Search Results (1,964)

This study proposes a standards-based Reference AI Business Model Canvas (Reference AI-BMC) that translates the use-case descriptors of ISO/IEC TR 24030 into the nine blocks of the Business Model Canvas, addressing the lack of a structured translation layer between AI standards and business-model design. Using ten selected fields of the ISO/IEC TR 24030 use-case template, a two-round Delphi process derives consensus-based mapping rules from expert judgments; Latent Dirichlet Allocation is used as a field-level semantic analysis to provide interpretive context for the Delphi-derived mappings. Primary mappings are reported as default translation references that met the 80% strict-consensus threshold, secondary mappings as context-dependent relations, and the adjudicated dual-mapping exception A5 (Threats/Challenges → Cost Structure) as a separately documented case. After converting the finalized primary mapping rules into a coding manual, three independent coders applied them to 81 AI use cases; the Layer 1 coding yielded Krippendorff’s α = 1.000, descriptively indicating no observed coder disagreement under the specified coding conditions. The Reference AI-BMC contributes a standards-based, consensus-derived translation layer for systematically organizing AI use cases in business-model terms, offering a structured starting point for early use-case workshops, preliminary portfolio screening, and standards-aware AI service design discussions. Together, these results position the Reference AI-BMC as a standards-based, consensus-derived reference layer for organizing AI use cases in BMC terms, with its applicability bounded by the ISO/IEC TR 24030 descriptor structure and the specified mapping procedure. Full article

Most existing studies on winter tourism focus on destination development and resource evaluation, while systematic exploration of policy performance assessment remains insufficient. From the perspective of new institutional economics, this study innovatively introduces institutional change theory into the field of winter tourism policy evaluation. It deconstructs the three-dimensional evolution of policies—covering “design, implementation, and outcome”—and incorporates satisfaction feedback from four stakeholders: the government, tourism enterprises, local residents, and tourists. This establishes a systematic “three-dimensional, four-stakeholder” evaluation framework. To address the difficulty in obtaining policy performance data and improve the scientific rigor of empirical research, a combined subjective and objective weighting measurement system is adopted, integrating three core research instruments: the Delphi method is used to screen and confirm evaluation indicators and their connotations to ensure the rationality and pertinence of the evaluation system; the analytic hierarchy process (AHP) is applied to determine the weight of each evaluation indicator, realizing scientific and quantitative weighting of subjective and objective indicators; and questionnaire surveys are conducted to collect first-hand data on the satisfaction of the four stakeholder groups, providing empirical support for subsequent performance evaluation. This study surveyed 7 government staff, 15 tourism enterprise practitioners, 90 local residents, and 90 tourists, yielding 202 valid samples after screening. The results indicate that Lhasa’s “Winter Tour in Tibet” policy series achieved an overall effectiveness rating of B. Key deficiencies identified include insufficient public participation, low policy awareness, and weak ecological benefits. Consequently, it proposes localized optimization paths, such as “ecological winter tourism” and “targeted publicity”. This study establishes a theoretical framework for winter tourism policy evaluation, improves the methodological system for tourism policy research in special regions, provides a practical reference for the formulation and optimization of winter tourism policies in high-altitude ethnic areas, and expands the geographical coverage and theoretical boundaries of winter tourism policy research. Full article

Background: Human papillomavirus (HPV) is a serious infection which is primarily transmitted through sexual intercourse. Almost 100% of cervical cancers are caused by HPV. Limited awareness of HPV leads to delayed cancer diagnoses, significantly increasing mortality and morbidity rates. Aim: The purpose of this study was to develop strategies to increase awareness of human papillomavirus screening and vaccination among women in Limpopo Province, South Africa. Setting: This study was carried out in the Vhembe District of the Thulamela Municipality of Limpopo Province. Methods: The E-Delphi method was used, and the researcher used a quantitative approach. A total population of 15 nursing managers was part of the study. Questionnaires were used to collect data. Data were analysed using the statistical package for the social sciences version 26. Results: In Round 1, 8 (53.3%) of the 15 participants strongly supported the strategy of updating women with the most recently revised HPV screening guidelines. In Round 2, consensus was achieved, with 14 (93.3%) of the participants strongly agreeing that the development of teaching programmes in healthcare facilities is necessary. This indicates a strong convergence of expert opinion on the importance of structured educational interventions to support the implementation of the strategy. The consensus in this study was defined as ≥70% agreement between participants on each item. Conclusions: The lack of awareness of HPV is concerning because early detection and treatment can prevent serious health problems. The study used the E-Delphi method to assess the effectiveness of strategies to increase awareness of HPV screening and vaccination in women. Contribution: Health policy initiatives may improve public awareness of HPV and vaccination, especially by focusing on educating nurses, which could improve women’s awareness and encourage HPV screening and vaccination. Full article

As global urban centers transition into “Super-Aged Societies,” the paradigm of urban sustainability has shifted from mere housing provision to the development of Sustainable Care Retirement Communities (SCRCs). This study addresses a critical gap in the urban aging literature: the lack of culturally sensitive frameworks for social resilience in non-Western contexts. By integrating Hofstede’s Cultural Dimensions Theory, this research investigates how national culture influences the prioritization of community attributes within the “15 min city” framework. Methodologically, a hierarchical evaluation framework comprising 4 dimensions and 26 indicators was established. It employed the Fuzzy Delphi Method (FDM) to achieve expert consensus among stakeholders in Taiwan’s Long-term Care 3.0 ecosystem. Analysis using Double Triangular Fuzzy Numbers identified the “Charging Model,” “Staff-to-Resident Ratio,” and “Zoning with Care Continuity” as the highest-priority factors ($G^i$ ≥ 7.8). These results indicate that in cultures with high uncertainty avoidance, institutional financial stability and human-centric staffing are perceived as the structural bedrock of social resilience. Furthermore, the study highlights the emergence of AI-driven “Active Sensing” environments as a pivotal component of technical resilience, mitigating the loneliness epidemic while maintaining institutional efficiency. The findings suggest that social resilience in SCRCs is not merely a product of physical accessibility but is theoretically inferred by experts to be deeply rooted in the synergy of Bonding and Bridging Social Capital, rather than being a directly measured outcome. This research provides urban planners and policy-makers with a robust, evidence-based toolkit to design inclusive, resilient, and culturally aligned aging-in-place environments in the face of unprecedented demographic challenges. Full article

Objective: To evaluate and compare fetal arterial and venous Doppler parameters in early-onset (EO) and late-onset (LO) fetal growth restriction (FGR), and to assess their performance within the study cohort and their association with composite adverse neonatal outcome (CANO). Methods: This prospective observational cohort study included 184 singleton pregnancies between 24 and 37 weeks of gestation, comprising 91 FGR cases and 93 appropriate-for-gestational-age controls. FGR was defined according to Delphi consensus criteria and classified as EO-FGR (<32 weeks) or LO-FGR (≥32 weeks). All fetuses underwent standardized Doppler assessment of the umbilical artery (UA), middle cerebral artery (MCA), uterine artery (UtA), and ductus venosus (DV). The cerebroplacental ratio (CPR) was calculated. Multivariable logistic regression models were constructed separately for EO-FGR and LO-FGR. Classification performance was evaluated using receiver operating characteristic analysis. CANO was defined as at least one of the following: 5-min Apgar score <7, respiratory distress syndrome, neonatal intensive care unit admission, or preterm birth. Results: In both EO-FGR and LO-FGR, UA PI values were significantly higher, whereas MCA PI and CPR were significantly lower than in controls. CPR demonstrated the highest discriminative performance among arterial parameters in both subgroups. DV Doppler indices were not significantly different in EO-FGR. In LO-FGR, DV S-wave and v-wave velocities were independently associated with FGR. No significant associations were observed between Doppler parameters and CANO in subgroup analyses. Conclusions: Arterial Doppler parameters, particularly CPR, showed consistent alterations in both EO- and LO-FGR. The contribution of venous Doppler parameters differed according to clinical subtype, with additional value observed in LO-FGR. Full article

Background: Leukemic non-nodal variant mantle cell lymphoma (nnMCL) is an uncommon subtype of mantle cell lymphoma that lacks lymphadenopathy and generally follows an indolent clinical course. Adverse genetic alterations such as TP53 inactivation and del(13q) may have prognostic significance. Clinical findings such as splenomegaly may serve as a clue to the diagnosis and should prompt further evaluation. Case Presentation: We describe a 91-year-old woman who presented with a one-month history of anemia (hemoglobin 12.3 g/dL), mild thrombocytopenia (platelets 136 × 10⁹/L), isolated splenomegaly and no palpable lymphadenopathy. Despite a normal total white blood cell count, intermittent relative lymphocytosis with atypical lymphocytes (4%) and smudge cells was detected on the complete blood count. Peripheral blood flow cytometry demonstrated a monoclonal kappa-restricted B-cell population negative for CD5 and CD10, comprising approximately 20% of lymphocytes. Conventional karyotyping and fluorescent in situ hybridization (FISH) analysis identified del(13q), del(17p)/TP53, and IGH-CCND1 rearrangement in 8–19.5% of peripheral blood leukocytes. A month after the initial assessment, the patient presented following a fall. CT imaging of the abdomen revealed marked splenomegaly, a large subcapsular/perisplenic hematoma, and moderate-to-large hemoperitoneum. Emergent laparotomy showed an enlarged spleen (1490 g, 23 × 16 × 7.5 cm) with laceration. Histologic evaluation showed atypical lymphoid cells positive for CD20 and cyclin D1, with strong p53 expression, negative for CD5 and SOX11, and a low Ki-67 index. Similar involvement was identified in the small bowel and appendix. Targeted sequencing of splenic tissue, performed as part of a retrospective molecular characterization, identified a pathogenic TP53 variant (p.His179Gln). Conclusions: This case provides a rare opportunity to evaluate splenic and small intestinal involvement by nnMCL at both the gross and histologic levels. It highlights the importance of integrating clinical findings with flow cytometry, imaging, cytogenetic, and molecular data in establishing the diagnosis. Even when peripheral blood findings suggest a low disease burden, imaging may better define the extent of disease and support appropriate clinical assessment, particularly in elderly patients at risk for complications related to splenomegaly. Full article

Background: NexoBrid^® (NXB), an enzymatic debridement agent approved in Japan in 2022, provides a less invasive alternative to surgical excision for burn treatment. However, its optimal therapeutic benefit depends on appropriate patient selection and proper application technique. Existing international consensus documents are not fully applicable to clinical practice in Japan because of differences in available devices and drugs. Therefore, a Japan-specific consensus document was developed by a panel of seven Japanese burn experts, including four plastic surgeons and three emergency physicians. Methods: A questionnaire-based survey was conducted using the Delphi method to achieve expert consensus. Consensus was defined as agreement by at least 80% of committee members for each statement. A total of 27 statements were evaluated over two rounds. Results: Consensus was achieved for 20 of 27 statements (74.1%) in the first round and for 21 of 27 statements (77.8%) in the second round. The finalised statements were organised into seven categories according to their attributes: indications, pain management, application timing, application technique, post-application wound care, skin grafting, and scarring/aesthetic outcomes. Conclusions: This consensus document integrates the opinions of plastic surgeons and emergency physicians in Japan, while also incorporating relevant international perspectives, to provide practical guidance on the use of NXB for burn treatment. It is intended to improve the quality of burn care by clarifying efficacy, safety, and precautions associated with NXB use. These recommendations should be updated as further clinical experience accumulates. Full article

Background: Over the past ten years, enzymatic debridement has been used more often to treat burn injuries in the UK and Europe. Even though it is increasingly adopted, there are still major differences in how it is practiced. These differences are mainly due to varying levels of professional experience, differences in the interpretation of available evidence, and concerns about safety and effectiveness. Methods: To help resolve these issues and create more consistent care, the UK National Consensus Working Group was formed. This group brought together burn care experts from different backgrounds to review current methods, published research, and consensus guidelines. They used a structured approach that included educational webinars, a thorough review of the literature, and a national survey using the Delphi method to gather expert opinions and real-world experiences. Results: As a result of this process, the UK Consensus Statement for the Use of Enzymatic Debridement in Burn Care was created and officially approved after extensive consultation at national meetings. The main recommendations focus on safely and effectively including enzymatic debridement in burn care, the need for clear procedures, and identifying areas where further research is needed, such as patient outcomes and dressing methods. Conclusions: The goal of this consensus statement is to unify practices, guide future research, and support ongoing improvements in burn care throughout the UK. Full article

Capsizing, sinking, and flooding accidents occurring in the coastal waters of the Republic of Korea constitute a persistent marine safety concern, accounting for approximately 17% of total fatalities associated with marine accidents. Previous statistical analyses of accident causation have identified key contributing factors such as adverse weather conditions, improper cargo loading, and deficiencies in vessel maintenance; however, the complex interdependencies among these factors have not been sufficiently quantified. To address this limitation, this study proposes a fuzzy Bayesian network (FBN) model to systematically evaluate and quantify the risk factors associated with capsizing, sinking, and flooding accidents. A total of 164 adjudicated marine accident cases that occurred in Korean coastal waters over a 10-year period (2015–2024) were analyzed (data collection cutoff: 31 December 2024) to estimate prior probabilities for six major causal categories. Conditional probability tables (CPTs) were derived through a structured Delphi survey conducted with marine safety experts possessing more than 10 years of professional experience. To mitigate the subjectivity inherent in expert judgment, triangular fuzzy numbers (TFNs) and centroid-based defuzzification were applied. Sensitivity analysis identified sea state (SI = 0.0155) and cargo loading condition (SI = 0.0125) as the two most influential factors affecting the probability of capsizing. Scenario analysis further revealed that when adverse weather conditions and improper cargo loading occur simultaneously, the probability of capsizing increases to 39.3%, representing a 5.3 percentage point increase compared to the baseline. In addition, the model demonstrated a close agreement with observed accident outcome distributions, with a Kullback–Leibler (KL) divergence of 0.038, indicating differences within 1.3 percentage points across all outcome categories. The findings of this study provide practical implications for targeted marine safety interventions and the prioritization of regulatory measures in the coastal waters of the Republic of Korea. Full article

Forensic accounting faces increasing complexity as reactive approaches fail to address escalating risks. This study pioneers a Proactive Risk Intelligence Framework (PRIF) for Chartered Accountant (CA) firms, targeting gaps in risk anticipation, stakeholder communication, and compliance. Employing mixed-method-design interviews with 30 risk advisors, case studies, and analysis of 30 forensic reports, the PRIF was developed and validated using thematic coding, risk metrics, and Delphi panel refinement. Integration of AI and blockchain reduced the risk detection time from 47 days post-event to 9–22 days pre-event, with accuracy increasing from 62% to 89–94%. The Stakeholder Communication Index (SCI) revealed a strong correlation (r = 0.83) between report quality and client retention (91% for high SCI vs. 54% for low SCI). PRIF adoption reduced compliance resolution time by 58% and financial misstatements by 47%, yielding an average ROI of 83%. This integrated framework combines real-time monitoring, stakeholder-centric reporting, and dynamic compliance for CA firms. While the findings are based on India-focused samples, practical benefits include scalable toolkits for firms and policy guidance for regulators with a broader impact on financial governance. PRIF shifts forensic accounting from reactive detection to proactive prevention, advancing stakeholder trust and industry standards. Full article

The transformation of the hospitality industry has increased the demand for managerial profiles capable of integrating technical, strategic, and socio-emotional competencies. However, a persistent gap remains between the competencies required by the labor market and those developed through formal education. This study aims to identify and validate the core competencies of hotel management and to translate them into a structured training proposal. A two-round Delphi study was conducted with senior hotel management experts (n = 42 in round 1; n = 32 in round 2), using a competency matrix derived from prior research. Quantitative analysis included frequency distributions, weighted scores, and consensus indicators. The results show a high level of consensus stability (3.1% disagreement), leading to a final matrix of 43 competencies organized into four dimensions: operational, interpersonal, cultural-communicative, and strategic. Interpersonal and leadership competencies emerged as the most prominent, highlighting their structural role in effective managerial performance. Based on these findings, a progressive training framework is proposed, structured around three domains (operations, leadership, and strategy) and supported by a metacognitive pathway that integrates planning, monitoring, and evaluation processes. This study contributes to the professionalization of hotel management by providing an empirically grounded competency model and a coherent framework for aligning educational programs with industry demands. Full article

Full-arch implant-supported rehabilitations are widely recognized as an effective treatment option for edentulous patients. Nevertheless, clinical decision-making regarding patient selection, surgical planning, prosthetic material choice, and long-term maintenance protocols remains heterogeneous and requires structured evidence-based guidance. A modified Delphi consensus process was conducted involving 29 experts during the Italian Consensus Conference. A systematic literature review covering the period 2015–2024 was performed, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Consensus was predefined as ≥90% agreement. Seven evidence-based consensus statements were developed addressing: (1) periodontal risk assessment using validated tools; (2) guided bone regeneration outcomes with technique-specific indications; (3) comparative survival of four versus six implants in mandibular full-arch rehabilitations; (4) equivalence of tilted and axial implant configurations; (5) prosthetic material selection, with monolithic zirconia showing high survival; (6) risk-stratified supportive maintenance protocols associated with a reduction in peri-implantitis incidence; and (7) systemic risk stratification, including absolute and relative contraindications, medication-related osteonecrosis of the jaw (MRONJ) risk management, and perioperative antibiotic prophylaxis. Full article

The rapid expansion of the new energy vehicle (NEV) market underscores a critical gap in the absence of a scientific health evaluation method for official inspections and annual checks. To address this, our study develops a comprehensive and quantitative health calibration system tailored for four specific application scenarios: annual inspection, battery health assessment, maintenance, and used car evaluation. Utilizing the Delphi method and Fuzzy Analytic Hierarchy Process (FAHP), we propose a construction method for a hierarchical and quantitative evaluation system. For each scenario, an independent quantitative evaluation table is established, identifying key indicators through a combination of specific operational contexts and expert opinions. The FAHP is then applied to determine the precise weights of these selected indicators, yielding a clear weighting structure for health metrics across different scenarios. This work culminates in a quantitative evaluation methodology for the health degree of in-use NEVs. By extending vehicle service life, reducing premature battery degradation, and enhancing safety, the proposed system directly supports the sustainable development of the NEV industry. It contributes to resource conservation, lower environmental impact, and greater consumer trust in green transportation. The proposed system is significant for fostering the healthy development of the NEV industry, enhancing vehicle safety and reliability, promoting technological progress, and strengthening consumer purchase confidence. Full article

The construction sector is a major consumer of raw materials and a significant source of greenhouse gas emissions, necessitating data-driven approaches to support circular economy implementation and sustainable project management. This study develops an integrated framework combining machine learning-based material stock prediction, carbon footprint assessment, and Environmental, Social, and Governance (ESG) performance evaluation for construction projects. A dataset of 128 residential buildings was compiled from official use-permit documentation. After dimensionality reduction using variance filtering and Spearman correlation analysis, 25 regression algorithms were evaluated to estimate quantities of concrete, reinforcement, and brick products. The K-Nearest Neighbor (KNN) Regressor achieved the best predictive performance, with mean absolute percentage errors of 10.64% for concrete, 10.23% for reinforcement, and 16.05% for brick products. Predicted material quantities were used to calculate CO₂ emissions across materialization, demolition, and disposal phases under linear and circular scenarios. The results indicate that circular economy implementation significantly reduces total emissions, particularly for concrete, with reductions of up to 97% under idealized full-substitution conditions, representing an upper-bound estimate. ESG assessment using the Delphi method identified environmental indicators as the most significant sustainability dimension. The proposed framework enables early-stage emission estimation and supports informed decision-making toward low-carbon and resource-efficient construction practices. Full article

Disasters pose severe threats to life, livelihoods, and socioeconomic stability globally, with disproportionate impacts on vulnerable groups. Despite growing recognition of the importance of citizen engagement in disaster risk reduction and resilience (D3R), existing participatory frameworks remain fragmented, predominantly top-down, and unsustainable beyond project funding cycles. There is a recognised need for an integrated conceptual framework that aims to systematically embed co-design and co-create principles into D3R governance while aiming to ensure the inclusion of vulnerable populations. This paper addresses this gap by presenting the Co-Design Co-Create Framework (CCF), a conceptual institutional model for citizen engagement in D3R. The CCF comprises six iterative phases—KNOW, RAISE AWARENESS, CO-DESIGN CO-CREATE, OUTREACH, KEEP ENGAGED, and EVALUATION—organized as a Living Lab ecosystem. Distinctive conceptual innovations include a Disaster Assembly mechanism designed to promote long-term sustainability through polycentric governance, explicit inclusion of vulnerable groups via Social Vulnerability Index assessment, proposed dual production of co-created policies and co-designed tangible solutions, and participatory tools including Policy Delphi and Storytelling. Unlike conventional time-bound initiatives, the CCF is designed to address critical gaps in existing disaster risk reduction (DRR) practices through embedded sustainability mechanisms, citizen empowerment aimed at Arnstein’s highest participation level, systematic knowledge-to-product translation, and bottom-up planning principles. This conceptual framework conceptualises disaster resilience as a continuously evolving, socially legitimate, and just process anchored in durable governance structures. Empirical validation through field implementation constitutes a direction for future research. Full article