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Introduction: As part of the development of an agreed minimum set of outcomes or Core Outcome Set (COS) for future nutritional intervention trials in older adults with malnutrition or at risk of malnutrition, this work reports on the Delphi surveys and final consensus. Methods: Outcomes from a scoping review were incorporated into a two-round Delphi survey. Researchers and healthcare professionals experienced in malnutrition in older adults were invited to take part in an online survey to rate 38 selected outcomes on a nine-point Likert scale ranging from 'not important' to 'critical' for their setting (community, hospital, or long-term care). Consensus for inclusion was reached when ≥75% (or ≥60% if a patient-reported outcome) of the participants scored the outcome as 'critical' and <15% as 'not important'. Resulting outcomes were voted for inclusion or exclusion in the COS in a final online consensus meeting. Results: Ninety-three and 72 participants from diverse professional backgrounds and countries participated in the 1st and 2nd Delphi round, respectively. After both rounds eleven outcomes met the inclusion criteria, largely irrespective of setting. Fifteen participants, representing academia, health care, health policy, industry, and PPI, voted in a final online consensus meeting resulting in ten outcomes: malnutrition status, dietary intake, appetite, body weight or BMI, muscle strength, muscle mass, functional performance, functional limitations, quality of life, and acceptability of the intervention. Conclusions: Ten outcomes will form the COS which is intended to be used by the scientific community in all future nutritional intervention studies for older adults with malnutrition or at risk of malnutrition. The subsequent phase will establish the appropriate methods to measure these outcomes. [ABSTRACT FROM AUTHOR]

In the 1970s, research on artificial intelligence in education emerged with the aim of acknowledging and accommodating the psychological aspects of the learning process. Since then, its applications have evolved and it is now used for student learning and assessment, teachers' pedagogical practice, management of educational institutions, and lifelong learning. Nevertheless, the ethical challenges of educational programmes using these systems have not been thoroughly studied. Anchored on the theoretical frame of dialogic ethics, this paper presents a section of a participatory futures research project. The goal of the research is to develop a toolkit that educators can use to ensure a smooth and ethical transition to artificial intelligence-based education while preserving the interests of educational development. This paper emphasises the need for an informed and participatory process that involves all stakeholders and begins with an expert consultation through the Delphi method, the results of which allowed the construction of eight hypothetical futures scenarios. These scenarios provide evidence that examining the ethics of using artificial intelligence systems presents an opportunity to reflect on the ethics of education as a whole. They highlight the challenge of balancing the benefits and drawbacks of such systems, especially concerning educational goals and the interplay between diverse educational actors and personal development in educational settings. The study outcomes are intended to encourage discussions on the integration of ethical artificial intelligence in education and facilitate the continuing professional development of teachers by equipping them with scenarios that can be used as a resource for training purposes. [ABSTRACT FROM AUTHOR]

Objectives: To develop a caries‐risk assessment application (myRisk app) and assess the psychometric properties based on content validity, construct validity, and how well it classifies the participants into different caries risk groups using caries increments at 10 months. Methods: The myRisk mobile application was developed using Android Studio 4.1.1. The content validity was assessed by three dental experts. To evaluate construct validity and the prediction of future dental caries, the participants (N = 88) were recruited from Rajvithi Home for Girls in Thailand by convenience sampling. The participants were completed a caries risk assessment (CRA) of myRisk app and ADA form. The oral examination was performed at the time of CRA and 10 months following the baseline. Results: Eighty‐eight participants aged 12–29 used the myRisk app and completed the ADA form. The app content validity was acceptable (IOC = 0.67). According to myRisk, 7.9%, 71.6%, and 20.5% of the participants were classified into the low‐, moderate‐, and high‐risk groups, respectively. The percent agreement of the caries‐risk classification with the ADA form was 30.7%. Significant differences between the three risk groups were found in active caries (p < 0.001), type, and frequency of sugary snacks (p = 0.002). The app had a sensitivity of 68%, a specificity of 61%, and an area under the receiver operating characterisitic (ROC) curve of 0.61. Conclusions: The myRisk app has acceptable content validity and sufficient diagnostic accuracy (sensitivity, specificity, and ROC curve). However, there is a different outcome in caries‐risk classification compared with the ADA form. [ABSTRACT FROM AUTHOR]

The application of deep learning (DL) in medicine introduces transformative tools with the potential to enhance prognosis, diagnosis, and treatment planning. However, ensuring transparent documentation is essential for researchers to enhance reproducibility and refine techniques. Our study addresses the unique challenges presented by DL in medical imaging by developing a comprehensive checklist using the Delphi method to enhance reproducibility and reliability in this dynamic field. We compiled a preliminary checklist based on a comprehensive review of existing checklists and relevant literature. A panel of 11 experts in medical imaging and DL assessed these items using Likert scales, with two survey rounds to refine responses and gauge consensus. We also employed the content validity ratio with a cutoff of 0.59 to determine item face and content validity. Round 1 included a 27-item questionnaire, with 12 items demonstrating high consensus for face and content validity that were then left out of round 2. Round 2 involved refining the checklist, resulting in an additional 17 items. In the last round, 3 items were deemed non-essential or infeasible, while 2 newly suggested items received unanimous agreement for inclusion, resulting in a final 26-item DL model reporting checklist derived from the Delphi process. The 26-item checklist facilitates the reproducible reporting of DL tools and enables scientists to replicate the study's results. [ABSTRACT FROM AUTHOR]

With the advent of the digital era, the demand for engineering and technological talents in the market is increasing. It is crucial to design a sustainable training and evaluation system suitable for engineering and technological innovation talents. However, traditional data evaluation models have problems with unsuitable evaluation indicators and low model accuracy. Therefore, the paper selects the decision-making-oriented evaluation model to build the basic talent training evaluation indicators, and design expert questionnaires based on the Delphi method to screen indicators. Moreover, the paper also combines the adaptive genetic algorithm optimised backpropagation neural network to establish a talent cultivation evaluation model, and conducts simulation experiments using MATLAB to verify its feasibility. The results showed that the evaluation accuracy R value of the research model was 0.99635, and the fitness value was 1.34, which was 0.5 higher than the unmodified model and achieved good evaluation results. At the same time, by comparing with the traditional genetic algorithm optimised model and the unimproved backpropagation model, the average evaluation accuracy of the research model increased by 66.44% and 13.59%, and the recall rate increased by 10.79% and 23.96%. The research model has improved the accuracy of evaluation, and its adaptability has also been enhanced, achieving superior evaluation results, which has important value in the cultivation of engineering and technological innovation talents. [ABSTRACT FROM AUTHOR]

Wind power technology has been widely used due to its characteristics of environmental protection, sustainability and low cost. The yaw system plays a vital role in improving the energy capture efficiency of a wind turbine. However, the method of layout determination is lacking in the yaw system. To solve this problem, a method that combines the Delphi method and the analytic hierarchy process was proposed in this study. Twelve evaluation indexes, including transmission efficiency, ratio range, operating temperature range and others, were identified by screening 18 technical indicators using the Delphi method. Subsequently, the evaluation system of the yaw system was established. Then, six configuration schemes were selected. Experts' scores of schemes were collected according to the evaluation system and the score matrix of evaluation indexes was obtained. The hierarchical model of the evaluation indexes of the yaw system was established and the comprehensive weight was obtained by using the analytic hierarchy process. After calculating the comprehensive evaluation score, the comprehensive evaluation result was obtained. The 2Z-X(A) negative mechanism, which achieved the highest score of 0.9227, is the optimal scheme. A new method and specific process are provided for designers. The research gap in the scheme selection method for yaw systems is filled. [ABSTRACT FROM AUTHOR]

Background: The 2005 revision of the code of ethics for nurses has been in effect in Taiwan for more than 17 years. Although this code has been smoothly implemented during this time, changing social expectations and ethical perspectives, advancements in science and technology, and the evolution of the nurse-patient relationship suggest this code should be once again be updated. Purpose: This study was conducted to suggest revisions to the Taiwan code of ethics for nurses necessary to meet current needs and address social and medical care environment trends. Methods: A multivariate research approach was adopted. The classification of the code of ethics for nurses norms in six international nursing organizations and evidence-based ethical and philosophical thinking literature were referenced, with the main notification demands incorporated into the Ministry of Health and Welfare's Nursing Workplace Controversy Reporting Platform. After drafting the aspects and provisions of Taiwan code of ethics for nurses norms, expert review procedures such as focus groups, Delphi expert consensus, and public forums were conducted. Results: After three expert focus group discussion rounds, a structured questionnaire was completed, and 50 Delphi experts in six fields completed the online questionnaire. After the second consensus round, the importance and clarity of the 47 ethical code provisions in the four aspects were determined with 100% and 99.8% agreement reached, indicating no significant difference in scores between the multidisciplinary expert group and the ethical code. The resulting revision proposed for the Taiwan code of ethics for nurses includes: nursing staff and care recipients (14 provisions), nursing staff and practice (13 provisions), nursing staff and the profession (10 provisions), and nursing staff and society (10 provisions). Conclusions/ Implications for Practice: In terms of education, the revised Taiwan code of ethics for nurses should be integrated into the nursing education curriculum of nursing colleges and used as teaching material for the continuing education of nurses. In terms of policy, these norms should be included as evaluation benchmarks and inspection items for hospitals. In addition, the attention and support of senior managers in institutions must be secured and a handling protocol for moral dilemma cases and related consultation mechanisms must be established. Nursing supervisors should be guided to develop the ability to address these dilemmas to help foster a positive workplace and a respectful team atmosphere. All professional groups should participate actively in promoting issues related to nursing ethics, organize seminars and continuing education activities, and make the revised Taiwan code of ethics for nurses and learning cases available online for reference by nursing staff nationwide. [ABSTRACT FROM AUTHOR]

STEM literacy is a desired principal outcome of STEM (Science, technology, engineering, and mathematics) education. With the increasing popularity of Early STEM learning, it is believed that STEM literacy could be developed in the early years. However, relatively few studies have examined STEM literacy in young children. This study utilized the Delphi method and the analytic hierarchy process (AHP) to elicit the opinions of a panel of experts with diverse backgrounds and to construct a framework of STEM literacy for kindergarten children. The findings of the study illustrate what young children could achieve from high-quality early STEM experiences. This would help to promote curriculum development, performance assessment, and best practices in early STEM education. [ABSTRACT FROM AUTHOR]

Geotechnical engineering, being preliminary in any construction project, is of paramount importance for achieving sustainability. One of the important domains of sustainable development in geotechnics is sustainability assessments as it is essential to determine the impact of engineering activities on built environment. An indicator-based sustainability assessment tool called Geotechnical Sustainability Assessment Tool (Geo-SAT) was developed in this regard. The indicators used in Geo-SAT are generic in nature and judged on equal weightages, hence create skewness. Furthermore, the essentiality of these indicators varies across different projects and their life cycle stages. So, the tool requires scale normalization to remove this exaggeration of results. In current research 32 technical indicators are sampled out of 171 indicators of Geo-SAT using Delphi technique. The weightages of these indicators have been then normalized using Multiple Criteria Decision Analysis (MCDA). Multiple Attribute Value Theory (MAVT), a sub-technique under MCDA, is used for analysis as it compares between different criteria (i.e., project life cycle stages, indicators, and expert's opinion) and computes the weighted averages. For this purpose, a questionnaire has been developed and distributed among 52 relevant field experts having a predefined experience criteria set by authors, to record their opinion regarding the importance of indicators across project life cycle stages. 50 responses were accepted based on their reliability and completeness. As a result, the sustainability indices for all indicators are then calculated using MAVT based on weights of importance and relative weights attained from the questionnaires. Furthermore, it is established that the most critical indicators for the dam's sustainability assessment are "quality control during construction", "construction material wastage" and "feasibility reports", with highest weightages of 4.8%, 4.3%, and 4.2%, respectively. It is concluded that inculcating these computed weightages to Geo-SAT will increase the reliability and reduce the skewness in the sustainability assessment of dam projects. The current research is an effort to develop a sustainability assessment tool for dams (as no such assessment tool exists for dams exclusively) by improving Geo-SAT in terms of scale normalization. The normalized version of Geo-SAT, which is based on weighted averages of indicators, is a way forward for future development of certification system. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the Refractory Epilepsy Screening Tool for Lennox–Gastaut Syndrome (REST‐LGS) for real‐world identification of LGS in adults and to develop a scoring system for the tool. Methods: A retrospective chart review of adults with drug resistant epilepsy (DRE) and intellectual development disorder (IDD) was conducted by 2 primary care providers blinded to diagnosis. The REST‐LGS was designed via the Modified Delphi Consensus and was previously validated. This tool consists of 8 criteria (4 major, 4 minor) considered indicative of LGS. To account for missing data in the earlier validation study and to evaluate applicability in a real‐world setting, the REST‐LGS was refined to include a scoring system in which major criteria were more heavily weighted than minor criteria, producing categories of "likely" (>11 points), "possible" (8–11 points), and "unlikely" (<8 points) LGS. Statistical analyses were descriptive. Results: Of the 100 patients included in the analysis, data for slow spike–waves in electroencephalography and seizure onset age – both major REST‐LGS criteria – were missing for 46% and 42% of patients, respectively. The majority of patients met 4 of the 8 REST‐LGS criteria (cognitive impairment since childhood, 71%; persistent seizures despite a trial of ≥2 antiseizure medications, 65%; seizure onset before the age of 12 years, 57%; ≥2 seizure types, 56%). All 4 major criteria were met in 22 patients (22%). The percentages of patients considered "likely," "possible," or "unlikely" to have LGS were 26%, 30%, and 44%, respectively. Of the 74 patients without a previous LGS diagnosis, 42 (57%) were identified as "possible" or "likely" to have LGS using REST‐LGS. Significance: In this analysis, the validated REST‐LGS was evaluated in a real‐world setting. The majority of previously undiagnosed patients were identified via REST‐LGS as "possible" or "likely" to have LGS. Extensive missing data highlights challenges of LGS diagnosis in adults. Plain Language Summary: There is a need to identify adult patients with Lennox–Gastaut syndrome (LGS) so they can receive appropriate treatment. The Refractory Epilepsy Screening Tool for LGS (REST‐LGS) questionnaire was designed by experts to identify whether patients with seizures that are not controlled by medications may have LGS. In this study, 2 physicians completed the REST‐LGS using charts for 100 patients who experience seizures not controlled by medications. Of the patients who were previously diagnosed as not having LGS, the majority were "likely" or "possible" to have LGS based on the REST‐LGS; therefore, the REST‐LGS can identify patients for further evaluation. [ABSTRACT FROM AUTHOR]

Objective: In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day‐to‐day practice in Egypt as well as several other resource‐limited countries. Premature mortality, poor quality of life, socio‐economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. Methods: The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. Results: Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. Significance: With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. Plain Language Summary: This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource‐limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels. [ABSTRACT FROM AUTHOR]

Background Inguinal lymph node dissection plays an important role in the management of melanoma, penile and vulval cancer. Inguinal lymph node dissection is associated with various intraoperative and postoperative complications with significant heterogeneity in classification and reporting. This lack of standardization challenges efforts to study and report inguinal lymph node dissection outcomes. The aim of this study was to devise a system to standardize the classification and reporting of inguinal lymph node dissection perioperative complications by creating a worldwide collaborative, the complications and adverse events in lymphadenectomy of the inguinal area (CALI) group. Methods A modified 3-round Delphi consensus approach surveyed a worldwide group of experts in inguinal lymph node dissection for melanoma, penile and vulval cancer. The group of experts included general surgeons, urologists and oncologists (gynaecological and surgical). The survey assessed expert agreement on inguinal lymph node dissection perioperative complications. Panel interrater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. Results Forty-seven experienced consultants were enrolled: 26 (55.3%) urologists, 11 (23.4%) surgical oncologists, 6 (12.8%) general surgeons and 4 (8.5%) gynaecology oncologists. Based on their expertise, 31 (66%), 10 (21.3%) and 22 (46.8%) of the participants treat penile cancer, vulval cancer and melanoma using inguinal lymph node dissection respectively; 89.4% (42 of 47) agreed with the definitions and inclusion as part of the inguinal lymph node dissection intraoperative complication group, while 93.6% (44 of 47) agreed that postoperative complications should be subclassified into five macrocategories. Unanimous agreement (100%, 37 of 37) was achieved with the final standardized classification system for reporting inguinal lymph node dissection complications in melanoma, vulval cancer and penile cancer. Conclusion The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulval and penile cancer. [ABSTRACT FROM AUTHOR]

This study presents a framework for determining the prioritization of vaccine introduction in the National Immunization Program (NIP) of the Republic of Korea, with a focus on case examples assessed in 2021 and 2023. We describe the predefined criteria for evaluating the prioritization of vaccines in the NIP and the established process in the Republic of Korea. These criteria included disease characteristics, vaccine characteristics, rationality and efficiency of resource allocation, and the acceptance of immunization. The process of prioritizing NIP introduction involved several sequential steps: a demand survey, evidence collection, preliminary evaluation, priority evaluation, and decision making. In 2021 and 2023, 14 and 25 committee members participated in evaluating the prioritization of vaccines in the NIP, respectively. Overall, 13 and 19 NIP vaccine candidates were included in the 2021 and 2023 evaluations, respectively. Through the Delphi survey and consensus processes, the priority order was determined: vaccination against Rotavirus infection was the top priority in 2021, while Influenza 4v (for chronic disease patients) took precedence in 2023. This study demonstrates an evidence-based decision-making process within the healthcare field. The outlined approach may provide valuable guidance for policymakers in other countries seeking to prioritize the inclusion of new vaccines in their NIP. [ABSTRACT FROM AUTHOR]

In the United States, science education has experienced substantial shifts in the last decade. For in-service teachers, professional development programs (PDPs) play an important role in reform success. Despite well-known core features of effective PDPs, research still suggests a range of results among programs that claim to use those features. An analysis of the nuances associated with these core features has emerged as an important step in bridging the gap between conceptual and actual effective PD. This article presents the validation of constructs for responsive facilitation, which may serve as a source of these nuances. Using an adapted Delphi Method, constructs were validated by multiple expert groups. A 10-construct consensus is presented with an eleventh remaining under dispute. All constructs have connections to current literature and may support the gap noted above. Implications include a structure that may provide nuance to the core features and support more consistently effective PD. [ABSTRACT FROM AUTHOR]

Background: Falls are a significant public health problem and constitute a major cause of injuries and mortality. Risk factors for falls are multifactorial and include medication use. Aim: To develop and investigate the content validity of the Medication-Related fall (MRF) screening and scoring tool. Method: The MRF tool was developed from clinical practice guidelines addressing medication-related problems, and additional medications identified by specialist pharmacists across a region of the United Kingdom (Northern Ireland). Medication classes were categorised according to their 'potential to cause falls' as: high-risk (three points), moderate-risk (two points) or low-risk (one point). The overall medication-related falls risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of surveys were conducted using SurveyMonkey®. Twenty-two experts from 10 countries determined their agreement with the falls risk associated with each medication on a 5-point Likert scale. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round. Results: Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool; ten were classified as high-risk, eight as moderate-risk and one as low-risk. Conclusion: The MRF tool is simple and has the potential to be integrated into medicines optimisation to reduce falls risk and negative fall-related outcomes. The score from the MRF tool can be used as a clinical parameter to assess the need for medication review and clinical interventions. [ABSTRACT FROM AUTHOR]

This study aimed to understand which character strengths are most important for people living with dementia and therefore which strengths-based psychological interventions could be most meaningful and acceptable. A participatory design, utilising Delphi methodology, was incorporated into an iterative three stage framework: (1) literature reviewed for Positive Psychology (PP) interventions and patient public involvement to define the character strengths; (2) modified Delphi (N = 10) identified which character strengths are most important for living with dementia; (3) focus groups (N = 14) explored which PP interventions are most acceptable and meaningful. Qualitative data from the focus groups was analysed using thematic analysis. Love, kindness and humour were deemed the most important character strengths for living with dementia. Qualitative data from the focus groups was captured in three superordinate themes: (1) lack of opportunity not capacity; (2) key considerations of PP interventions for people living with dementia; and (3) potential benefits of PP interventions. Love, kindness and humour come naturally to people with dementia, but people may lack social opportunities to use these strengths. Therefore, a PP intervention promoting positive emotion, social relationships and connection to one's values appears most meaningful and acceptable as this may provide a social context to use and maintain these strengths. [ABSTRACT FROM AUTHOR]

There is currently a limited understanding of what nurses in nursing homes view as the key education priorities to support their ability to provide the appropriate care for residents with heart failure (HF). A modified Delphi technique was utilized to gain a consensus on the key education priorities for nurses working in nursing homes in Northern Ireland. An initial list of items (n = 58), across 19 domains, was generated using the findings of a scoping review and stakeholder interviews, and a review of available clinical guidelines. Two rounds of surveys were undertaken. Items were presented using a 5-point Likert scale, with an additional exercise in the second round to rank the domains in order of importance. Fifty-four participants completed the first-round survey and 34 (63%) returned to complete the second. The findings highlight the importance of providing nurses in nursing home settings with general HF education and the delivery of person-centered care. Participants perceived education around technology for the management of HF and quality improvement or research methodologies associated with HF in nursing homes as lower priorities. This study illuminates key priorities from nursing home nurses regarding HF education that are applicable to this care setting. [ABSTRACT FROM AUTHOR]

Purpose: Acquainting organisations regarding the concepts of Total Quality Management (TQM) and its implementation is one measure that effectively improves their global position and performance. Kaizen is one of the concepts of TQM, which focuses on low-cost organisational transformational methods and often saves consuming significant resources (time, capital, etc.). Using Kaizen in organisational transformation sets efficient guidelines to improve processes agility and leanness and increase manufacturing productivity. Hence, this study aims to identify the key success factors in Kaizen projects and presents a score function that measures the readiness level of organisations to implement Kaizen projects. Design/methodology/approach: A literature review first extracts the key success factors in Kaizen projects. Afterwards, the selected factors are screened via the fuzzy Delphi method using expert opinions from the manufacturing sector of an emerging economy. Subsequently, their importance is cross-examined by the Bayesian best–worst Method (BBWM). The BBWM is one of the most recent multiple criteria decision-making (MCDM) methods that lead to stable, dynamic and robust pairwise comparisons. After analysing the weights of the key factors, a score function is designed so that organisations can understand how much they are ready to launch Kaizen projects. Findings: According to the findings, "Training and education" and "Employee attitude" played an important role in the success of Kaizen projects. The literature extracted 22 success factors of Kaizen projects, and 10 factors were eliminated through the fuzzy Delphi method. Twelve success factors in Kaizen projects were evaluated and investigated through the BBWM. Matching to this method, "Training and education" and "Employee attitude" weighed 0.119 and 0.112, relatively. Furthermore, "Support from senior management" was the least important factor. Originality/value: To the best knowledge of the authors, this is the first research in which the success factors of Kaizen projects have been identified and analysed through an integrated multi-layer decision-making framework. Although some studies have investigated the key success factors of Kaizen projects and analysed them through statistical approaches, research that examines the success factors of Kaizen projects through MCDM methods is yet to be reported. Moreover, the score function that measures the level of readiness of each organisation for the successful implementation of Kaizen projects is a unique contribution to this research. [ABSTRACT FROM AUTHOR]

Background The critical care literature has seen an increase in the development and validation of tools using artificial intelligence for early detection of patient events or disease onset in the intensive care unit (ICU). The hemodynamic stability index (HSI) was found to have an AUC of 0.82 in predicting the need for hemodynamic intervention in the ICU. Future studies using this tool may benefit from targeting those outcomes that are more relevant to clinicians and most achievable. Methods A three-round Delphi study was conducted with a panel of 10 critical care physicians and three nurses in the United States to identify outcomes that may be most relevant and achievable with the HSI when evaluated for use in the ICU. To achieve criteria for relevance, at least 65% of panelists had to rate an outcome as a 4 or 5 on a 5-point scale. Results Nineteen of 24 outcomes that may be associated with the HSI achieved consensus for relevance. The Kemeny-Young approach was used to develop a matrix depicting the distribution of outcomes considering both relevance and achievability. Reduces time spent in hemodynamic instability and reduces times to recognition of hemodynamic instability were the highest-ranking outcomes considering both relevance and achievability. Conclusion This Delphi study was a feasible method to identify relevant outcomes that may be associated with an appropriate predictive analytic tool in the ICU. These findings can provide insight to researchers looking to study such tools to impact outcomes relevant to critical care practitioners. Future studies should test these tools in the ICU that target the most clinically relevant and achievable outcomes, such as time spent hemodynamically unstable or time until actionable nursing assessment or treatment.

Abstract Background The Medium and Long-Term Plan for the Prevention and Treatment of Chronic Diseases (2017–2025) in China has highlighted the importance of reducing fat, sodium, and sugar in foods. However, front-of-pack labeling, which enables consumers to assess the health levels of prepackaged foods, is lacking in China. In response to the Zhejiang Provincial Health Commission’s request, we sought to develop a method for efficiently evaluating the health level of prepackaged foods. Methods Through a comprehensive literature review, we established a systematic framework: the Prepackaged Foods Healthiness Ranking Index (PHRI). We determined specific threshold values and grading criteria and conducted two rounds of Delphi survey to refine the index. Using a measurement dataset, we aimed to determine the optimal limit values for assessing the health level of prepackaged foods in real-world settings. Results After two rounds of Delphi surveys, the PHRI underwent multiple revisions until consensus among experts was reached. The final decision regarding the upper limit values set 30% Nutrient Reference Values as the limit for solid foods and 15% Nutrient Reference Values for liquid foods. The calculation of PHRI values was successfully implemented with the dataset, in accord with current nutrition awareness and real-world conditions. Conclusions The PHRI provides a valuable tool for assessing the healthiness of prepackaged foods. This front-of-pack labeling system provides a convenient method for evaluating the nutritional quality of prepackaged foods. Ultimately, the PHRI has the potential to contribute to advancements in health policy, practice, and education in China.

Design patterns for learning are about articulating, testing and sharing the principles of problem solving in the educational context. In this way, multiple patterns are developed to solve common problems, described in various pattern language formats. Therefore, this work is about characterizing and establishing functional relationships between the components involved in the construction of a learning design pattern. The research was carried out in a Delphi study of double round individual non-contact between experts (n = 14), from different areas (educational technology, e-learning, distance education, higher education), selected through the coefficient of expert competence. The main result is a pattern language composed of attributes, components, and groups of processes. It is concluded that the language obtained allows externalizing knowledge from its consistent and shareable structure, which makes it suitable for use in different scenarios that require a formal pattern language and facilitates its implementation in online learning contexts.

Multi-criteria methods are highly attractive tools to address the inherent complexity of evaluating problems in various scientific areas. The combination of methods such as Delphi/AHP is emerging as a robust alternative to evaluate the sustainability of renewable energy sources. In this theoretical-descriptive research, the use of the Delphi method is proposed to select criteria and sub-criteria to obtain a high level of reliability, while the AHP method is used to establish an order of preference among the alternatives analyzed. This process requires the support of a committee of experts, whose role is to identify the various biomass alternatives that can be used in the sugar industry, considering aspects related to sustainability. The selected experts have identified energy, exergy, and emergetic indicators, in which economic, environmental, and social aspects are integrated. The multi-criteria analysis shows that the V1 variant was the most satisfactory in terms of biomass sustainability, representing 45% and 53% of the overall priorities in the evaluated case studies. In addition, the sensitivity analysis under an equal-weighted scenario for both study cases evidenced that variant V1 acquired the highest score (38.17%) among all alternatives. Variant V4 achieved the second highest score (31.79%), while alternative V2 achieved only 29.04%, respectively. The integration of Delphi/AHP methods emerges as a novel tool to assess sustainability in different industries of the energy sector.

Abstract Background The exclusive breastfeeding rates is low in some countries. Low breastfeeding rates results in higher healthcare expenses and adverse health outcomes for individuals and society. Co-parenting is effective in promoting breastfeeding as it involves shared responsibility and collaboration between parents in raising children. However, the current breastfeeding co-parenting intervention programs exhibits significant variations in components, timing, and duration across studies. An evidence-based breastfeeding co-parenting intervention program is essential for enhancing breastfeeding-related outcomes. Objective To develop an evidence-based breastfeeding co-parenting intervention program for healthcare providers to guide parents with primiparas on breastfeeding. Method To form an initial version of the intervention program, a systematic literature review was conducted to consolidate information on current intervention programs. Two rounds of Delphi method were followed to gather expert comments for the program modification to establish the formal version. Results Fourteen articles published between 1995 and 2022 were screened. Details of these researches, including starting and ending time, duration and specific contents, were integrated to developed the initial program. Then, six experts completed the two rounds consultation with a positive coefficient of 85.71%, coefficient judgment basis of 0.93, familiarity coefficient of 0.87, authority coefficient of 0.90 and the Kendall’s W of 0.62. Finally, an evidence-based breastfeeding co-parenting intervention program was constructed in this study, consisting of breastfeeding co-parenting courses, individual counselling and a father’s support group. Conclusion This research developed a breastfeeding co-parenting intervention program for healthcare providers to guide primiparous parents to improve breastfeeding rates. Through a systematic literature review and Delphi method with good reliability, the program integrates breastfeeding courses, individual counseling, and a father’s support group. Future research will focus on evaluating its impact and scalability to benefit maternal and infant health globally. Trial registration ChiCTR.org.cn (ChiCTR2300069648). Registration date: 2023-03-22.

Abstract Lifestyle is an important factor affecting people's health. Evaluating and promoting healthy lifestyles among occupational population can not only improve work ability and efficiency, but also contribute to the prevention a variety of potential diseases. This study developed a preliminary index system based on literature review and group discussion. Two rounds of expert consultation were conducted on 12 experts using Delphi method. The questionnaire recovery rate of the two rounds of Delphi survey was over 85%, the expert authority coefficient was over 0.70, and Kendall W was 0.450 and 0.446, which were significant (P

Abstract Objective Manual therapy is a crucial component in rehabilitation education, yet there is a lack of models for evaluating learning in this area. This study aims to develop a foundational evaluation model for manual therapy learning among rehabilitation students, based on the Delphi method, and to analyze the theoretical basis and practical significance of this model. Methods An initial framework for evaluating the fundamentals of manual therapy learning was constructed through a literature review and theoretical analysis. Using the Delphi method, consultations were conducted with young experts in the field of rehabilitation from January 2024 to March 2024. Fifteen experts completed three rounds of consultation. Each round involved analysis using Dview software, refining and adjusting indicators based on expert opinions, and finally summarizing all retained indicators using Mindmaster. Results The effective response rates for the three rounds of questionnaires were 88%, 100%, and 100%, respectively. Expert familiarity scores were 0.91, 0.95, and 0.95; coefficient of judgment were 0.92, 0.93, and 0.93; authority coefficients were 0.92, 0.94, and 0.94, respectively. Based on three rounds of consultation, the model established includes 3 primary indicators, 10 secondary indicators, 17 tertiary indicators, and 9 quaternary indicators. A total of 24 statistical indicators were finalized, with 8 under the Cognitive Abilities category, 10 under the Practical Skills category, and 6 under the Emotional Competence category. Conclusion This study has developed an evaluation model for manual therapy learning among rehabilitation students, based on the Delphi method. The model includes multi-level evaluation indicators covering the key dimensions of Cognitive Abilities, Practical Skills, and Emotional Competence. These indicators provide a preliminary evaluation framework for manual therapy education and a theoretical basis for future research.

Objective: Primary immune thrombocytopenia (ITP) is an acquired disorder of platelets with a complex and unclear mechanism of increased immune destruction or impaired production of platelets. While the management of ITP is evolving, there is still a need for guidance, particularly in certain circumstances such as pregnancy, emergencies, or patients requiring co-medications. We aimed to determine the tendencies of hematologists in Türkiye in the event of such special considerations. Materials and Methods: Applying a modified Delphi method, the Turkish National ITP Working Group, founded under the auspices of the Turkish Society of Hematology, developed a questionnaire consisting of statements regarding pregnancy, emergencies, and circumstances requiring co-treatment with antiaggregants or anticoagulants. A total of 107 hematologists working in university or state hospitals voted for their agreement or disagreement with the statements for two sequential rounds. Results: The participating hematologists reached an agreement on starting treatment for pregnant patients with platelets of less than 30x109/L and delivery either vaginally or by cesarean section being safe at platelet counts above 50x109/L. For emergencies and the rescue management of ITP, the panel agreed against the use of high-dose corticosteroids alone, preferring combinations with transfusions or intravenous immunoglobulin. For patients who require interventions, platelet counts of >50x109/L were regarded as safe for low-risk procedures as well as co-treatment with antiplatelets or anticoagulants. Conclusion: As the National ITP Study Group, we have observed the need to increase the practice guidance regarding patients with primary ITP requiring additional treatments including invasive interventions and co-treatments for coagulation. Decisions on the management of ITP during pregnancy should be individualized. There is a lack of consensus on the thresholds of platelet counts as well as co-morbidities and co-medications. This lack of consensus may be due to variations in practices.

ObjectiveTo construct an evaluation index system for the development level of county-level chronic disease management centers, providing a basis for evaluating and comparing the construction of these centers. MethodsFocusing on the key points of county-level chronic disease management center construction and combining relevant literature, a candidate index database was constructed. Twenty-nine experts in the field of chronic disease management were selected to conduct two rounds of Delphi consultation to determine the evaluation index system for the development level of county-level chronic disease management centers, and the analytic hierarchy process was used to determine the index weights. ResultsThe active participation rates of experts in the two rounds of Delphi consultation were 90.91% and 96.67%, respectively, with expert authority coefficients of 0.85 and 0.84, and Kendall′s W of 0.15 and 0.20 (both P < 0.001). After two rounds of consultation, a final evaluation index system for the development level of county-level chronic disease management centers was constructed, consisting of 5 dimensions and 45 indicators: organizational management and basic conditions, chronic disease management informatization, county-township collaborative management of chronic diseases, capacity building and quality control of chronic disease management, and quality and effectiveness of chronic disease management. The weights of the 5 dimensions were 0.212 2, 0.180 1, 0.219 4, 0.179 4, and 0.208 9, respectively. ConclusionThe evaluation index system for the development level of county-level chronic disease management centers constructed in this study is reasonable, practical, representative, and instructive, providing a reference basis for evaluating the development level of these centers and key directions for subsequent construction.

In light of the pressing global challenges related to greenhouse gas emissions from the construction industry, current evaluation systems for green building construction sustainability remain limited, often overlooking sustainability domains. This study innovatively established an evaluation framework by exploring five critical domains: environmental sustainability, economic benefits, socio-cultural impacts, technological innovation, and health and well-being. Sixteen key evaluation indicators were identified using the Delphi method, with the novel inclusion of a carbon emission reduction target achievement indicator, thereby promoting the goal of carbon neutrality in green buildings. To determine a more reasonable weight distribution, this paper combined the fuzzy analytic hierarchy process (fuzzy AHP) with the entropy weight method. Additionally, the study employed a fuzzy matter-element method enhanced by genetic algorithms for precise evaluation of green building construction sustainability. The feasibility and effectiveness of the proposed model were validated through an empirical analysis of a green building project in Beijing. The results of this research provide innovative theoretical references and practical guidelines for green building construction sustainability evaluation.

A deep understanding of the dynamics between performance pressures and ethical leadership becomes crucial in an era of stressful economic recovery. This research explores the complex relationship between organizational performance pressures and ethical leadership, focusing on how these pressures impact ethical decision-making and the challenges of maintaining ethical integrity in demanding environments. Employing a convenience sampling method and the rank-type Delphi method, the study engaged 40 experts from both academic and practical fields to identify and rank key performance pressures that compromise ethical leadership. Significant pressures identified include the imperative to generate positive financial reports, achieve greater efficiency, withstand competitive pressures, and pursue aggressive growth strategies, all eroding ethical leadership. These pressures lead to unethical practices, such as falsifying financial reports, exploiting working conditions, unfair competition, and aggressive merger and acquisition tactics. The findings underscore the critical need for leaders to recognize and manage these pressures effectively to foster an environment conducive to ethical leadership. This study contributes valuable insights into the mechanisms by which performance pressures undermine ethical leadership and highlights the importance of cultivating a culture that promotes normative behavior and addresses ethical challenges, thereby enriching the existing body of knowledge on organizational ethics and leadership.

Abstract Objective In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day‐to‐day practice in Egypt as well as several other resource‐limited countries. Premature mortality, poor quality of life, socio‐economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. Methods The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. Results Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. Significance With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. Plain Language Summary This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource‐limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

This report provides an expert appraisal of the Canadian Para Report Card on physical activity (PA) for children and adolescents with disabilities. Thirteen indicators were graded by a panel of researchers, representatives from disability and PA organizations, and parents of children and adolescents with disabilities using benchmarks of the Global Matrix 4.0 and previous Canadian PA Report Cards. Facilitated panel discussions were used to appraise the available evidence based on data gaps, opportunities, and recommendations. The available data sources included four nationally generalizable or representative data sets. Grades were assigned to 8/13 indicators and ranged from B+ to F. Data gaps in measurement and national surveillance systems were identified. Ableism was an issue identified within some of the reporting benchmarks. The absence of PA from existing accessibility legislation in Canada was a policy gap of concern. Recommendations related to research, surveillance, and policy are provided to enhance PA among children and adolescents with disabilities in Canada. [ABSTRACT FROM AUTHOR]

The purpose was to synthesize information gathered from the interpretation and conclusion sections of the Global Matrix of Para Report Cards on the physical activity of children and adolescents with disabilities. The synthesis was based on the strengths, weaknesses, opportunities, and threats framework. The procedure consisted of three stages: (a) the application of the International Classification of Functioning, Disability and Health as the theoretical framework; (b) identifying and aligning Global Matrix indicators and benchmarks with the International Classification of Functioning, Disability and Health components through a Delphi approach; and (c) using content analysis to identify themes from specific report cards. Outcomes reveal that further attention toward including children and adolescents with disabilities in fitness assessments is needed as well as adapted assessment methods. Program availability, equipment and facilities, and professional training emerged as strengths but need further development to overcome weaknesses. Paralympic inspiration was an opportunity, whereas extreme weather conditions presented potential threats to physical activity participation among children and adolescents with disabilities. [ABSTRACT FROM AUTHOR]

Background Protection provided by seasonal influenza vaccination (SIV) may be measured against numerous outcomes, and their heterogeneity may hamper decision-making. The aim of this study was to explore outcomes used for estimation of SIV efficacy/effectiveness (VE) and obtain expert consensus on their importance.Research design and methods An umbrella review was first conducted to collect and map outcomes considered in systematic reviews of SIV VE. A Delphi study was then performed to reach expert convergence on the importance of single outcomes, measured on a 9-point Likert scale, in principal target groups, namely children, working-age adults, older adults, subjects with co-morbidities and pregnant women.Results The literature review identified 489 outcomes. Following data reduction, 20 outcomes were selected for the Delphi process. After two Delphi rounds and a final consensus meeting, convergence was reached. All 20 outcomes were judged to be important or critically important. More severe outcomes, such as influenza-related hospital encounters and mortality with or without laboratory confirmation, were generally top-ranked across all target groups (median scores ≥8 out of 9).Conclusions Rather than focusing on laboratory-confirmed infection per se, experimental and observational VE studies should include more severe influenza-related outcomes because they are expected to exercise a greater impact on decision-making.

Background As an important part of the general practice team, assistant general practitioners undertake a lot of grassroots general practice work, but at present, there is no recognized national level assistant general practitioners post competency model to provide scientific basis for training qualified assistant general practitioners. Objective The competency of assistant general practitioners for China was constructed to provide support for the design of national assistant physician qualification examination, and provide theoretical basis for the training and evaluation of assistant general practitioners. Methods Based on the research group's previous literature research and behavioral event interviews, from September 2019 to January 2020, the entry pool was established, and 30 experts engaged in general practice were consulted by Delphi method for 2 rounds. The index and weight coefficient of the Chinese assistant general practitioner post competency model were determined by AHP. Results Six first-level indicators [the basic medical and health services (0.244 8), medical knowledge and life-long learning (0.244 8), and professional quality (0.244 8), interpersonal communication and team work (0.138 9), the basic public health services (0.085 8), the information utilization ability and management capacity (0.041 0) ] and 63 second-level indicators were finalized, and the weight coefficients of each indicator were defined. Conclusion This study constructs the post competency of assistant general practitioners for China for the first time, which has a high degree of expert representativeness and authority, and a more comprehensive and reasonable index selection, laying a foundation for the empirical study of the index system.

Since independence is the most important characteristic of an auditor, we want to expand and develop this characteristic in auditing institutions, so our goal is to provide a practical and practical solution to maintain independence in auditing institutions. We collected and summarized. The experts stated that out of 34 characteristics of auditor independence, except 8 cases are applicable in audit institutions. If these features are not collected in one place and are dispersed and individually under the title of auditor independence, we will rarely see the independence of audit institutions. Currently, the only place where the characteristics of independence can be summarized and considered under a practical and operational model is in the ranking of audit institutions, which is done by the public accountants community. If these characteristics and criteria are taken into account and used in a practical way in the ranking of auditing institutions, we can increase and maintain the independence of auditing institutions. The ranking of auditing institutions can be more appropriate by considering the independence characteristics and bringing fair distribution of work. [ABSTRACT FROM AUTHOR]

Urban finance is one of the most basic urban development policies. This article investigated Tehran Municipality to provide financial sources of income and provide the cooperative financial model. For this purpose, a mixed method was adopted with the priority of the qualitative stage over the quantitative stage. In the qualitative approach, the proficient subject experts were interviewed to meet the objectives of the research until the theoretical adequacy was achieved. Then, the Delphi method was used to confirm or modify the indicators identified from the qualitative content analysis of the interviews. Thus, the pattern of providing financial resources was extracted from the data of the qualitative phase. After that, the questionnaire was given to 300 financial employees of Tehran Municipality to weigh the indicators identified from the qualitative phase. The data were analyzed using SPSS 22 and Lisrel 8.5 software and the confirmatory factor analysis technique to determine the variables' weight. The findings showed that seven dimensions of justice, transparency, local independence, thrift, income adequacy, sustainability and practicality, and non-shifting of the tax base were extracted in the financing model. The indicators of these dimensions include charges on official documents, charges on added value, charges on buildings and lands, charges on communications and transportation, charges on professional business licenses, charges on parking, charges on centralized collection, charges on property (Real estate), and income from municipal services. Obtaining these results showed that we can achieve a comprehensive theoretical and applied model in this field only when we pay attention to identifying its definitions, concepts, dimensions and components based on the conditions governing the economic environment of the country and Tehran municipality because the financing issue is multifaceted and complex in the municipality. [ABSTRACT FROM AUTHOR]

This research aims to design a pattern for managers' professional ethics factors focusing on the mine workers' mental health. This research's method, which is based on the interpretative paradigm, is developmental, respecting the goal, and it has an exploratory-analytical nature by an inductive approach adoption, and it has used mixed research (qualitative/quantitative) from the statistical community of industry and university experts through a targeted sampling method. Three steps have been considered to achieve the research's main goal. The factors of the managers' professional ethics have been identified in the research's first step through investigating the published articles at the national and international level with content analysis method by NVIVO software, and then, the 15 main factors were finalized and confirmed through the Delphi method and using EXCEL software in the second step in order to naturalize the factors extracted from the articles emphasizing its effect on mine workers' mental health. The factors rating and pattern presentation were done in the third step using the ISM method. The present research has provided the factors of professional ethics of Iranian mine managers and the relationships between these factors emphasizing the mine workers' mental health to be applied by the mining industries' managers of Iran and invited them to pay extra attention to factors such as characteristic traits and perceptual skills which are the most effective variables through presenting a pattern of managers' professional ethics factors. [ABSTRACT FROM AUTHOR]

The present paper investigates the process of codifying crimes against humanity, with a specific focus on the difficulties encountered in achieving regulatory consistency and precision within international legal traditions. Notwithstanding the implementation of the Rome Statute and the endeavors of the International Law Commission (ILC), there are still deficiencies in the codification, namely in the areas of preventing and punishing these offenses. By employing the Neutrosophic Analytic Hierarchy Process (NAHP), Delphi method, and Neutrosophic Cognitive Maps (NCM), this study reveals key elements that impact the codification process. These elements include the necessity for a distinct convention and the sufficiency of current legal norms. Neutrosophic Cognitive Maps provide the visualization of the connections and interdependencies among important elements, therefore providing a deeper comprehension of their influence. An expert consensus highlighted the need for precise definitions, regulatory consistency, and a strong theoretical and legal basis. To enhance accountability and avoid future crimes against humanity, the report asserts that stronger international collaboration and a systematic approach to integrating these elements are essential. Subsequent investigations should prioritize the pragmatic application of suggested standards, comparative examination with other global legal systems, and ongoing expert verification through neutrosophic techniques. [ABSTRACT FROM AUTHOR]