Search Results (1,262)

Background/Objectives: Adolescence is a sensitive developmental window shaped by both vulnerabilities and adaptive potential. From an evolutionary standpoint, mental health difficulties in this period may represent functional responses to environmental stressors rather than mere dysfunctions. Despite increasing interest, integrative models capturing the dynamic interplay of risk and protective factors in adolescent mental health remain limited. This study presents a holistic, multi-level framework grounded in ecological and evolutionary theories to improve understanding and intervention strategies. Methods: A two-round Delphi method was used to develop and validate the framework. Twelve experts in adolescent mental health evaluated a preliminary draft derived from the literature. In Round 1, 12 items were rated across five criteria (YES/NO format), with feedback provided when consensus thresholds were not met. Revisions were made using consensus index scores. In Round 2, the revised draft was assessed across eight broader dimensions. A consensus threshold of 0.75 was used in both rounds. Results: Twelve out of thirteen experts (92%) agreed to join the panel. Round 1 item scores ranged from 0.72 to 0.85, with an average consensus index of 0.78. In Round 2, ratings improved significantly, ranging from 0.82 to 1.0, with an average of 0.95. The Steering Committee incorporated expert feedback by refining the structure, deepening content, updating sources, and clarifying key components. Conclusions: The final framework allows for the clustering of indicators across macro-, medium-, and micro-level domains. It offers a robust foundation for future research and the development of targeted, evolutionarily informed mental health interventions for adolescents. Full article

Green buildings (GBs) are a means of achieving sustainable construction. However, they face challenges, such as higher (perceived or actual) investment costs and inadequate capital. Green finance (GF) presents opportunities to address some challenges of GB. Barriers hinder GF-in-GB; however, previous studies identifying barriers to GF-in-GB are limited. Moreover, prior studies have not considered the interrelationships among these barriers. This study aims to identify and prioritize the critical barriers to GF-in-GB in Ghana to inform decision-making by policymakers and stakeholders. This study developed a valid set of barriers and criteria from the literature to ascertain their interactions through two rounds of Delphi surveys with 12 professionals with GF-in-GB experience. A two-step fuzzy decision-making trial and evaluation laboratory (FDEMATEL) method was employed to validate 16 criteria of barriers using linguistic preferences. The findings of this study indicate that split incentives, inadequate private investment, inadequate management support, and limited green projects are critical barriers to GF-in-GB. These criteria deserve critical attention, as they are of high importance cause indices and can give rise to effect barriers. The government can adopt the research findings in policymaking and by other stakeholders that seek to eliminate barriers by focusing on the most influential ones. Full article

Background: First-Line Nurse Managers (FLNMs) have been recognised as key contributors to achieving organisational objectives, serving as vital intermediaries between management, staff, and patients. Assessing whether the Span of Control (SOC) is appropriate and providing the necessary support for FLNMs to fulfil their responsibilities poses a considerable challenge for healthcare organisations. No tool exists in Spain to guide decisions regarding FLNM’s SOC and resource needs. The aim of this study is to design a tool for assessing the span of control of first-line nurse managers in hospitals. Methods: This study employed a tool development and content validation design to create the EASOC-Nursing instrument (Eliges Aragón SOC tool). The study was conducted in three stages: an integrative literature review, followed by a national Delphi study with 43 experts in nursing management, and finally, focus group discussions. Results: A tool was created to assess first-line nurse managers’ (FLNM) span of control (SOC) using 13 key indicators, organised into four categories: unit (operations and resources, conflicts, and logging and monitoring of activities), professional (staff and competencies), FLNM (autonomy, education, and leadership), and organisation (support systems, education, and research). It includes a total of 31 items and determines SOC adequacy by establishing cut-off points that classify it as below acceptable, appropriate, or excessive. When the SOC is inadequate, the tool provides specific recommendations for support measures, such as the provision of administrative personnel or the appointment of a co-leader. Conclusions: The EASOC-Nursing tool offers a comprehensive evaluation of the core dimensions of the FLNM role and its responsibilities in Spain. Furthermore, it delivers practical guidance on the most suitable types of support to facilitate the attainment of optimal outcomes for both patients and healthcare organisations. In light of the global nursing shortage, the availability of a robust and context-sensitive instrument to assess the SOC enables hospital nursing management to allocate resources more strategically, thereby enhancing working conditions for professionals and contributing to improved patient care outcomes. Full article

Advancements in assistive technologies (ATs), particularly those powered by Artificial Intelligence (AI), have significantly enhanced the quality of life and independence of individuals with various disorders, thus fostering progress in education, employment, social engagement and well-being. Despite these advancements, significant challenges remain in the implementation of such technologies in various domains, emphasizing the necessity for deeper exploration of their future development. This study examines the future trends and perspectives of ATs, providing valuable insights from a national context and comparing the results with those of international Delphi research. Using a two-round Delphi method, we engaged a panel of 23 experts from Bulgaria, representing disability organizations, academia and practice. Ten future-oriented projections were assessed, while participant demographics and attitudes toward ATs were also analyzed. The survey’s statistical findings indicate a moderate consensus among the Bulgarian experts. They demonstrate cautious optimism about the use of ATs, especially AI-driven technology, for individuals with disabilities. The results are similar with those of the international study, with only few differences, highlighting the shared perspectives of experts at both national and international levels. The research offers valuable insights into emerging trends in AI-driven ATs and provides valuable knowledge for policymakers, researchers and developers seeking to align innovation with the expectations of diverse stakeholders. Full article

Aim: Hostile aortic neck anatomy—characterized by short neck length, severe angulation, conical shape, and mural thrombus or calcifications—represents a major limitation to the durability and applicability of standard endovascular aneurysm repair (EVAR). In response to these challenges, newer endografts with improved conformability have been developed. This study aimed to evaluate the mid-term outcomes of EVAR using the GORE EXCLUDER Conformable AAA Endoprosthesis (CEXC) (W.L. Gore & Associates Inc., Flagstaff, AZ, USA) in patients with hostile neck anatomy, with specific attention to type III endoleak occurrence, aortic sac remodeling, and maintenance of distal sealing. Methods: A retrospective observational analysis was conducted on 50 consecutive patients treated with the CEXC endograft between October 2019 and September 2023. Patients included had either elective or urgent indications for EVAR and were evaluated preoperatively using CT angiography. Hostile neck criteria were defined according to the 2019 Delphi Consensus. Procedural variables, imaging follow-up, and clinical outcomes were collected. The primary endpoints were technical and clinical success, while secondary outcomes included endoleak rates, aneurysm sac evolution, and reintervention-free survival. Results: Technical success was achieved in 100% of cases, with a clinical success rate of 98%. No type Ia, Ib, or III endoleaks were observed at a median follow-up of 23 months. Sac shrinkage (>5 mm reduction) occurred in 70% of patients, and distal sealing was preserved in 100% of cases. One perioperative death occurred in an emergency setting, and no late reinterventions or aneurysm-related mortalities were reported. The use of intravascular ultrasound (IVUS) and floppy guidewires contributed to precise deployment and sealing in angulated anatomies. Conclusions: The CEXC endograft proved to be a safe and effective option for EVAR in patients with hostile aortic anatomy, ensuring durable proximal and distal sealing, promoting favorable sac remodeling, and preventing type III endoleaks. These findings support the use of CEXC in anatomically complex settings, as long as procedures are meticulously planned and guided by appropriate intraoperative imaging and deployment techniques. Full article

Environmental, social, and governance (ESG) has become a concern for companies, investors, and regulators. Its significance cannot be underestimated, as stakeholders increasingly demand accountability and transparency regarding corporate practices in these areas. Government agencies enforce laws mandating companies adhere to established ESG standards in response. However, despite these regulatory pressures, several obstacles have hindered organizations from effectively implementing sustainability initiatives, often resulting in lackluster outcomes. In this study, we developed a framework to implement ESG principles across various companies, utilizing the critical success factor (CSF) theory. By incorporating the perspectives of stakeholders, we identified the essential elements to achieve ESG. The developed framework in ESG studies employed the hybrid Delphi technique and the analytical hierarchy process (AHP), a structured method for organizing and analyzing complex decisions. Based on the results obtained from targeted questions, variables that influence ESG performance were identified. The effectiveness of different sustainability initiatives was also assessed to understand stakeholder engagement strategies and evaluate the impact of organizational culture on ESG adoption. Full article

Background: Autism spectrum disorder (ASD) presents diverse challenges that significantly impact feeding, nutrition, growth, and development. The heterogeneity of ASD manifestations adds complexity to assessments due to the broad range of factors to be considered. Moreover, the literature lacks a comprehensive tool specifically addressing nutritional aspects in ASD. Methods: Conducted in two steps, this study first involved researchers selecting evidence-based elements related to ASD and nutrition to develop a preliminary tool. Content validation was subsequently undertaken using a modified Delphi method, whereby expert consensus was sought from 30 dietitians with experience in ASD, who evaluated the tool through a digital questionnaire. Four quality criteria were evaluated: functionality, organization, language and comprehensibility, and comprehensiveness. Results: Levels of strong agreement with the quality criteria ranged from 63.3% to 80%, specifically functionality (76.7%), organization (73.3%), language and comprehensibility (80%), and comprehensiveness (63.3%). Thematic analysis highlighted six key areas for improvement. The instrument assesses nutritional aspects across seven domains: life history, food-related aspects, feeding behavior, dietary intake, daily routines, clinical aspects, and anthropometry. Conclusions: This is the first known tool to comprehensively address the nutritional needs of individuals with ASD, offering a detailed framework for clinical application. It supports initial assessments, ongoing monitoring, and targeted interventions, supporting dietitians worldwide in clinical decision-making. Full article

This study develops a comprehensive analytical framework to examine how nations secure core positions in global supply chains (GSCs) for key industries. It combines a comparative analysis of advanced economies—Los Angeles (aerospace), Munich (high-end manufacturing), London (biopharmaceuticals), and Tokyo (automotive)—with a survey-based empirical assessment of Chinese industry practitioners. Using the Analytic Hierarchy Process (AHP), factor analysis and the Delphi method, an evaluation framework is constructed across five dimensions: technology, value, governance, resilience, and sustainability. The findings show that developed economies sustain their leadership through upstream innovation and standard-setting, coordination of high-value activities, integrated industrial ecosystems, and risk-buffering mechanisms. Empirical results reveal that while China demonstrates relative strengths in governance and value creation, it continues to lag in frontier technologies, resilience, and sustainability. Building on both comparative and empirical evidence, the study proposes strategic pathways for China’s key industries, including technological breakthroughs, innovation-driven clusters, governance reforms, digital resilience, and green cooperation. These insights provide actionable guidance for policymakers and highlight how latecomer economies can transform structural disadvantages into innovation momentum, evolving from participants to rule-setters in global supply chains. Full article

Postpartum lactating people are particularly vulnerable to inequities in social determinants of health (SDH), yet no validated tool currently exists to assess these factors comprehensively. This study aimed to co-develop and establish the content validity of an instrument to integratively evaluate SDH in this population. Guided by the Mixed Methods Appraisal Tool, an interdisciplinary e-Delphi panel assessed item sufficiency, clarity, coherence, and relevance. Statistical analyses included the item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices, average agreement between experts (AABE), Fleiss’ kappa (κ), and Aiken’s V coefficient (V) (p < 0.05). Cognitive interviews were conducted with postpartum lactating participants representing diverse characteristics to assess interpretability. The initial version of the instrument included 135 items across nine sections addressing general demographics, education, employment, home environment, lifestyle, social support, healthcare access, stress, intimate partner violence, insomnia, and nutrition. Based on expert input, it was refined to 131 items through structural and lexical revisions. Content validity indices indicated strong agreement: I-CVI ranged from 0.66–1.00, S-CVI/Ave > 0.95, AABE > 14.26, and κ and V > 0.90. Final adjustments following cognitive interviews led to a 128-item version optimized for clarity and relevance. This instrument offers strong content validity for SDH assessment in postpartum lactating people and supports sustainable use in health research. Full article

Social facilities play a crucial role in urban development. However, there are currently few studies on the rationality of the spatial layout of social facilities in inland coastal cross-river cities. In view of this, we choose Nanjing City, China as an example, based on the point of interest (POI) data of social facility, and use the techniques including kernel density analysis, standard error ellipses, and spatial correlation analysis to systematically investigate the spatial distribution characteristics and patterns of social facilities in Nanjing. The research results show that there are significant differences in the spatial distribution of different types of social facilities in Nanjing, and the overall layout presents a pattern of denser distribution in the central urban area and more dispersed distribution in the peripheral areas. Shopping and transportation facilities are mostly concentrated in the core area of the main urban district, medical facilities are relatively concentrated, and cultural and educational facilities are located in all regions. The expert weighting analysis based on the Delphi method indicates that the influence weights of shopping consumption and transportation facilities on urban facilities are relatively greater than those of other factors. Overall, the social service facilities in the central urban area of Nanjing are well developed and well arranged, whereas the construction of facilities in several new districts and suburbs still needs to be further strengthened. The findings offer a scientific foundation for improving the layout of social facilities and urban planning in Nanjing, while also serving as a valuable reference for the development of other inland coastal cities spanning rivers. Full article

The present study explores the enablers for the integration of Industry 5.0 principles within the automotive industry, emphasizing the transition towards human-centric, sustainable, and resilient manufacturing. This research utilized a three-round Delphi method involving a panel of experts to identify, evaluate, and prioritize key enablers associated with the adoption of Industry 5.0. In order to enhance the analytical depth, consensus trajectory mapping was employed to track opinion convergence across rounds. Fuzzy ranking was applied to provide a more nuanced evaluation of item prioritization. The results indicate a substantial degree of consensus on subjects such as collaborative robotics, cognitive automation, and circular manufacturing. The present study offers theoretical and practical implications, providing a roadmap for researchers and automotive stakeholders seeking to operationalize Industry 5.0 values. Full article

The Chengdu–Chongqing Economic Mega Region (CCEMR), as a strategic economic hub in Western China, is increasingly facing challenges in balancing urban growth, agricultural stability, and ecological conservation within its territorial spatial planning framework. This study addresses the critical need to integrate multidimensional resilience assessment into China’s territorial spatial planning system. A framework for functional resilience assessment was developed through integrated GIS spatial analysis, with three resilience dimensions explicitly aligned to China’s “Three Zones and Three Lines” (referring to urban, agricultural, and ecological space and spatial control lines) territorial planning system: urban resilience was evaluated using KL-TOPSIS ranking, where weights were derived from combined Delphi expert consultation and AHP; agricultural resilience was quantified through the entropy method for weight determination and GIS raster calculation; and ecological resilience was assessed via a Risk–Recovery–Potential (RRP) model integrating Ecosystem Risk, Recovery Capacity (ERC), and Service Value (ESV) metrics, implemented through GIS spatial analysis and raster operations. Significant spatial disparities emerge, with only 1.29% of CCEMR exhibiting high resilience (concentrated in integrated urban–ecological zones like Chengdu). Rural and mountainous areas demonstrate moderate-to-low resilience due to resource constraints, creating misalignments between resilience patterns and current territorial spatial zoning schemes. These findings provide scientific evidence for optimizing the delineation of the Three Major Spatial Patterns: urbanized areas, major agricultural production zones, and ecological functional zones. In this research, a transformative methodology is established for translating resilience diagnostics directly into territorial spatial planning protocols. By bridging functional resilience assessment with statutory zoning systems, this methodology enables the following: (1) data-driven resilience construction for the Three Major Spatial Patterns (urbanized areas, major agricultural production zones, and ecological functional zones); (2) strategic infrastructure prioritization; and (3) enhanced cross-jurisdictional coordination mechanisms. The framework positions spatial planning as a proactive tool for adaptive territorial governance without requiring plan revision. Full article

The historic landscape and the value of the ancient city in the stock era present a diversified and mixed problem; as such, this study explores a quantifiable spatial correlation method for landscape layering characteristics and value space, in order to provide support for the urban renewal paths that integrate historical and contemporary needs. Taking as an example Chaozhou Ancient City, a renowned historical and cultural city in China, this study draws on the theory of historical urban landscape layering and comprehensively uses historical graphic interpretation, GIS spatial quantitative analysis, the single-land-use dynamic degree model, the Analytic Network Process, and the Delphi method to quantitatively analyze and evaluate the landscape layering characteristics and value space of the ancient city. Meanwhile, it explores the relationship between the historical landscape layering characteristics and value space of ancient cities using the spatial autocorrelation model and the coupling coordination modulus model. The key findings are as follows: (1) The high-layer space (66.1%) and high-value space (31.1%) of the historic landscape of Chaozhou Ancient City show significant mismatch and imbalance. Spatially, layer spaces increase from the city center toward the periphery, whereas value spaces decrease from the center outward, demonstrating marked spatial heterogeneity. (2) The layer–value space shows a spatial distribution of agglomeration, with Moran’s I index values of 0.2712 and 0.6437, respectively. The agglomeration degree of the value space is much higher than that of the layer space, and both show significant non-equilibrium and associative coupling. (3) Coupling coordination: basically balanced (D = 0.56) indicates a transition toward a more integrated state, although 48% of the region remains in a state of severe dysfunction, mainly consisting of two types of spaces: “high-layer–high-value” and “low-layer–low-value.” These two dysfunctional types should be prioritized in future conservation and renewal strategies. This study provides a more comprehensive quantitative analysis path for identifying and evaluating the landscape layer–value space of the ancient city, providing visualization tools and decision-making support for the future protection and renewal of Chaozhou Ancient City and the declaration of the World Heritage. Full article

Buffer zones around protected areas (PA) face complex governance challenges as territorial transitions accelerate globally, yet limited consensus exists on their definition, ecosystem service (ES) priorities, and management strategies. This study employed a three-round Delphi methodology with 23 transdisciplinary experts to build consensus on buffer zone governance around Cerro Castillo National Park in Chilean Patagonia, using the IPBES ecosystem services framework to structure the analysis. Round 1 employed open-ended questions to explore expert perspectives, Round 2 evaluated 56 statements and 15 strategic components using structured questionnaires, and Round 3 refined non-consensus items. Experts achieved 76.7% overall consensus across three thematic areas: PA interface conceptualization (79.2% consensus on 24 statements), ES assessment (91.2% consensus on 34 statements), and territorial transition strategies (15 components evaluated). Water-related services achieved unanimous agreement across multiple IPBES categories, revealing their potential as boundary objects bridging conservation and development perspectives. Educational approaches and voluntary compliance emerged as high-feasibility strategic components, while regulatory frameworks showed high importance but implementation uncertainty. The study demonstrates that structured expert consultation can identify collaborative pathways for buffer zone governance, with water services providing concrete entry points for multi-stakeholder cooperation and education-based strategies offering promising implementation pathways for sustainable territorial transitions. Full article

Plant-based diets are increasingly recognized for their potential health benefits, reduced environmental impact, and alignment with ethical concerns related to animal welfare. Plant-based meat analogues (PBMAs), formulated using alternative vegetable protein sources, can contribute to the nutritional adequacy of such diets while supporting consumer adherence by replicating the sensory characteristics of conventional meat products. This study aimed to establish evidence-based nutritional recommendations for the formulation of nutritionally balanced PBMAs through expert consensus, using a modified Delphi method. Consensus was achieved for 12 nutritional recommendations across three stakeholder groups: (i) academic researchers; (ii) representatives from scientific societies, non-governmental organizations, civil society, and government agencies; and (iii) industry stakeholders involved in PBMA production. Recommendations focused on limiting nutrients of concern—such as sodium and saturated fats—were unanimously endorsed by all groups. Additionally, consensus was reached on recommendations emphasizing the inclusion of ingredients that ensure an adequate intake of essential nutrients, including proteins, fiber, vitamins, and minerals. Among the six proposed regulatory recommendations, three achieved consensus. The resulting set of nutritional recommendations offers a valuable framework to support the food industry in developing PBMAs that align with consumer expectations for health, nutrition, and sustainability. Moreover, these recommendations can play a pivotal role in assisting regulatory authorities in defining identity and quality standards for PBMAs. Full article