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Background: Fatty liver disease in the absence of excessive alcohol consumption is an increasingly common condition with a global prevalence of ~ 25-30% and is also associated with cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies its pathogenesis, the term metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed for this condition. MAFLD is closely intertwined with obesity, type 2 diabetes mellitus and atherogenic dyslipidemia, which are established cardiovascular risk factors. Unlike CVD, which has received attention in the literature on fatty liver disease, the CVD risk associated with MAFLD is often underestimated, especially among Cardiologists. Methods and results: A multidisciplinary panel of fifty-two international experts comprising Hepatologists, Endocrinologists, Diabetologists, Cardiologists and Family Physicians from six continents (Asia, Europe, North America, South America, Africa and Oceania) participated in a formal Delphi survey and developed consensus statements on the association between MAFLD and the risk of CVD. Statements were developed on different aspects of CVD risk, ranging from epidemiology to mechanisms, screening, and management. Conculsions: The expert panel identified important clinical associations between MAFLD and the risk of CVD that could serve to increase awareness of the adverse metabolic and cardiovascular outcomes of MAFLD. Finally, the expert panel also suggests potential areas for future research.

Effective decision-making process is the basis for successfully solving any engineering problem. Many decisions taken in the construction projects differ in their nature due to the complex nature of the construction projects. One of the most crucial decisions that might result in numerous issues over the course of a construction project is the selection of the contractor. This study aims to use the ordinal priority approach (OPA) for the contractor selection process in the construction industry. The proposed model involves two computer programs; the first of these will be used to evaluate the decision-makers/experts in the construction projects, while the second will be used to formulate the OPA mathematical model. The experts’ interview was used to identify the criteria of evaluation process of the decision-makers/experts, while Delphi survey with principal component analysis (PCA) was conducted to identify the required selection criteria of the construction projects contractors. The results illustrate that there are 20 criteria for selecting the construction contractor, and 7 criteria for evaluating the decision-makers/experts in the construction projects. Finally, the proposed model has been applied in a real construction project, and showed good results.

Introduction This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity. Methods A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement. Results Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m 2 , and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease. Conclusions In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach. Graphical Abstract

There are two different approaches to involve participants in consecutive rounds of a Delphi survey: (1) invitation to every round independent of response to the previous round (“all-rounds”) and (2) invitation only when responded to the previous round (“respondents-only”). This study aimed to investigate the effect of invitation approach on the response rate and final outcome of a Delphi survey. Both experts (N = 188) and patients (N = 188) took part in a Delphi survey to update the core outcome set (COS) for axial spondyloarthritis. A study with 1:1 allocation to two experimental groups (ie, “all-rounds” [N = 187] and “respondents-only” [N = 189]) was built-in. The overall response rate was lower in the “respondents-only group” (46%) compared to the “all-rounds group” (61%). All domains that were selected for inclusion in the COS by the “respondents-only group” were also selected by the “all-rounds group.” Additionally, the four most important domains were identical between groups after the final round, with only minor differences in the other domains. Inviting panel members who missed a round to a subsequent round will lead to a better representation of opinions of the originally invited panel and reduces the chance of false consensus, while it does not influence the final outcome of the Delphi.

This contribution explains new variants of Argumentative Delphi surveys that can also be used in sociological research, some examples and the learnings from and limits of argumentative surveys with feedback. Argumentative Delphi surveys are not new. As Christian Dayé explains in his book, the early expert surveys and especially the Delphi surveys used explanations and arguments for exchanging knowledge - but always without direct interation (Dayé, C. (2020). Experts, Social Scientistss and Techniques of Prognosis in cold war of America. Socio-Historical Studies of the Social and Human Sciences, palgrave McMilan, Switzerland:41, see also Cuhls, K. (1998). Technikvorausschau in Japan. Ein Rückblick auf 30 Jahre Delphi-Expertenbefragungen. Physica. [Technology Foresight in Japan]). The very first approaches of Delphi surveys did not only make use of expert knowledge in judging issues under uncertainty or were trying to make accurate predictions with statistical analysis, but there were also tests in groups of students. In some of them, the groups did not only choose and tick boxes, but gave reasons or comments for their judgments. Modern Argumentative Delphi surveys do ask for comments AND use a variety of open questions for adding information to the statistical findings. This way of performing a Delphi survey gets more and more ground and can be analysed in a fast way by new means of text mining and Delphi software tools. But they have their limits - especially as they are very demanding for the participants and the analysts. If many people participate, many arguments are given, and they can quickly go beyond the limits of the participants‘ understanding and their time availability. Some lessons learned from recent Delphi projects are reported. This is closing the cycle to Dayé’s description of expert knowledge inclusion in policy-making - a way of integration of expert opinion without direct interaction.

Background Delphi surveys are commonly used to prioritise critical outcomes in core outcome set (COS) development. This trial aims to compare a three-round (Multi-Round) Delphi (MRD) with a Real-Time Delphi (RTD) in the prioritisation of outcomes for inclusion in a COS for neonatal encephalopathy treatments and explore whether ‘feedback’, ‘iteration’, and ‘initial condition’ effects may occur in the two survey methods. Methods We recruited 269 participants (parents/caregivers, healthcare providers and researchers/academics) of which 222 were randomised to either the MRD or the RTD. We investigated the outcomes prioritised in each survey and the ‘feedback’, ‘iteration’, and ‘initial condition’ effects to identify differences between the two survey methods. Results In the RTD, n  = 92 participants (83%) fully completed the survey. In the MRD, n  = 60 participants (54%) completed all three rounds. Of the 92 outcomes presented, 26 (28%) were prioritised differently between the RTD and MRD. Significantly fewer participants amended their scores when shown stakeholder responses in the RTD compared to the MRD (‘feedback effect’). The ‘iteration effect’ analysis found most experts appeared satisfied with their initial ratings in the RTD and did not amend their scores following stakeholder response feedback. Where they did amend their scores, ratings were amended substantially, suggesting greater convergence. Variance in scores reduced with subsequent rounds of the MRD (‘iteration effect’). Whilst most participants did not change their initial scores in the RTD, of those that did, later recruits tended to align their final score more closely to the group mean final score than earlier recruits (an ‘initial condition’ effect). Conclusion The feedback effect differed between the two Delphi methods but the magnitude of this difference was small and likely due to the large number of observations rather than because of a meaningfully large difference. It did not appear to be advantageous to require participants to engage in three rounds of a survey due to the low change in scores. Larger drop-out through successive rounds in the MRD, together with a lesser convergence of scores and longer time to completion, indicate considerable benefits of the RTD approach. Trial registration NCT04471103. Registered on 14 July 2020.

To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries. A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked. High-income countries. Household food security experts in academia, government and non-government organisations who had published in the last 5 years. Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem. This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

Purpose Particularly in volatile, uncertain, complex and ambiguous (VUCA) business conditions, staff in supply chain management (SCM) look to real-time (RT) data processing to reduce uncertainties. However, based on the premise that data processing can be perfectly mastered, such expectations do not reflect reality. The purpose of this paper is to investigate whether RT data processing reduces SCM uncertainties under real-world conditions. Design/methodology/approach Aiming to facilitate communication on the research question, a Delphi expert survey was conducted to identify challenges of RT data processing in SCM operations and to assess whether it does influence the reduction of SCM uncertainty. In total, 14 prospective statements concerning RT data processing in SCM operations were developed and evaluated by 68 SCM and data-science experts. Findings RT data processing was found to have an ambivalent influence on the reduction of SCM complexity and associated uncertainty. Analysis of the data collected from the study participants revealed a new type of uncertainty related to SCM data itself. Originality/value This paper discusses the challenges of gathering relevant, timely and accurate data sets in VUCA environments and creates awareness of the relationship between data-related uncertainty and SCM uncertainty. Thus, it provides valuable insights for practitioners and the basis for further research on this subject.

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.

Background The key step in evaluating the quality of clinical nursing practice education lies in establishing a scientific, objective, and feasible index system. Current assessments of clinical teaching typically measure hospital learning environments, classroom teaching, teaching competency, or the internship quality of nursing students. As a result, clinical evaluations are often insufficient to provide focused feedback, guide faculty development, or identify specific areas for clinical teachers to implement change and improvement. Therefore, the purpose of our study was to to construct a scientific, systematic, and clinically applicable evaluation index system of clinical nursing practice teaching quality and determine each indicator’s weight to provide references for the scientific and objective evaluation of clinical nursing practice teaching quality. Methods Based on the “Structure-Process-Outcome” theoretical model, a literature review and Delphi surveys were conducted to establish the evaluation index system of clinical nursing practice teaching quality. Analytic Hierarchy Process (AHP) was employed to determine the weight of each indicator. Results The effective response rate for the two rounds of expert surveys was 100%. The expert authority coefficients were 0.961 and 0.975, respectively. The coefficient of variation for the indicators at each level ranged from 0 to 0.25 and 0 to 0.21, and the Kendall harmony coefficients were 0.209 and 0.135, respectively, with statistically significant differences (P < 0.001). The final established index system included 3 first-level, 10 second-level, and 29 third-level indicators. According to the weights computed by the AHP, first-level indicators were ranked as “Process quality” (39.81%), “Structure quality” (36.67%), and “Outcome quality” (23.52%). Among the secondary indicators, experts paid the most attention to “Teaching staff” (23.68%), “Implementation of teaching rules and regulations (14.14%), and “Teaching plans” (13.20%). The top three third-level indicators were “Level of teaching staff” (12.62%), “Structure of teaching staff” (11.06%), and “Implementation of the management system for teaching objects” (7.54%). Conclusion The constructed evaluation index system of clinical nursing practice teaching quality is scientific and reliable, with reasonable weight. The managers’ focus has shifted from outcome-oriented to process-oriented approaches, and more focus on teaching team construction, teaching regulations implementation, and teaching design is needed to improve clinical teaching quality.