Search Results (1,725)

Background: Disease-related malnutrition (DRM) remains an underdiagnosed condition in Latin American hospitals, with substantial clinical and economic consequences. The global nutritionDay initiative, promoted by ESPEN, provides a standardized audit to evaluate and improve hospital nutritional care. This study aimed to develop expert consensus recommendations to optimize the nutritional care process in Guatemalan hospitals, based on the findings from nutritionDay 2022. Methods: A modified Delphi study was conducted, including three meetings held before and after each round to discuss the results. Sixteen clinical nutrition professionals from eleven hospitals participated. A total of 89 items were assessed, with a predefined consensus threshold of 70%. Data were analyzed using R software (version 4.5.0) and Kendall’s W coefficient was applied to evaluate inter-round agreement. Results: Consensus was achieved for 51 key recommendations covering nutritional screening, clinical assessment, anthropometry, body composition, functional assessment, biochemical monitoring, dietary intervention, and post-discharge follow-up. The proposed actions are aligned with international guidelines (ESPEN, ASPEN, GLIM) and adapted to the Guatemalan healthcare context. Conclusions: This consensus provides a comprehensive and context-specific framework for standardizing and improving hospital nutritional care in Guatemala and similar settings. Its implementation could help reduce DRM prevalence and foster the development of quality indicators and digital tools for clinical nutrition management. Full article

Small and medium-sized enterprises face significant challenges in effectively implementing design thinking due to limited resources, leadership skepticism, and a paucity of suitable frameworks. This study addresses these challenges by developing and validating a web-based Design Thinking and Innovation Strategy Toolbox tailored to SME needs. The Toolbox is designed to align with the ISO 56001:2024 Innovation Management Systems standard and was developed through systematic literature reviews and expert interviews, shaping practical modules based on previously identified barriers and success factors. A multi-round Delphi study with 14 experienced consultants refined the Toolbox, focusing on usability, ISO compliance, and practical relevance. The results indicate strong consensus among experts regarding its clarity, adaptability, and alignment with SME constraints, while also highlighting areas for improvement such as visual design and continuous feedback mechanisms. Preliminary validation suggests that the Toolbox can support SMEs in improving sustainable innovation, strategic alignment, and capability development. By addressing contextual constraints, this research contributes to the field of design-led innovation in SMEs by offering a practical, ISO-compliant tool that connects theory and practice in resource-limited environments. Full article

The aim of this study was to identify and explore the most significant barriers in implementing smart manufacturing (SM) in terms of small and medium enterprises (SMEs). A two-round Delphi method was used to uncover them in this regard. To assess the reliability of the obtained results, Cronbach’s alpha, Intraclass correlation coefficient, and a statistical F-test were performed for both rounds. Cronbach’s alpha for round 1 was 0.729, and 0.816 for round 2. On this basis, good inter-rater reliability was demonstrated in round 2. At the same time, the Intraclass correlation coefficient from round 1 was 0.54, and from round 2, it was 0.74, indicating a significant improvement in panel consensus. The comparison of the equality of variances within the two rounds using the F-test confirmed that a third round of the survey was not necessary. Moreover, the coefficient of variation and relative interquartile range were applied to assess internal consistency among the involved experts to come to a more comprehensive and cohesive understanding of the issue at hand. A total of 30 barriers/limitations or shortages were identified in the preparatory phase of the research, which, in some sense, do not allow or slow down the implementation of the SM. The Delphi survey found that financial problems, lack of government support, and technological constraints can be considered as the most serious barriers to the implementation of SM in an SME environment. Finally, the obstacles/constraints or shortcomings that proved to be the most critical were analyzed in terms of their impact on the ability of small and medium-sized enterprises to embrace the challenges of smart manufacturing. Full article

Background/Objectives: Childhood eye disorders, including refractive errors, strabismus, and amblyopia, are prevalent yet often underdiagnosed in Saudi Arabia. Limited data on barriers to pediatric eye care hinder efforts to optimize service delivery. This study aimed to identify barriers to accessing pediatric eye care and to develop consensus-based strategies for improvement. Methods: A Delphi technique involving three iterative rounds of questionnaires was conducted with a panel of 22 eye care experts across Saudi Arabia. Consensus was defined as ≥80% agreement among participants. In total, 30 statements were developed from thematic analysis of open-ended responses and a supporting literature review. Panelists rated each statement on a five-point Likert scale, and descriptive statistics were applied. Internal consistency across rounds was assessed using Cronbach’s alpha. Results: Of the 30 proposed statements, 25 (83.3%) reached consensus, with a mean agreement score of 4.45 ± 0.59. Internal consistency was high (Cronbach’s alpha = 0.92). High-priority recommendations included implementing mandatory vision screening, integrating optometrists into primary healthcare, and establishing specialized pediatric eye care centers. Other recommendations emphasized expanding mobile clinics and increasing public awareness. Areas that did not reach consensus included referral inefficiencies, adequacy of the current workforce, and school accommodations for children with visual impairment. Conclusions: This study presents the first national consensus on pediatric eye care in Saudi Arabia and provides actionable recommendations to strengthen services. The findings offer a strategic framework to guide policy, enhance workforce development, and reduce childhood visual impairment through early detection and intervention. Full article

Climate change is increasingly affecting the aquaculture sector, particularly in estuarine systems that support high-value production. In the Galician Rías Baixas, where shellfish farming is a cornerstone of the coastal economy, rising sea temperatures, sea-level rise, and changing precipitation patterns pose significant risks to mussel aquaculture. This study presents a spatially explicit Aquaculture Suitability Similarity Index (ASI) designed to identify alternative cultivation areas that replicate the environmental and logistical characteristics of historically successful mussel farms. The ASI integrates a set of environmental variables (water temperature, salinity, biogeochemical quality, current velocity, and wave height) and technical constraints (depth and distance to port), with factor weights derived via expert elicitation using the Delphi method. Results show that most waters are highly similar to current farming areas, suggesting strong potential for spatial expansion or relocation. In contrast, areas near the mouths of the rías and the adjacent continental shelf show lower suitability due to greater oceanic exposure and associated logistical challenges. The ASI provides a robust, transferable tool to inform aquaculture spatial planning and climate adaptation strategies. Its methodological framework can be adapted to other regions and species, supporting evidence-based decision-making for sustainable aquaculture development. Full article

Background/Objectives: Childbirth is a natural and joyfully anticipated life event for parents and relatives. Yet, in some cases, it can be a medical emergency requiring immediate intervention, i.e., neonatal resuscitation. The majority of newborns breathe spontaneously; a small number, though, may receive basic life support (assisted transition), and an even smaller but clinically significant number require advanced life support (resuscitation). Within the context of family-centered care, the presence of parents during resuscitation has emerged as a factor with potential implications for emotional adjustment, communication with healthcare providers, and early parent–infant bonding. However, the presence of family members during neonatal resuscitation remains a subject of ongoing debate among healthcare professionals (HCPs). Despite increasing recognition of its potential benefits, HCPs’ views on parental presence during such critical procedures have not been extensively investigated in Greece. This study aims at developing and validating a tool to assess healthcare professionals’ views on parental presence during neonatal resuscitation. Methods: A preliminary questionnaire was developed based on the principles of family-centered care and adapted to the Greek population. The first phase included expert assessment of validity, clarity, and relevance using a modified Delphi method. Item Content Validity Index (I-CVI) and Scale CVI (S-CVI) were calculated. Pilot testing was conducted to assess test–retest reliability. Reliability was assessed using the Intraclass Correlation Coefficient (ICC) and Bland–Altman analyses. The study followed the principles of the Declaration of Helsinki, ensuring anonymity, informed consent, and confidentiality. Results: The questionnaire includes 37–50 items allocated in four sections. It demonstrated excellent content validity (CVI = 1.00) and good test–retest reliability (ICC = 0.86). Qualitative feedback indicated that the tool is user-friendly and comprehensive. Interestingly, participants expressed genuine concerns regarding the implementation of parental presence in neonatal resuscitation. Conclusions: The questionnaire development process led to a comprehensive tool, ready for large-scale testing in order to further establish its validity and internal consistency. Full article

Rapid urbanization and aging population present global challenges for smart cities, especially for equitable pandemic response and age friendly urban transitions. This paper through a two-round Delphi study assessed Amman’s efficiency in pandemic response focusing on digital inclusion for older adults and critical barriers to age-friendly urbanism. The results indicate moderate satisfaction with Amman’s overall pandemic response alongside significant limitations, particularly in digital equity for older adults. Key systemic barriers included compromised air quality, inadequate public transportation, notably poor public Wi-Fi, and deficient digital infrastructure. Furthermore, political and financial obstacles, such as high living costs and low governance transparency, significantly hindered progress. Experts prioritized solutions emphasizing improved physical accessibility, expanded green spaces, and enhanced digital literacy. This study underscores the urgent need for integrated, multi-dimensional strategies, including participatory governance and targeted digital inclusion programs, to foster sustainable and equitable smart city development that enhances resilience and inclusiveness for aging populations in post pandemic urban planning contexts. Full article

Biophilic design (BD) has become one of the most critical design approaches for improving the user experience and sustainability in hospitality settings. This paper examines how Biophilic Design Elements (BDEs) can be integrated into the interior architecture of rooftop restaurants and how the presence of BDEs can enhance guest satisfaction and restaurant operations. The study is based on the Nature Preferences Theory (NPT) and Dynamic Capabilities Theory (DCT), creating a framework that explores the relationship between biophilic principles and measurable user outcomes, as well as design innovation. A mixed-methods design was employed, where qualitative insights gathered from a Delphi panel of interior design and hospitality professionals were integrated with quantitative data collected through guest surveys. The study suggested that some high-performance BDEs, which are natural materials, utilise daylight, greenery, and water, as well as culturally embedded design motifs. The results indicate that users are positive about an environment with principles of well-being, authenticity, and sensory connection with nature. Researchers focused on context-sensitive, flexible, and low-cost strategies that are adaptable to rooftops in developing urban cities. The study is significant as it presents real-life biophilic design methods applicable in hospitality environments atop buildings and demonstrates how they may align with the Sustainable Development Goals (SDGs). The suggested framework applies to both academic studies and the industry, focusing future designs on nature, user experience, and operational sustainability. Full article

The European Union’s (EU) Farm to Fork strategy seeks to reduce agricultural pesticide use by 50%, both of total pesticide use and of the most hazardous chemicals. While Ireland has achieved the goal of overall pesticide use reduction, more progress is needed regarding more hazardous substances. Ireland’s cool damp climate is unique within the EU, and with little empirical data on the possible impacts of achieving this goal on Irish farming, we sought to estimate these in cereal crops using a ‘Delphi’ style iterative expert panel methodology, conducted over two rounds, rather than until consensus was reached, to allow for knowledge gaps that may exist to become apparent. A total of 17 crop production experts with at least five years of relevant experience were surveyed anonymously, and then their answers were compiled and fed back to them, allowing participants to revise their responses based on the opinion of the group. Participants estimated that reduced use of more hazardous fungicides and insecticides could both reduce yields by 10–15%, while reduced use of herbicides would reduce yields of winter cereals by up to 30%. These impacts are substantially higher than those predicted in other Europe-wide studies. Application of additional Integrated Pest Management measures was estimated to reduce yield loss but not entirely mitigate it. These findings highlight the economic and food security trade-offs that may be required to achieve the Farm to Fork strategy’s goals. Full article

The tangible and intangible heritage of a region can form the basis for innovative tourism models capable of fostering sustainable development in a specific local area. In this context, thematic trails are increasingly recognized as a tool for connecting tourism to local heritage, although they tend to focus on food and wine itineraries, avoiding the development of structured models that can be replicated in other production chains. This study aims to fill this gap by proposing a scalable framework for designing thematic tourism itineraries that integrate and enhance local heritage. Inspired by the “Destinazione Impresa” model, the proposed framework emphasizes community engagement and multilevel collaboration among stakeholders as key factors for sustainable and localized tourism. The framework was tested in two rural areas of Piedmont (Italy) selected for their distinctive productive traditions and limited exposure to mass tourism: Moncucco Torinese, linked to the gypsum supply chain, and the Biellese area, linked to dairy production. The participatory methodology employed, based on the Delphi method, confirmed the willingness of local stakeholders to co-design thematic trails. Findings highlight the potential of thematic trails to enhance economic diversification, foster community participation and preserve local identity, while offering a practical and transferable methodology for sustainable tourism development in underexplored areas. Full article

Laser trepan drilling and laser helical drilling are typical methods for fabrication of micro through-holes through scanning laser beam. In the drilling process, the subsequent laser pulse may be occluded by the edge and the sputter deposition at the edge of the previous drilled trench. Dynamic focus feeding and widening path can be employed to lessen the occlusion effect and both of them are always employed in laser helical drilling. However, Widening the trench needs to remove more volume of material and may bring certain negative effects such as lowering the recoil pressure as well as less splashing melt due to the limited constraint of trench wall. The effects of dynamic feeding the focal plane and widening the scanning path on the quality and efficiency in the nanosecond laser drilling process were investigated through laser drilling holes with diameter of 500 μm on a 300 μm thick GH4169 plate. Results show that dynamic focus feeding is beneficial in both drilling efficiency and drilling quality. Through laser helical drilling with dynamic focus feeding, micro through-hole can be fabricated in 5 s, and both smaller tilting angle of 0.073 rad and smaller heat-affected zone of 0.63 mm in radius can be obtained. Widening scanning path is helpful to perforating rapidly but leads to much more recast layer coating. the quality of the micro through-holes depends not only on the utilization efficiency of the laser energy, but also on high temperature spatter deposition, which is the source of the difference between different drilling strategies. Due to the low cost in equipment and the better hole quality, the laser drilling, especially laser helical drilling, has potential applications ranging from aerospace fields to normal fields such as the agricultural machinery industry. Full article

Vessel arrival priority determination is a critical factor affecting port safety and efficiency in maritime traffic management, yet existing approaches relying on First Come, First Served (FCFS) principles or empirical judgment have limitations in systematic decision-making. This study aims to develop a systematic decision-making framework that overcomes these limitations by creating an automated, expert knowledge-based priority determination system for vessel traffic services. A dynamic score-based vessel arrival priority determination model was developed integrating the Delphi technique and Fuzzy Analytic Hierarchy Process (Fuzzy AHP). Basic score evaluation factors were derived through Delphi surveys conducted with 50 field experts, and weights were calculated by differentially applying Fuzzy AHP and conventional AHP according to hierarchical complexity. The proposed model consists of a dynamic scoring system integrating basic scores reflecting vessel characteristics and operational conditions, special situation scores considering emergency situations, and risk scores quantifying safety intervals between vessels. To validate the model performance, simulation-based evaluation with eight scenarios was conducted targeting experienced VTS (Vessel Traffic Services) officers, demonstrating strong agreement with expert judgment across diverse operational conditions. The developed algorithm processes real-time maritime traffic data to dynamically calculate priorities, providing port managers and maritime authorities with an automated decision support tool that enhances VTS management and coastal traffic operations. Full article

Given the tourism industry’s pivotal role in the global economy and its substantial environmental and socio-cultural impacts, advancing sustainable tourism development has become imperative. While existing research has largely focused on theoretical perspectives and sectoral organizations have issued best-practice guidelines, few studies have examined how industry professionals actively influence and implement sustainability measures. Consequently, research that bridges theoretical analysis with practical application remains scarce. This research addresses this gap by proposing a strategic action plan to guide Spain’s tourism sector toward a more sustainable model. Using a mixed-methods approach, it combines insights from a Delphi panel of experts with an in-depth review of scholarly and professional literature. The findings lead to a set of targeted initiatives aligned with the eight axes of Spain’s Sustainable Tourism Strategy 2030, aimed at strengthening the social, economic, environmental, and institutional dimensions of national tourism development. The expert panel emphasized the need for stronger regulatory standards and improved public–private collaboration as critical enablers of sustainability. This study also identifies key structural shortcomings within the sector and provides actionable policy recommendations to support stakeholders and policymakers in advancing sustainable tourism practices in Spain. Full article

With the ongoing advancement of urban renewal and cultural tourism, public spaces within historic cultural districts face dual challenges of structural complexity and diverse user demands. There is an urgent need to establish a scientific, user-oriented evaluation system to enhance spatial quality and user satisfaction. This study takes the Nanhesha Historic and Cultural Quarter in Yangzhou as a case study, focusing on two primary user groups: tourists and local residents. Employing semi-structured interviews and grounded theory, it distils a demand evaluation framework comprising four dimensions—spatial structure, environmental perception, socio-cultural aspects, and facility systems—with a total of 21 indicators. Subsequently, employing the Delphi method, experts were invited to refine the indicators through two rounds of deliberation. The Kano model was then applied to classify the demand attributes of different groups, identifying five common demands and sixteen differentiated demands. These were categorised into three sensitivity levels. Further integrating the Satisfaction Increment Index (SII), Dissatisfaction Decrement Index (DDI), and sensitivity values, a two-dimensional prioritisation model was constructed. This yielded a unified three-tier priority system alongside independent ranking frameworks for each user group. Findings reveal that visitors prioritise immediate experiential attributes such as spatial accessibility, appropriate scale, and environmental cleanliness, whereas residents favour long-term usage-oriented aspects including cultural expression, convenient facilities, and climate adaptability. This research not only enriches the theoretical framework for studying public space perception in historic cultural districts but also provides actionable evaluation criteria and practical pathways for multi-stakeholder spatial optimisation design. It offers guidance for the high-quality, refined development of public spaces within historic quarters. Full article

The governance of artificial intelligence (AI) in education requires theoretical grounding that extends beyond system compliance toward outcome-focused accountability. The EU AI Act classifies AI-based learning outcome assessment (AIB-LOA) as a high-risk application (Annex III, point 3b), underscoring the importance of algorithmic decision-making in student evaluation. Current regulatory frameworks such as GDPR and ALTAI focus primarily on ex-ante and system-focused approaches. ALTAI applications in education concentrate on compliance and vulnerability analysis while often failing to integrate governance principles with established educational evaluation practices. While explainable AI research demonstrates methodological sophistication (e.g., LIME, SHAP), it often fails to deliver pedagogically meaningful transparency. This study develops the XAI-ED Consequential Assessment Framework (XAI-ED CAF) as a sector-specific, outcome-focused governance model for AIB-LOA. The framework reinterprets ALTAI’s seven requirements (human agency, robustness, privacy, transparency, fairness, societal well-being, and accountability) through three evaluation theories: Messick’s consequential validity, Kirkpatrick’s four-level model, and Stufflebeam’s CIPP framework. Through this theoretical integration, the study identifies indicators and potential evidence types for institutional self-assessment. The analysis indicates that trustworthy AI in education extends beyond technical transparency or legal compliance. Governance must address student autonomy, pedagogical validity, interpretability, fairness, institutional culture, and accountability. The XAI-ED CAF reconfigures ALTAI as a pedagogically grounded accountability model, establishing structured evaluative criteria that align with both regulatory and educational standards. The framework contributes to AI governance in education by connecting regulatory obligations with pedagogical evaluation theory. It supports policymakers, institutions, and researchers in developing outcome-focused self-assessment practices. Future research should test and refine the framework through Delphi studies and institutional applications across various contexts. Full article