Expert Opinion Research Articles

Expert opinion on the multivitamin deficiencies observed in day-to-day practice in Indian settings

: Although there is an array of empirical evidence regarding vitamin deficiencies in isolation, there is a dearth of particular data regarding multivitamin use in Indian contexts. So, the present survey-based study aims to gather clinicians' opinions regarding the multivitamin deficiencies noted in day-to-day practice in Indian settings.The cross-sectional, multi-response study employed an 18-item questionnaire to collect current feedback, clinical observations, and the clinical experience of specialists regarding multivitamin deficiencies observed in routine practice within Indian settings.Out of 191 participants, 53.93% opined that only a few patients have folic acid deficiency in most of the patients. More than half (51.83%) of patients have vitamin B12 deficiency. About 53% of the clinicians reported that zinc deficiency was seen in a few patients. Around 43% of the clinicians reported that 11 to 12 patients with diabetes using metformin were more likely to have a multivitamin deficiency.This study offered valuable insights into the multivitamin deficiencies observed by clinicians in their daily practice among Indian patients. The survey also underscored the importance of regular monitoring of vitamin B12 levels in diabetic patients using metformin to reduce the risk of deficiency.

유아기 자녀를 둔 부모공감능력의 의미와 구성요인에 관한 델파이 연구

Objectives This study aims to clarify the meaning of parental empathy ability using the Delphi technique and to derive constituent and sub-factors. Methods To this end, the concept of parental empathy ability was defined through preceding research and liter-ature review, and the structuring factors of the ability were derived. An expert Delphi survey was conducted using the derived data to confirm the exploratory study of deriving the components of parental empathy ability. The data analysis method of the first Delphi survey questionnaire was conducted in order to define the concept of parental empathy and derive the structuring factors. A structured questionnaire, free-choice and open-ended questions were conducted with 13 experts in order to confirm the content validity. Using SPSS 25.0, the average value, standard deviation, skewness, agreement, convergence, and CVR ranges of each variable were calculated, and questions that did not meet each criterion were modified and deleted. Since the number of panels participating in the Delphi survey in this study is 13, if the CVR value is .554 or higher, it can be judged that the content validity is valid. The contents, were revised and supplemented with the experts, used to construct the second Delphi survey. It was used to construct the second questionnaire by reflecting the opinions of experts and revising and supplementing the contents. The second survey tool were gathered from the responses of the first survey. In or-der to clarify the opinions of each panel, structured questions with a 5-point rating scale were presented. Results First, the area of the scale consisted of three areas: ‘emotional empathy ability’, ‘cognitive empathy abil-ity’, and ‘behavioral empathy ability’, ‘emotional empathy ability’ consisted of perspective acceptance, cognitive empathy, and perspective acceptance, ‘cognitive empathy ability’ consisted of emotional response, emotional al-location, and emotional perception, and ‘behavioral empathy ability’ consisted of pseudo-movement, expression consistency, listening, and relationship formation. Conclusions The study is significant in that it derives categories and sub-factors of parental empathy ability that have recently come into focus. Furthermore, the study is significant in that it can be used as basic data for deriving the question composition through focus group interviews in the future.

Strategic alternatives for Muslim-friendly homestay in Sabah Malaysia: a SWOT/TOWS analysis

Purpose This study aims to explore the strengths, weaknesses, opportunities and threats (SWOT) of the Muslim-friendly homestay business in Malaysia to help identify and recommend practical strategies to capitalize on the strengths and potentials while overcoming the current shortcomings and threats. Design/methodology/approach The Muslim-friendly business owner and operators in Sabah, Malaysia, were the subject of a series of focus groups and expert opinion interviews. The data was transcribed, and then the variables were categorized into the four SWOT categories using content and thematic analysis. Meanwhile, threats, opportunities, weaknesses and strengths (TOWS) analysis is used to identify the best strategy alternatives. Findings The SWOT analysis identifies several strengths (e.g. diverse and unique Islamic culture and heritage [S1], iconic Islamic landmarks [S2], rich natural beauty [S3], well-established halal tourism industry [S4]); weaknesses (e.g. limited awareness [W1], limited infrastructure and facilities [W2], limited human resources and trained personnel [W3], lack of Islamic tourism products and experiences [W4]); opportunities (e.g. growing demand for Islamic tourism [O1], increasing disposable income [O2], potential for collaborations [O3], potential for partnerships [O4], potential for expanding Sabah’s halal tourism offerings [O5]); and threats (e.g. competition [T1], political instability [T2], economic downturns [T3] and environmental and social challenges [T4]). Practical implications This paper could serve as a guideline and supplementary information for stakeholders in the homestay industry to grasp their business environment better. Originality/value To the best of the authors’ knowledge, this is the first study of its type to blend SWOT and TOWS analysis with the sector of Muslim-friendly homestays. Hence, the findings might expand understanding of the Muslim-friendly homestays industry and aid businesses in penetrating this growing market.

An approach towards total quality in architectural education in India track: higher education (architecture education)

Architecture Education is a service and product, which demands, quality delivery to meet the expectations of stakeholders. Architecture Education in India is over 100 years old, and the focus of higher education in India post-independence has been on addressing the demand for skilled professionals required for a developing nation. Over the years the emphasis on quantity has impacted the quality of graduates and there is a need for a quality framework for better delivery to all the stakeholders and to produce more employable graduates. Quality imperatives are critical to all contemporary societies which demand a better quality of life through holistic built environments across the globe delivered through professionals having the skill set to meet societal aspirations There is an increasing demand for trained professionals given the tremendous growth in the physical infrastructure in urban and rural areas particularly the current shortfall in the housing sector besides other tertiary sectors of the economy. The paper addresses the issues about architectural education as mandated through statutory processes prescribed by the Council of Architecture, New India’s Minimum Standards of Architectural Education in India, and the New Education Policy -2020 of the Government of India. The research process adopted identifies the gaps in the current system of education through content and perception analysis through interviews and expert opinions and suggests methodologies that can transform the current processes through an understanding of total quality principles and their application to the higher education sector. The paper evaluates various aspects of architectural education such as institutional mechanisms, the process of admission, curricula structure, pedagogy, teaching-learning processes, scheme of examinations, faculty selection process, and their growth through the perspective of total quality parameters for the service sector. The paper attempts to suggest an approach towards Total Quality in Architectural Education in India driven by quality and research, relevant to the socio-economic, cultural, and physical context of the developing economies in the 21st Century.

Surface Water Resources Planning in an Ungauged Transboundary Basin Using Satellite Products and the AHP Method

Global concern over optimizing transboundary water resources for residents is hindered by the lack of observational data, particularly in ungauged basins, mainly due to inaccessibility or security issues. Remote sensing and GIS technology provide a practical solution for monitoring and managing water resources in such basins. This research evaluates surface water resources in the Qaretikan ungauged transboundary basin using satellite products for precipitation, temperature, and evapotranspiration from 2005 to 2014. The accuracy of these datasets was assessed using statistical measures. The water balance components, i.e., precipitation and evaporation, were utilized to calculate runoff over the basin using the Justin method. Downstream environmental flow was estimated using the Lyon method, and available water was determined. This study identified a potential annual storage water of 11.8 MCM in the Qaretikan basin. The Analytic Hierarchy Process (AHP) integrated expert opinions to prioritize water usage decisions based on proposed decision options. The results revealed greenhouse cultivation water allocation as the top priority among the identified options, highlighting its importance in sustainable water resource management within the basin.

Pulmonary arterial hypertension related to congenital heart disease with a left-to-right shunt: phenotypic spectrum and approach to management

Patients with pulmonary hypertension associated with a left-right shunt include a wide spectrum of pathophysiological substrates, ranging from those characterized by pulmonary over-circulation to those with advanced pulmonary vascular disease. The former group may benefit from shunt repair in carefully selected cases but, when advanced pulmonary vascular disease has developed, defect closure should be avoided, and pulmonary vasodilators may be used to improve effort tolerance and hemodynamics. There is a paucity of evidence, however, to support decision-making in the care of these patients. We discuss the principles of management in patients with pulmonary hypertension and a predominant left-right shunt. The recommendations and statements made in this paper are based on pathophysiological considerations and expert opinion.

Lietuvos Didžiosios Kunigaikštystės viešieji notarai XVI amžiaus kryžkelėse: nuo 1512 metų Europos notariato nuostatų iki Antrojo Lietuvos Statuto

The Imperial Notary Ordinance, which began being written in the late fifteenth century, not only further cemented the statements set forth in Ars notariae, but also fundamentally transformed the status of notariat, declaring the notariat a governmental institution. According to the opinion of Notariat experts, this Ordinance that was declared in 1512 is fundamental for having the main professional characteristics of the contemporary Latin notariat. This similarity also outlines the continuity of modern European notariat.Lithuanian society in the beginning of the sixteenth century lived with a notariat that was not fully developed, since, only after receiving the right from the Pope in 1501, public notaries began being nominated in the Vilnius diocese. During the first half of the sixteenth century, the development of notariat was visible particularly in the dioceses of GDL. This was to be expected, knowing that the notariat was established in GDL through the Church. Notariat developed in the secular government only as much as there was cooperation with and participation of diocesal notaries public, by serving in the office of a ruler or a voivod. We can observe a tendency in the beginning of the sixteenth century of secularization of the notaries public – they would switch to service in a purely secular office after leaving the clergy and/or becoming supporters of the Reformation. At the same time, similarly to Poland, in the later half of fifteenth century and onwards, Lithuania saw the rise of notaries with apostolic mandate, which declared the primacy of the Pope’s rule. We think, that the Notary Ordinance of 1512, could have had impact (negative?) to the further development of GDL notariat. Firstly by raising the questions of political loyalty and personal choice in regards to which highest authority to obey – the Pope’s or the emperor’s, ecclesiastical or secular.During research we acknowledge that both the First and the Second Statutes of Lithuania could have been partially influenced by the Notary Ordinance by notaries public participating in their conception. Thanks to them, articles regarding the Roman law have been created. The removal of Latin language as the written language of the courts by the Second Statute was not beneficial to the Roman notariat and a serious challenge to the notaries public and to the further development of notariat in GDL. The New Statute became an opportunity for the secular notariat to form as a legal institute. However, for it to happen there had to be further political decisions in support of it, there had to have been the right conditions and enough time to prepare qualified specialists and for the society to be prepared to trust those specialists.

Adherence to endocrine therapy with tamoxifen and satisfaction with follow-up of women with breast cancer by a gynecologist: A survey study

Background. Side effects of endocrine therapy with tamoxifen (TAM) reduce the quality of life of patients with breast cancer (BC) and adversely affect treatment compliance. Against the background of treatment of BC with TAM, the risk of developing endometrial hyperplasia (EH) increases. At the moment, algorithms for monitoring patients receiving TAM by an obstetrician-gynecologist have not been developed and approved. There are also divergent opinions of experts regarding the diagnosis and management of patients in the detection of EH. This article presents the results of the final stage of the study in 2017–2022 – a survey study. The purpose of this study was to assess adherence to endocrine therapy and satisfaction with observation by a gynecologist of women with BC after 5 years of observation and their relationship with the identified early associated polymorphisms of the CYP2D6, CYP3A5, CYP2C9 and ABCB1 genes. Materials and methods. 54 patients with BC, out of 120 who had previously passed the first pharmacogenetic stage of the study, were interviewed with specially designed questionnaire. Due to the small sample size, delta percentages (∆%) were used in each comparison group with a difference threshold of 5%. To assess associations with the studied genetic polymorphisms, previously obtained significant associations of adverse drug reactions with pharmacogenetics in the same patients were used. Results. The prevalence of all adverse drug reactions (ADRs), with the exception of EH, was higher in the group of patients who canceled TAM. Over 5 years of follow-up, 57.4% of patients were regularly observed by an obstetrician-gynecologist, 42.59% of patients visited a gynecologist less than once a year. Of all the respondents, 53.7% of patients are satisfied with the regularity and quality of dispensary observation by an oncologist, 33.33% of patients are satisfied with the regularity and quality of dispensary observation by an obstetrician-gynecologist. All studied ADRs (EH, hot flashes, asthenia, bone pain and dyspepsia) associated with various genetic polymorphisms, prevailed in the group of patients who stopped taking TAM due to drug intolerance (∆%: 25.72, 6.97, 4.81, 6.97 and 24.52 respectively) compared with the TAM-group. Conclusion. The results obtained confirm the role of the studied genetic polymorphisms in the development of ADRs of TAM, but only systemic (hot flashes, asthenia, bone pain and dyspepsia). With regard to endometrial hyperplasia, no significant differences were obtained, which requires more extensive studies.

Substantial unrealised global biodiversity of continental microcrustaceans

Abstract Freshwater ecosystems provide essential services for human well-being, with their conservation success reliant on the precise quantification of biodiversity. Diplostraca (= Cladocera) and Copepoda are diverse groups of microcrustaceans in aquatic ecosystems, important for a multitude of these services. We examined biodiversity trends of these groups, utilizing a comprehensive dataset, approximately 2341 studies, spanning from the early 19th Century to the present day, aiming at predicting the total number of microcrustacean species that will have been described by 2100. Descriptions increased until the 1900s, surged, and then declined after 1975. The predictive models indicate that by the year 2100, an additional 16–68% of cladoceran species and 37–126% of copepod species are likely to be identified, representing a significant portion of currently unrealised biodiversity. Eighteen prolific authors contributed to a quarter of these descriptions, with the rest spread among numerous authorities. Based on our extrapolation, the total number of microcrustacean species could potentially exceed 6114 by 2050 and 9046 by 2100, notwithstanding extinctions. These findings, which point to a significant amount of unrealised biodiversity, underscore the need to refine biodiversity estimates beyond conventional expert opinion. Such accuracy is crucial for addressing the underappreciated scale of the current biodiversity crisis.

Podcasts “Depan Pintu” as a Tool for Political Literacy in the Digital Era

In Indonesia, social media holds significant sway in the political landscape due to its broad outreach. It also serves as a tool for fostering political awareness and education. This study focuses on evaluating how 'Podcast Depan Pintu' contributes towards attaining this objective within the digital era by using qualitative means such as content analysis of podcast episodes and observing related interactions through social media channels. Analysis shows that among millennials and Gen Z listeners, ‘Podcast Depan Pintu’ has been successful in enhancing their comprehension of current affairs with respect to politics owing partly to insightful guest speakers sharing expert opinions while creating inventive ways for diving deeper into ongoing issues via active engagement across various online platforms.

Study of the factors influencing the life cycle cost of green buildings using SEM-SD method

ABSTRACT The recent surge in carbon emissions from the building sector has raised significant environmental concerns. While green building practices have proven effective, their widespread adoption has been hindered by high costs. This study aims to explore the factors impacting the life cycle costs of green buildings, with the aim of achieving “double carbon” reduction. Through an analysis of 42 articles, 24 factors were distilled based on expert opinion. After collecting 322 data through questionnaires, a model of the factors influencing the life cycle cost of green buildings was constructed using structural equation modeling, and a cost simulation study was carried out through the system dynamics method in the practical case to examine how the cost changed. The findings highlight the pivotal role of planning and design, implementation, and operation and maintenance phases. Notably, green building design programs, green construction programs, and the property management level stand out as critical factors emerged as critical factors. These insights can inform strategies to reduce the cost of green buildings, thereby fostering energy conservation and emission reduction in the construction industry.

Age Regulation of Outsourced Workers After the Omnibus Law of the Labor Cluster Based on Wage Theory

This research investigates the effects of the enactment of the Job Creation Law (Law Number 11 of 2020) in Indonesia on labor regulations, specifically focusing on wage regulation for outsourced workers and its implications for human rights. Employing a normative juridical approach, the study examines legal materials such as laws, regulations, court decisions, and expert opinions. Through qualitative analysis techniques, the pre- and post-Job Creation Law regulations concerning outsourced workers' wages are explored. The findings uncover significant changes in wage provisions, including the elimination of sectoral minimum wage regulations and the reduction in types of wages for outsourced workers. Moreover, the research reveals discrepancies between the Job Creation Law and international conventions' indicators of freedom, availability, accessibility, and suitability. Concerns are raised regarding the adequacy of workers' rights protection, accessibility to fair wages, and the inclusivity of vulnerable groups within the legal framework. This study contributes to understanding the Job Creation Law's implications for labor and human rights in Indonesia, highlighting areas where the law may fail to ensure equitable treatment and fair compensation for outsourced workers. Policy recommendations aimed at upholding human rights standards in labor regulations are proposed based on the study's findings.

The impact of methamphetamine on psychosocial variables in patients from Iraq

BackgroundThe current work reviews the psychosocial factors associated with different urinary methamphetamine concentration levels.MethodsFrom April to November 2023, 243 participants from Baghdad’s Al-Ataa Hospital were the subjects of a cross-sectional descriptive analysis study. We included 73 patients in this study.ResultThe urinary methamphetamine concentration levels were from 3 to 92,274 ng/ml, with a mean ± SD of 10,873.6 ± 18,641. Patients diagnosed with major depression disorder exhibited higher scores on GHQ-30, UCLA, MOAS, and BDI-II with a significant P-value of 0.0001, 0.001, 0.0001, and 0.0001, consequently with an effect size of 0.015, 0.001, 1.05, and 3.24, respectively.ConclusionsThe multi-screening test can produce a false positive. It frequently interferes with other drugs, especially antidepressants. This will result in patients being stigmatized and accused. On the other hand, those who accidentally come into contact with crystal smoke will experience the same withdrawal symptoms as the addicted patients. Their urinary methamphetamine level (titer) could have negative results. Urinary methamphetamine levels should be zero in healthy patients. In this situation, screening tests, expert opinion, and urine methamphetamine testing are strongly recommended.

Trends of the cannabis market in Poland over the last decade = Tendencje na rynku konopi indyjskich w ostatniej dekadzie w Polsce

Cannabis is the most widely used drug. in recent years, interest in cannabis has grown significantly. over the last decade, the number of cannabis users worldwide has increased by almost 21%, reaching approximately 219 million people in 2021. Can- nabis cultivation covers practically all regions of the world. In recent years, 151 countries have reported cannabis cultivation, both outdoors and indoors. The increased growth of the latter is particularly observed in North America and Europe. Global data shows that in 2021, 5,226 tons of marihuana and 2,014 tons of hashish were confiscated. an increase in seizures of can- nabis products is observed in Europe and Poland. Another trend concerns the increasing content of the psychoactive substance Δ9-tetrahydrocannabinol (Δ9-THC) in cannabis plants. According to UNODC data, over the last 25 years there has been a 4-fold increase in the content of Δ9-THc in cannabis. over the last decade, the average content of Δ9-tetrahydrocannabinol in marihua- na seized in europe has increased approximately twice, and in hashish three times. The aim of this work is to assess potential changes in the content of the main psychoactive ingredients in cannabis in Poland in the last decade (2012–2022), based on expert opinions developed by the Institute of Forensic research in Kraków. The conduct- ed analyses confirmed the trends observed around the world. in the last ten years, the number of cases in which the drug-type cannabis was detected increased from 5.3% to 68.4% of total number of illicit drug cases examined for the presence of narcotic drugs, psychotropic substances and new psychoactive substances. an increasing trend in the content of Δ9-THC in the drug-type cannabis was also noted. over the last decade, the average total content of Δ9-THC increased almost three times and in 2022 reached 12%. This is due to the growth of cannabis cultivation in Europe, carried out using the technique known as sinsemilla, genetic modifications, as well as the appearance on the market of the feminized cannabis seeds.

What patient positioning in chest X-ray is still acceptable? – An empirical study on thresholding quality metrics

AbstractBackground and AimIssues in patient positioning during chest X-ray (CXR) acquisition impair diagnostic quality and potentially increase radiation dose. Automated quality assessment was proposed to address this. Our objective is to determine thresholds on some quality control metrics following international guidelines, that represent expert knowledge and can be applied in a comprehensible and explainable AI approach for such an automatic quality assessment.Materials and MethodsAn AI-method estimating collimation distance to the ribcage, balancing between both clavicle heads, and number of ribs above the diaphragm as metrics for collimation, rotation, and inhalation quality was applied on 64,315 posteroanterior CXR images from a public dataset (ChestX-ray8). From this set 920 CXR images were sampled and manually annotated to gain additional trusted reference metrics. Seven readers from different institutions then classified the acquisition quality of these images independently into okay, inadequate, or unacceptable following the criteria of international guidelines. Optimal thresholds on the metrics were determined to reproduce these classes using the metrics only.ResultsA fair to moderate agreement between the experts was found. When disregarding all inadequate rates a classification on the metrics was able to separate okay rated cases from unacceptable cases for collimation (AUC 0.97), rotation (AUC = 0.93) and inhalation (AUC = 0.97).ConclusionSuitable thresholds were determined to reproduce expert opinions in the assessment of the most important quality criteria in CXR acquisition. These thresholds were finally applied on the AI-method's estimates to automatically classify image acquisition quality comprehensibly and according to the guidelines.

Glucose Targets Using Continuous Glucose Monitoring Metrics in Older Adults With Diabetes: Are We There Yet?

The older population is increasing worldwide and up to 30% of older adults have diabetes. Older adults with diabetes are at risk of glucose-related acute and chronic complications. Recently, mostly in type 1 diabetes (T1D), continuous glucose monitoring (CGM) devices have proven beneficial in improving time in range (TIR glucose, 70-180 mg/dL or glucose 3.9-10 mmol/L), glycated hemoglobin (HbA1c), and in lowering hypoglycemia (time below range [TBR] glucose <70 mg/dL or glucose <3.9 mmol/L). The international consensus group formulated CGM glycemic targets relating to older adults with diabetes based on very limited data. Their recommendations, based on expert opinion, were aimed at mitigating hypoglycemia in all older adults. However, older adults with diabetes are a heterogeneous group, ranging from healthy to very complex frail individuals based on chronological, biological, and functional aging. Recent clinical trial and real-world data, mostly from healthy older adults with T1D, demonstrated that older adults often achieve CGM targets, including TIR recommended for non-vulnerable groups, but less often meet the recommended TBR <1%. Existing data also support that hypoglycemia avoidance may be more strongly related to minimization of glucose variability (coefficient of variation [CV]) rather than lower TIR. Very limited data are available for glucose goals in older adults adjusted for the complexity of their health status. Herein, we review the bidirectional associations between glucose and health status in older adults with diabetes; use of diabetes technologies, and their impact on glucose control; discuss current guidelines; and propose a new set of CGM targets for older adults with insulin-treated diabetes that are individualized for health and living status.

Situating a Prism to See ‘All Colors’: Evaluations of the E-school System in Türkiye from the Perspective of Educational Equity

This research intends to delve into the first-hand information pertaining to learning analytics that belongs to PreK–12 education at micro, meso, and macro levels (Shum, 2012) in Türkiye from the perspective of equity in education through seeking to obtain the views of educational authorities and policy makers viz. school principals, the members of district national education directorate as well as those of Innovation and Educational Technologies General Directorate of MoNE (Republic of Türkiye Ministry of Education). To do so, adopting a qualitative route, the study attempts to inquire into the perceptions of the said groups i.e., 45 participants; in total-with 15 participants from each-about the role and place of the existing “E-school” structure that employs learning analytics towards the use of Big Data in Türkiye. This is realized particularly toward addressing and catering to students at risk alongside the disadvantaged. In this direction the research question is: “How do the decision-making bodies in Türkiye see the current E-school system as regards ensuring and sustaining educational equity?”. The semi-structured interviews aim to direct questions e.g., respecting the situation with school dropouts, the cases of students with special needs, the situation of those who are struggling and of refugees. The findings indicate a superposition; an entangled being of inherent disadvantages and that the present system needs to be further amended to better care for ‘all’ to speak of equity. This study will cast light on the potential value of learning analytics regarding its use for targeting/solving equity problems through the expert opinions from a developing country with highly dynamic demographics.

Influence of Human Resource Management on Work Performance at Vietnam Higher Education Institutions

The purpose of the paper is to examine the impact of human resource management on employee performance in Vietnam universities. In addition to empirically testing the hypotheses in the context of university autonomy in Vietnam, the research has attempted to further examine the achieved results and challenges for human resource management in Vietnam's higher education institutions through the variable regulating University autonomy. The findings in the research have provided empirical support for the correlation between human resource management and employee performance in higher education institutions. The author asked for the opinions of several experts on the questionnaire. Then send the test questionnaire to 10 agencies in higher education institutions. The author has adjusted the questionnaire to make it easier to understand to get the most accurate and reliable answers. The author sent the questionnaire during the period from April 2023 to June 2023, the total number of survey questionnaires distributed was 370 questionnaires, of which 350 votes are eligible for analysis.

Impact of interventions to reduce nosocomial transmission of SARS-CoV-2 in English NHS Trusts: a computational modelling study

BackgroundPrior to September 2021, 55,000–90,000 hospital inpatients in England were identified as having a potentially nosocomial SARS-CoV-2 infection. This includes cases that were likely missed due to pauci- or asymptomatic infection. Further, high numbers of healthcare workers (HCWs) are thought to have been infected, and there is evidence that some of these cases may also have been nosocomially linked, with both HCW to HCW and patient to HCW transmission being reported. From the start of the SARS-CoV-2 pandemic interventions in hospitals such as testing patients on admission and universal mask wearing were introduced to stop spread within and between patient and HCW populations, the effectiveness of which are largely unknown.Materials/methodsUsing an individual-based model of within-hospital transmission, we estimated the contribution of individual interventions (together and in combination) to the effectiveness of the overall package of interventions implemented in English hospitals during the COVID-19 pandemic. A panel of experts in infection prevention and control informed intervention choice and helped ensure the model reflected implementation in practice. Model parameters and associated uncertainty were derived using national and local data, literature review and formal elicitation of expert opinion. We simulated scenarios to explore how many nosocomial infections might have been seen in patients and HCWs if interventions had not been implemented. We simulated the time period from March-2020 to July-2022 encompassing different strains and multiple doses of vaccination.ResultsModelling results suggest that in a scenario without inpatient testing, infection prevention and control measures, and reductions in occupancy and visitors, the number of patients developing a nosocomial SARS-CoV-2 infection could have been twice as high over the course of the pandemic, and over 600,000 HCWs could have been infected in the first wave alone. Isolation of symptomatic HCWs and universal masking by HCWs were the most effective interventions for preventing infections in both patient and HCW populations. Model findings suggest that collectively the interventions introduced over the SARS-CoV-2 pandemic in England averted 400,000 (240,000 – 500,000) infections in inpatients and 410,000 (370,000 – 450,000) HCW infections.ConclusionsInterventions to reduce the spread of nosocomial infections have varying impact, but the package of interventions implemented in England significantly reduced nosocomial transmission to both patients and HCWs over the SARS-CoV-2 pandemic.

Incidence of Intraoperative Cardiothoracic Intervention During Open Surgery Following Acute Posterior Sternoclavicular Joint Injury: A Case Series and Review of the Literature.

Acute posterior sternoclavicular joint injuries are rare but potentially lethal injuries-signs of mediastinal compression range from nonspecific to neurovascular compromise. Currently, orthopaedic experts recommend a cardiothoracic surgeon be placed on standby during open surgery for potential intraoperative complications. However, few studies have reported on how often cardiothoracic intervention is required. First, we identified patients in our institution by CPT codes 23530, 23525, and 23532 from January 1, 2002 to May 1, 2023. Demographic variables and intraoperative cardiothoracic intervention rates were collected. Second, we systematically reviewed the literature to identify articles on acute posterior sternoclavicular injury using PubMed, Embase, and CINAHL databases (through August 20, 2023). Exclusion criteria included conservative treatment, successful closed reduction, chronic injury (>6wk) cadaver studies, reviews, and nonavailable text. Thirteen local patients underwent open surgery for an acute posterior sternoclavicular joint injury, 11 males and 2 females with an average age of 18.2 years old (range: 15 to 32.4). The most common mechanism of injury was sports (n=9; 69.2%). Four (30.8%) patients had physical or radiographic evidence of mediastinal compression. No patients required intraoperative cardiothoracic intervention in our institution. The literature search yielded 132 articles and 512 open surgeries for acute posterior sternoclavicular joint injuries. Four patients required intraoperative cardiothoracic intervention, all of whom presented with polytrauma and/or clinical or radiographic signs of neurovascular compromise, giving a combined overall rate of 0.76%. Expert opinion commonly recommends cardiothoracic backup during open surgery for acute posterior sternoclavicular joint injuries. On the basis of our local data and systematic literature review, we found an overall cardiothoracic intervention rate of 0.76%. In the presence of polytrauma and/or findings of neurovascular compromise, we suggest having cardiothoracic surgery on close standby during the procedure. However, a patient with an isolated acute posterior sternoclavicular joint injury and no clinical or radiographic findings of neurovascular compromise does not appear to require a cardiothoracic surgeon on standby. Ultimately, the decision to involve cardiothoracic backup during open surgery for an acute posterior sternoclavicular injury should be made on a case-by-case basis after a thorough physical and radiographic evaluation of the patient. Level III.