Search Results (418)

The growing urgency of resource-efficient construction in water-stressed and rapidly urbanizing regions necessitates integrated decision support frameworks that move beyond isolated sustainability metrics. This study operationalizes the water-energy nexus within building design evaluation by developing a structured hybrid multi-criteria decision-making (MCDM) framework tailored to the Indian construction context. Unlike conventional sustainability assessments that treat water and energy independently, the proposed approach integrates life cycle-based water consumption, operational and embodied energy demand, environmental impacts, economic feasibility, and project constraints within a unified analytical hierarchy. A Delphi-validated criterion structure comprising five main criteria and twenty sub-criteria is weighted using the Analytic Hierarchy Process (AHP), and ranked using the VIKOR compromise solution method. To strengthen methodological robustness, ranking outcomes are validated across three independent MCDM logics including TOPSIS, PROMETHEE, and COPRAS. The framework evaluates four representative building strategies aligned with Indian regulatory and certification systems (NBC, ECBC, IGBC/GRIHA, and net-zero water-energy design). Using expert-informed weights derived from a Delphi–AHP involving a panel of experienced practitioners, the VIKOR compromise ranking consistently identifies the net-zero alternative as the most favorable option within the evaluated framework. The results are therefore interpreted as an expert-informed assessment demonstrating the applicability of the proposed decision support methodology rather than as statistically generalizable priorities for the entire Indian construction sector. The study contributes by (i) embedding nexus-based resource interdependence into building-level MCDM modeling, (ii) enhancing transparency through explicit benefit-cost classification and decision matrix disclosure, and (iii) demonstrating ranking stability across multiple validation techniques. The proposed framework provides a transferable methodological approach that can be adapted to different regional contexts through locally derived expert inputs. Full article

Tourism destinations are constantly invoking culture into the sustainability agenda, yet existing tourism sustainability indicator frameworks overemphasize environmental and economic metrics, and cultural identity is often marginalized or addressed through fragmented heritage measures, thereby restricting tourism destinations from effectively evaluating their potential to sustain and reinforce identity within the context of sustainable cultural tourism. In this view, cultural identity potential (CIP), defined as a destination’s capacity to sustain and transmit cultural identity in cultural tourism, remains under-operationalized in existing destination assessments. To address this gap, this study develops a comprehensive indicator-based framework to assess the cultural identity potential in sustainable cultural tourism. A two-phase design method was adopted: (1) a multi-step process to scope sustainable cultural tourism dimensions and operationalize CIP into criteria and indicators; and (2) a modified Delphi technique to refine and validate key criteria and indicators. A regional panel of 25 academic and non-academic experts participated in round 1, while 18 participated in round 2. The finalized framework comprises 39 criteria and 110 indicators (79% of the initial 139 items) across the destination management, economic, social, cultural, and environmental dimensions. Consensus increased across rounds, demonstrating convergence, with stability testing demonstrating that 91.2% of the re-rated indicators did not change significantly (p ≥ 0.05), supporting consistency of retained items. Overall, the CIP framework provides a policy-ready tool for evaluating and monitoring cultural identity potential in Cross River State and similar regions, serving as a reference for practitioners in sustainable cultural tourism development. Full article

Integrating health-oriented physical activity into community-scale walking environments is a key strategy for promoting healthy aging within sustainable urban development. However, community walking environments are often planned and managed without systematic evaluation frameworks to determine whether daily walking conditions effectively support health-oriented physical activity. To address this gap, this study proposes a planning-oriented health effectiveness assessment framework that translates exercise prescription principles into spatial, functional, and managerial performance indicators. Based on the Frequency, Intensity, Time, Type, Volume, and Progression (FITT-VP) exercise prescription framework, a multi-method approach was adopted. Evaluation indicators were identified through a structured literature review and refined using the Delphi method. User perception differences were incorporated using the Kano model, and the Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) was applied to quantitatively evaluate and rank the health effectiveness of community walking environments. The framework was empirically tested through a case study of Binshui communities in the Jimei District of Xiamen, China. The outcomes imply that priority indicators include progression route planning integrity, interval training feasibility, multifunctional training area match, monthly maintenance frequency, nighttime illumination uniformity. Community walking environments can function as effective everyday planning instruments for promoting physical activity among aging populations when exercise science principles are systematically embedded into urban design and management. By operationalizing exercise prescription principles as planning performance criteria, this study advances sustainable urban planning research and provides an evidence-based assessment tool for age-friendly neighborhood regeneration and community health governance. Full article

The growing demand for sustainable development has exposed significant limitations in how Higher Education Institutions (HEIs) evaluate sustainability-oriented research, particularly due to fragmented indicators, descriptive approaches, and the absence of robust data-driven assessment frameworks. This study proposes a comprehensive framework for evaluating the sustainability orientation of university research models, integrating validated measurement instruments with advanced analytical and predictive techniques to support evidence-based decision-making in higher education governance. The framework is based on a multidimensional instrument comprising 26 indicators across environmental, social, economic, and institutional dimensions, developed through expert judgment using the Delphi method and statistically validated through Confirmatory Factor Analysis (CFA). The instrument was applied to 260 researchers from four public HEIs located in the Colombia–Ecuador border region, and perceived performance was contrasted with actual institutional indicators, revealing significant nonlinear discrepancies. To address this complexity, an artificial neural network model was developed to estimate real sustainability performance based on survey data, achieving a predictive accuracy of 90.92%. Beyond institutional diagnosis, the proposed framework functions as a decision-support tool that enables HEIs to identify critical gaps, prioritize interventions, and guide continuous improvement strategies in research management. Due to its methodological rigor, scalability, and transferability, the framework can be adapted to diverse higher education contexts, contributing to the advancement of sustainability assessment methods and governance practices in universities. Full article

Against the backdrop of intensified global talent competition, the return of overseas talents has become a key engine driving the enhancement of core competitiveness in developing countries. Accurately identifying its critical driving factors is essential for China to address the challenges of talent introduction. This study constructs a hybrid multiple-criteria decision-making framework to systematically explore the influence mechanism of overseas talent return: first, a 15-criterion decision structure covering economic, policy, educational, technological, and social aspects is established via systematic literature review and two-round Delphi expert surveys; second, the grey DEMATEL-ANP technique is adopted to quantify the inter-relationships and relative weights of the criteria and screen and rank the critical driving factors accurately. Empirical results show that the six core driving factors ranked by importance are talent policy support, economic development level, scientific and technological development strength, public service quality, educational resource supply, and attention to science and technology, with significant synergistic interaction effects among these factors. This research provides a scientific decision-making framework and empirical support for developing countries to formulate targeted talent introduction policies and optimize the talent development ecosystem. Full article

Cost overrun is a major challenge in the construction industry. However, there is a notable lack of data from empirical studies that exhaustively identify and analyze risk factors contributing to overruns. This study aims to address this gap by systematically identifying and analyzing these risk factors. A hybrid methodology was employed. It combined a systematic literature review, a three-round Delphi process, and fuzzy set techniques. Insights from the literature review informed the first-round Delphi questionnaire. Subsequent rounds were refined based on earlier results. In the third round, experts’ opinions on the likelihood and impact of the cost risk factors were collected using a 5-point Likert scale. Finally, a fuzzy approach was employed to assess the severity of cost risk factors based on the combined effects of their likelihood and impact. The results revealed that the primary cost risk factors include escalation and fluctuation in material prices, inflation, material shortages, the country’s political instability, the country’s economic instability, delays in payment to the contractor, and delays in material procurement and delivery. Notably, the significant cost risk factors are largely beyond the contractor’s control and are closely tied to the broader political and economic conditions of the country. Full article

This paper develops a region-specific technological transformation strategy for the automotive and mobility sector in Southeast Lower Saxony (SON) under conditions of high uncertainty driven by electrification, digitalization, and automation. The study integrates three analytical components: (i) a SWOT-based baseline assessment of SON’s current strengths, weaknesses, opportunities, and threats; (ii) a scenario-technique framework describing alternative German mobility futures toward 2035; and (iii) a two-round Delphi survey with experts from the Institutes of Automotive Engineering and Engineering Design to evaluate actionable transformation measures. SWOT factors are mapped to scenario key-factor projections and assessed using a trinary impact scale (−1/0/+1), followed by aggregation and normalization to derive scenario-specific change factors. Delphi-rated measures are then prioritized using scenario-overarching performance and SWOT relevance, yielding a tiered strategy concept. The resulting strategy is organized around five interdependent pillars: strengthening industry–research cooperation, advancing research in modern mobility, developing key mobility-support technologies (battery technology, AI, circular economy), expanding digital infrastructure, and upgrading R&D infrastructure and talent capacity, supported by enabling regulatory and workforce measures. The paper provides focus points from regional diagnosis to prioritized action, supporting robust strategic decision-making and adaptive capability building in SON. Full article

Background: Hirschsprung disease (HD) is associated with substantial postoperative morbidity, particularly due to Hirschsprung-associated enterocolitis (HAEC), despite definitive surgical treatment. Postoperative outcomes may vary according to the length of the aganglionic segment and the surgical technique used, and optimal management of recurrent HAEC remains a significant clinical challenge. Methods: The medical records of patients who underwent corrective surgery for HD between 2011 and 2023 were retrospectively reviewed. Demographic characteristics, disease segment length, surgical technique, postoperative complications, and HAEC episodes were recorded. HAEC diagnosis and follow-up assessments were conducted in accordance with the Delphi criteria. Patients with recurrent HAEC and obstructive symptoms refractory to standard conservative management were evaluated for botulinum toxin injection (BTI). Results: A total of 72 patients were included in the study. The majority of the patients were male (83.3%), with a mean age at diagnosis of 11 months. The Duhamel procedure was the most frequently performed surgical technique. Although the rate of anastomotic leakage was greater in patients who underwent the Swenson procedure compared with the Duhamel group, this difference did not reach statistical significance when the appropriate statistical methods were used because the small sample size. No significant difference in the incidence of HAEC was observed among the different surgical techniques. BTI was administered to 13 patients, and regression of enterocolitis episodes according to the Delphi criteria was observed in 11 patients (84.6%). Most postoperative complications are observed in patients with long-segment Hirschsprung disease. Conclusions: Postoperative complications and HAEC remain major clinical challenges in the management of Hirschsprung disease, particularly in patients with long-segment involvement. Although the surgical technique may influence certain complication rates, HAEC appears to be a multifactorial condition. Botulinum toxin injection may serve as a supportive treatment option in selected patients with refractory HAEC; however, prospective controlled studies are needed to further clarify its role. Full article

The construction industry is central to the socio-economic and infrastructural advancement of developing countries; however, it continues to face persistent performance challenges, most notably recurrent cost overruns. While systematic cost risk management is recognized as a critical approach to improving project outcomes, its adoption across the industry remains limited. This study seeks to identify and rank the critical obstacles that hinder contractors from integrating systematic cost risk management into building construction projects. A comprehensive methodology was employed, including an in-depth literature review and three rounds of Delphi. The Relative Importance Index (RII) was used to evaluate the severity of the identified barriers, and Holm-corrected Spearman’s rank correlation analysis was applied to examine the relationships among them. The findings reveal that the most influential barriers include the absence of structured risk management frameworks within organizations, insufficient top management support, the lack of collaborative risk management mechanisms among stakeholders, limited technical knowledge and skills in risk management, and inadequate client support. The strong positive correlations among these barriers highlight their interdependent nature and underscore the systemic challenges facing contractors. This study contributes to the broader field of civil and structural engineering by providing evidence-based insights that can support the development of targeted strategies to enhance cost risk management practices in developing-country construction environments. Full article

Background/Objectives: The treatment of dual disorders (DDs) must be comprehensive and multidisciplinary. Evidence supports the effectiveness of psychotherapy in treating DDs. The second part of this consensus synthesizes the available evidence on psychological treatment for specific DDs. Methods: Two consensus methods were sequentially implemented: the nominal group technique and the Delphi method. Results: This consensus review encompassed a compilation of recommendations for the psychological treatment of neurodevelopmental, anxiety, post-traumatic stress, somatic symptom, eating, and personality disorders. Finally, recommendations for the future research agenda on the psychological treatment of DD were included. Conclusions: (1) Psychological treatment, particularly integrated treatment, is effective. (2) In the case of dual autism, interventions for substance use disorders should be adapted to this population’s characteristics. (3) More research is needed on dual social anxiety, panic, generalized anxiety, somatic symptom, and eating disorders, for which Cognitive Behavioral Therapy (CBT) is the most commonly used treatment. (4) For dual attention deficit hyperactivity disorder, multicomponent treatment is recommended (psychoeducation, CBT, and peer or family support). (5) For dual anxiety disorders, CBT is the first-line treatment. (6) For dual post-traumatic stress disorder, CBT (cognitive processing therapy and prolonged exposure therapy), acceptance and commitment therapy, stress inoculation training, and Eye Movement Desensitization and Reprocessing (EMDR) are effective. (7) For dual personality disorders, evidence is scarce. (8) For borderline personality disorder, dialectical behavior therapy, dynamic deconstructive psychotherapy, and dual-focus schema therapy show promise. (9) For antisocial personality disorder, CBT, contingency management, and counseling on impulsive lifestyles may be useful. (10) Much more evidence is needed from studies that overcome the methodological limitations of existing ones. Full article

Background/Objectives: The treatment of dual disorders (DDs) must be comprehensive and multidisciplinary. There is evidence supporting the effectiveness of psychotherapy in their treatment. However, clinical guidelines, consensus statements, and reviews on the treatment of DDs typically devote considerably less space to psychological therapy than to pharmacological therapy. Therefore, this work aimed to synthesize the available evidence, recommendations, and clinical experience on the psychological treatment of DDs to reach a consensus. Methods: Two consensus methods were sequentially implemented: the nominal group technique and the Delphi method. Results: The first part of this consensus review encompassed a compilation of general recommendations for the psychological treatment of DDs, evidence on the efficacy of the most frequently used therapies, and recommendations for the psychological treatment of severe dual mental disorders. These disorders include schizophrenia and other psychotic disorders, bipolar disorders, depressive disorders, and obsessive compulsive disorders. Conclusions: (1) Psychological treatment is effective; (2) integrated psychological treatment is more effective; (3) motivational interviewing, cognitive behavioral therapy, and relapse prevention are the psychological interventions with the most supporting evidence; (4) the best alternative is multicomponent strategies; (5) the most frequently studied severe mental disorders are schizophrenia and depression; (6) for dual schizophrenia, motivational interviewing and integrated cognitive behavioral therapy combined with other components are recommended; (7) for dual depression, cognitive behavioral therapy with relapse prevention or motivational interviewing is recommended; (8) for dual bipolar disorder, group therapies with psychoeducation or relapse prevention and inclusion of the family, contingency management, and family intervention are recommended; (9) more empirical evidence is needed, especially for obsessive compulsive and schizoaffective disorders; and (10) more randomized clinical trials are needed to improve current methodological limitations. Full article

Introduction: This document presents recommendations of the Polish Respiratory Society on discharge instructions following hospitalization for an exacerbation of chronic obstructive pulmonary disease (COPD). Methods: The Delphi method was applied to achieve consensus among independent experts. Results: Fourteen recommendations were formulated. Experts emphasized that discharge summaries require clear graphical and editorial design to ensure readability for both patients and healthcare professionals. The involvement of a multidisciplinary team was recommended to provide coherent and comprehensive documentation. Discharge instructions should be discussed with the patient during hospitalization and supplemented with standardized educational materials provided separately. These materials should cover inhaler technique, smoking cessation, physical activity, pulmonary rehabilitation, and vaccination. For patients with respiratory failure, home oxygen therapy or non-invasive ventilation must be addressed. Discharge recommendations should highlight modifications in baseline COPD treatment and management of comorbidities. A personalized action plan for future exacerbations is essential, and dietary consultation is advised. Finally, discharge summaries should specify follow-up appointments and include prescriptions for inhaled medications. Conclusions: The Polish Respiratory Society recommends that discharge instructions be provided to all patients hospitalized for a COPD exacerbation. Full article

Background/Objectives: Depression is a serious mental illness worldwide, with a continuously increasing prevalence. As evidence supporting forest therapy as a non-pharmacological intervention has accumulated, the need for collaboration between the medical and forest therapy sectors has emerged; however, practical tools applicable in real-world clinical settings remain limited. This study aimed to derive components of a diagnostic assessment sheet to support clinicians in developing personalized forest therapy programs for patients with depression. Methods: Program-related literature and case materials from diverse disciplines were systematically analyzed to identify transferable program development elements and therapeutic activities. Based on these findings, a two-round Delphi survey was conducted with 17 experts in forest therapy and medicine. Results: Through the Delphi process, 26 therapeutic activities were identified and classified into six final activity types. Assessment items were developed to support clinicians in selecting appropriate activity types, and nine key precaution items were identified to enhance safety and appropriateness during program design and implementation. Conclusions: This study provides a structured framework to guide clinicians and forest therapy instructors in composing individualized forest therapy programs for patients with depression, supporting practical medical–forest therapy integration. Future research should validate the diagnostic assessment sheet through empirical field testing. Full article

Background: Population ageing and the growing prevalence of chronic diseases, particularly stroke, have negative repercussions on fine motor function, compromising the independence of older adults. The Specialist Nurse in Rehabilitation Nursing plays a central role in functional recovery and in improving quality of life. This study aims to describe the process of developing and validating the design of rehabilitation nursing care for older adults with impaired fine motor function. Methods: This paper is a three-phase methodological study conducted between January and July 2025: (1) initial development of the design of rehabilitation nursing care for older adults with impaired fine motor function; (2) validation of the content of the proposed design, using the modified e-Delphi technique; and (3) development of the final model of the care design. Results: The e-Delphi study, involving a panel of 15 experts, allowed the content validation of the design of rehabilitation nursing care for older adults with impaired fine motor function after two rounds. Following the suggestions, the final care design model, in relation to fine motor function, comprises five steps: (1) collection of relevant data, (2) identification of possible nursing diagnoses, (3) definition of objectives, (4) planning and implementation of interventions, and (5) evaluation of outcomes. As part of step 4, photographic records of exercises focused on the recovery of fine motor function were included. Conclusions: The final model of the design of rehabilitation nursing care for older adults with impaired fine motor function, developed and validated in this study, may serve as a guiding framework in the delivery of specialised care to this population. Full article

In response to persistent gaps in pain management competencies among nurses in Saudi Arabian teaching hospitals and similar healthcare settings globally, this manuscript presents a developed and validated action plan designed to support the effective transfer of pain management competencies into clinical practice. The action plan was developed to address the critical need for structured, practical strategies that enhance nurses’ ability to apply pain management knowledge in diverse interdisciplinary environments. The action plan was validated through a rigorous three-round e-Delphi technique involving 12 expert panel members, achieving a 75% consensus on its content and structure. The final validated plan includes clear action statements, implementation methods, designated responsibilities, and defined timeframes. The core action statements focus on the following: (i) motivating nurses to pursue further study; (ii) equipping nursing teams with appropriate pain management tools; (iii) developing content-specific, practice-oriented short training programs; (iv) tailoring training to accommodate different learning styles; (v) using diverse teaching methods; (vi) creating strategies to encourage participation in training; and (vii) promoting the application of acquired knowledge in clinical settings. Adoption and implementation of this action plan by nursing leadership are anticipated to significantly enhance the transfer of pain management competencies, ultimately improving patient outcomes. The plan is adaptable for use in similar healthcare settings worldwide, offering a replicable model for strengthening nursing practice through targeted competency development. Full article