Search Results (6,572)

Background/objectives: Individuals with type 1 diabetes (T1DM) face an elevated risk of cardiovascular disease (CVD), yet the factors driving atherosclerosis remain unclear. This study aimed to assess factors associated with preclinical atherosclerosis development or progression in T1DM. Methods: We conducted a prospective study in T1DM individuals without established CVD, aged ≥40 years, with diabetic kidney disease and/or ≥10 years of T1DM plus another cardiovascular risk factor (CVRF). Baseline evaluation followed a standardized CV risk assessment protocol, including carotid ultrasound and cardiovascular risk estimation using the Steno Type 1 Risk Engine (ST1RE). Ultrasound was repeated after 3–5 years; progression was defined as an increase in plaque number. CVRF control was considered optimal when LDL-cholesterol was within target based on atherosclerotic burden, blood pressure <130/80 mmHg, HbA1c <7%, and non-smoking status. Logistic regression models identified predictors of progression. Results: We included 151 participants (55.6% women; mean age 49.8 ± 8.9 years; T1DM duration 27.3 ± 9.1 years); 42.4% had plaques at baseline. Over a follow-up of 5.22 ± 1.29 years, despite improved CVRF control (p < 0.05), 40.4% experienced progression. Older age (OR 1.38 [1.1–1.8]) and active smoking (OR 3.29 [1.4–7.5]) were significant predictors of progression. Baseline cardiovascular risk measured by the ST1RE independently predicted progression (OR 1.09 [1.03–1.15]) after adjusting for other CVRFs. Persistent smoking (OR 2.52 [1.06–5.99]) and baseline ST1RE (OR 1.06 [1.02–1.11]) remained significant after accounting for baseline and follow-up CVRFs. Conclusions: Despite improved CVRF control, atherosclerosis progression is common in T1D. ST1RE may help identify individuals at highest risk for targeted preventive strategies. Full article

Background: Creatine supplementation is widely used to enhance exercise performance, mainly resistance training adaptations, yet its differential effects on upper- and lower-body strength and muscular power remain unclear across populations. Objective: This systematic review and meta-analysis aimed to quantify the effects of creatine supplementation in studies that included different exercise modalities or no exercise on upper- and lower-body muscular strength and power in adults. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted through 21 September 2024 to identify randomized controlled trials evaluating the effects of creatine supplementation on strength (bench/chest press, leg press, and handgrip) and power (upper and lower body). Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated using random-effects modeling. Subgroup analyses examined the influence of age, sex, training status, dose, duration, and training frequency. Results: A total of 69 studies with 1937 participants were included for analysis. Creatine plus resistance training produced small but statistically significant improvements in bench and chest press strength [WMD = 1.43 kg, p = 0.002], squat strength [WMD = 5.64 kg, p = 0.001], vertical jump [WMD = 1.48 cm, p = 0.01], and Wingate peak power [WMD = 47.81 Watts, p = 0.004] when compared to the placebo. Additionally, creatine supplementation combined with exercise training revealed no significant differences in handgrip strength [WMD = 4.26 kg, p = 0.10] and leg press strength [WMD = 3.129 kg, p = 0.11], when compared with the placebo. Furthermore, subgroup analysis based on age revealed significant increases in bench and chest press [WMD = 1.81 kg, p = 0.002], leg press [WMD = 8.30 kg, p = 0.004], and squat strength [WMD = 6.46 kg, p = 0.001] for younger adults but not for older adults. Subgroup analyses by sex revealed significant increases in leg press strength [WMD = 9.79 kg, p = 0.001], squat strength [WMD = 6.43 kg, p = 0.001], vertical jump [WMD = 1.52 cm, p = 0.04], and Wingate peak power [WMD = 55.31 Watts, p = 0.001] in males, but this was not observed in females. Conclusions: This meta-analysis indicates that creatine supplementation, especially when combined with resistance training, significantly improves strength in key compound lifts such as the bench or chest press and squat, as well as muscular power, but effects are not uniform across all measures. Benefits were most consistent in younger adults and males, while older adults and females showed smaller or non-significant changes in several outcomes. No overall improvement was observed for handgrip strength or leg press strength, suggesting that the ergogenic effects may be more pronounced in certain multi-joint compound exercises like the squat and bench press. Although the leg press is also a multi-joint exercise, results for this measure were mixed in our analysis, which may reflect differences in study design, participant characteristics, or variability in testing protocols. The sensitivity of strength tests to detect changes appears to vary, with smaller or more isolated measures showing less responsiveness. More well-powered trials in underrepresented groups, particularly women and older adults, are needed to clarify population-specific responses. Full article

Background/Objectives: Commonly known as clubfoot, congenital talipes equinovarus (CTEV) is a structural deformity characterized by cavus, adductus, varus, and equinus (CAVE) positioning of the foot. Idiopathic clubfoot requires prompt treatment to achieve functional, pain-free, and aesthetically normal feet. The Ponseti method is a conservative treatment involving serial manipulation, casting, and Achilles tenotomy, which has demonstrated high success rates. The purpose of this study is to report 10 years of experience using the Ponseti method. Methods: A retrospective and follow-up analysis were conducted with 72 patients (118 feet) with idiopathic clubfoot were treated between 2011 and 2023 who met the minimum follow-up requirement of 12 months (mean follow-up: 54.15 months). The severity of deformities was assessed using the Pirani score. Data collection included demographic details, number of casts, tenotomy procedures, adherence to the Denis Browne brace protocol, and complications. Results: Initial correction of deformities was achieved in all 91 patients (100%). Outcomes were measured using the Ponseti functional scoring system. The average number of casts applied was 9.51 per patient. Percutaneous Achilles tenotomy was performed in 91.21% of cases. Relapse occurred in 22.2% of patients, which required additional treatments. The outcomes were excellent in 77.7% of cases, good in 13.88%, fair in 6.94%, and poor in 1.38%. Discussion: The Ponseti method is effective for idiopathic clubfoot treatment and achieves high rates of initial correction, favorable mid-term outcomes, and minimal complications. These results confirm its reliability and align with previously reported success rates. Full article

Device-free localization and tracking (DFLT) has emerged as a promising technique for location-aware Internet-of-Things (IoT) applications. However, most existing DFLT systems based on narrowband sensing networks suffer from reduced accuracy in indoor environments due to the susceptibility of received signal strength (RSS) measurements to multipath interference. In this paper, we propose a real-time DFLT system leveraging ultra-wideband (UWB) sensors. The system estimates target-induced shadowing using two UWB RSS measurements, which are shown to be more resilient to multipath effects compared to their narrowband counterparts. To enable real-time tracking, we further design an efficient measurement protocol tailored for UWB networks. Field experiments conducted in both indoor and outdoor environments demonstrate that our UWB-based system significantly outperforms its traditional narrowband DFLT solutions in terms of accuracy and robustness. Full article

Background/Objectives: The optimal protein dose for critically ill cancer patients, especially for muscle mass preservation and survival, remains unclear. This study evaluated whether a higher protein intake, compared to usual intake, was associated with improved clinical outcomes in this population. Methods: This was a prospective analysis of critically ill adult cancer patients admitted to an oncological intensive care unit (ICU). Patients were initially assigned to receive protein prescriptions of either 1.5 or 2.0 g per kilogram per day (g/kg/day), but due to common limitations in achieving prescribed targets in this setting, a prespecified per-protocol analysis was conducted. After three days of exclusive nutritional therapy, patients were reclassified into two groups based on actual protein intake: >1.5 g/kg/day (higher intake group, IG) and ≤1.5 g/kg/day (usual intake group, CG). The primary outcome was muscle mass preservation, measured by quadriceps muscle thickness (QMT) via ultrasound on days 1, 7, and 14. Secondary outcomes included ICU survival, hospital and ICU length of stay, mechanical ventilation duration, dialysis requirement, and 60-day survival. Results: From June 2019 to September 2023, 117 patients were included. Following the planned interim analysis, the study was stopped after meeting the Pocock criterion for ICU survival (p = 0.0013). After reclassification, 68.4% (n = 80) were in the IG and 31.6% (n = 37) in the CG. ICU stay was similar (both medians 13 days), but the IG had shorter hospital stays [21.0 vs. 27.5 days, p = 0.020], less QMT loss, and improved ICU (HR = 0.31, 95% CI 0.15–0.64), hospital (HR = 0.43, CI 0.23–0.80), and 60-day survival (HR = 0.43, CI 0.23–0.80), along with shorter ventilation duration (HR = 0.54, CI 0.30–0.99). Conclusions: Higher protein intake (>1.5 g/kg/day) was associated with better muscle mass preservation and improved clinical outcomes in critically ill cancer patients. Full article

Linear Low-Density Polyethylene (LLDPE) is a versatile polyolefin made by copolymerizing ethene with minor amounts of a 1-alkene. The short side chain branches in the comonomer units partly hinder the ability of the polyethylene main chain to crystallize, thus providing a way to fine-tune material properties between the extremes of a thermoplastic and a moderate elastomer. In this function, higher 1-alkenes such as 1-hexene or 1-octene are more effective than shorter homologs like propene or 1-butene, because their alkyl substituents are fully incompatible with the polyethylene lattice. On the other hand, the former comonomers are also more expensive and, above all, poorly reactive with heterogeneous Ziegler–Natta (ZN) catalysts, the workhorses of the polyolefin industry; as a matter of fact, they can only be used with technologically more demanding molecular catalysts. The molecular kinetic factors governing this important and complicated catalytic reactivity are still poorly understood, and perusal of the literature led us to conclude that data reliability is often questionable due to experimental limitations in reaction equipment and protocols, particularly in academic laboratories. In this study, we made use of a state-of-the-art High-Throughput Experimentation workflow to measure the reactivity ratios with ethene of two representative higher 1-alkenes, namely 1-hexene and 1-decene, in the presence of a variety of well-defined molecular catalysts of metallocene and post-metallocene nature comparatively with a typical MgCl₂/TiCl₄ ZN catalyst for polyethylene application. We found that the two comonomers react almost identically with molecular catalysts, whereas a major decrease in reactivity for 1-decene compared with 1-hexene was observed idiosyncratically for the ZN catalyst. In our opinion, the overall results suggest that in the latter case, surface effects can be dominant over direct comonomer interactions with the coordination sphere of the active metal in dictating the observed molecular kinetic behavior. Full article

Introduction and Aims: Androgen deprivation therapy (ADT) with systemic anti-cancer treatment (SACT) ± palliative radiotherapy (pRT) is the current standard of care for Oligo-metastatic hormone-sensitive prostate cancer (o-mHSPC). Cytoreductive radical prostatectomy (cRP) has gained interest in this group of patients, with potential benefits including reduced tumour burden and a lower risk of local events from disease progression. In this review, we compare both survival outcomes and local event rates between cRP and upfront ADT ± SACT. Methods: All randomised trials and observational studies comparing cRP with standard treatment (ST), which we defined as ADT ± SACT for o-mHSPC, were included in the review. The study protocol was registered in PROSPERO (CRD42024516586), and the review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases searched included Embase, Medline, Cochrane Library, PubMed, and Web of Science. A risk of bias assessment was performed for the included studies as recommended by the Cochrane Handbook of Systematic Reviews and Interventions. The primary outcome measures were Overall Survival (OS), Cancer-Specific Survival (CSS), Progression-free Survival (PFS), Castrate-resistant Prostate Cancer-free Survival (CRPC-FS), and local complication rates. The secondary outcome measures were complication rates and functional outcomes post-cRP. Results: A total of 5130 studies were identified for this review (5119 by database searching and 11 through manual searching). Eight studies were included in the review, comprising 611 patients. cRP was identified to have superior OS (HR: 0.56 (95% CI: 0.34–0.92), I² = 0%, p = 0.02 (very low certainty)) and CSS (HR: 0.27 (95% CI: 0.15–0.47), I² = 0%, p < 0.0001 (very low certainty)). The PFS (HR: 0.67 (95% CI: 0.34–1.33), I² = 58%, p = 0.25 (very low certainty)) and CRPC-FS (HR: 0.67 (95% CI: 0.32–1.43), I² = 57%, p = 0.30 (very low certainty)) were similar between the two groups. The rates of local events were significantly lower in patients undergoing cRP (RR 0.27 (95% CI: 0.13–0.59), I² = 17%, p = 0.001 (low certainty)). The rates of Clavien–Dindo (CD) grade 3 or higher complications ranged from 0% to 13.1%. Additionally, the reported continence rates ranged from 81.5% to 91.3%. The review is limited by the lack of a uniform definition for o-mHSPC and the predominance of low-quality, heterogeneous studies. Despite mitigation strategies, the overall certainty of evidence remains very low per GRADE assessment. Conclusion: cRP significantly reduces local event rates compared with ST and offers comparable PFS and CFPC-FS, with superior OS and CSS in the cRP arm compared to the ST arm in patients with o-mHSPC. However, there is a paucity of high-quality literature on this subject. Ongoing randomised controlled trials may soon clarify the role of cRP in the context of o-mHSPC concerning survival benefits. Full article

The objective of this study was to assess the content of selected elements—fluorine, calcium and inorganic phosphorus—in infusions prepared from selected commercial leaf teas available on the Polish market. A comprehensive analysis was conducted based on tea type and geographical origin. In addition, the Target Hazard Quotient (THQ) was calculated to estimate the non-carcinogenic health risk associated with fluoride intake from tea consumption. Methods: A total of 98 leaf tea samples were analyzed, including 55 black, 27 green, 9 oolong, and 7 white teas. Standardized brewing protocols were applied. Measured parameters included pH, calcium and inorganic phosphorus content, buffer capacity, and titratable acidity. Fluoride concentrations were determined using an ion-selective electrode. Statistical analysis was performed using non-parametric methods (Kruskal–Wallis ANOVA with DSCF post hoc test), and heatmaps were generated to illustrate the distribution of THQ across different models. Results: Black teas exhibited significantly lower pH values and higher titratable acidity, buffer capacity, and inorganic phosphorus levels compared to other tea types, indicating distinct physicochemical properties. Although all THQ values for fluoride remained well below the safety threshold (THQ < 1), the highest values were observed in elderly individuals with low body weight, particularly women consuming green tea, suggesting increased vulnerability in this subgroup. Conclusions: Among the analyzed samples, black teas demonstrated the most distinct chemical profile, characterized by the lowest pH and the highest acidity, buffer capacity, and fluoride and phosphorus content—especially in teas originating from Africa and Central Asia. While fluoride exposure from leaf tea infusions does not appear to pose a direct health risk, older adults, particularly low-weight women, may be more susceptible to potential non-carcinogenic effects and should moderate their intake of high-fluoride teas. Full article

Mastitis, an inflammatory disease caused by the invasion of various pathogenic microorganisms into mammary gland tissue, is a core health issue plaguing the global dairy industry. The consequences of this disease are manifold. In addition to directly compromising the health and welfare of dairy cows, it also precipitates a substantial decline in lactation function, a precipitous drop in raw milk production, and alterations in milk composition (e.g., increased somatic cell counts and imbalanced ratios of milk protein to fat). These changes result in a marked degradation of milk quality and safety, and in turn, engender significant economic losses for the livestock industry. Therefore, the establishment and implementation of a comprehensive prevention and control system is a key strategy to effectively curb the occurrence of mastitis, reduce its incidence rate, and minimise economic losses. This review systematically explores the complex etiological factors and pathogenic mechanisms of mastitis in dairy cows, and summarises various diagnostic methods, including milk apparent indicators monitoring, pathogen detection, physiological parameter monitoring, omics technologies, and emerging technologies. Furthermore, it undertakes an analysis of treatment protocols for mastitis in dairy cows, with a particular emphasis on the significance of rational antibiotic use and alternative therapies. Moreover, it delineates preventive measures encompassing both environmental and hygiene management, and dairy cow health management. The objective of this paper is to provide a comprehensive and scientific theoretical basis and practical guidance for dairy farming practices. This will help to improve the health of dairy cows, ensure a stable supply of high-quality dairy products, and promote the sustainable and healthy development of the dairy farming industry. Full article

(1) Background: Upper limb (UL) function plays a central role in daily life, enabling essential tasks such as reaching, grasping, and eating. While numerous tools exist to evaluate UL kinematics, their application in pediatric populations is often limited by a lack of age-specific validation. This study presents a novel motion analysis protocol featuring a customized marker set, aimed at assessing UL movements in the three anatomical planes across different age groups, with a focus on pediatric applicability. (2) Materials and Methods: A SmartDX motion capture system was used, with 30 markers positioned on the upper body, referencing the trunk as the root of the kinematic chain. Ten healthy participants (mean age: 18.69 ± 12.45 years; range: 8.0–41.4) without UL impairments were recruited. The broad age range was intentionally selected to assess the protocol’s transversal applicability. (3) Results: Results showed excellent intra-operator reliability for shoulder and wrist kinematics (ICC > 0.906) and good reliability for elbow movements (ICC > 0.755). Inter-operator reliability was good to excellent (shoulder ICC > 0.958; elbow ICC > 0.762; wrist ICC > 0.826) Usability, measured via the System Usability Scale, was rated as good (83.25). (4) Conclusions: The proposed protocol demonstrated strong reliability and practical usability, supporting its adoption in clinical and research settings. Its design allows for adaptability across motion capture platforms, promoting wider implementation in pediatric UL functional assessment. Full article

Purpose: The popliteus tendon (PT), though often overlooked, plays a vital role in the functional and mechanical stability of the posterolateral corner (PLC) of the knee. This narrative review consolidates the current anatomical, biomechanical, imaging, clinical, and surgical data on the PT, with an emphasis on its morphological variability and relevance in orthopedic sports medicine. Methods: A comprehensive review of the literature was conducted, including classical anatomical studies, recent classification systems, biomechanical evaluations, imaging protocols, and rehabilitation strategies. Particular focus was given to the anatomical classification proposed by Olewnik et al. and its implications in surgical and diagnostic contexts. Results: Anatomical investigations have demonstrated considerable variability in the PT, including bifid tendons and accessory fascicles. These variants have a measurable impact on preoperative planning, diagnostic imaging interpretation, and outcomes of surgical procedures, such as anterior cruciate ligament (ACL) and PLC reconstructions. The PT also contributes significantly to knee rotational control and meniscal stabilization, particularly in athletic populations. Imaging modalities, such as MRI and dynamic ultrasound, show high diagnostic utility, while arthroscopy remains the definitive diagnostic and therapeutic modality. Rehabilitation should emphasize neuromuscular re-education and progressive control of tibial rotation. A phase-based rehabilitation framework and clinical action table are proposed. Conclusions: The PT should be recognized as a critical structure in both the conservative and the surgical management of posterolateral and rotational knee instability. Enhanced awareness of its anatomical variability and functional importance can improve diagnostic accuracy, surgical precision, and clinical outcomes. In particular, MRI and high-resolution ultrasound can aid in identifying accessory fascicles and bifid tendons, while arthroscopy benefits from preoperative knowledge of PT variants to avoid misidentification and iatrogenic injury. Surgical planning for ACL and PLC reconstructions may be refined by applying the classification system described. Future research should focus on refining diagnostic algorithms, developing PT-specific functional tests, and integrating popliteus evaluation into high-level clinical decision-making and surgical navigation systems. Full article

Wildlife rescue centres face considerable challenges in promoting animal welfare and enhancing the care and housing conditions of animals under professional supervision. These challenges are further compounded by the diversity of species admitted, each with distinct specific needs. In Colombia and other Latin American countries, primates are among the most frequently rescued and behaviourally complex mammalian taxa, requiring particular attention. In response, this study aimed to assess the content validity of proposed animal welfare indicators for Cebus albifrons through a Delphi consultation process and to develop two species-specific assessment protocols: a daily-use tool for keepers and a comprehensive protocol for professional audits. A panel of 23 experts in primate care and rehabilitation participated in two consultation rounds to evaluate and prioritise the indicators based on their content validity, perceived reliability, and practicality. Indicators were classified as either animal-based (direct measures) or resource- and management-based (indirect measures). After each round, experts received summarised feedback to refine their responses and facilitate consensus building. Of the 39 initially proposed indicators, 28 were validated for inclusion in the extended protocol and 10 selected for the daily-use checklist. Among these, 20 indicators in the extended protocol and 6 in the daily protocol were resource- or management-based—such as adequate food provision, physical enrichment, and habitat dimensions—highlighting their practical applicability and relevance in identifying welfare issues and risk factors. Although these indirect indicators were more numerous, the top-ranked indicators in both protocols were animal-based, including signs of pain, affiliative behaviours, and abnormal repetitive behaviours. These are essential for accurately reflecting the animals’ welfare state and are therefore critical components of welfare assessment in captive non-human primates. This study demonstrates that welfare assessment tools can be effectively tailored to the specific needs of wildlife rescue centres, providing a robust foundation for enhancing welfare practices. These protocols not only offer practical approaches for assessing welfare but also underscore the importance of embedding animal welfare as a priority alongside conservation efforts. Future research should aim to refine these tools further, assess their implementation, and evaluate inter- and intra-observer reliability to ensure consistency across different settings. Full article

Growing concern for environmental sustainability has resulted in the implementation of sanitization methods that respect ecological principles. This research evaluates a “green” sanitizing protocol that uses CAM (Minimum Environmental Criteria)-compliant products against a traditional protocol within two ASL Roma 1 facilities. The study performed a Life Cycle Assessment (LCA) following ISO 14040, ISO 14044, and ISO 14067 standards to measure greenhouse gases emissions. Microbiological sampling was conducted according to established protocols across three different risk zones utilizing contact plates and surface swabs. The Life Cycle Assessment showed that CO₂ emissions reduced by 49.6% to 53.3% at different sites due to reduced energy use together with concentrated detergents and improved washing cycles. Microbiological testing revealed notable decreases in contamination rates across both cleaning systems yet demonstrated the “green” system achieved superior results specifically within high-risk zones. The “green” protocol matched traditional cleaning methods hygienically but delivered significant environmental advantages which positions it as a sustainable hospital cleaning solution. Full article

(1) Background: Violence against healthcare professionals is becoming a growing concern for healthcare systems and a public health issue, and in Portugal it remains undocumented at a national level, leaving a critical knowledge gap. This scenario compromises the development of effective public policies and evidence-based institutional strategies, which are essential for guiding policymakers in the implementation of preventive measures and appropriate safety protocols to assess the nature, frequency, and key factors contributing to violence against healthcare professionals (doctors and nurses) in clinical settings. (2) Methods: This is a quantitative, descriptive, and cross-sectional study. The sample size was 440 professionals (n = 440). Between January and May 2024, healthcare professionals (physicians and nurses) working in four local health units located in the south of Portugal were invited to participate in this study via institutional e-mail. Data was collected using a structured questionnaire on the healthcare professional’s sociodemographic and work-related characteristics and aspects related to violence towards healthcare professionals in the workplace. Unconditional logistic regression models were fitted to compute crude odds ratios (ORs) and 95% confidence intervals (95%CIs) for the association between sociodemographic and work-related characteristics and violence at work. (3) Results: Nearly 40% of the healthcare professionals sampled reported having been victims of violence in the workplace, and, among these, the majority reported experiencing psychological violence (94.2%), followed by physical violence (46.2%), another type of violence (39.1%), and sexual violence (4.1%). Incidents were mostly occasional (65.5%), occurring during the daytime (51.5%) and on weekdays (84.8%). Healthcare professionals aged between 34 and 55 years old were approximately twice as likely to experience violence compared to those who were 56 years old or older (OR = 2.28; 95%CI 1.33–3.90). Also, those who had been with the organization for more than 4 years (5–7 years: OR = 2.37; 95%CI 1.05–5.37. ≥8 years: OR = 1.87; 95%CI 1.00–3.50), as well as those who worked shifts (OR = 1.84; 95%CI 1.25–2.72), reported incidents of violence more frequently. (4) Conclusions: The low response rate (12.5%) and cross-sectional design limit the generalizability of the results, which should be interpreted considering these methodological limitations. Workplace violence in Portugal is a reality, and it requires solutions. Information related to violent incidents must be comprehensively gathered to understand the full extent of the problem and develop prevention strategies based on potentially changeable risk factors to minimize the negative effects of workplace violence. Full article

This study aims to develop a performance evaluation system specifically for the design phase of high-rise building projects within the architecture, engineering, and construction industry, where performance is often only measured during construction. The research process included three stages: identification of 21 key performance indicators through a literature review and expert validation; development of standardized indicator sheets detailing calculation protocols and data collection procedures; and creation of a functional dashboard-based evaluation system using Excel. The system was validated through expert review and tested with a simulated project generated using an AI-based language model. The evaluation system proved functional, accessible, and effective in detecting performance issues across five core categories: planning, cost, time, quality, and people. The results from the simulated application highlighted strengths in quality and stakeholder collaboration but also revealed significant gaps in cost and time performance. This study addresses a gap in the existing literature by focusing on performance evaluation during the design phase of construction projects, a stage often underrepresented in performance studies. The resulting system offers a structured, practical tool adaptable to real-world projects. The validation relied on a limited number of expert participants and a simulated project. Future research should recommend broader international validation and real-world application. Full article