Sustainable tourism indicators (STI) are widely recognized as a useful tool for assessing the sustainability level of a tourism destination. Methods for STI development, however, are still ...inconsistent and often characterized by a debate between approaches proposed by three parties: scientists, policy-makers and supporters of participatory decision-making. Despite the development of approaches that address this debate, there has been little agreement on the broader methodological and conceptual foundations of STI development. In the pursuit of finding consensus, a Delphi survey is conducted in which an expert panel assesses and discusses the potential of innovative hybrid methodologies. Findings emphasise a shift towards more participatory formats and show that the requirements of all three parties can be met. This study advances future STI development processes by structuring the debate, evaluating existing and new approaches and exemplifying how to conceptualize formats to facilitate local involvement, thereby mapping out future pathways for STI development.
Postpartum anxiety has negative consequences for both mother and infant, so effective identification and measurement is vital to enable intervention. Despite NICE recommendations to prioritise the ...measurement of postpartum anxiety in mothers, current clinical measurement in England remains both fragmented and flawed. The Postpartum Specific Anxiety Scale PSAS offers an alternative, as it measures maternal-focused anxieties which can enable specifically targeted interventions. However, it is only currently used as a research tool and may require modification for clinical use. To inform modification of the PSAS, nineteen stakeholders from a variety of organisations participated in a two-round Delphi consensus survey to measure its clinical relevance and potential for effective identification of clinical anxiety. Descriptive analyses revealed all subscales of the PSAS scored highly across all domains, excluding Practical Infant Care Anxieties. Analyses also indicated good consensus between stakeholders across specific items, suggesting that the some items on the PSAS are relevant and effective at identifying clinical postpartum anxiety. Participants also expressed a need for a shorter version of the PSAS for clinical use, and that additional items may need including. Future research must now adapt the existing PSAS based on the results of this study and pilot the adapted measure in a clinical population.
The construction industry is believed to be more susceptible to human errors than other industries because of its unique characteristics, particularly when it comes to urban construction projects ...(UCP). Despite the considerable attention given to human errors in construction sector, there has been a lack of emphasis on analysing these errors in specific projects like construction in urban environments with distinct complexities. Hence, this paper seeks to determine and assess the critical factors influencing human errors associated with the UCP. In this vein, Three rounds of Delphi surveys were done with 17 specialists in safety and construction management. According to the Delphi survey results, 35 substantial factors that contribute to the incidence of human errors in the UCP were discovered. Then, an empirical questionnaire based on the 5-point Likert scale of measurement was developed and distributed among 37 construction experts to assess the level of impact that each factor on occurring human error in the UCP. The questionnaire had 35 influential factors related to human errors, categorised into five primary divisions (environmental, technological/information systems, individual (permanently related), individual (temporarily related), and organisational). Before the distribution, the reliability and validity of the questionnaire were evaluated and confirmed. The factors were ranked using the Step-wise Weight Assessment Ratio Analysis (SWARA) technique at this point. The research findings indicated that the criterion of “technological factors/information systems” is the most crucial, with the criterion of “individual factors (permanently related)” coming in second and the criterion of “environmental factors” coming in third. The sub-criterion “weak maintenance management systems” scores first in the general ranking of sub-criteria, indicating traditional network systems, the absence of appropriate tools and equipment, and a lack of understanding of required resources. The sub-criterion “defects in details and information and lack of design dynamism” is placed second, while the sub-criterion “violation of safety regulations (use of drugs, etc.)” is ranked third. The study results can help industry practitioners make more educated judgements to minimise and manage human errors in the UCP.
•The significant contributing factors to human errors in the urban construction industry were identified.•A total of 35 factors were identified and classified into 5 groups.•The top three groups are Information systems/Technological, Individual (permanently related), Environmental.•The strategic blueprints and recommendations for stakeholders were provided.
Forecasting future trends constitutes a key process for supporting urban and territorial policy making in general. In this work, we explore how the domains of smart cities, smart transport, and smart ...energy will evolve until 2030 from a scientific and technological perspective, as a means to inform future policies for urban development in Europe. We started our work with an extensive review of recent and relevant research, covering policy and market reports, scientific journal articles, and other scientific publications. Then, a two-round Delphi survey with 120 field experts was conducted to assess the plausibility of the literature review findings to materialize until 2030. According to our empirical findings, there will be several speedy and structural changes in the three domains: we were able to identify a set of 18 statements that are highly probable to become reality in the next decade, whereas 17 statements were classified as plausible but not highly probable, and three statements raised controversiality. This work provides significant added value in supporting territorial policymakers' and stakeholders' decision making under uncertainty, as well as in designing highly relevant research agendas, attuned to contemporary and emerging trends.
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•we performed a foresight exercise on emerging trends in smart cities, transport and energy in urban settings with the participation of 120 experts•the three domains will undergo speedy and structural changes until 2030•18 statements are highly probable, whereas 17 statements are plausible but not highly probable to become realized.•researchers can pinpoint multiple areas in which further research and development will be required in the forthcoming years•policy makers can use the results to manage uncertainty and design more informed and anticipatory policies
Energy systems are rapidly changing, and many promising low-carbon solutions are now available for different industries. For a society to efficiently implement these promising technologies, experts ...and policymakers from different fields must comprehensively understand the possibilities and barriers of these technologies. This paper investigates how experts in different fields perceive the transition by conducting two broad Delphi surveys regarding energy transition and greenhouse gas emission targets in the context of Finnish society. The focus of the research is Power-to-X technologies, the required actions and barriers for achieving emissions targets, and societal electrification. The results reveal that while it is possible to achieve the ambitious emissions targets, a variety of political and technological changes are required. It is also established that Finnish society will increase low-carbon electricity consumption in the near future. For instance, Power-to-Gas and Power-to-Fuel technologies are viewed possible technologies for achieving the targets.
•Two Delphi surveys regarding energy transition in Finnish society were conducted.•The research reveals actions required to achieve carbon-neutral society.•The importance of implementing different Power-to-X technologies is established.•There is no single emission reduction policy or regulation fit for all sectors.
Immune‐mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be ...attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune‐mediated erythrocyte destruction, and adverse consequences of long‐term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence‐based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors.
Comparisons of clinical trial findings in systematic reviews can be hindered by the heterogeneity of the outcomes reported. Moreover, the outcomes that matter most to patients might be underreported. ...A core outcome set can address these issues, as it defines a minimum set of outcomes that should be reported in all clinical trials in a particular area of research. The objective in this study was to develop a core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy.
Firstly, eligible outcomes were identified through a systematic review of trials of medication review in older patients (≥65 years) and interviews with 15 older patients. Secondly, an international three-round Delphi survey in four countries involving patients, healthcare professionals, and experts was conducted to validate outcomes to be included in the core outcome set. Consensus meetings were conducted to validate the results.
Of the 164 participants invited to take part in the Delphi survey, 150 completed Round 1, including 55 patients or family caregivers, 55 healthcare professionals, and 40 experts. A total of 129 participants completed all three rounds. Sixty-four eligible outcomes were extracted from 47 articles, 32 clinical trial protocols, and patient interviews. Thirty outcomes were removed and one added after Round 1, 18 outcomes were removed after Round 2, and seven after Round 3. Results were discussed during consensus meetings. Consensus was reached on seven outcomes, which constitute the core outcome set: drug-related hospital admissions; drug overuse; drug underuse; potentially inappropriate medications; clinically significant drug-drug interactions; health-related quality of life; pain relief.
We developed a core outcome set of seven outcomes which should be used in future trials of medication review in multi-morbid older patients with polypharmacy.
Pakistan’s existential reliance on the Indus River Basin for water security is threatened by population growth, climate change, and increasing intersectoral demands. Pakistan’s National Water Policy ...of 2018 (NWP) adopts ‘More Crop per Drop’ as a key policy platform. Within the ‘More Crop per Drop’ strategy the NWP mandates banning flood irrigation nationally and introducing high efficiency irrigation systems (HEIS) to save water. The concept of water use efficiency (WUE) and the impact of replacing flood irrigation with HEIS on basin-wide water use are contested in the context of Pakistan. Research is lacking on how this aspect of the ‘More Crop per Drop’ strategy was included in the NWP and the evidence on which it is based. This paper addresses the gap in the literature by presenting the results of a Delphi study exploring the origins of the strategy, identifying the prevalent WUE paradigm in Pakistan, and exploring the level of appreciation of the effects of the strategy on the so-called rebound effect and water security. The study identifies that the NWP was developed mainly by the Water and Power Development Authority supported by provincial water management institutions, influenced by international funding agencies. The study establishes that the irrigation efficiency paradigm (IEP) is the dominant paradigm operating in the water bureaucracy. The farm-scale focus of this paradigm does not account for the basin-level rebound effect or the potential negative impact of the policy on water security. The study also finds that government extension workers are key sources of information for farmers considering the adoption of HEIS. We caution that banning flood irrigation and introducing HEIS in the absence of an appropriate regulatory framework could worsen Pakistan’s water security rather than ‘save’ irrigation water for reallocation and foreshadow additional research to further explore the situation.
•Pakistan has an existential reliance on the Indus River for water security.•Pakistan’s National Water Policy requires adoption of More Crop per Drop.•Adoption of More Crop per Drop in closed basins can increase water withdrawals.•Widespread adoption of More Crop per Drop in Pakistan could threaten water security.•Reviewing Pakistan’s Water Policy may be important and timely for water security.
The literature on sustainable business models (SBMs) offers different classifications of the available kinds of SBM. Our careful reading of this literature reveals that the received classifications ...have developed ad-hoc from multiple divergent perspectives. As a consequence, the proposed classifications are only partly overlapping and difficult to reconcile, thus hampering cumulative progress. Building on this premise, we offer a synthesis and consolidation of the available knowledge about SBMs. Following the notion of patterns as problem–solution combinations, we developed, tested, and applied a new multi-method and multi-step approach centred on an expert review process that combines literature review, Delphi survey, and physical card sorting to identify and validate the currently existing SBM patterns. Ten international experts participated in this process. They classified 45 SBM patterns, assigned these patterns to 11 groups along ecological, social, and economic dimensions of sustainability and evaluated their potential to contribute to value creation. The resulting taxonomy can serve as a basis for more unified and comparable studies of SBMs and for new business model tools that can be used in various disciplines and industries to analyse and develop sustainability-oriented business models in a consistent manner.
•A critical assessment of knowledge on sustainable business models (SBMs) is offered.•45 patterns to support sustainability-oriented business model innovation are presented.•The patterns are organised into 11 expert-validated groups.•The patterns and groups are related to ecological, social, and economic value creation.•A methodology to consolidate knowledge about business model patterns is presented.
To establish consensus practices among a panel of national experts for the discharge of premature infants with bronchopulmonary dysplasia (BPD) from the hospital to home.
We conducted a Delphi study ...that included US neonatologists and pediatric pulmonologists from the Bronchopulmonary Dysplasia Collaborative to establish consensus practices—defined as recommendations with at least 80% agreement—for infants with BPD being discharged from the hospital. Specifically, we evaluated recommendations for diagnostic tests to be completed around discharge, follow-up respiratory care, and family education.
Thirty-one expert participants completed 3 rounds of surveys, with a 99% response rate (92 of 93). Consensus was established that infants with moderate-severe BPD (ie, those who remain on respiratory support at 36 weeks) and those discharged on oxygen should be targeted for in-person pulmonary follow-up within 1 month of hospital discharge. Specialized neonatal follow-up is an alternative for infants with mild BPD. Infants with moderate or severe BPD should have an echocardiogram performed after 36 weeks to screen for pulmonary hypertension. Infants with BPD warrant additional evaluations if they have growth restriction or poor growth, pulmonary hypertension, or tachypnea and if they are discharged to home on oxygen, diuretics, or nonoral feeds.
This Delphi survey establishes expert consensus around best practices for follow-up respiratory management and routine evaluation for infants with BPD surrounding neonatal discharge. Areas of disagreement for which consensus was not established are discussed.
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