Expert Opinion Research Articles

Ensemble learning based on relative accuracy approach and diversity teams

Ensemble learning, which involves combining the opinions of multiple experts to arrive at a better result, has been used for centuries. In this work, a review of the major voting methods in ensemble learning is explored. This work will focus on a new method for combining the results of individual learners. The method depends on the relative accuracy and diversity of teams. Instead of trying to assign weight to each different trainer, the concept of diversity teams is presented. Each team will vote as one player; however, the individual accuracies of each learner still be implemented. The concept of relaxing parameters that deal with each team as one player is presented. Our experiments demonstrate that traditional ensemble voting methods outperform individual learners. There is a limit to the superiority of the ensemble learner that any ensemble learner cannot go beyond. The proposed voting method gives the same results as the traditional ensemble voting methods, however, a different diversity of the proposed method from the traditional voting method or for different values of the relaxing parameter can be achieved.

Machine learning prediction of refractory ventricular fibrillation in out-of-hospital cardiac arrest using features available to EMS

BackgroundShock-refractory ventricular fibrillation (VF) or ventricular tachycardia (VT) is a treatment challenge in out-of-hospital cardiac arrest (OHCA). This study aimed to develop and validate machine learning models that could be implemented by emergency medical services (EMS) to predict refractory VF/VT in OHCA patients. MethodsThis was a retrospective study examining adult non-traumatic OHCA patients brought into the emergency department by Singapore EMS from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Data from April 2010 to March 2020 were extracted for this study. Refractory VF/VT was defined as VF/VT persisting or recurring after at least one shock. Features were selected based on expert clinical opinion and availability to dispatch prior to arrival at scene. Multivariable logistic regression (MVR), LASSO and random forest (RF) models were investigated. Model performance was evaluated using receiver operator characteristic (ROC) area under curve (AUC) analysis and calibration plots. Results20,713 patients were included in this study, of which 860 (4.1%) fulfilled the criteria for refractory VF/VT. All models performed comparably and were moderately well-calibrated. ROC-AUC were 0.732 (95% CI, 0.695 – 0.769) for MVR, 0.738 (95% CI, 0.701 – 0.774) for LASSO, and 0.731 (95% CI, 0.690 – 0.773) for RF. The shared important predictors across all models included male gender and public location. ConclusionThe machine learning models developed have potential clinical utility to improve outcomes in cases of refractory VF/VT OHCA. Prediction of refractory VF/VT prior to arrival at patient’s side may allow for increased options for intervention both by EMS and tertiary care centres.

An integrated Fine-Kinney risk assessment model utilizing Fermatean fuzzy AHP-WASPAS for occupational hazards in the aquaculture sector

The multidisciplinary field of occupational health and safety (OHS) aims to identify, assess, and mitigating hazards that arise in the workplace or due to the execution of the work. The Fine-Kinney method is a quantitative risk assessment widely applied in many industries to identify, evaluate and prevent potential hazards. Despite the widespread usage of the classic Fine-Kinney approach in several research, its effectiveness in addressing the issue of objective risk appraisal among decision-makers is limited. Therefore, this study proposes a comprehensive occupational risk assessment framework that integrates the Fine-Kinney method with the analytical hierarchy process (AHP) and weighted aggregated sum product assessment (WASPAS) under the Fermatean fuzzy environment. The Fermatean fuzzy set (FFS) offers a more flexible solution in determining the uncertainty and vagueness of information, as it covers membership and non-membership degrees in a wider area compared to intuitionistic and Pythagorean fuzzy sets. The AHP approach is used to calculate the weightage of each each Fine-Kinney risk parameter (probability (P), exposure (E), and consequence (C)), and WASPAS method is used to find the ranking of the hazards. In the proposed model, Fermatean fuzzy weighted geometric (FFWG) operator is used for aggregation of expert opinions. Finally, sensitivity and comparative analyses are also performed to further highlight the adaptability and efficiency of the proposed occupational health and safety risk assessment (OHSRA) model, and a case study analyzing occupational hazards for aquaculture operations is presented to demonstrate the model's rationality and feasibility.

Navigating the Agricultural Landscape

Abstract: In today’s world agricultural landscape, technological progress has become essential for improving productivity, sustainability, and profitability. This paper investigates Farm Tech Central, an innovative platform that sits at the intersection of agricultural technology and information sharing. Through a thorough examination, this paper clarifies the crucial role played by Farm Tech Central in enabling access to state-of-the-art agricultural technologies, research findings, and best practices. Acting as a central hub for farmers, agronomists, researchers, and industry stakeholders, Farm Tech Central provides users with valuable resources and tools to enhance farm operations, manage risks, and take advantage of emerging opportunities. Utilizing case studies, data analysis, and expert opinions, this paper delves into how Farm Tech Central is transforming agriculture by promoting modernization, encouraging sustainable practices, and fostering innovation. As the agricultural sector continues its journey towards digitalization and technological integration, Farm Tech Central emerges as a leading platform for collaboration, knowledge sharing, and technological progress, poised to usher in a new era of agricultural excellence

Expert opinion regarding early screening, patient awareness, and telemedicine practices in Indian settings

Objective: To collect clinicians’ perspectives regarding the significance of early screening, patient awareness, and telemedicine practice in routine Indian settings for diabetes management. Methodology: The study employed a 25-item questionnaire to gather insights from specialists across different Indian settings regarding their perspectives on early screening, patient awareness, and telemedicine practices among diabetologists. Results: According to the cross-sectional survey, 59% of respondents believed that regular awareness programs were helpful in the early screening of diabetes among high-risk individuals. Meanwhile, 64% of clinicians reported that clinical-level screening was a more effective tool for early screening. Around 74% of clinicians reported that microvascular complications namely diabetic retinopathy, diabetic neuropathy, and diabetic kidney diseases should be targeted during early screening of diabetes. The American Diabetes Association (ADA) risk score was the most commonly used risk score for early diabetes screening, according to 54% of clinicians. Moreover, 67% of clinicians reported that 11 to 25% of diabetic individuals had complications of lipitension, and 64% reported that 11 to 20% of T2DM individuals had depression. Regarding telemedicine, 65% of clinicians preferred to use it occasionally. However, at an individual level, factors like cost, literacy, less familiarity with using the tool, and emotional reasons hindered the effective adoption of telemedicine, as reported by 56% of clinicians. Conclusion: The survey highlighted the effectiveness of awareness programs and clinical-level screening for early diabetes management, emphasizing the importance of targeting microvascular complications. Increased prevalence of complications like lipitension and depression was noted in diabetic individuals. Telemedicine, though recognized as valuable, faces challenges due to individual-level factors.

La gestione della piastrinopenia immune acuta in età pediatrica

This report summarizes the most relevant issues of the document that the Working Group on Coagulation Disorders of the Italian Association of Paediatric Haematology and Oncology (AIEOP) developed to gather shared expert opinions on the management of newly diagnosed idiopathic thrombocytopenic purpura (ITP), updating previous guidelines and providing recommendations to paediatricians. These recommendations are not intended to be standards or fixed rules but rather a tool to support paediatricians in the management of the diagnostic work-up and treatment of children with newly diagnosed ITP

AAPM&R consensus guidance on spasticity assessment and management.

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) conducted a comprehensive review in 2021 to identify opportunities for enhancing the care of adult and pediatric patients with spasticity. A technical expert panel (TEP) was convened to develop consensus-based practice recommendations aimed at addressing gaps in spasticity care. To develop consensus-based practice recommendations to identify and address gaps in spasticity care. The Spasticity TEP engaged in a 16-month virtual meeting process, focusing on formulating search terms, refining research questions, and conducting a structured evidence review. Evidence quality was assessed by the AAPM&R Evidence, Quality and Performance Committee (EQPC), and a modified Delphi process was employed to achieve consensus on recommendation statements and evidence grading. The Strength of Recommendation Taxonomy (SORT) guided the rating of individual studies and the strength of recommendations. The TEP approved five recommendations for spasticity management and five best practices for assessment and management, with one recommendation unable to be graded due to evidence limitations. Best practices were defined as widely accepted components of care, while recommendations required structured evidence reviews and grading. The consensus guidance statement represents current best practices and evidence-based treatment options, intended for use by PM&R physicians caring for patients with spasticity. This consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.

Cancer Surveillance in Solid Organ Transplant Recipients With a Pretransplant History of Malignancy: Multidisciplinary Collaborative Expert Opinion.

With improved medical treatments, the prognosis for many malignancies has improved, and more patients are presenting for transplant evaluation with a history of treated cancer. Solid organ transplant (SOT) recipients with a prior malignancy are at higher risk of posttransplant recurrence or de novo malignancy, and they may require a cancer surveillance program that is individualized to their specific needs. There is a dearth of literature on optimal surveillance strategies specific to SOT recipients. A working group of transplant physicians and cancer-specific specialists met to provide expert opinion recommendations on optimal cancer surveillance after transplantation for patients with a history of malignancy. Surveillance strategies provided are mainly based on general population recurrence risk data, immunosuppression effects, and limited transplant-specific data and should be considered expert opinion based on current knowledge. Prospective studies of cancer-specific surveillance models in SOT recipients should be supported to inform posttransplant management of this high-risk population.

A capture-recapture modeling framework emphasizing expert opinion in disease surveillance.

In disease surveillance, capture-recapture methods are commonly used to estimate the number of diseased cases in a defined target population. Since the number of cases never identified by any surveillance system cannot be observed, estimation of the case count typically requires at least one crucial assumption about the dependency between surveillance systems. However, such assumptions are generally unverifiable based on the observed data alone. In this paper, we advocate a modeling framework hinging on the choice of a key population-level parameter that reflects dependencies among surveillance streams. With the key dependency parameter as the focus, the proposed method offers the benefits of (a) incorporating expert opinion in the spirit of prior information to guide estimation; (b) providing accessible bias corrections, and (c) leveraging an adapted credible interval approach to facilitate inference. We apply the proposed framework to two real human immunodeficiency virus surveillance datasets exhibiting three-stream and four-stream capture-recapture-based case count estimation. Our approach enables estimation of the number of human immunodeficiency virus positive cases for both examples, under realistic assumptions that are under the investigator's control and can be readily interpreted. The proposed framework also permits principled uncertainty analyses through which a user can acknowledge their level of confidence in assumptions made about the key non-identifiable dependency parameter.

Educating patients on osteoporosis and bone health: Can "ChatGPT" provide high-quality content?

The rise of artificial intelligence (AI) models like ChatGPT offers potential for varied applications, including patient education in healthcare. With gaps in osteoporosis and bone health knowledge and adherence to prevention and treatment, this study aims to evaluate the accuracy of ChatGPT in delivering evidence-based information related to osteoporosis. Twenty of the most common frequently asked questions (FAQs) related to osteoporosis were subcategorized into diagnosis, diagnostic method, risk factors, and treatment and prevention. These FAQs were sourced online and inputted into ChatGPT-3.5. Three orthopedic surgeons and one advanced practice provider who routinely treat patients with fragility fractures independently reviewed the ChatGPT-generated answers, grading them on a scale from 0 (harmful) to 4 (excellent). Mean response accuracy scores were calculated. To compare the variance of the means across the four categories, a one-way analysis of variance (ANOVA) was used. ChatGPT displayed an overall mean accuracy score of 91%. Its responses were graded as "accurate requiring minimal clarification" or "excellent," with a mean response score ranging from 3.25 to 4. No answers were deemed inaccurate or harmful. No significant difference was observed in the means of responses across the defined categories. ChatGPT-3.5 provided high-quality educational content. It showcased a high degree of accuracy in addressing osteoporosis-related questions, aligning closely with expert opinions and current literature, with structured and inclusive answers. However, while AI models can enhance patient information accessibility, they should be used as an adjunct rather than a substitute for human expertise and clinical judgment.

Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee.

Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high β-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding.

Performance Evaluation of Railway Infrastructure Managers: A Novel Hybrid Fuzzy MCDM Model

Modern challenges such as the liberalization of the railway sector and growing demands for sustainability, high-quality services, and user satisfaction set new standards in railway operations. In this context, railway infrastructure managers (RIMs) play a crucial role in ensuring innovative approaches that will strengthen the position of railways in the market by enhancing efficiency and competitiveness. Evaluating their performance is essential for assessing the achieved objectives, and it is conducted through a wide range of key performance indicators (KPIs), which encompass various dimensions of operations. Monitoring and analyzing KPIs are crucial for improving service quality, achieving sustainability, and establishing a foundation for research and development of new strategies in the railway sector. This paper provides a detailed overview and evaluation of KPIs for RIMs. This paper creates a framework for RIM evaluation using various scientific methods, from identifying KPIs to applying complex analysis methods. A novel hybrid model, which integrates the fuzzy Delphi method for aggregating expert opinions on the KPIs’ importance, the extended fuzzy analytic hierarchy process (AHP) method for determining the relative weights of these KPIs, and the ADAM method for ranking RIMs, has been developed in this paper. This approach enables a detailed analysis and comparison of RIMs and their performances, providing the basis for informed decision-making and the development of new strategies within the railway sector. The analysis results provide insight into the current state of railway infrastructure and encourage further efforts to improve the railway sector by identifying key areas for enhancement. The main contributions of the research include a detailed overview of KPIs for RIMs and the development of a hybrid multi-criteria decision making (MCDM) model. The hybrid model represents a significant step in RIM performance analysis, providing a basis for future research in this area. The model is universal and, as such, represents a valuable contribution to MCDM theory.

Digital literacy scale: Validity and reliability study with the rasch model

AbstractThe study aimed to develop a Likert-type measurement tool (Digital Literacy Scale, DLS) to determine the digital literacy levels of secondary school students. The validity and reliability of the developed measurement tool were verified using the Rasch model. The Rasch Model can estimate missing data and allow for small study groups (Rasch, Rasch, Probabilistic models for some intelligence and attainment tests, Danish Institute for Educational Research, 1960). Additionally, this model can verify the expected pattern of the measurement tool by calibrating it across participants and items. The content validity of DLS was ensured by expert opinion, and the construct validity was ensured by using the Rach model. In the content validity study, a 25-item pool was created for the draft DLS, and 5 items were removed from the draft DLS at this stage. Construct validity studies were carried out with the remaining 20 items using the classical test theory and item response theory (Rasch model). Exploratory Factor Analysis (EFA) and first-level Confirmatory Factor Analysis (CFA) were used within the scope of classical test theory. Then some Rasch assumptions such as dimensionlessness, local independence, monotonicity, and bias were tested for DLS. In the validity and reliability analysis of DLS, no items were eliminated, and the quantitative theoretical results were statistically confirmed. The analysis results showed that the minimum statistical values required for a good measurement tool were met. Accordingly, 20 valid and reliable compatible items that can be used to determine the digital literacy status of secondary school students were produced.

Establishment of in-hospital nutrition support program for middle-aged and elderly patients with acute decompendated heart failure

ObjectiveTo construct a nutrition support program for middle-aged and elderly patients with acute decompensated heart failure (ADHF) during hospitalization.MethodsBased on the JBI Evidence-Based Health Care Model as the theoretical framework, the best evidence was extracted through literature analysis and a preliminary nutrition support plan for middle-aged and elderly ADHF patients during hospitalization was formed. Two rounds of expert opinion consultation were conducted using the Delphi method. The indicators were modified, supplemented and reduced according to the expert’s scoring and feedback, and the expert scoring was calculated.ResultsThe response rates of the experts in the two rounds of consultation were 86.7% and 100%, respectively, and the coefficient of variation (CV) for each round was between 0.00% and 29.67% (all < 0.25). In the first round of expert consultation, 4 items were modified, 3 items were deleted, and 3 items were added. In the second round of the expert consultation, one item was deleted and one item was modified. Through two rounds of expert consultation, expert consensus was reached and a nutrition support plan for ADHF patients was finally formed, including 4 first-level indicators, 7 s-level indicators, and 24 third-level indicators.ConclusionThe nutrition support program constructed in this study for middle-aged and elderly ADHF patients during hospitalization is authoritative, scientific and practical, and provides a theoretical basis for clinical development of nutrition support program for middle-aged and elderly ADHF patients during hospitalization.

Ongoing decision-making dilemma for treatment of de novo spinal infections: a comparison of the Spinal Infection Treatment Evaluation Score with the Spinal Instability Spondylodiscitis Score and Spine Instability Neoplastic Score.

De novo spinal infections are an increasing medical problem. The decision-making for surgical or nonsurgical treatment for de novo spinal infections is often a non-evidence-based process and commonly a case-by-case decision by single physicians. A scoring system based on the latest evidence might help improve the decision-making process compared with other purely radiology-based scoring systems or the judgment of a single senior physician. Patients older than 18 years with an infection of the spine who underwent nonsurgical or surgical treatment between 2019 and 2021 were identified. Clinical data for neurological status, pain, and existing comorbidities were gathered and transferred to an anonymous spreadsheet. Patients without an MR image and a CT scan of the affected spine region were excluded from the investigation. A multidisciplinary expert panel used the Spine Instability Neoplastic Score (SINS), Spinal Instability Spondylodiscitis Score (SISS), and Spinal Infection Treatment Evaluation Score (SITE Score), previously developed by the authors' group, on every clinical case. Each physician of the expert panel gave an individual treatment recommendation for surgical or nonsurgical treatment for each patient. Treatment recommendations formed the expert panel opinion, which was used to calculate predictive validities for each score. A total of 263 patients with spinal infections were identified. After the exclusion of doubled patients, patients without de novo infections, or those without CT and MRI scans, 123 patients remained for the investigation. Overall, 70.70% of patients were treated surgically and 29.30% were treated nonoperatively. Intraclass correlation coefficients (ICCs) for the SITE Score, SINS, and SISS were 0.94 (95% CI 0.91-0.95, p < 0.01), 0.65 (95% CI 0.91-0.83, p < 0.01), and 0.80 (95% CI 0.91-0.89, p < 0.01). In comparison with the expert panel decision, the SITE Score reached a sensitivity of 96.97% and a specificity of 81.90% for all included patients. For potentially unstable and unstable lesions, the SISS and the SINS yielded sensitivities of 84.42% and 64.07%, respectively, and specificities of 31.16% and 56.52%, respectively. The SITE Score showed higher overall sensitivity with 97.53% and a higher specificity for patients with epidural abscesses (75.00%) compared with potentially unstable and unstable lesions for the SINS and the SISS. The SITE Score showed a significantly higher agreement for the definitive treatment decision regarding the expert panel decision, compared with the decision by a single physician for patients with spondylodiscitis, discitis, or spinal osteomyelitis. The SITE Score shows high sensitivity and specificity regarding the treatment recommendation by a multidisciplinary expert panel. The SITE Score shows higher predictive validity compared with radiology-based scoring systems or a single physician and demonstrates a high validity for patients with epidural abscesses.

From Laughter to Learning: Teaching Methods through Engaging Narrative Workshops

Can we increase students’ grasp and integration of research methods in political science, and do so in a fun way? We believe the answer is yes. In this article, we introduce the workshop-based narrative framework “The Tale of Folke Folkesson,” where students role-play as the methods expert group Linnaeus Opinion Laboratory (LOL). Through an interactive engagement with the story, students are exposed to the combined utility of various qualitative and quantitative techniques such as content analysis, survey research, experiments, and interviews. This methodological exercise enables students to recognize not only the individual strengths and weaknesses of each method, but also how one method can offset the limitations and/or amplify the benefits of another. Importantly for student learning, it does so in a fun and engaging way. Beyond introducing the narrative framework, we describe how educators can adapt the “Tale of Folke Folkesson” to meet their specific educational needs.

The final part of the CRESS trilogy- how to evaluate the quality of stability studies.

High quality laboratory results are critical for patient management. However, poor sample quality can impact these results and patient safety. To ensure reliable and accurate results laboratories must be aware of each analyte's stability under various storage conditions and matrices to guarantee correct and dependable outcomes. This knowledge allows laboratories to define the allowable delay between sample collection and centrifugation/analysis for all analytes to guarantee appropriate results quality and interpretation. The EFLM WG-PRE therefore established a 4-step plan to tackle this issue, aiming to standardize and harmonize stability studies for improved comparison andmeta-analysis. The plan included the development of checklists and how-to guides for performing and reporting stability studies as well as a central resource of stability data. This manuscript deals with the issue of evaluating publications and incorporating them into a central resource. To evaluate stability studies, the CRESS checklist was used to structure 20 sections used to judge the quality of studies. Each section has 4 levels of quality, with scores converted to numerical values and weighted based on expert opinion. Based on this, a final score ranging from A to D was determined. The procedure was then tested on six manuscripts and checked for agreement between expert judgements. The results demonstrated that the proposed evaluation process is a useful tool to distinguish between best in class manuscripts and those of lower quality. The EFLM WG-PRE strongly believes that the provided recommendations and checklists will help improving stability studies both in quality and standardisation.

Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol

BackgroundPeople with substance use disorders (SUDs) have restricted engagement with health-care facilities and describe repeated experiences of stigma, discrimination, and mistreatment when receiving care at health-care and public addiction treatment centers (PATCs). The purpose of the current study is to design practical cultural-based strategies to reduce addiction-related stigma and discrimination at PATCs.Methods/designThe present study will use a mixed-methods design with an explanatory sequential approach. Phase 1 of the study will combine a cluster sampling technique combined with a cross-sectional survey of Patients with Substance Use Disorders (SUDs) in Mazandaran, Iran. A total of three hundred and sixty individuals with SUDs will be selected to assess their experiences of stigma and factors predicting stigma. Phase 2 will involve qualitative study aimed at exploring participants’ perceptions regarding the aspects and determinants of their stigma experience. The participants will include two groups: people with SUDs and staff/health-care providers at PATCs. Participants for Phase 2 will be purposively sampled from those involved in Phase 1.Qualitative data will be collected using in-depth semi-structured interviews and focus group discussions and analyzed using content analysis with a conventional approach. Phase 3 will focus on the development of new strategies to reduce the experiences of stigma among people with SUDs at PATCs. These strategies will be formulated based on the findings derived from the qualitative and quantitative data obtained in Phases 1 and 2, a comprehensive review of the literature, and expert opinions gathered using the nominal group technique.DiscussionThis is one of the few studies conducted within the domain of stigma pertaining to individuals who use drugs within the context of Iranian culture employing a mixed-methods approach, this study aims to develop culturally sensitive strategies to reduce such problems from the perspective of Iranian people who use drugs. It is anticipated that the study will yield evidence-based insights and provide practical strategies to reduce the stigma and discrimination experienced by people who use drugs at PATCs. Such outcomes are important for informing policymaking and designing healthcare interventions tailored to the needs of individuals grappling with substance dependency.

Assessment of Customs Brokerage Performance in Vietnam: A Study of the Analytic Hierarchy Process (AHP)

This study aims to apply a fact-based methodology called the Analytic Hierarchy Process (AHP) to evaluate the performance of customs brokers in Vietnam. It involves weighting the importance of factors affecting the quality of customs brokerage service based on market rules and regulatory compliance. The significance of the factors was ranked through the AHP method, based on expert opinions gathered from semi-structured interviews with 10 senior managers with over five years of service among Vietnam’s customs brokers. The results indicate that professional qualification, trade compliance and professionalism marked by high commitment, trustworthiness and adaptability with customers, are the most critical factors influencing the quality of customs brokerage service. Building upon the AHP model, the study formulates the Vietnam Customs Broker Scoring Criteria for the General Department of Vietnam Customs (GDVC).

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.