we’d be remiss to say that author order doesn’t matter. In theory, everyone on the list should be credited equally since it takes a team to successfully complete a project; however, due to industry customs and other practical limitations, some authors will always be more visible than others.

The following are some notable implications regarding author order.

• The “first author” is a coveted position because of its increased visibility. This author is the first name readers will see, and because of various citation rules, publications are usually referred to by the name of the first author only. In-text or bibliographic referencing rules, for example, often reduce all other named authors to “et al.” Since employers use first-authorship to evaluate academic personnel for employment, promotion, and tenure, and since graduate students often need a number of first-author publications to earn their degree, being the lead author on a manuscript is crucial for many researchers, especially early in their career.
• The last author position is traditionally reserved for the supervisor or principal investigator. As such, this person receives much of the credit when the research goes well and the flak when things go wrong. The last author may also be the corresponding author, the person who is the primary contact for journal editors (the first author could, however, fill this role as well, especially if they contributed most to the work).
• Given that there is no uniform rule about author order, readers may find it difficult to assess the nature of an author’s contribution to a research project. To address this issue, some journals, particularly medical ones, nowadays insist on detailed author contribution notes (make sure you check the target journal guidelines before submission to find out how the journal you are planning to submit to handles this). Nevertheless, even this does little to counter how strongly citation rules have enhanced the attention first-named authors receive.

Common Methods for Listing Authors

The following are some common methods for establishing author order lists.

• Relative contribution. As mentioned above, the most common way authors are listed is by relative contribution. The author who made the most substantial contribution to the work described in an article and did most of the underlying research should be listed as the first author. The others are ranked in descending order of contribution. However, in many disciplines, such as the life sciences, the last author in a group is the principal investigator or “senior author”—the person who often provides ideas based on their earlier research and supervised the current work.
• Alphabetical list . Certain fields, particularly those involving large group projects, employ other methods . For example, high-energy particle physics teams list authors alphabetically.
• Multiple “first” authors . Additional “first” authors (so-called “co-first authors”) can be noted by an asterisk or other symbols accompanied by an explanatory note. This practice is common in interdisciplinary studies; however, as we explained above, the first name listed on a paper will still enjoy more visibility than any other “first” author.
• Multiple “last” authors . Similar to recognizing several first authors, multiple last authors can be recognized via typographical symbols and footnotes. This practice arose as some journals wanted to increase accountability by requiring senior lab members to review all data and interpretations produced in their labs instead of being awarded automatic last-authorship on every publication by someone in their group.
• Negotiated order . If you were thinking you could avoid politics by drowning yourself in research, you’re sorely mistaken. While there are relatively clear guidelines and practices for designating first and last authors, there’s no overriding convention for the middle authors. The list can be decided by negotiation, so sharpen those persuasive argument skills!

As you can see, choosing the right author order can be quite complicated. Therefore, we urge researchers to consider these factors early in the research process and to confirm this order during the English proofreading process, whether you self-edit or received manuscript editing or paper editing services , all of which should be done before submission to a journal. Don’t wait until the manuscript is drafted before you decide on the author order in your paper. All the parties involved will need to agree on the author list before submission, and no one will want to delay submission because of a disagreement about who should be included on the author list, and in what order (along with other journal manuscript authorship issues).

On top of that, journals sometimes have clear rules about changing authors or even authorship order during the review process, might not encourage it, and might require detailed statements explaining the specific contribution of every new/old author, official statements of agreement of all authors, and/or a corrigendum to be submitted, all of which can further delay the publication process. We recommend periodically revisiting the named author issue during the drafting stage to make sure that everyone is on the same page and that the list is updated to appropriately reflect changes in team composition or contributions to a research project.

First Author vs. Corresponding Author? How to Decide Which to Choose

This article discusses the importance of authorship in academic publishing. The first author executes a large portion of the work throughout the research process and signifies the researcher has provided the greatest intellectual contribution. The corresponding author is explicitly identified on the first page of the manuscript, is selected to further manage the pre and post-publication responsibilities, and serves as the point of contact for communication with a journal during the submission, peer review, and publication process.

Updated on April 26, 2023

Every process is conducted through a series of steps. The Scientific Method, for example, provides guidelines for navigating the research process and generally includes:

• Making observations
• Identifying a problem
• Formulating a hypothesis
• Designing an experiment
• Analyzing the data
• Reporting a conclusion

While the actual procedures may vary between fields, the underlying process remains intact. The same holds true for the publication process:

• Complete your research
• Choose a journal
• Prepare the manuscript
• Submit the manuscript
• Make any revisions
• Publication

Each of these processes contains many more specific steps and processes, including assigning authorship to the research manuscript . This article outlines the importance of authorship, delineates the meanings of first author and corresponding author, and addresses some of the challenges associated with the process.

Why is authorship important?

On the surface, the positioning of a researcher’s name and title on a manuscript seems straightforward, a simple task. Most lay people use the list of names solely for searching and citation purposes.

In reality, though, the order of those names tells a complex story of authorship. It is, in fact, the primary way for a researcher to convey the extent of their contribution to the reader.

To attain authorship on a manuscript, a researcher must not only contribute substantially to the work but also take responsibility and accountability for the information it contains. The International Committee of Medical Journal Editors (ICMJE) recommends authorship be based on 4 specific criteria related to these broad principles.

With authorship comes both recognition and obligation that have important academic, social, and financial implications. The two most prominent authorship positions are first author and corresponding author .

What is the first author?

The first author position is a coveted spot. No matter how many other authors’ names appear on the manuscript or which referencing style is used, the first author’s last name will be mentioned in every future citation of the work.

For this reason alone, the name of the first author is remembered, indexed, and promoted more than any other. It is not just a status symbol, though. The first author executes a large portion or majority of the work throughout the research process.

First author credit signifies the researcher has provided the greatest intellectual contribution, and, therefore, comes with substantial benefits. The manuscripts of first authors hold substantial value for grant and position applications, staff appraisals and reviews, and many other forms of career development.

First author duties

The designation as first author is not based on academic or professional hierarchy, the prestige, or expertise of the author. It’s based on the inputs and outputs of work. First authors must:

• Make significant, original, and insightful intellectual contributions
• Participate in the conception and planning of the study
• Generate data through performing experiments, conducting literature reviews, and organizing surveys and interviews
• Analyze the results through statistical analysis and by generating graphs, tables, and illustrations
• Write and edit the manuscript
• Help with queries and revisions after submission

The researcher fulfilling all these duties is rightfully the first author.

What is the corresponding author?

Like the first author designation, the title of corresponding author also comes with considerable prestige. The corresponding author is explicitly identified on the first page of the manuscript. In addition to meeting all the preexisting authorship requirements, this person is selected to further manage the pre and post-publication responsibilities.

The corresponding author is customarily a senior researcher or academic with extensive publishing knowledge and experience. As the primary source of communication for both the publisher and the readers, the corresponding author’s contact information is included within the article.

The corresponding author must have exceptional communication skills. The role assumes primary responsibility for connecting with target journals. They must be organized and meticulous with the substantial volume of tasks associated with the position.

Corresponding author duties

Neither electing a corresponding author nor accepting the position should be taken lightly as it is an essential and long lasting obligation. The duties span from prior to publication to well afterwards and include:

While all corresponding authors serve as the point of contact for communication with a journal during the submission, peer review, and publication process, some journals outline additional conditions for the role. The National Academy of Sciences offers a table that compiles the corresponding author requirements for various journals.

What if there are authorship disputes or changes?

While openly discussing and defining a research team’s roles during the initial planning phase is vital for curbing authorship disputes, combining this practice with other forward-thinking acts is key. Responsibilities and work status must be addressed during regularly scheduled meetings and special meetings need to be called when a team member is added or ends involvement in the project.

How to avoid authorship disputes

To avoid disputes, teams start by mapping out the most obvious roles, author and non-author contributor, and by rejecting any proposed “non-role.” The input of non-author contributors is narrow in scope, providing technical, administrative or writing assistance, and does not fulfill the previously outlined authorship criteria.

A non-role is any inappropriate or irrelevant participant who will harm the research process, such as unethical types of authors . This category encompasses guest authors, forged authors, ghost authors, and orphan authors and must be avoided at all costs.

Many journals require a document be included with the submission package to delineate author contributions to explain and justify author order. By creating this list as a living document from the outset, a research team fulfills the prerequisite for the publisher and guarantees transparency and fairness throughout.

Because changing authorship after publication is messy, necessitating specific documentation, signatures, and approval, it is frowned upon by journal editors. While taking proactive steps to avoid disputes that may result in this situation saves the research team time and hassle, it does not always alleviate future changes.

The addition, removal, or reordering of authors on a manuscript while actively going through the publication process requires a letter signed by all original and additional authors stating the reason for the change and their mutual agreement. For changes made after publication, an authorship corrigendum must be submitted by all authors per COPE guidelines .

Final thoughts

Getting to the manuscript writing and publication stages of a research project are exciting milestones for everyone involved. Ideally, authorship roles are clearly defined and assigned at this point.

Though the first author and corresponding author positions are sometimes performed by the same person, the obligations of each are unique. The first author undertakes the bulk of work duties and makes a significant intellectual contribution to the research project. The corresponding author carries out the communication and administrative tasks necessary for publishing the manuscript.

Both roles are vital to the research and publication processes. They require intense labor and responsibility. With this comes great recognition and prestige for first authors and corresponding authors.

Charla Viera, MS

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How to Decide the First Author and Corresponding Author in a Manuscript

When a scholarly/academic paper is produced, the researchers participating in the work must assign a first author and corresponding author. This is a challenging decision and sometimes there’s conflict because the positions can also indicate status (whether real or perceived).

The first author and corresponding author, ideally, are decided during the research and through a mutual agreement among the authors. It’s made based on an understanding of the role and significance of the positions. The author order generally indicates the amount of contribution.

The first author is considered to have contributed more than the second author, and so forth, until reaching the author in the last position. A shared first author (co-first author) or shared corresponding author (co-corresponding author), however, isn’t out of the question.

The last position may also be prestigious – considered the senior author or principal investigator. One of the authors in the list will also be the corresponding author. This means they coordinate the publication process (such as arranging editing and communicating with the journal and with other inquiries) and have their contact information shown upfront in the work.

• What you’ll learn in this post
• The differences between first author and corresponding author (and what’s a senior author?).
• How first author and corresponding author are defined.
• How to fairly determine which author(s) will fulfill which role(s).
• When and why the same person might fulfill both roles.

Determining the author order

What defines the first author, some of the main duties of a first author are:, what defines a corresponding author, some of the corresponding author’s main duties are:, and who is the senior author, a few words on guarantors, can the first and the corresponding authors be the same person, how do you decide who does what role what are the potential ethical issues.

The order of authors should reasonably correspond to how the authors contributed to the work. It also implies specific credit and responsibilities that go with being in these positions. Working it out over a cup of tea or coffee as soon as possible can help to avoid disputes, and even mediation , later on.

The issue of determining a senior author is also a bit challenging. You need to understand these roles and responsibilities. Don’t just think about who gets the most credit.

Publishing in a scientific journal or any peer-reviewed publication, including preprints and poster presentations , makes research visible to the greater public. It brings discoveries and insights into the eyes of the main experts around the world. This, in turn, builds the author’s reputation as a researcher.

Having a good list of published papers can also help achieve some career goals, such as getting a degree, a promotion or, as a scientist, getting funding to continue with research. The number of first-author papers may also be looked upon as a positive metric.

An “author” (having authorship) of a paper must meet certain criteria for their contributions. The International Committee of Medical Journal Editors (ICJME) guidelines state authorship must at least include:

• made substantial contributions to work
• approved the final version
• assumed responsibility and accountability for what is published

However, while the minimum requirements for authorship are generally agreed upon, the credit/responsibility given to a specific author list isn’t so clear. The position on the list can determine the author’s expected duties and show the readers how the author contributed to the work.

So let’s take a deeper look at the definitions of these positions. Hopefully, this will help in your decision-making process. It may in fact affect your future career and status.

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The first author is usually the person who makes the greatest practical/intellectual contributions to the work.

This person might have co-authors’ assistance with specific tasks, but they are the main responsible one for acquiring and analyzing the data, and for writing the final manuscript.

The first position in the authorship list of a paper is the most attractive one. First authors will have their (last) name mentioned in every future citation of the work, no matter how many other authors there are.

There can also be co-first authors. This is common in projects that require different areas of expertise. It’s also used where it’s hard to figure out who made a larger contribution. Two or even three authors can be listed as equal contributors.

The co-first authors are denoted by an asterisk or other symbol (for example, “ Author A*, Author B*, Author C, Author D.. ”) and a note on the first page.

But even then, the person listed first will continue to be the most visible. This is because of how citations are created. To give equal credit to both first authors, an alternative is to cite the paper as “ Author A & Author B et al .”., instead of “ Author A et al. ”

• Make intellectual contributions to the work. Participate in the conception and planning of the study; define aims and trace a methodological approach to achieve them.
• Generate the data. For instance, perform experiments, conduct literature reviews, write programming code, etc.
• Analyze the results. Generate graphs , tables , and illustrations to convey the data, and perform statistical analyses when needed.
• Write and edit the manuscript.
• Help the corresponding author with referees’ queries when the paper is under revision.

The corresponding author is responsible for bringing together the manuscript, and for the whole process of submitting it to a journal, up to (hopefully!) final acceptance. Of course, the corresponding author also must meet the academic authorship requirements.

The ICJME defines a corresponding author as someone who takes primary responsibility for communication with the journal during the manuscript submission, peer review, and publication process.

In that sense, the corresponding author is also responsible for ensuring that all the journal’s administrative requirements are fulfilled. This can include providing documents related to ethics committee approval, data and signatures from all authors, and conflict of interest (COI) statements.

In line with this, the Committee on Publication Ethics (COPE) says the corresponding author should be someone willing to fulfill all obligations the journal stipulates ( COPE Discussion Document , 2014).

The corresponding author’s contact details are included in the article. This makes them the representative for inquiries about the work. A good corresponding author must therefore be readily available. All communications with journals or readers should be done in a timely way.

English ability is also a big help if you’re the corresponding author and you want to publish in English. You’re usually the person whom I , as the editor, will be communicating with when you choose an editing service.

• Certify the manuscript contains all the necessary parts, it is appropriately organized, and it complies with the journal’s requirements. Upload the manuscript and other files.
• Make sure all authors have reviewed and approved the final version of the manuscript before submission. Get signed consent.
• Be in charge of all communications related to the paper. Distribute notifications to all authors (e.g., emails, peer review feedback , decision letters).
• Meet all deadlines,­ communicate with the authors and editors efficiently, and follow time schedules for publication.
• Ensure all editorial and submission policies are followed.

Note: Although there’s common sense on the main roles of a corresponding author, some of the responsibilities involved can change from one journal to another (e.g., see this list , created by the National Academy of Sciences, with different journals and their respective requirements).

The senior author is the person who provides the intellectual input and helps to design the study and the protocols to be followed. This is especially because they’re experts in that field of research.

They are also sometimes the financial driving force behind the study and generally supervise several projects. For these reasons, they are also known as the “ principal investigator .” They usually have broad experience in publishing processes, and their names appear in the last positions of the author list.

Honestly, the senior author is often the lab leader or simply the person in charge. For the work they’ve put into this to date, they earned this honor.

Some journals now ask for one author on a paper to be listed as a guarantor. The guarantor:

• accepts official responsibility for the overall integrity of the manuscript (including ethics, data handling, reporting of results, and study conduct)
• does not act as the primary correspondent for the manuscript
• ensures all statements in the manuscript are true to his knowledge

The guarantor can be the same as the corresponding author, or can be another of the authors.

It’s often recommended that the Principal Investigator or Senior Researcher on a manuscript act as the guarantor as they will be responsible for the study supervision already; however, this is not explicitly required.

Yes, first authors can also be corresponding authors in a manuscript. In fact, it’s quite common.

The main conflict here is when authors equate being a corresponding author with seniority. Senior authors are often viewed as the perfect corresponding authors because of all the qualities they have, as mentioned.

However, as discussed, a corresponding author is charged with communicating with editors and readers only. Journal editors usually see this as an administrative role. Therefore, the corresponding author doesn’t necessarily have to be the seniormost author.

While there’s a special responsibility involved in this role, it’s not supposed to be a mark of distinction. Also, most senior authors will probably have less available time to reply to queries during the submission review process. And they may not have time to respond to reader queries in the future.

So, first authors should be expected to serve as corresponding authors. This is the case as long as they’re consistently involved in the study and know-how to go through the submission/publication process.

This includes deciding on the need for scientific editing if the English needs improving. The role can also help them gain experience in corresponding with journals and general readers.

Even when the first and corresponding authors aren’t the same person some of their duties can be shared.

While a corresponding author can help the first author, or main author, with data analysis, for example, the first author can help the corresponding author prepare the documents for submission.

The same applies to other authors. Deciding who does what role should be clearly discussed and defined beforehand. Ideally, researchers involved in the study should have regular meetings to clarify responsibilities and update the status of the work. New co-authors may be included and other members may end their involvement along the way. Doing this planning may help prevent conflicts regarding academic authorship and help manage any disputes (Albert & Wager, 2009).

There are many possible reasons for conflict (you can find many examples of real cases on COPE’s website ). Disputes around first authorship are more common because this is the most prestigious position and an important measure of productivity. This happens, for example, when two authors both claim they contributed the most. This issue can be solved by proposing co-first authorship, or by using a system to quantify their contributions and then decide who should go first.

There can also be disagreements when the senior author wants to be the first author, or main author. For example, they may need more or higher-impact publications as the first author. Or they wrote the manuscript and believe this entitles them to be the first author.

Disputes on who will be the corresponding author are less likely. That’s because the role, as mentioned, doesn’t have any special distinction other than a visible name and contact. However, some senior authors may still want this role and occasionally there’s some conflict.

Ideally, the corresponding author should be decided among the others. It’s also possible to share the position, have shared corresponding authors; e.g. both the first and senior authors are co-corresponding authors. This may actually work out well if one is available and the other isn’t.

Every participant should feel free to seek clarity throughout the collaboration. Consider having a written document ( see this example PDF file on APA) in place as guidance ( COPE Discussion Document , 2014; Guidelines on Authorship and Acknowledgement , n.d.).

Before publication, authors should reunite to check the previous responsibilities list and create a final version of the documents. This includes detailed information on the type and extent of the contribution of each person involved. For categories of contributions, see the Contributor Roles Taxonomy [CRediT] website (McNutt et al., 2018). To quantify contributions, different proposed systems can be found in the literature (APA, for example, proposed a scorecard – see their Helpful Tools files).

As several journals now request and publish information about each author’s contributions, such documents can be essential. This can help in creating standards that will improve transparency in the system of scientific publishing. That, in turn, greatly reduces ethical concerns and authorship disputes.

Our Publication Support team is ready to hear from you if you want to accelerate your path to publication. And explore valuable research services that can help increase your impact and avoid ethical mishaps.

This is a guest post from Adam Goulston, PsyD, MBA, MS, MISD, ELS. Adam runs the Asia-based science marketing and PR company Scize . He has worked as an in-house Senior Language Editor, as well as a manuscript editor, with Edanz.

Albert, T., & Wager, E. (2009). How to handle authorship disputes: A guide for new researchers. Committee on Publication Ethics. https://doi.org/10.24318/cope.2018.1.1

COPE Discussion Document: Authorship. (2014). Committee on Publication Ethics. https://doi.org/10.24318/cope.2019.3.3

Guidelines on Authorship and Acknowledgement. (n.d.). Retrieved from https://research.fas.harvard.edu/links/guidelines-authorship-and-acknowledgement

McNutt, M. K., Bradford, M., Drazen, J. M., Hanson, B., Howard, B., Jamieson, K. H., Kiermer, V., Marcus, E., Pope, B. K., Schekman, R., Swaminathan, S., Stang, P. J., & Verma, I. M. (2018). Transparency in authors’ contributions and responsibilities to promote integrity in scientific publication. Proceedings of the National Academy of Sciences, 115(11), 2557-2560. https://doi.org/10.1073/pnas.1715374115

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What is a Corresponding Author?

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Are you familiar with the terms “corresponding author” and “first author,” but you don’t know what they really mean? This is a common doubt, especially at the beginning of a researcher’s career, but easy to explain: fundamentally, a corresponding author takes the lead in the manuscript submission for publication process, whereas the first author is actually the one who did the research and wrote the manuscript.

The order of the authors can be arranged in whatever order suits the research group best, but submissions must be made by the corresponding author. It can also be the case that you don’t belong in a research group, and you want to publish your own paper independently, so you will probably be the corresponding author and first author at the same time.

Corresponding author meaning:

The corresponding author is the one individual who takes primary responsibility for communication with the journal during the manuscript submission, peer review, and publication process. Normally, he or she also ensures that all the journal’s administrative requirements, such as providing details of authorship, ethics committee approval, clinical trial registration documentation, and gathering conflict of interest forms and statements, are properly completed, although these duties may be delegated to one or more co-authors.

Generally, corresponding authors are senior researchers or group leaders with some – or a lot of experience – in the submission and publishing process of scientific research. They are someone who has not only contributed to the paper significantly but also has the ability to ensure that it goes through the publication process smoothly and successfully.

What is a corresponding author supposed to do?

A corresponding author is responsible for several critical aspects at each stage of a study’s dissemination – before and after publication.

If you are a corresponding author for the first time, take a look at these 6 simple tips that will help you succeed in this important task:

• Ensure that major deadlines are met
• Prepare a submission-ready manuscript
• Put together a submission package
• Get all author details correct
• Ensure ethical practices are followed
• Take the lead on open access

In short, the corresponding author is the one responsible for bringing research (and researchers) to the eyes of the public. To be successful, and because the researchers’ reputation is also at stake, corresponding authors always need to remember that a fine quality text is the first step to impress a team of peers or even a more refined audience. Elsevier’s team of language and translation professionals is always ready to perform text editing services that will provide the best possible material to go forward with a submission or/and a publication process confidently.

Who is the first author of a scientific paper?

The first author is usually the person who made the most significant intellectual contribution to the work. That includes designing the study, acquiring and analyzing data from experiments and writing the actual manuscript. As a first author, you will have to impress a vast group of players in the submission and publication processes. But, first of all, if you are in a research group, you will have to catch the corresponding author’s eye. The best way to give your work the attention it deserves, and the confidence you expect from your corresponding author, is to deliver a flawless manuscript, both in terms of scientific accuracy and grammar.

If you are not sure about the written quality of your manuscript, and you feel your career might depend on it, take full advantage of Elsevier’s professional text editing services. They can make a real difference in your work’s acceptance at each stage, before it comes out to the public.

Language Editing Services by Elsevier Author Services:

Through our Language Editing Services , we correct proofreading errors, and check for grammar and syntax to make sure your paper sounds natural and professional. We also make sure that editors and reviewers can understand the science behind your manuscript.

With more than a hundred years of experience in publishing, Elsevier is trusted by millions of authors around the world.

Check our video Elsevier Author Services – Language Editing to learn more about Author Services.

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Affiliations.

• 1 Research and Instruction/Circulation Librarian, Hirsh Health Sciences Library, Tufts University, Boston, MA 02111, [email protected].
• 2 Research and Education Librarian, Biomedical Libraries, Dartmouth College, Hanover, NH 03755, [email protected].
• PMID: 31607826
• PMCID: PMC6774542
• DOI: 10.5195/jmla.2019.700

In most scientific communities, the order of author names on a publication serves to assign credit and responsibility. Unless authors are presented in alphabetical order, it is assumed that the first author contributes the most and the last author is the driving force, both intellectually and financially, behind the research. Many, but not all, journals individually delineate what it means to be a contributing author and the nature of each author's role. But what does this mean when a paper has co-first authors? How are academic librarians going to handle questions surrounding co-first authorship in an era in which author metrics are important for career advancement and tenure? In this commentary, the authors look at the growing trend of co-first authorship and what this means for database searchers.

Copyright: © 2019, Authors.

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Title: every author as first author.

Abstract: We propose a new standard for writing author names on papers and in bibliographies, which places every author as a first author -- superimposed. This approach enables authors to write papers as true equals, without any advantage given to whoever's name happens to come first alphabetically (for example). We develop the technology for implementing this standard in LaTeX, BibTeX, and HTML; show several examples; and discuss further advantages.

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eLife Magazine: 1000 Insights and counting

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Author: Julia Deathridge, Associate Features Editor, eLife

Earlier this year the magazine section of eLife reached an important landmark – the publication of the 1000th Insight article in the journal. Here we celebrate this milestone by highlighting some of the notable Insight articles we have published, and reveal what happens behind the scenes during the commissioning process. But, first…

What is an Insight article?

Insight articles are linked to research papers published in eLife and are almost always written by one of the researchers who peer reviewed the manuscript. They explain why the results reported are significant in a given field of research, and often outline some of the challenges that remain.

Since publishing our first Insight 12 years ago, we have covered research articles on subjects as diverse as how kombucha gets its distinctive taste , identifying the sex of a dinosaur , and how AI is improving protein research . The range of topics covered in Insights reflects the broad scope of eLife and the ground-breaking discoveries published in the journal (from the most detailed map of the fruit fly brain , to a robot that can culture cells ).

Insights also address some of science’s most intriguing mysteries, such as “ How the brain constructs dreams ” which is our most popular article with over 48,000 views at time of writing. Other highly viewed Insights include articles about how many copies of a protein a cell can make , and a worm’s remarkable ability to regenerate .

Over 60% of Insight articles have also been cited and contributed to further discussions in their field; the most cited article (on advances in cryo-electron microscopy ) has received almost 200 citations since it was published in 2014.

How do we decide which research papers warrant an Insight?

Out of the almost 2,000 papers eLife typically publishes each year, only around 90 will receive an Insight – so the competition is stiff. The commissioning process begins after the first round of peer review, when the Reviewing Editor handling the paper is asked whether the article merits an Insight and why.

When deciding which of the papers that have been recommended should be progressed for an Insight, the Features Team take a number of factors into account: how convincing were the reasons given for having an Insight about this paper? How enthusiastic were the reviewers? And how many Insights have we published in this field in recent months? Once the leading candidates have been identified, one of the reviewers is then asked to write the Insight and – if they agree – they are sent a set of guidelines about writing for a broad scientific readership.

What are we looking for in Insight articles?

It is vital that the Insight is both engaging and readily understandable by readers in all areas of the life and biomedical sciences, and a member of the eLife Features team works with the author to ensure that the article meets these criteria. For example, we encourage authors to use short paragraphs and sentences, and to avoid acronyms where possible. Ideally, an Insight article will read more like a Wikipedia entry than a research paper.

We also ask authors to include a figure in their Insight, and published examples range from schematics of pathways (such as how HIV behaves inside host cells ), to colourful illustrations (such as how a group of researchers monitored the sleep patterns of baboons ). The Insight is then rounded off with a few paragraphs describing what future work may emerge from this research, and which questions remain to be answered.

The finished article is then published on our website with its own DOI and is also indexed in PubMed.

What does the future hold for our Insight section?

In 2023, eLife adopted a new approach to peer review and publishing . Previously articles that had been selected for peer review were either accepted or rejected at the end of the review process. Under the new approach, an article selected for peer review will be published on the eLife website as a Reviewed Preprint that includes an eLife Assessment , Public Reviews and a response from the authors (if available).

At time of writing, we have published Insights on 26 Reviewed Preprints, including articles on a new platform for tracking individual proteins , and how third-party testing revealed the poor performance of certain commercially available antibodies . We are continuing to commission Insights on Reviewed Preprints, with many already in the pipeline to be published over the next few months.

It is not possible to say what topics will be covered in the Insight section in the months ahead, but you can be sure that the articles will cover a broad range of exciting research. To stay up to date with the latest Insight articles, sign up for our bi-weekly email or you can follow eLife on X (formerly Twitter) , Facebook or LinkedIn .

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• 12 September 2018

Thousands of scientists publish a paper every five days

• John P. A. Ioannidis 0 ,
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John P. A. Ioannidis is a professor of medicine at the Meta-Research Innovation Center at Stanford (METRICS), Stanford University, California.

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Richard Klavans is a researcher at SciTech Strategies in Philadelphia, Pennsylvania, and New Mexico.

Kevin W. Boyack is a researcher at SciTech Strategies in Philadelphia, Pennsylvania, and New Mexico.

Illustration by David Parkins

Authorship is the coin of scholarship — and some researchers are minting a lot. We searched Scopus for authors who had published more than 72 papers (the equivalent of one paper every 5 days) in any one calendar year between 2000 and 2016, a figure that many would consider implausibly prolific 1 . We found more than 9,000 individuals, and made every effort to count only ‘full papers’ — articles, conference papers, substantive comments and reviews — not editorials, letters to the editor and the like. We hoped that this could be a useful exercise in understanding what scientific authorship means.

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Hvistendahl, M. Science 342 , 1035–1039 (2013).

Nature 483 , 246 (2012).

Abritis, A., McCook, A. & Retraction Watch. Science 357 , 541 (2017).

Patience, G. S., Galli, F., Patience, P. A. & Boffito, D. C. Preprint at https://doi.org/10.1101/323519 (2018).

Drenth, J. J. Am. Med. Assoc. 280 , 219–221 (1998).

Article   Google Scholar  

Sauermann, H, & Haeussler, C. Sci. Adv. 3 , e1700404 (2017).

Kim, S. K. PLoS One 13 , e0200785 (2018).

Papatheodorou, S. I., Trikalinos, T. A. & Ioannidis, J. P. J. Clin. Epidemiol. 61 , 546–551 (2008).

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Focus: Education — Career Advice

How to write your first research paper.

Writing a research manuscript is an intimidating process for many novice writers in the sciences. One of the stumbling blocks is the beginning of the process and creating the first draft. This paper presents guidelines on how to initiate the writing process and draft each section of a research manuscript. The paper discusses seven rules that allow the writer to prepare a well-structured and comprehensive manuscript for a publication submission. In addition, the author lists different strategies for successful revision. Each of those strategies represents a step in the revision process and should help the writer improve the quality of the manuscript. The paper could be considered a brief manual for publication.

It is late at night. You have been struggling with your project for a year. You generated an enormous amount of interesting data. Your pipette feels like an extension of your hand, and running western blots has become part of your daily routine, similar to brushing your teeth. Your colleagues think you are ready to write a paper, and your lab mates tease you about your “slow” writing progress. Yet days pass, and you cannot force yourself to sit down to write. You have not written anything for a while (lab reports do not count), and you feel you have lost your stamina. How does the writing process work? How can you fit your writing into a daily schedule packed with experiments? What section should you start with? What distinguishes a good research paper from a bad one? How should you revise your paper? These and many other questions buzz in your head and keep you stressed. As a result, you procrastinate. In this paper, I will discuss the issues related to the writing process of a scientific paper. Specifically, I will focus on the best approaches to start a scientific paper, tips for writing each section, and the best revision strategies.

1. Schedule your writing time in Outlook

Whether you have written 100 papers or you are struggling with your first, starting the process is the most difficult part unless you have a rigid writing schedule. Writing is hard. It is a very difficult process of intense concentration and brain work. As stated in Hayes’ framework for the study of writing: “It is a generative activity requiring motivation, and it is an intellectual activity requiring cognitive processes and memory” [ 1 ]. In his book How to Write a Lot: A Practical Guide to Productive Academic Writing , Paul Silvia says that for some, “it’s easier to embalm the dead than to write an article about it” [ 2 ]. Just as with any type of hard work, you will not succeed unless you practice regularly. If you have not done physical exercises for a year, only regular workouts can get you into good shape again. The same kind of regular exercises, or I call them “writing sessions,” are required to be a productive author. Choose from 1- to 2-hour blocks in your daily work schedule and consider them as non-cancellable appointments. When figuring out which blocks of time will be set for writing, you should select the time that works best for this type of work. For many people, mornings are more productive. One Yale University graduate student spent a semester writing from 8 a.m. to 9 a.m. when her lab was empty. At the end of the semester, she was amazed at how much she accomplished without even interrupting her regular lab hours. In addition, doing the hardest task first thing in the morning contributes to the sense of accomplishment during the rest of the day. This positive feeling spills over into our work and life and has a very positive effect on our overall attitude.

Rule 1: Create regular time blocks for writing as appointments in your calendar and keep these appointments.

2. start with an outline.

Now that you have scheduled time, you need to decide how to start writing. The best strategy is to start with an outline. This will not be an outline that you are used to, with Roman numerals for each section and neat parallel listing of topic sentences and supporting points. This outline will be similar to a template for your paper. Initially, the outline will form a structure for your paper; it will help generate ideas and formulate hypotheses. Following the advice of George M. Whitesides, “. . . start with a blank piece of paper, and write down, in any order, all important ideas that occur to you concerning the paper” [ 3 ]. Use Table 1 as a starting point for your outline. Include your visuals (figures, tables, formulas, equations, and algorithms), and list your findings. These will constitute the first level of your outline, which will eventually expand as you elaborate.

The next stage is to add context and structure. Here you will group all your ideas into sections: Introduction, Methods, Results, and Discussion/Conclusion ( Table 2 ). This step will help add coherence to your work and sift your ideas.

Now that you have expanded your outline, you are ready for the next step: discussing the ideas for your paper with your colleagues and mentor. Many universities have a writing center where graduate students can schedule individual consultations and receive assistance with their paper drafts. Getting feedback during early stages of your draft can save a lot of time. Talking through ideas allows people to conceptualize and organize thoughts to find their direction without wasting time on unnecessary writing. Outlining is the most effective way of communicating your ideas and exchanging thoughts. Moreover, it is also the best stage to decide to which publication you will submit the paper. Many people come up with three choices and discuss them with their mentors and colleagues. Having a list of journal priorities can help you quickly resubmit your paper if your paper is rejected.

Rule 2: Create a detailed outline and discuss it with your mentor and peers.

3. continue with drafts.

After you get enough feedback and decide on the journal you will submit to, the process of real writing begins. Copy your outline into a separate file and expand on each of the points, adding data and elaborating on the details. When you create the first draft, do not succumb to the temptation of editing. Do not slow down to choose a better word or better phrase; do not halt to improve your sentence structure. Pour your ideas into the paper and leave revision and editing for later. As Paul Silvia explains, “Revising while you generate text is like drinking decaffeinated coffee in the early morning: noble idea, wrong time” [ 2 ].

Many students complain that they are not productive writers because they experience writer’s block. Staring at an empty screen is frustrating, but your screen is not really empty: You have a template of your article, and all you need to do is fill in the blanks. Indeed, writer’s block is a logical fallacy for a scientist ― it is just an excuse to procrastinate. When scientists start writing a research paper, they already have their files with data, lab notes with materials and experimental designs, some visuals, and tables with results. All they need to do is scrutinize these pieces and put them together into a comprehensive paper.

3.1. Starting with Materials and Methods

If you still struggle with starting a paper, then write the Materials and Methods section first. Since you have all your notes, it should not be problematic for you to describe the experimental design and procedures. Your most important goal in this section is to be as explicit as possible by providing enough detail and references. In the end, the purpose of this section is to allow other researchers to evaluate and repeat your work. So do not run into the same problems as the writers of the sentences in (1):

1a. Bacteria were pelleted by centrifugation. 1b. To isolate T cells, lymph nodes were collected.

As you can see, crucial pieces of information are missing: the speed of centrifuging your bacteria, the time, and the temperature in (1a); the source of lymph nodes for collection in (b). The sentences can be improved when information is added, as in (2a) and (2b), respectfully:

2a. Bacteria were pelleted by centrifugation at 3000g for 15 min at 25°C. 2b. To isolate T cells, mediastinal and mesenteric lymph nodes from Balb/c mice were collected at day 7 after immunization with ovabumin.

If your method has previously been published and is well-known, then you should provide only the literature reference, as in (3a). If your method is unpublished, then you need to make sure you provide all essential details, as in (3b).

3a. Stem cells were isolated, according to Johnson [23]. 3b. Stem cells were isolated using biotinylated carbon nanotubes coated with anti-CD34 antibodies.

Furthermore, cohesion and fluency are crucial in this section. One of the malpractices resulting in disrupted fluency is switching from passive voice to active and vice versa within the same paragraph, as shown in (4). This switching misleads and distracts the reader.

4. Behavioral computer-based experiments of Study 1 were programmed by using E-Prime. We took ratings of enjoyment, mood, and arousal as the patients listened to preferred pleasant music and unpreferred music by using Visual Analogue Scales (SI Methods). The preferred and unpreferred status of the music was operationalized along a continuum of pleasantness [ 4 ].

The problem with (4) is that the reader has to switch from the point of view of the experiment (passive voice) to the point of view of the experimenter (active voice). This switch causes confusion about the performer of the actions in the first and the third sentences. To improve the coherence and fluency of the paragraph above, you should be consistent in choosing the point of view: first person “we” or passive voice [ 5 ]. Let’s consider two revised examples in (5).

5a. We programmed behavioral computer-based experiments of Study 1 by using E-Prime. We took ratings of enjoyment, mood, and arousal by using Visual Analogue Scales (SI Methods) as the patients listened to preferred pleasant music and unpreferred music. We operationalized the preferred and unpreferred status of the music along a continuum of pleasantness. 5b. Behavioral computer-based experiments of Study 1 were programmed by using E-Prime. Ratings of enjoyment, mood, and arousal were taken as the patients listened to preferred pleasant music and unpreferred music by using Visual Analogue Scales (SI Methods). The preferred and unpreferred status of the music was operationalized along a continuum of pleasantness.

If you choose the point of view of the experimenter, then you may end up with repetitive “we did this” sentences. For many readers, paragraphs with sentences all beginning with “we” may also sound disruptive. So if you choose active sentences, you need to keep the number of “we” subjects to a minimum and vary the beginnings of the sentences [ 6 ].

Interestingly, recent studies have reported that the Materials and Methods section is the only section in research papers in which passive voice predominantly overrides the use of the active voice [ 5 , 7 , 8 , 9 ]. For example, Martínez shows a significant drop in active voice use in the Methods sections based on the corpus of 1 million words of experimental full text research articles in the biological sciences [ 7 ]. According to the author, the active voice patterned with “we” is used only as a tool to reveal personal responsibility for the procedural decisions in designing and performing experimental work. This means that while all other sections of the research paper use active voice, passive voice is still the most predominant in Materials and Methods sections.

Writing Materials and Methods sections is a meticulous and time consuming task requiring extreme accuracy and clarity. This is why when you complete your draft, you should ask for as much feedback from your colleagues as possible. Numerous readers of this section will help you identify the missing links and improve the technical style of this section.

Rule 3: Be meticulous and accurate in describing the Materials and Methods. Do not change the point of view within one paragraph.

3.2. writing results section.

For many authors, writing the Results section is more intimidating than writing the Materials and Methods section . If people are interested in your paper, they are interested in your results. That is why it is vital to use all your writing skills to objectively present your key findings in an orderly and logical sequence using illustrative materials and text.

Your Results should be organized into different segments or subsections where each one presents the purpose of the experiment, your experimental approach, data including text and visuals (tables, figures, schematics, algorithms, and formulas), and data commentary. For most journals, your data commentary will include a meaningful summary of the data presented in the visuals and an explanation of the most significant findings. This data presentation should not repeat the data in the visuals, but rather highlight the most important points. In the “standard” research paper approach, your Results section should exclude data interpretation, leaving it for the Discussion section. However, interpretations gradually and secretly creep into research papers: “Reducing the data, generalizing from the data, and highlighting scientific cases are all highly interpretive processes. It should be clear by now that we do not let the data speak for themselves in research reports; in summarizing our results, we interpret them for the reader” [ 10 ]. As a result, many journals including the Journal of Experimental Medicine and the Journal of Clinical Investigation use joint Results/Discussion sections, where results are immediately followed by interpretations.

Another important aspect of this section is to create a comprehensive and supported argument or a well-researched case. This means that you should be selective in presenting data and choose only those experimental details that are essential for your reader to understand your findings. You might have conducted an experiment 20 times and collected numerous records, but this does not mean that you should present all those records in your paper. You need to distinguish your results from your data and be able to discard excessive experimental details that could distract and confuse the reader. However, creating a picture or an argument should not be confused with data manipulation or falsification, which is a willful distortion of data and results. If some of your findings contradict your ideas, you have to mention this and find a plausible explanation for the contradiction.

In addition, your text should not include irrelevant and peripheral information, including overview sentences, as in (6).

6. To show our results, we first introduce all components of experimental system and then describe the outcome of infections.

Indeed, wordiness convolutes your sentences and conceals your ideas from readers. One common source of wordiness is unnecessary intensifiers. Adverbial intensifiers such as “clearly,” “essential,” “quite,” “basically,” “rather,” “fairly,” “really,” and “virtually” not only add verbosity to your sentences, but also lower your results’ credibility. They appeal to the reader’s emotions but lower objectivity, as in the common examples in (7):

7a. Table 3 clearly shows that … 7b. It is obvious from figure 4 that …

Another source of wordiness is nominalizations, i.e., nouns derived from verbs and adjectives paired with weak verbs including “be,” “have,” “do,” “make,” “cause,” “provide,” and “get” and constructions such as “there is/are.”

8a. We tested the hypothesis that there is a disruption of membrane asymmetry. 8b. In this paper we provide an argument that stem cells repopulate injured organs.

In the sentences above, the abstract nominalizations “disruption” and “argument” do not contribute to the clarity of the sentences, but rather clutter them with useless vocabulary that distracts from the meaning. To improve your sentences, avoid unnecessary nominalizations and change passive verbs and constructions into active and direct sentences.

9a. We tested the hypothesis that the membrane asymmetry is disrupted. 9b. In this paper we argue that stem cells repopulate injured organs.

Your Results section is the heart of your paper, representing a year or more of your daily research. So lead your reader through your story by writing direct, concise, and clear sentences.

Rule 4: Be clear, concise, and objective in describing your Results.

3.3. now it is time for your introduction.

Now that you are almost half through drafting your research paper, it is time to update your outline. While describing your Methods and Results, many of you diverged from the original outline and re-focused your ideas. So before you move on to create your Introduction, re-read your Methods and Results sections and change your outline to match your research focus. The updated outline will help you review the general picture of your paper, the topic, the main idea, and the purpose, which are all important for writing your introduction.

The best way to structure your introduction is to follow the three-move approach shown in Table 3 .

Adapted from Swales and Feak [ 11 ].

The moves and information from your outline can help to create your Introduction efficiently and without missing steps. These moves are traffic signs that lead the reader through the road of your ideas. Each move plays an important role in your paper and should be presented with deep thought and care. When you establish the territory, you place your research in context and highlight the importance of your research topic. By finding the niche, you outline the scope of your research problem and enter the scientific dialogue. The final move, “occupying the niche,” is where you explain your research in a nutshell and highlight your paper’s significance. The three moves allow your readers to evaluate their interest in your paper and play a significant role in the paper review process, determining your paper reviewers.

Some academic writers assume that the reader “should follow the paper” to find the answers about your methodology and your findings. As a result, many novice writers do not present their experimental approach and the major findings, wrongly believing that the reader will locate the necessary information later while reading the subsequent sections [ 5 ]. However, this “suspense” approach is not appropriate for scientific writing. To interest the reader, scientific authors should be direct and straightforward and present informative one-sentence summaries of the results and the approach.

Another problem is that writers understate the significance of the Introduction. Many new researchers mistakenly think that all their readers understand the importance of the research question and omit this part. However, this assumption is faulty because the purpose of the section is not to evaluate the importance of the research question in general. The goal is to present the importance of your research contribution and your findings. Therefore, you should be explicit and clear in describing the benefit of the paper.

The Introduction should not be long. Indeed, for most journals, this is a very brief section of about 250 to 600 words, but it might be the most difficult section due to its importance.

Rule 5: Interest your reader in the Introduction section by signalling all its elements and stating the novelty of the work.

3.4. discussion of the results.

For many scientists, writing a Discussion section is as scary as starting a paper. Most of the fear comes from the variation in the section. Since every paper has its unique results and findings, the Discussion section differs in its length, shape, and structure. However, some general principles of writing this section still exist. Knowing these rules, or “moves,” can change your attitude about this section and help you create a comprehensive interpretation of your results.

The purpose of the Discussion section is to place your findings in the research context and “to explain the meaning of the findings and why they are important, without appearing arrogant, condescending, or patronizing” [ 11 ]. The structure of the first two moves is almost a mirror reflection of the one in the Introduction. In the Introduction, you zoom in from general to specific and from the background to your research question; in the Discussion section, you zoom out from the summary of your findings to the research context, as shown in Table 4 .

Adapted from Swales and Feak and Hess [ 11 , 12 ].

The biggest challenge for many writers is the opening paragraph of the Discussion section. Following the moves in Table 1 , the best choice is to start with the study’s major findings that provide the answer to the research question in your Introduction. The most common starting phrases are “Our findings demonstrate . . .,” or “In this study, we have shown that . . .,” or “Our results suggest . . .” In some cases, however, reminding the reader about the research question or even providing a brief context and then stating the answer would make more sense. This is important in those cases where the researcher presents a number of findings or where more than one research question was presented. Your summary of the study’s major findings should be followed by your presentation of the importance of these findings. One of the most frequent mistakes of the novice writer is to assume the importance of his findings. Even if the importance is clear to you, it may not be obvious to your reader. Digesting the findings and their importance to your reader is as crucial as stating your research question.

Another useful strategy is to be proactive in the first move by predicting and commenting on the alternative explanations of the results. Addressing potential doubts will save you from painful comments about the wrong interpretation of your results and will present you as a thoughtful and considerate researcher. Moreover, the evaluation of the alternative explanations might help you create a logical step to the next move of the discussion section: the research context.

The goal of the research context move is to show how your findings fit into the general picture of the current research and how you contribute to the existing knowledge on the topic. This is also the place to discuss any discrepancies and unexpected findings that may otherwise distort the general picture of your paper. Moreover, outlining the scope of your research by showing the limitations, weaknesses, and assumptions is essential and adds modesty to your image as a scientist. However, make sure that you do not end your paper with the problems that override your findings. Try to suggest feasible explanations and solutions.

If your submission does not require a separate Conclusion section, then adding another paragraph about the “take-home message” is a must. This should be a general statement reiterating your answer to the research question and adding its scientific implications, practical application, or advice.

Just as in all other sections of your paper, the clear and precise language and concise comprehensive sentences are vital. However, in addition to that, your writing should convey confidence and authority. The easiest way to illustrate your tone is to use the active voice and the first person pronouns. Accompanied by clarity and succinctness, these tools are the best to convince your readers of your point and your ideas.

Rule 6: Present the principles, relationships, and generalizations in a concise and convincing tone.

4. choosing the best working revision strategies.

Now that you have created the first draft, your attitude toward your writing should have improved. Moreover, you should feel more confident that you are able to accomplish your project and submit your paper within a reasonable timeframe. You also have worked out your writing schedule and followed it precisely. Do not stop ― you are only at the midpoint from your destination. Just as the best and most precious diamond is no more than an unattractive stone recognized only by trained professionals, your ideas and your results may go unnoticed if they are not polished and brushed. Despite your attempts to present your ideas in a logical and comprehensive way, first drafts are frequently a mess. Use the advice of Paul Silvia: “Your first drafts should sound like they were hastily translated from Icelandic by a non-native speaker” [ 2 ]. The degree of your success will depend on how you are able to revise and edit your paper.

The revision can be done at the macrostructure and the microstructure levels [ 13 ]. The macrostructure revision includes the revision of the organization, content, and flow. The microstructure level includes individual words, sentence structure, grammar, punctuation, and spelling.

The best way to approach the macrostructure revision is through the outline of the ideas in your paper. The last time you updated your outline was before writing the Introduction and the Discussion. Now that you have the beginning and the conclusion, you can take a bird’s-eye view of the whole paper. The outline will allow you to see if the ideas of your paper are coherently structured, if your results are logically built, and if the discussion is linked to the research question in the Introduction. You will be able to see if something is missing in any of the sections or if you need to rearrange your information to make your point.

The next step is to revise each of the sections starting from the beginning. Ideally, you should limit yourself to working on small sections of about five pages at a time [ 14 ]. After these short sections, your eyes get used to your writing and your efficiency in spotting problems decreases. When reading for content and organization, you should control your urge to edit your paper for sentence structure and grammar and focus only on the flow of your ideas and logic of your presentation. Experienced researchers tend to make almost three times the number of changes to meaning than novice writers [ 15 , 16 ]. Revising is a difficult but useful skill, which academic writers obtain with years of practice.

In contrast to the macrostructure revision, which is a linear process and is done usually through a detailed outline and by sections, microstructure revision is a non-linear process. While the goal of the macrostructure revision is to analyze your ideas and their logic, the goal of the microstructure editing is to scrutinize the form of your ideas: your paragraphs, sentences, and words. You do not need and are not recommended to follow the order of the paper to perform this type of revision. You can start from the end or from different sections. You can even revise by reading sentences backward, sentence by sentence and word by word.

One of the microstructure revision strategies frequently used during writing center consultations is to read the paper aloud [ 17 ]. You may read aloud to yourself, to a tape recorder, or to a colleague or friend. When reading and listening to your paper, you are more likely to notice the places where the fluency is disrupted and where you stumble because of a very long and unclear sentence or a wrong connector.

Another revision strategy is to learn your common errors and to do a targeted search for them [ 13 ]. All writers have a set of problems that are specific to them, i.e., their writing idiosyncrasies. Remembering these problems is as important for an academic writer as remembering your friends’ birthdays. Create a list of these idiosyncrasies and run a search for these problems using your word processor. If your problem is demonstrative pronouns without summary words, then search for “this/these/those” in your text and check if you used the word appropriately. If you have a problem with intensifiers, then search for “really” or “very” and delete them from the text. The same targeted search can be done to eliminate wordiness. Searching for “there is/are” or “and” can help you avoid the bulky sentences.

The final strategy is working with a hard copy and a pencil. Print a double space copy with font size 14 and re-read your paper in several steps. Try reading your paper line by line with the rest of the text covered with a piece of paper. When you are forced to see only a small portion of your writing, you are less likely to get distracted and are more likely to notice problems. You will end up spotting more unnecessary words, wrongly worded phrases, or unparallel constructions.

After you apply all these strategies, you are ready to share your writing with your friends, colleagues, and a writing advisor in the writing center. Get as much feedback as you can, especially from non-specialists in your field. Patiently listen to what others say to you ― you are not expected to defend your writing or explain what you wanted to say. You may decide what you want to change and how after you receive the feedback and sort it in your head. Even though some researchers make the revision an endless process and can hardly stop after a 14th draft; having from five to seven drafts of your paper is a norm in the sciences. If you can’t stop revising, then set a deadline for yourself and stick to it. Deadlines always help.

Rule 7: Revise your paper at the macrostructure and the microstructure level using different strategies and techniques. Receive feedback and revise again.

5. it is time to submit.

It is late at night again. You are still in your lab finishing revisions and getting ready to submit your paper. You feel happy ― you have finally finished a year’s worth of work. You will submit your paper tomorrow, and regardless of the outcome, you know that you can do it. If one journal does not take your paper, you will take advantage of the feedback and resubmit again. You will have a publication, and this is the most important achievement.

What is even more important is that you have your scheduled writing time that you are going to keep for your future publications, for reading and taking notes, for writing grants, and for reviewing papers. You are not going to lose stamina this time, and you will become a productive scientist. But for now, let’s celebrate the end of the paper.

• Hayes JR. In: The Science of Writing: Theories, Methods, Individual Differences, and Applications. Levy CM, Ransdell SE, editors. Mahwah, NJ: Lawrence Erlbaum; 1996. A new framework for understanding cognition and affect in writing; pp. 1–28. [ Google Scholar ]
• Silvia PJ. How to Write a Lot. Washington, DC: American Psychological Association; 2007. [ Google Scholar ]
• Whitesides GM. Whitesides’ Group: Writing a Paper. Adv Mater. 2004; 16 (15):1375–1377. [ Google Scholar ]
• Soto D, Funes MJ, Guzmán-García A, Warbrick T, Rotshtein T, Humphreys GW. Pleasant music overcomes the loss of awareness in patients with visual neglect. Proc Natl Acad Sci USA. 2009; 106 (14):6011–6016. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hofmann AH. Scientific Writing and Communication. Papers, Proposals, and Presentations. New York: Oxford University Press; 2010. [ Google Scholar ]
• Zeiger M. Essentials of Writing Biomedical Research Papers. 2nd edition. San Francisco, CA: McGraw-Hill Companies, Inc.; 2000. [ Google Scholar ]
• Martínez I. Native and non-native writers’ use of first person pronouns in the different sections of biology research articles in English. Journal of Second Language Writing. 2005; 14 (3):174–190. [ Google Scholar ]
• Rodman L. The Active Voice In Scientific Articles: Frequency And Discourse Functions. Journal Of Technical Writing And Communication. 1994; 24 (3):309–331. [ Google Scholar ]
• Tarone LE, Dwyer S, Gillette S, Icke V. On the use of the passive in two astrophysics journal papers with extensions to other languages and other fields. English for Specific Purposes. 1998; 17 :113–132. [ Google Scholar ]
• Penrose AM, Katz SB. Writing in the sciences: Exploring conventions of scientific discourse. New York: St. Martin’s Press; 1998. [ Google Scholar ]
• Swales JM, Feak CB. Academic Writing for Graduate Students. 2nd edition. Ann Arbor: University of Michigan Press; 2004. [ Google Scholar ]
• Hess DR. How to Write an Effective Discussion. Respiratory Care. 2004; 29 (10):1238–1241. [ PubMed ] [ Google Scholar ]
• Belcher WL. Writing Your Journal Article in 12 Weeks: a guide to academic publishing success. Thousand Oaks, CA: SAGE Publications; 2009. [ Google Scholar ]
• Single PB. Demystifying Dissertation Writing: A Streamlined Process of Choice of Topic to Final Text. Virginia: Stylus Publishing LLC; 2010. [ Google Scholar ]
• Faigley L, Witte SP. Analyzing revision. Composition and Communication. 1981; 32 :400–414. [ Google Scholar ]
• Flower LS, Hayes JR, Carey L, Schriver KS, Stratman J. Detection, diagnosis, and the strategies of revision. College Composition and Communication. 1986; 37 (1):16–55. [ Google Scholar ]
• Young BR. In: A Tutor’s Guide: Helping Writers One to One. Rafoth B, editor. Portsmouth, NH: Boynton/Cook Publishers; 2005. Can You Proofread This? pp. 140–158. [ Google Scholar ]

• Open access
• Published: 16 April 2024

Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria

• Solange Durão   ORCID: orcid.org/0000-0001-7028-2638 1 ,
• Emmanuel Effa 2 ,
• Nyanyiwe Mbeye 3 ,
• Mashudu Mthethwa 2 ,
• Michael McCaul 4 ,
• Celeste Naude 4 ,
• Amanda Brand 4 ,
• Ntombifuthi Blose 1 ,
• Denny Mabetha 1 ,
• Moriam Chibuzor 2 ,
• Dachi Arikpo 2 ,
• Roselyn Chipojola 3 ,
• Gertrude Kunje 3 ,
• Per Olav Vandvik 5 , 6 ,
• Ekpereonne Esu 2 ,
• Simon Lewin 7 &
• Tamara Kredo 2 , 4  

Health Research Policy and Systems volume  22 , Article number:  48 ( 2024 ) Cite this article

Metrics details

Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach.

We followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed.

Based on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants.

Conclusions

Through dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.

Peer Review reports

Globally, more than half of all deaths in children and youth in 2019 were among children under 5 years [ 1 ]. It is estimated that there are 5.2 million deaths among under-fives each year, with Sub-Saharan Africa (SSA) having the highest mortality rate [ 2 ]. Most countries in SSA are not on track to meet maternal and child health targets set by Sustainable Development Goal 3 to ‘ensure healthy lives and promote wellbeing’, specifically the target of 25 or fewer deaths per 1000 live births [ 1 ]. As of December 2021, under-five mortality rates were reported as 113.8, 38.6 and 32.2 deaths per 1000 live births for Nigeria, Malawi and South Africa respectively [ 3 ]. Factors accounting for regional disparities in child mortality rates include poverty, socioeconomic inequities, poor health systems, and poor nutrition, with disease outbreaks adding substantially to the burden [ 4 ].

Addressing these issues requires an evidence-informed approach to ensure that scarce resources are used effectively and efficiently, avoid harm, maximise benefits, and improve healthcare delivery and outcomes [ 5 , 6 , 7 ]. Evidence-informed practices have been growing in SSA [ 5 ], and include the use of recommendations from clinical practice guidelines that are intended to optimise patient care or public health practice [ 8 ]. Guidelines bridge the gap between research evidence and practice and are recognised as important quality-improvement tools that aim to standardise care, inform funding decisions, and improve access to care, amongst others.

The development of evidence-informed, trustworthy guidelines from scratch—also known as de novo guideline development—is a resource-intensive and time-consuming process [ 9 ]. However, guideline developers can adopt or adapt existing recommendations from guidelines developed in other settings, to make the process more efficient while maintaining transparency and minimising waste and duplication [ 10 , 11 , 12 , 13 ]. For example, the World Health Organisation (WHO) produces high-quality global-level guidelines, which may be adopted and implemented in a member country or, alternatively, adapted for that context. Guidelines can be adopted when there is no need to change the recommendation, the evidence base, or how it is implemented in a local setting while considering factors such as cost, workforce, health systems, management options and access to care [ 10 ]. They can also be adapted when there is a need to modify a guideline(s) or recommendation(s) produced in one cultural and organisational setting for application in a different context [ 10 ]. However, adaptation of such guidelines to national contexts is often not well described [ 14 ]. An evaluation of experiences of guideline adaptation across WHO regions found that adaptation is understood and implemented in a variety of ways across countries [ 15 ].

Furthermore, reporting of guidelines in the African context is usually below global standards, specifically regarding their rigor of development. Kredo and colleagues reviewed Southern African Development Community (SADC) guidelines on five specific diseases published between 2003 and 2010 and besides poor reporting they found that guidelines needed broader stakeholder involvement and greater transparency [ 16 ]. Scoping reviews of newborn and child health guidelines in South Africa, Malawi and Nigeria published between 2017 and 2022 and of pre-hospital clinical guidance in sub-Saharan Africa found that the methods and reporting of the identified guidelines do not adhere to global standards [ 17 , 18 ].

In terms of priority setting processes for guideline development in African settings, little information is available. A scoping review of studies describing prioritization exercises published up to July 2019 did not identify any studies from African countries, with most studies being from Europe [ 19 ]. There is thus room for strengthening and supporting guideline development and adaptation in SSA, including the initial priority setting for those guidelines.

The Global Evidence, Local Adaptation (GELA) project focuses on addressing some of these gaps, including improving guideline development processes in SSA. The project aims to maximise the impact of research on poverty-related diseases by enhancing decision makers’ and researchers' capacity to use global research, including existing high-quality global guidelines, to develop locally relevant guidelines for newborn and child health in three sub-Saharan Africa countries: South Africa (SA), Malawi and Nigeria. The first step of this project was to identify priorities for newborn and child health guideline development in each country, and this paper aims to describe our approach.

Priority setting methods

Priority setting is an important step in guideline development [ 9 ]. It enables the identification of the most important issues through an iterative, inclusive and explicit process [ 7 , 20 ], and ensures efficient resource use by identifying topics for which guidelines are truly needed [ 19 , 21 ].

A variety of methods and approaches for priority setting for research and for guidelines have been used in the literature but there is no existing gold standard method for priority setting [ 19 , 22 ]. Researchers have analysed priority setting exercises and proposed good practice principles that can be followed during such exercises [ 22 , 23 ]. These principles, or elements, of priority setting are linked to the different stages in the process: pre-prioritisation, prioritisation, and post-prioritisation stages, as described in Fig.  1 [ 19 , 22 , 23 , 24 , 25 ]. In the pre-prioritisation stage, they include (i) involving internal and external stakeholders in the decision-making process, (ii) use of an explicit and transparent process, (iii) information management, (iv) consideration of values and context in which the priorities are being set, including those of stakeholders, staff and patients, and (v) planning for implementation, i.e. planning for translation of the priorities into practice. In the prioritization stage they include (i) using relevant criteria to identify priorities and (ii) choosing a method to decide on priorities, which could be consensus-based, such as the 3D Combined Approach Matrix (CAM), or metric-based approaches, such as the Child Health and Nutrition Research Initiative (CHNRI) approach [ 26 ]. In the post-prioritisation phase, they include (i) an evaluation of the priority setting process, and (sii) putting in place mechanisms for reviewing decisions.

Elements of each priority setting stage (adapted from El-Harakeh 2020, Jo 2015, Sibbald 2009, Tong 2019, Viergever 2010)

We followed good practice priority setting method, as described above. Our approach included a pre-prioritisation stage to identify potential priority topics through stakeholder engagement and review of the literature, and a prioritisation stage for consultation and finalisation of the priority topics through online surveys and consensus meetings, using specific criteria (Fig.  2 ). Country teams were responsible for implementing each step in their respective countries and any differences in the process due to practical or other factors within the three countries were captured as part of the documentation of the process.

Overview of priority setting approach overview

Pre-prioritization

Stakeholder identification and engagement.

We engaged with two different pre-specified groups. The first were the members of the Guideline steering group set up in each GELA project country. Up to 13 individuals were identified and invited to participate from the relevant national departments or ministries of health, professional associations, country-level WHO offices, and any other individuals suggested by these bodies in each country. They were identified through existing contacts of the researcher team within national departments of health responsible for guideline development and working within newborn and child health area, with whom they had worked before. These individuals then also made suggestions of other members from other stakeholder groups such as academia, non-governmental organisations, etc., who worked in the field of newborn and child health. The steering group provided initial suggestions of priority topics, made the final decisions regarding which to prioritise, and provided general oversight and technical advice on the in-country implementation of the project.

The second stakeholder group was broader and included individuals or organisations who are involved, can affect or are affected by national decisions or actions related to priority topics in the field of newborn or child health in sub-Saharan Africa [ 27 , 28 ]. These included policymakers, guideline developers, health professionals, civil society representatives, patient advocacy groups as well as WHO Afro representatives, specifically those linked to potential priority topics identified. To identify them, we carried out a stakeholder mapping exercise, which included reviewing secondary data, such as existing guidance and publications and searching the websites of ministries of health, relevant professional associations, universities, NGOs and civil society groups. The national GELA Guideline Steering group members also made suggestions. This process was guided by the stakeholder power-interest matrix where those who have the most influence, and capacity to change practice for impact were prioritised and invited [ 29 ]. Participants were invited, via email, to complete a priority setting survey.

Identifying a long list of topics

We generated an initial long list of potential priority topics through (i) reviewing existing and planned WHO guidelines on newborn and child health, from which potential topics were extracted based on existing recommendations; (ii) consulting with the GELA guideline Steering Group; and (iii) reviewing the disease burden/technical data related to newborn and child health in each country, which was identified through targeted literature searches. WHO guidelines were used as a starting point as these are prepared following rigorous methods and are intended for implementation across the various member countries. Potential topics were organised according to the disease/condition being addressed and the type of intervention (e.g., diagnosis, prevention, treatment, or rehabilitation), and were collated into a spreadsheet or word document.

Prioritization stage

Online survey.

The potential topics identified in the first phase were included in online surveys with stakeholders. We first user-tested the survey among the GELA project team to ensure it was readable and understandable. We then invited all identified stakeholders, via email, to complete the survey developed using REDCap [ 30 ]. In Nigeria, the survey invitation was also circulated via WhatsApp to specific stakeholders. In the invitation emails, we also asked stakeholders to forward the email to any colleagues that may have an interest in the topic.

The landing page of the survey provided information about the study’s purpose, that it was a collaboration with the national department/ministries of health, what we were asking participants to do, and a link for more details about the GELA project, after which participants were required to provide consent before they could complete the survey. The survey asked respondents to rate the listed topics according to five criteria (Box 1 ) using a 6-point Likert scale (6—very critical and 1—not important at all) [ 22 , 31 ]. The criteria used were identified through a survey conducted with the GELA research team in which they rated the top five criteria of 22 criteria for priority setting for guidelines identified by El Harakeh et al. [ 32 ]. An explanation for each criterion was provided in the survey. Originally, we had intended that stakeholders would rate each topic according to each criterion, but we asked instead that they consider the five criteria as a whole when rating a topic. We decided that this approach was less onerous for survey respondents and less likely to lead to poor response rates. Topics rated as being of ‘critical importance’ and ‘very critical importance’ were selected for presentation at the consensus meetings with the Steering Group. The first part of the survey also collected demographic information such as type of stakeholders, what they are primarily practicing as and for how many years, the percentage of time spent in patient care, and the type of institution they are primarily based at.

The surveys remained open for 3–4 weeks. Reminder emails were sent to those who were originally invited to participate, once in SA and Malawi, and weekly in Nigeria. As we could not track emails forwarded to others, due to the anonymity setting of the survey, it was not possible to remind those who had been invited in this manner.

Box 1. Criteria used in the priority setting process

Health burden—whether there is a high impact of the health problem/condition in the country as measured by financial cost, mortality, morbidity, or other indicators (e.g. QALYs, DALYs)

Urgency—whether there is an urgent need to address the issue or practice gap

Absence of guidance—whether there are no up-to-date existing guidelines addressing the specific topic and the topic would fit into existing national guideline development processes and priorities

Impact on health outcomes—whether a recommendation on the topic would have a beneficial impact on health outcomes in the country

Feasibility of intervention implementation—whether a guideline/recommendation addressing the topic would be feasible to implement in the national context (i.e. if this is through recognised guideline development bodies

Steering Group consensus meeting

Each country convened a meeting of their Guideline Steering Group to identify the final top three priority topics for guideline development. The number of topics per country was based on the number of recommendations that could be addressed in each country over the broader project period given the resources available. The moderator was a member of the research team and guided the meetings and discussions. This meeting was online in South Africa, and in-person in Malawi and Nigeria. We adopted a modified Nominal Group Technique [ 33 ] to achieve consensus, including five steps:

Step 1: the research team presented a summary of how the topics for the online survey were identified, which included consultation with the same steering group, as well as the results of the survey, including the summary of the topics that were rated as critically and very critically important, which needed further prioritisation.

Step 2: With the help of the moderator the group discussed each topic to ensure that all members understood them in the same way, and we elicited their thoughts on the ratings from the survey.

Step 3: The steering group members were asked to vote, anonymously, on the topics rated as critical or very critical in the survey using a Zoom poll (South Africa) or manually using post-its (Malawi). In Nigeria, the steering group decided to reach consensus through discussion to ensure full ownership of the resulting topics by every member of the group In South Africa only one round of voting was done as the members felt there was sufficient consensus after that. When voting, members ranked the importance of each topic on a six-point Likert scale against the same five criteria used in the online survey.

Step 4: The moderator summarised the results of the voting using bar charts to visualise the rating frequency distribution [ 34 ]. The variations for ratings observed were discussed among the group, including potential explanations before another round of voting, in cases where this took place.

Step 5: Consensus on the top three topics was reached. It was originally anticipated that at the end of this meeting three priority topics—formulated as questions in Population, Intervention, Comparator, and Outcomes (PICO) format—would have been identified for the next stages of the GELA project. However, the topics identified were broad, and further scoping of the literature and existing guidelines were needed to unpack and refine them. Several subsequent meetings with the Steering Groups were therefore needed in each country to present this scoping and finalise the three priority PICO questions per country.

Data management and analysis

Data were exported from the REDCap data management software, cleaned, and analysed using R studio [ 35 ] or STATA 12 [ 36 ]. Simple descriptive statistics were used during the analysis. Median and interquartile ranges (IQRs) were used to rank the topics, which were presented graphically and tabulated in descending order from very critically important to not important at all. Frequencies and proportions were used to describe categorical data. Response rates and missing data were noted. The data were considered as missing at random.

Pre-prioritisation

The members identified and invited to join the Steering Group in each country are described in Table  1 .

Stakeholder mapping identified a range of stakeholders for the survey, including 78 in South Africa, 31 in Malawi, and 40 in Nigeria (Table  2 ). In South Africa, there was greater representation from researchers/academics and health professionals; in Malawi from policymakers and researchers/academics; and in Nigeria from policymakers and professional associations, most of whom were academics.

Initial list of topics

In South Africa and Nigeria, the initial lists of topics identified were very long; over 65 topics, across 14 broad topic areas in South Africa, and 51 topics in Nigeria. Through engagement and input from the respective Steering Group members and other experts—via virtual meetings or email—the lists were narrowed down. The survey in South Africa included 14 topics across six conditions, in Nigeria 27 topics across 10 conditions, and in Malawi 30 topics across eight conditions (Table  3 ). Aside from undernutrition, which was a broad topic included in the surveys of all three countries, there was very little overlap in topics across all the countries. Pneumonia/acute respiratory infection and tuberculosis were common to Malawi and Nigeria, and schistosomiasis was common to South Africa and Malawi.

Prioritisation

All the stakeholders described in Table  2 were invited to complete the online survey via email. In Nigeria, WhatsApp messages were also sent to representatives of professional groups (paediatricians, Obstetricians, neonatologists), who then shared on their groups. The surveys were open for approximately three to four weeks at the end of 2022: 10 October to 8 November in South Africa; 7 to 25 November in Malawi; and 10 November to 3 December in Nigeria. Whereas in South Africa and Malawi fewer people accessed the survey compared to the number of people invited (38/78 in SA, 23/61 in Malawi), in Nigeria a greater number of people accessed it (78/57). However, a similar percentage of those that accessed the survey fully completed it (66% in SA, 70% in Malawi, and 68% in Nigeria). Some respondents completed the first part of the survey, i.e. demographic characteristics, but not the section where they were required to rate the importance of the topics. These respondents were not included in the analysis.

Overall, most respondents were health professionals (81%) and had between 5 and 20 years of experience in practice (63%) (Table  4 ). About a third of participants spent more than 75%, or between 50 and 75%, of their time in direct patient care. Most participants were primarily based at a teaching hospital (41%), and at a hospital (17%) or university (16%).

In SA, nine of 14 topics were rated as critically important , five were rated as very important , and no topic was rated as very critically important (Tables 5 , 6 , 7 ). In Malawi, 10/30 topics were rated as very critically important , 14 as critically important , five as very important , and one as important . In Nigeria, 11/27 topics were rated as very critically important , 13 were rated as critically important , one as very important , one as important and one as not important . The topics that were taken through to the discussion with the Steering Groups included all the critically important topics in South Africa, and all the very critically important topics in Malawi and Nigeria. Individual ratings for each topic included in the survey of each country are presented in the Additional file 1 : Fig. S1–S3.

Some survey respondents suggested additional topics. In South Africa 12/25 people suggested an additional 21 topics, six of 16 respondents in Malawi suggested an additional 15 topics, and 30 of 53 respondents in Nigeria suggested an additional 63 topics. In general, there was little overlap in the additional topics suggested and none were taken up as potential priorities across the countries.

Consensus meeting with Steering Groups

The main consensus meetings were held between November and December 2022 across the three countries. These were attended by members of the SG and research teams in each country. Additional individuals who joined the main Steering Group meetings included observers ( n  = 2), the Malawi and Nigeria project leads ( n  = 2) at the South African meeting, the project coordinator (TK) in Malawi, and a representative from the Department of Health Planning, Research and Statistics in Nigeria.

After the presentation of the results of the online survey (Step 1) and discussion about the top-rated topics (Step 2) (Table  5 ), facilitated by the moderator, the Steering Group members voted to identify the top three topics (Step 3). In South Africa, one round of voting indicated some consensus; of seven people who voted, three topics were rated as critically or very critically important by most people, and three topics were not rated by any member as critical/very critical . After further discussion on the results of the voting (Step 4), four topics were prioritized (Step 5). Figure  3 describes what took place in each step. In Malawi, although 10 top-rated topics were presented, the Steering Group members derived 10 new topics from topic 1 and 9, and these were the topics voted on. Two rounds of voting were done, after which three topics were identified. In Nigeria, the Steering Group agreed to reach decisions on topics by consensus. After extensive deliberations, considering the prevalence of health problems in neonates and the primary causes of these, they decided on four priority topics to consider.

Flow diagram of the steps in the modified Nominal Group Technique

Across all three countries, the topics selected by the end of the consensus meeting were very broad, i.e., each one encompassed many potential questions and was not yet sufficiently specific for a guideline process (i.e., in the Population, Intervention, Comparator, Outcomes—PICO format). Therefore, research teams had to do further work to unpack and refine these. To clarify the PICO questions linked to each topic, the teams compared existing national guidance on prioritised topics with recommendations in relevant WHO guidelines and other global guidance; this allowed identification of gaps in national guidance that the project could address. In Malawi, the team also consulted with experts in the field. This process resulted in seven potential PICO questions in South Africa, six in Malawi, and four in Nigeria. These were presented to the Steering Groups in additional meetings and via email communication, several rounds of which were required before final PICO questions were identified (Table  8 ). The final topics were also discussed with stakeholders responsible for developing and implementing national guidance, to clarify whether they linked to national priorities and whether they could fit within existing guideline development processes and infrastructure. Only topics that fit these conditions were taken through to the next stage of the project, the development of recommendations.

We conducted a priority setting exercise to identify topics and inform new guideline development addressing gaps in newborn and child health in South Africa, Malawi, and Nigeria. In each country, the process included engagements with national Steering Groups comprising representatives of various national-level organisations, multi-stakeholder online surveys, and consensus meetings. At the end of the process three priority PICO questions were identified in each country. In South Africa, the topics concerned anemia prevention in infants and young children through iron supplementation and multiple micronutrient powders, and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants.

The topics identified are informing the next stages of the GELA project, which include a systematic guideline adaptation process, including scoping existing guidelines or systematic reviews addressing the topics, conducting evidence synthesis where necessary, and convening of guideline panels to make recommendations linked to some or all of the priority PICO questions in the three countries [ 10 ]. Through this process we are aiming to highlight best practice methods for guideline development, including priority setting with the involvement of relevant stakeholders through a transparent and systematic process, and through ensuring the guidelines are developed following rigorous methods and clear and transparent reporting.

The priorities identified at the end of the process had limited overlap across the three countries. This highlights the importance of contextualised priority setting processes, one of the good practice principles of priority setting [ 23 ]. Although contextualised priority setting is important because contextual factors drive the needs and the gaps in healthcare delivery and implementation in different countries, there can also be common priorities and issues. Therefore, countries with similar priorities could draw on existing work at a global or country level, for adaptation into their context, to prevent any regional system fragmentation.

Some of the topics included in the online survey were broad, which made it difficult to identify the questions in required format for a guideline question (PICO) at the end of the main expert consensus meetings. This required substantial work to refine the topics, as well as additional meetings with the Steering Groups, which delayed the finalisation of priority topics and the next steps of the project that depended on priority topics being identified. Ideally, the topics included in the survey should have been more specific. Otherwise, some of the work to clarify the top-rated topics identified through the survey could have been done before the Steering Group consensus meeting, to ensure better efficiency. Future priority setting should also consider more frequent meetings with national Steering Groups advising on topics, given the iterative nature of the process. The process may have been more efficient and easier if the starting point had been a narrower topic area, rather than covering all of newborn and child health.

Although this project aimed to identify priority topics in PICO format that would lead to one recommendation, this may not have been clear to all stakeholders involved. In some cases, stakeholders identified topics that were broad in nature and that would lend themselves for a full guideline encompassing different recommendation. This should be better clarified at the start of the process, when engaging with the stakeholders.

We noted better response rates to the online survey where emails inviting stakeholders to participate in the survey were from a recognised institutional address, and supplemented with WhatsApp communication, a method increasingly recognised as valuable for sharing digital health information [ 37 ].

In some cases, certain Steering Group members tended to dominate the consensus discussions. Management of stakeholder input during these meetings is a critical required skill for successfully gathering everyone’s views. In a study done to prioritise childhood cancer supportive care topics for the development of guidelines, Loeffen and colleagues chose to do a Delphi survey as one of the strengths of this method is the lack of face-to-face meetings to prevent dominant voices being introduced [ 38 ].

Strengths and limitations

We followed a good practice method for priority setting including stakeholder engagement and using an explicit process [ 23 ]. We convened Steering Groups with representatives from relevant national decision-makers to advise on the project and topics, working in close collaboration with Departments of Health, aiming to ensure the project addresses national priorities that could fill a gap in national guidelines and guideline development processes. The online survey facilitated engagement with a broader range of stakeholders, to ensure broad representation of views and perspectives. Furthermore, the guideline development groups that would be identified in the next stage of the project to review the evidence and develop recommendations for each of the identified questions would ensure representation of key stakeholders. We also used specific criteria to rate the importance of topics, which were derived from the literature and which also received input to ensure they were understandable and relevant.

Our study had a few limitations. The response rates to surveys were poor, and could perhaps have been improved if they had remained open for longer. We sent reminder emails to those participants we had invited to complete the survey, but it was not possible to do this for others who may have received the link from others. We did not include patients or carers in the survey; research suggests that their perspectives may differ regarding what treatment decisions are important [ 39 , 40 ]. We did, however, include civil society groups which provided perspectives that consider equity and patient and caregiver perspectives.

Through an explicit process, including stakeholder engagement, reviewing of existing global guidelines and burden of disease, and online surveys we identified three priority questions each in South Africa, Malawi and Nigeria for guidelines addressing newborn and child health. We found that the process was not linear but rather iterative in nature, requiring several engagements with stakeholders to help finalise the topics, as well as managing the conflicting priorities of different groups of stakeholders. Our experience highlights the importance of contextualised priority setting, as shown by the limited overlap in topics prioritised across the three countries, as well as of the relationships with key decisionmakers, who help define the priorities.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Global Evidence Local Adaptation

Non-governmental organisation

Non-profit organisation

United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund; 2020.

United Nations. Levels and trends in child mortality: report 2020. Estimates developed by the: UNICEF; 2020 2020.

United Nations International Children's Fund. Under-five mortality. 2021 2021.

Stewart R, El-Harakeh A, Cherian SA. Evidence synthesis communities in low-income and middle-income countries and the COVID-19 response. Lancet. 2020;396(10262):1539–41.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Stewart R, Dayal H, Langer L, van Rooyen C. The evidence ecosystem in South Africa: growing resilience and institutionalisation of evidence use. Palgrave Commun. 2019;5(1):90.

Article   Google Scholar  

Mijumbi RM, Oxman AD, Panisset U, Sewankambo NK. Feasibility of a rapid response mechanism to meet policymakers’ urgent needs for research evidence about health systems in a low income country: a case study. Implement Sci. 2014;9(1):114.

Article   PubMed   PubMed Central   Google Scholar  

Uneke CJ, Ezeoha AE, Ndukwe CD, Oyibo PG, Onwe F. Promotion of evidence-informed health policymaking in Nigeria: bridging the gap between researchers and policymakers. Glob Public Health. 2012;7(7):750–65.

Article   PubMed   Google Scholar  

Institute of Medicine. Clinical Practice Guidelines We Can Trust. Graham, R., Mancher, M., Wolman, D., Greenfield, S., & Steinberg, E. Eds: Washington, DC: The National Academy Press; 2011, 290.

World Health Organization. WHO handbook for guideline development. 2nd ed. Geneva: World Health Organization; 2014. p. 167.

Google Scholar  

Schünemann HJ, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa RA, Manja V, et al. GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol. 2017;81:101–10.

Brand A, Hohlfeld A, McCaul M, Durao S, Young T, Kredo T. Lessons in providing rapid evidence to inform national treatment guidelines for COVID-19 in South Africa. In: Collaborating in response to COVID-19: editorial and methods initiatives across Cochrane. Cochrane Database Syst Rev. 2020;12(Suppl 1):79–81.

McCaul M, de Waal B, Hodkinson P, Pigoga JL, Young T, Wallis LA. Developing prehospital clinical practice guidelines for resource limited settings: why re-invent the wheel? BMC Res Notes. 2018;11(1):97.

McCaul M, Tovey D, Young T, Welch V, Dewidar O, Goetghebeur M, et al. Resources supporting trustworthy, rapid and equitable evidence synthesis and guideline development: results from the COVID-19 evidence network to support decision-making (COVID-END). J Clin Epidemiol. 2022;151:88–95.

Opiyo N, Shepperd S, Musila N, English M, Fretheim A. The, “Child Health Evidence Week” and GRADE grid may aid transparency in the deliberative process of guideline development. J Clin Epidemiol. 2012;65(9):962–9.

Wang Z, Grundy Q, Parker L, Bero L. Variations in processes for guideline adaptation: a qualitative study of World Health Organization staff experiences in implementing guidelines. BMC Public Health. 2020;20(1):1758.

Kredo T, Gerritsen A, van Heerden J, Conway S, Siegfried N. Clinical practice guidelines within the Southern African development community: a descriptive study of the quality of guideline development and concordance with best evidence for five priority diseases. Health Res Policy Sys. 2012;10(1):1.

Mthethwa M, Mbeye NM, Effa E, Arikpo D, Blose N, Brand A, et al. Newborn and child health national and provincial clinical practice guidelines in South Africa, Nigeria and Malawi: a scoping review. BMC Health Serv Res. 2024;24(1):221.

Malherbe P, Smit P, Sharma K, McCaul M. Guidance we can trust? The status and quality of prehospital clinical guidance in sub-Saharan Africa: a scoping review. Afr J Emerg Med. 2021;11(1):79–86.

El-Harakeh A, Lotfi T, Ahmad A, Morsi RZ, Fadlallah R, Bou-Karroum L, et al. The implementation of prioritization exercises in the development and update of health practice guidelines: a scoping review. PLoS ONE. 2020;15(3): e0229249.

Rudan I, Kapiriri L, Tomlinson M, Balliet M, Cohen B, Chopra M. Evidence-based priority setting for health care and research: tools to support policy in maternal, neonatal, and child health in Africa. PLoS Med. 2010;7(7): e1000308.

Chalmers I, Bracken MB, Djulbegovic B, Garattini S, Grant J, Gülmezoglu AM, et al. How to increase value and reduce waste when research priorities are set. Lancet. 2014;383(9912):156–65.

Viergever RF, Olifson S, Ghaffar A, Terry RF. A checklist for health research priority setting: nine common themes of good practice. Health Res Policy Sys. 2010;8(1):36.

Sibbald SL, Singer PA, Upshur R, Martin DK. Priority setting: what constitutes success? A conceptual framework for successful priority setting. BMC Health Serv Res. 2009;9(1):43.

Jo H-S, Kim DI, Oh M-K. National priority setting of clinical practice guidelines development for chronic disease management. J Korean Med Sci. 2015;30(12):1733.

Tong A, Synnot A, Crowe S, Hill S, Matus A, Scholes-Robertson N, et al. Reporting guideline for priority setting of health research (REPRISE). BMC Med Res Methodol. 2019;19(1):243.

Yoshida S. Approaches, tools and methods used for setting priorities in health research in the 21(st) century. (2047–2978 (Print)).

Lavis JN, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 3: setting priorities for supporting evidence-informed policymaking. Health Res Policy Sys. 2009;7(S1):S3.

Reed MS, Curzon R. Stakeholder mapping for the governance of biosecurity: a literature review. J Integr Environ Sci. 2015;12(1):15–38.

Onasanya A. A stakeholder analysis of schistosomiasis diagnostic landscape in South-West Nigeria: insights for diagnostics co-creation. Front Public Health. 2020;8:16.

Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95: 103208.

Clavisi O, Bragge P, Tavender E, Turner T, Gruen RL. Effective stakeholder participation in setting research priorities using a Global Evidence Mapping approach. J Clin Epidemiol. 2013;66(5):496-502.e2.

El-Harakeh A, Morsi RZ, Fadlallah R, Bou-Karroum L, Lotfi T, Akl EA. Prioritization approaches in the development of health practice guidelines: a systematic review. BMC Health Serv Res. 2019;19(1):692.

Rankin NM, McGregor D, Butow PN, White K, Phillips JL, Young JM, et al. Adapting the nominal group technique for priority setting of evidence-practice gaps in implementation science. BMC Med Res Methodol. 2016;16(1):110.

van der Veer SN, van Biesen W, Bernaert P, Bolignano D, Brown EA, Covic A, et al. Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults. Int Urol Nephrol. 2016;48(6):859–69.

R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Core Team; 2022.

StataCorp. Stata Statistical Software: Release 12. College Station: StataCorp LP; 2011.

Glenton C, Nabukenya J, Agarwal S, Meltzer M, Mukendi E, Lwanga IN, et al. Using an online community of practice to explore the informal use of mobile phones by health workers. Oxford Open Digital Health. 2023;1: oqac003.

Loeffen EAH, Mulder RL, Kremer LCM, Michiels EMC, Abbink FCH, Ball LM, et al. Development of clinical practice guidelines for supportive care in childhood cancer—prioritization of topics using a Delphi approach. Support Care Cancer. 2015;23(7):1987–95.

Article   CAS   PubMed   Google Scholar  

Voigt I, Wrede J, Diederichs-Egidi H, Dierks ML, Junius-Walker U. Priority setting in general practice: health priorities of older patients differ from treatment priorities of their physicians. Croat Med J. 2010;51(6):483–92.

van der Veer SN, Haller MC, Pittens CA, Broerse J, Castledine C, Gallieni M, et al. Setting priorities for optimizing vascular access decision making–an international survey of patients and clinicians. PLoS ONE. 2015;10(7): e0128228.

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Acknowledgements

Carron Finnan, SAMRC corporate communications for the design of Figs. 1 and 2 .

The members of the steering groups in each country.

This project is funded as part of the EDCTP2 programme supported by the European Union (grant number RIA2020S-3303-GELA). The funder had no role in the design of the study, or in the collection, analysis, and interpretation of data, or in writing the manuscript.

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Solange Durão, Ntombifuthi Blose & Denny Mabetha

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Emmanuel Effa, Mashudu Mthethwa, Moriam Chibuzor, Dachi Arikpo, Ekpereonne Esu & Tamara Kredo

Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi

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SD, EEf, NM, MMt, MMc, TK, RC, GK, POV, and SL were involved in the conception and design of the study. SD, EE, MC, DA, EEs, DM, NB, GK, RC were involved with data acquisition or analysis. SD, EE, CN, AB, MMc, MC, DA, EEs, NB, and SL were involved in interpreting the findings. All authors contributed to drafting the manuscript or revising it critically and approved the final manuscript to be published.

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This study has been approved in the three countries in which it is taking place. In South Africa the study was approved by the SAMRC Human Research Ethics Committee on 19 July 2022 (protocol ID EC011-6/2022). In Nigeria, the study was approved by the National Health Research Ethics Committee (Approval Number NHREC/01/01/2007-30/06/2022). In Malawi, the study was approved by the College of Medicine Research and Ethics Committee (COMREC) (number P.06/22/3665).

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Additional file1: figure s1..

Rating of importance of survey topics in South Africa. Figure S2. Rating of importance of Malawi survey topics. Figure S3. Rating of importance of the topics included in the Nigeria survey.

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Durão, S., Effa, E., Mbeye, N. et al. Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria. Health Res Policy Sys 22 , 48 (2024). https://doi.org/10.1186/s12961-024-01133-7

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Facility for Rare Isotope Beams

At michigan state university, frib researchers lead team to merge nuclear physics experiments and astronomical observations to advance equation-of-state research, world-class particle-accelerator facilities and recent advances in neutron-star observation give physicists a new toolkit for describing nuclear interactions at a wide range of densities..

For most stars, neutron stars and black holes are their final resting places. When a supergiant star runs out of fuel, it expands and then rapidly collapses on itself. This act creates a neutron star—an object denser than our sun crammed into a space 13 to  18 miles wide. In such a heavily condensed stellar environment, most electrons combine with protons to make neutrons, resulting in a dense ball of matter consisting mainly of neutrons. Researchers try to understand the forces that control this process by creating dense matter in the laboratory through colliding neutron-rich nuclei and taking detailed measurements.

A research team—led by William Lynch and Betty Tsang at FRIB—is focused on learning about neutrons in dense environments. Lynch, Tsang, and their collaborators used 20 years of experimental data from accelerator facilities and neutron-star observations to understand how particles interact in nuclear matter under a wide range of densities and pressures. The team wanted to determine how the ratio of neutrons to protons influences nuclear forces in a system. The team recently published its findings in Nature Astronomy .

“In nuclear physics, we are often confined to studying small systems, but we know exactly what particles are in our nuclear systems. Stars provide us an unbelievable opportunity, because they are large systems where nuclear physics plays a vital role, but we do not know for sure what particles are in their interiors,” said Lynch, professor of nuclear physics at FRIB and in the Michigan State University (MSU) Department of Physics and Astronomy. “They are interesting because the density varies greatly within such large systems.  Nuclear forces play a dominant role within them, yet we know comparatively little about that role.” 

When a star with a mass that is 20-30 times that of the sun exhausts its fuel, it cools, collapses, and explodes in a supernova. After this explosion, only the matter in the deepest part of the star’s interior coalesces to form a neutron star. This neutron star has no fuel to burn and over time, it radiates its remaining heat into the surrounding space. Scientists expect that matter in the outer core of a cold neutron star is roughly similar to the matter in atomic nuclei but with three differences: neutron stars are much larger, they are denser in their interiors, and a larger fraction of their nucleons are neutrons. Deep within the inner core of a neutron star, the composition of neutron star matter remains a mystery. 

  “If experiments could provide more guidance about the forces that act in their interiors, we could make better predictions of their interior composition and of phase transitions within them. Neutron stars present a great research opportunity to combine these disciplines,” said Lynch.

Accelerator facilities like FRIB help physicists study how subatomic particles interact under exotic conditions that are more common in neutron stars. When researchers compare these experiments to neutron-star observations, they can calculate the equation of state (EOS) of particles interacting in low-temperature, dense environments. The EOS describes matter in specific conditions, and how its properties change with density. Solving EOS for a wide range of settings helps researchers understand the strong nuclear force’s effects within dense objects, like neutron stars, in the cosmos. It also helps us learn more about neutron stars as they cool.

“This is the first time that we pulled together such a wealth of experimental data to explain the equation of state under these conditions, and this is important,” said Tsang, professor of nuclear science at FRIB. “Previous efforts have used theory to explain the low-density and low-energy end of nuclear matter. We wanted to use all the data we had available to us from our previous experiences with accelerators to obtain a comprehensive equation of state.”   

Researchers seeking the EOS often calculate it at higher temperatures or lower densities. They then draw conclusions for the system across a wider range of conditions. However, physicists have come to understand in recent years that an EOS obtained from an experiment is only relevant for a specific range of densities. As a result, the team needed to pull together data from a variety of accelerator experiments that used different measurements of colliding nuclei to replace those assumptions with data. “In this work, we asked two questions,” said Lynch. “For a given measurement, what density does that measurement probe? After that, we asked what that measurement tells us about the equation of state at that density.”   

In its recent paper, the team combined its own experiments from accelerator facilities in the United States and Japan. It pulled together data from 12 different experimental constraints and three neutron-star observations. The researchers focused on determining the EOS for nuclear matter ranging from half to three times a nuclei’s saturation density—the density found at the core of all stable nuclei. By producing this comprehensive EOS, the team provided new benchmarks for the larger nuclear physics and astrophysics communities to more accurately model interactions of nuclear matter.

The team improved its measurements at intermediate densities that neutron star observations do not provide through experiments at the GSI Helmholtz Centre for Heavy Ion Research in Germany, the RIKEN Nishina Center for Accelerator-Based Science in Japan, and the National Superconducting Cyclotron Laboratory (FRIB’s predecessor). To enable key measurements discussed in this article, their experiments helped fund technical advances in data acquisition for active targets and time projection chambers that are being employed in many other experiments world-wide.   

In running these experiments at FRIB, Tsang and Lynch can continue to interact with MSU students who help advance the research with their own input and innovation. MSU operates FRIB as a scientific user facility for the U.S. Department of Energy Office of Science (DOE-SC), supporting the mission of the DOE-SC Office of Nuclear Physics. FRIB is the only accelerator-based user facility on a university campus as one of 28 DOE-SC user facilities .  Chun Yen Tsang, the first author on the Nature Astronomy  paper, was a graduate student under Betty Tsang during this research and is now a researcher working jointly at Brookhaven National Laboratory and Kent State University. 

“Projects like this one are essential for attracting the brightest students, which ultimately makes these discoveries possible, and provides a steady pipeline to the U.S. workforce in nuclear science,” Tsang said.

The proposed FRIB energy upgrade ( FRIB400 ), supported by the scientific user community in the 2023 Nuclear Science Advisory Committee Long Range Plan , will allow the team to probe at even higher densities in the years to come. FRIB400 will double the reach of FRIB along the neutron dripline into a region relevant for neutron-star crusts and to allow study of extreme, neutron-rich nuclei such as calcium-68. 

Eric Gedenk is a freelance science writer.

Michigan State University operates the Facility for Rare Isotope Beams (FRIB) as a user facility for the U.S. Department of Energy Office of Science (DOE-SC), supporting the mission of the DOE-SC Office of Nuclear Physics. Hosting what is designed to be the most powerful heavy-ion accelerator, FRIB enables scientists to make discoveries about the properties of rare isotopes in order to better understand the physics of nuclei, nuclear astrophysics, fundamental interactions, and applications for society, including in medicine, homeland security, and industry.

The U.S. Department of Energy Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of today’s most pressing challenges. For more information, visit energy.gov/science.