Broad Definition Research Articles

The Impact of Surgical Approach on 90-Day Prosthetic Joint Infection After Total Hip Replacement — A Population-Based, Propensity Score-Matched Cohort Study

BackgroundProsthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). This study aimed to determine if the anterior approach (AP) influenced the incidence of early PJI in THA compared to posterior approach (PP). MethodsRecord linkage was performed between state-wide hospitalization data and a national joint replacement registry to identify unilateral THA performed via the AP or PP. Complete data on 12,605 AP and 25,569 PP THAs were obtained. Propensity score matching (PSM) was undertaken to match covariates between the approaches. Outcomes were the 90-day PJI hospital readmission rate(using narrow and broad definitions) and 90-day PJI revision rate (defined as component removal or exchange). ResultsThe raw PJI readmission rate for AP was lower than PP (0.8% versus 1.1%, respectively). In the PSM analysis, there was no statistically significant difference in PJI readmission rate between approaches using narrow or broad definition of PJI readmission. In terms of revision for infection, both methods showed AP had a significantly lower rate than PP, with an adjusted odds ratio (OR) of 0.47 (95% confidence interval (CI) 0.30, 0.75) for the 1:1 nearest neighbor method and 0.50 (95% CI 0.32, 0.77) for the subclassification method. ConclusionAfter addressing known confounders, there was no significant difference in the 90-day hospital readmission rate for hip PJI between approaches. There was a significantly reduced 90-day PJI revision rate for AP. The difference in revision may reflect differences in the surgical management of PJI between hip approaches rather than a difference in the underlying rate of infection.

Contracts and Agreements as Grounds for Expenditure Obligations: A Legal Aspect

The paper analyzes the provisions of the Budget Code of the Russian Federation, stipulating that expenditure obligations in the Russian Federation arise, among other things, as a result of the conclusion of contracts and agreements. The study revealed that the provisions of the Budget Code of the Russian Federation contain broad definitions that allow for the emergence of expenditure obligations from contracts that do not have regulatory properties, in particular from contracts concluded on behalf of a public legal entity by a state institution. The paper substantiates that such regulation does not take into account the legal standing of the Constitutional Court of the Russian Federation according to which the expenditure obligation must be established in a normative form. It is revealed that the budget legislation regarding the regulation of expenditure obligations is not synchronized with the legislation regulating the organization of public power. The paper provides arguments proving the need to specify that only public law contracts should act as the grounds for the occurrence of expenditure obligations. According to the results of the study, it is proposed to adjust the Budget Code of the Russian Federation in terms of specifying a specific list of types of contracts and agreements, because of which expenditure obligations arise.

P-755 Timeless importance of the embryo transfer technique: a real-life retrospective study comparing direct versus afterload catheters

Abstract Study question Can the embryo transfer (ET) technique influence clinical pregnancy rate (CPR)? Summary answer Our study demonstrated that CPR is significantly affected by the ET technique. In particular, with the afterload technique both CPR and easy transfer rates increased. What is known already Despite it having widely demonstrated that the occurrence of difficult ETs reduces the success of assisted reproductive technology (ART) cycles and that afterload technique has showed a decrease in the number of difficult transfers compared to the direct one, few data are available assessing pregnancy outcomes in the two different techniques. The present study represents the progression of a published prospective randomized controlled trial (RCT) performed in the same setting on a smaller population comparing direct and afterload techniques on the difficult transfer rate, but not designed to demonstrate differences in terms of CPR. Study design, size, duration Single center retrospective cohort analysis of 8,189 fresh and frozen single blastocyst transfers performed between January 2016 and December 2021 in a tertiary University affiliated fertility center. Of the total, 2,000 ETs were performed with the direct technique and 6,189 with the afterload one. All fresh single day-5 and single day-5 and day-6 frozen blastocyst transfers performed during the study timeframe were included. Participants/materials, setting, methods Direct technique was the only one used from January 2016 to September 2017. In the clinical trial recruitment period, the choice was given by randomization. From April 2019, only the afterload technique was used: the operator never had chance to choose the technique. Preimplantation genetic testing cycles, gamete donation and day-7 blastocyst transfers were excluded. CPR was the primary outcome, while difficult transfer rate the secondary one. Univariate and multivariate logistic regression have been performed. Main results and the role of chance During the period, 8,189 single blastocyst transfers were performed. Afterload ET showed a percentage of difficult transfers which was almost one third compared to that of the direct ET, being respectively 9.06% and 26.85% (OR 0.27, 95% CI 0.24-0.31p <0.001). Overall, the CPR between the two groups was significantly different: 44.69% in afterload ET and 41.65% in direct ET (OR 1.13, 95% CI 1.02-1.25, p = 0.017). As for the interaction between the two techniques and difficult transfer on CPR, only the direct difficult ET resulted in a significantly lower CPR with an OR of 0.62 (95%CI 0.49-0.77, p < 0.001). Lastly, among the 15 operators that performed the ETs, a range of difficult transfers from 3.8% to 45.4 % in the direct group and 0.8% to 20.5% in the afterload group was found (p < 0.001). Limitations, reasons for caution The main limitations of the study are the difference in sample sizes between the two groups, the wide range of time considered, and the 15 operators included. A further possible reason is the high prevalence of difficult transfer, probably due to the broad definition we used. Wider implications of the findings The study points out how in embryo transfers the use of the afterload technique instead of the direct one significantly improves clinical pregnancy rate and easy transfer rate. Since there is a limited knowledge on the embryo transfer technique impact, our findings aim to increase the effectiveness of embryo transfers. Trial registration number NCT05364528.

Atherosclerotic Cardiovascular Disease in Type2 Diabetes: A Retrospective, Observational Study of Economic and Clinical Burden in Sweden.

Individuals with type2 diabetes (T2D) are at high risk of experiencing atherosclerotic cardiovascular disease (ASCVD), which is associated with morbidity, mortality and healthcare resource utilisation. Clinical guidelines recommend the use of glucose-lowering medications with cardiovascular benefits in individuals with T2D and cardiovascular disease, but there is evidence that this is not reflected in clinical practice. We used linked national registry data from Sweden to compare outcomes in people with T2D and ASCVD against matched controls with T2D without ASCVD, over 5years. Direct costs (inpatient, outpatient and selected drug costs), indirect costs resulting from work absence, early retirement, cardiovascular events and mortality were examined. Individuals with T2D who were at least 16years old and were alive and resident in Sweden on 1January 2012 were identified in an existing database. In four separate analyses, individuals with a record indicating ASCVD according to a broad definition, peripheral artery disease (PAD), stroke or myocardial infarction (MI) before 1January 2012 were identified using diagnosis and/or procedure codes and propensity score matched 1:1 to controls with T2D and without ASCVD, using covariates for birth, sex and level of education in 2012. Follow-up continued until death, migration from Sweden or the end of the study period in 2016. In total, 80,305 individuals with ASCVD, 15,397 individuals with PAD, 17,539 individuals with previous stroke and 25,729 individuals with previous MI were included. Total mean annual costs per person were €14,785 for PAD (2.7 × costs for controls), €11,397 for previous stroke (2.2 × controls), €10,730 for ASCVD (1.9 × controls) and €10,342 for previous MI (1.7 × controls). Indirect costs and costs of inpatient care were the major cost drivers. ASCVD, PAD, stroke and MI were all associated with an increased likelihood of early retirement, cardiovascular events and mortality. ASCVD is associated with considerable costs, morbidity and mortality in individuals with T2D. These results support structured assessment of ASCVD risk and broader implementation of guideline-recommended treatments in T2D healthcare.

Introduction to the Perspectives Forum on the Topic of Meta-Therapy in Speech-Language Pathology

Introduction to the <i>Perspectives</i> Forum on the Topic of Meta-Therapy in Speech-Language Pathology

Przegląd wybranych badań nad zastosowaniem arteterapii w pracy z dziećmi uchodźców i imigrantów

This article presents an overview of research on the importance and effectiveness of art therapy methods in immigrant and refugee children. The literature on the subject indicates an increased risk of problems in the area of both mental and physical health in immigrants and their children. Refugees and their children are in a particularly difficult situation because, in addition to the challenges of adapting to a new place of settlement, they also experience trauma related to the country of origin. Among the therapeutic interactions and work with refugee and immigrant children, art therapy has a special place. The article adopts a broad definition of it, according to which it is “all forms and methods of therapeutic assistance in which various fields of art are used: painting, drawing, literature, music, dance, drama”. A review of studies examining the importance of art therapy in the context of improving psychological functioning in various age groups of immigrant and refugee children is presented. It turns out that the therapeutic impact with the use of art may be important in the context of coping for dealing with the problems experienced by these groups of people.

The association between sociodemographic, clinical, and potentially preventive therapies with oxaliplatin-induced peripheral neuropathy in colorectal cancer patients.

The purpose of this retrospective cohort study was to evaluate whether several potentially preventive therapies reduced the rate of oxaliplatin-induced peripheral neuropathy (OIPN) in colorectal cancer patients and to assess the relationship of sociodemographic/clinical factors with OIPN diagnosis. Data were obtained from the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Eligible patients were diagnosed with colorectal cancer between 2007 and 2015, ≥ 66years of age, and treated with oxaliplatin. Two definitions were used to denote diagnosis of OIPN based on diagnosis codes: OIPN 1 (specific definition, drug-induced polyneuropathy) and OIPN 2 (broader definition, additional codes for peripheral neuropathy). Cox regression was used to obtain hazard ratios (HR) with 95% confidence intervals (CI) for the relative rate of OIPN within 2years of oxaliplatin initiation. There were 4792 subjects available for analysis. At 2years, the unadjusted cumulative incidence of OIPN 1 was 13.1% and 27.1% for OIPN 2. For both outcomes, no therapies reduced the rate of OIPN diagnosis. The anticonvulsants gabapentin and oxcarbazepine/carbamazepine were associated with an increased rate of OIPN (both definitions) as were increasing cycles of oxaliplatin. Compared to younger patients, those 75-84years of age experienced a 15% decreased rate of OIPN. For OIPN 2, prior peripheral neuropathy and moderate/severe liver disease were also associated with an increased hazard rate. For OIPN 1, state buy-in health insurance coverage was associated with a decreased hazard rate. Additional studies are needed to identify preventive therapeutics for OIPN in cancer patients treated with oxaliplatin.

The 'Bogus Child' and the 'Big Uncle': The Impossible South Asian Family in Post-Imperial Britain.

Between 1962 and 1965, a broad definition of dependence allowed for the migration of Commonwealth Citizens to join working family members in Britain. This article investigates how the Home Office targeted male dependent youth as a category that could reduce unwanted immigration from the Commonwealth, particularly South Asia. Home Office officials obscured the stories of dependent migrants, constructed the figure of the 'bogus child', and denigrated male familial connections, which resulted in the denial of family reunion. Colonial assumptions about the mendacity of South Asians and the illegibility of South Asian family forms shaped British policy. The 1965 White Paper and the 1968 Commonwealth Immigrants Act foreclosed the possibility of a broad definition of family and consolidated the legitimacy of the cisheterosexual family. Home Office discussions dovetailed with an emergent common sense circulated in newspapers and public debate about the illegitimacy of the South Asian family in Britain. This article interrogates the racist reasoning of the Home Office and this emergent common sense not only to show how immigration policy generates racialization but also to reveal the specificity of South Asian racialization in the post-imperial social formation.

Defining a common language to assess external deformities in free‐ranging cetaceans

Abstract Wild animals are increasingly exposed to human‐induced threats in the ocean realm. Cetacean species, as predators and biomonitoring models, are subjected to a variety of stressors that may result in poor health, injuries, and persistent marks. These malformations can easily be documented by photography or video and can be used to infer about the animals' health, especially if combined with long‐term photographic identification. However, the value of such information for monitoring is vastly increased if a standardised language is used. We provide a broad definition of deformity, as a general concept for conditions or abnormal features in cetacean species, and categorise externally detected deformities in free‐ranging individuals. We define six categories and 58 sub‐categories of deformities in cetaceans: anatomical malformations (11 sub‐categories), skin lesions (29), anomalous pigmentation (4), injuries due to physical impacts (14), emaciation, and epibionts. Categorisation was based on peer‐reviewed literature published between 2000 and 2021 (n = 253 studies), comprising 80 of the 101 extant species, documented in studies conducted across 50 countries; reviewed literature included papers from 86 scientific journals, with three journals contributing 100 out of the 253 documents. Overall, and for both Odontoceti and Mysticeti, physical impact was the most reported category; injuries due to physical impacts were documented in 74% of the 253 studies we reviewed. This may be related to the common exposure of cetaceans to intense human marine traffic and fishing activities. Especially with the growing use of open science, a consistent and common language is fundamental for data comparison and to support cetacean research, management and conservation efficiently. We suggest that researchers adopt these definitions and categories when describing abnormalities observed in free‐living cetaceans.

Impact of physical activity on healthcare costs: a systematic review

BackgroundThis systematic review aims to describe the relation between physical inactivity and healthcare costs, by taking into account healthcare costs of physical-inactivity-related diseases (common practice), including physical-activity-related injuries (new) and costs in life-years gained due to avoiding diseases (new), whenever available. Moreover, the association between physical inactivity and healthcare costs may both be negatively and positively impacted by increased physical activity.MethodsA systematic review was conducted, including records reporting on physical (in)activity in relation to healthcare costs for a general population. Studies were required to report sufficient information to calculate the percentage of total healthcare costs potentially attributable to physical inactivity.ResultsOf the 264 records identified, 25 were included in this review. Included studies showed substantial variation in the assessment methods of physical activity and in type of costs included. Overall, studies showed that physical inactivity is related to higher healthcare costs. Only one study included costs of healthcare resources used in prolonged life when physical-inactivity-related diseases were averted, showing net higher healthcare costs. No study included healthcare costs for physical-activity-related injuries.ConclusionsPhysical inactivity is associated with higher healthcare costs in the general population in the short-term. However, in the long-term aversion of diseases related with physical inactivity may increase longevity and, as a consequence, healthcare costs in life-years gained. Future studies should use a broad definition of costs, including costs in life-years gained and costs related to physical-activity-related injuries.

ICD-10 codes for surveillance of non-fatal abusive head trauma in Aotearoa New Zealand: a retrospective cohort study

ObjectivesTo assess the validity of an International Classification of Diseases (ICD) code based definition of non-fatal head trauma caused by child abuse (abusive head trauma) for population surveillance in New...

Conceptualizing Difference

Abstract This article formulates the concept of democracy as a configuration to overcome the rigid universalist, liberal-proceduralist dominated conceptions of democracy that define invariant core elements and combine them with culturally individualistic features. Instead, the approach presented here focuses on the basic principles behind democracy. Lincoln's often-criticized broad definition of democracy as “government by, of, and for the people” provides the opportunity for an open, transglobal approach that focuses on the premise of political self-efficacy for all citizens and portrays democracy not as a mechanism but as a way of life. Political self-efficacy can be institutionalized in different ways, so this contribution refers to specific models of democracy (e.g., liberal, republican, or communitarian).

The Serious Business of Having Fun: EU Legal Protection for Those Working Online in the Digital Economy

While a huge amount of judicial and academic attention has been paid to the employment status of those who provide physical services via an app, such as ride-hailing services by Uber drivers and food delivery services by Deliveroo cyclists, much less attention has been given to the legal position of those providing services as influencers and content creators in the online world via platforms such as Instagram and YouTube. It may be possible that some fall within the Court of Justice’s increasingly broad definition of ‘worker’, a position helped by the presumption of worker status in the proposed Platform Work Directive. If so, they will benefit from the full range of EU employment rights. But many are genuinely self-employed and so are entitled to almost no employment protection. Yet, like workers, they have a vulnerability. If their access to these platforms is turned off, it is highly damaging for their work; and there may be no obvious alternative platform to give them the profile which is necessary for them to succeed. The EU is showing itself to be innovative in responding to this challenge: first, with an extended personal scope under the proposed Platform Workers Directive which gives some rights to ‘persons performing platform work’ (PPPW) (and more rights still to ‘platform workers’), and second, in the P2B Regulation 2019/1150 and the Digital Services Act, by moving away from the focus on the status of the individual and paying attention instead to the obligations of the platform. These obligations can be summed up by the acronym TAR: Transparency, Accountability and Remedies. They are procedural rather than substantive obligations but they do recognize the need for at least some protection for those who, in the past, would have been denied it. This legislation is, indirectly, beginning to reshape our understanding of what constitutes labour law. Gig Economy, Precarity, Worker Protection, Online Platforms, Influencers, Content Creators

A meta-analysis of genome-wide association studies of childhood wheezing phenotypes identifies ANXA1 as a susceptibility locus for persistent wheezing.

Many genes associated with asthma explain only a fraction of its heritability. Most genome-wide association studies (GWASs) used a broad definition of 'doctor-diagnosed asthma', thereby diluting genetic signals by not considering asthma heterogeneity. The objective of our study was to identify genetic associates of childhood wheezing phenotypes. We conducted a novel multivariate GWAS meta-analysis of wheezing phenotypes jointly derived using unbiased analysis of data collected from birth to 18 years in 9568 individuals from five UK birth cohorts. Forty-four independent SNPs were associated with early-onset persistent, 25 with pre-school remitting, 33 with mid-childhood remitting, and 32 with late-onset wheeze. We identified a novel locus on chr9q21.13 (close to annexin 1 [ANXA1], p<6.7 × 10-9), associated exclusively with early-onset persistent wheeze. We identified rs75260654 as the most likely causative single nucleotide polymorphism (SNP) using Promoter Capture Hi-C loops, and then showed that the risk allele (T) confers a reduction in ANXA1 expression. Finally, in a murine model of house dust mite (HDM)-induced allergic airway disease, we demonstrated that anxa1 protein expression increased and anxa1 mRNA was significantly induced in lung tissue following HDM exposure. Using anxa1-/- deficient mice, we showed that loss of anxa1 results in heightened airway hyperreactivity and Th2 inflammation upon allergen challenge. Targeting this pathway in persistent disease may represent an exciting therapeutic prospect. UK Medical Research Council Programme Grant MR/S025340/1 and the Wellcome Trust Strategic Award (108818/15/Z) provided most of the funding for this study.

PTSD, subsequent violence, and increased focus on trauma-informed care

PTSD, subsequent violence, and increased focus on trauma-informed care

The Role of Environmental Insurance in “Green” Post-War Rebuilding of Ukrainian Regions

"Environmental insurance is top priority in a given scope of issues because it represents effective mechanism of risk regulation, formulating legal guarantees and providing significant instrument for implementing environmental-economic processes. Existing rudimentary mechanisms of environmental insurance in Ukraine are limited in nature and unable to fulfil the tasks set, notably under burdens of determinism and increased risks of war and post-war periods. The authors have set a study goal to evaluate preconditions of environmental insurance in post-war Ukraine and to define main priorities, primary tasking algorithms and specifics of environmental risk insurance in circular economy. The researchers applied empirical methods for study of scientific materials and regulatory documents and conducted their description and comparison. The authors analysed major approaches to implementation of mandatory environmental insurance strategy in Ukraine and gave broad definition of its structural elements and priority principles. They conducted analysis of regulatory and legal base, explored opportunities of engaging “green” insurance providers to national environmental insurance system. There has been a suggestion of variability in environmental insurance approaches with possibility to differentiate by risks, fields of economy and by regional distribution. The researchers have undertaken a forecast of effective implementation for economy, environmental protection and social area. They concluded about the need of preventive changes in economic and legal field and maximum implementation of international experience in national environmental insurance system with account of specific influence of certain factors, notable for post-war period in Ukraine."

Modelling and analysis of bad impact of smoking in society with Constant Proportional-Caputo Fabrizio operator

Smoking is now regarded as an epidemic because of the excessive mortality rate and large costs related to it. In line with the arena of the health enterprize, smoking is the third most common cause of mortality among human beings and the most preventable cause of sickness. Intending to study this problem, this manuscript frequently stresses the usage of the hybrid fractional differential operator to evaluate the dynamics of the fractional order quitting smoking version. We study a fractional-order version with a Constant Proportional-Caputo Fabrizio (CPCF) operator to investigate and examine the dynamical transmission of smoking. The qualitative analysis, and well-posedness of the fractional order system are examined. The analysis of the Volterra-type Lyapunov function for global stability is verified with the first and derivative tests. Also, Banach contraction characteristics are used to fulfil the criteria for the uniqueness of the exact solution. A complete discussion of additional analysis of the CPCF operator is furnished. In order to demonstrate the impacts of modifying the fractional order and to validate the theoretical findings, numerical simulations are carried out using an iterative Laplace transform method for a variety of fractional orders. The stability of the iterative scheme is also verified by using Picard’s stable condition from the fixed point theorem. The CPCF operator has a broader definition than the Caputo–Fabrizio (CF) operator, and it elaborates on new insights into the mechanisms of smoking transmission throughout society.

RELATIVE COMPARATIVE ASSESSMENT OF EU-28 FARM SUSTAINABILITY

The main sustainability aspects are defined in a broader definition regarding to which the agriculture should be economically efficient, environmentally compatible and socially responsible. The EU is transforming the holdings and this reflects on the farm economic size and furthermore its sustainability. This paper aims to find out the connection between the farm economic size and the sustainability. The relative comparative approach applies an assessment by normalizing the FADN data (representing an average statistical farm performance from each MS sample) and determines the scope of the Member States according to pre-defined criteria used as a sustainability score.

The Diplomatic Presidency: American Foreign Policy from FDR to George H. W. Bush by Tizoc Victor Chavez

In the second half of the twentieth century, a combination of domestic and international factors prompted U.S. presidents to make personal diplomacy a “central feature of how America engages with the world” (11). In his richly detailed and expansive exploration of this process, Tizoc Victor Chavez convincingly argues that existing scholarship has underestimated the importance of the U.S. president’s role as diplomat in chief, with certain key summits or individual relationships covered extensively by historians but few studies offering a comprehensive and expansive analysis. Addressing this shortcoming, Chavez operates from a broad definition of presidential personal diplomacy that includes “direct communication between presidents and their foreign counterparts, whether face to face, through correspondence, or on the telephone,” (3) and works chronologically through each president from Franklin Roosevelt to George H.W. Bush, paying particular attention to presidential travel and the cultivation of crucial relationships. A final chapter connects the case studies to some overarching theories, such as Samuel Huntington’s categories of institutionalization (195–196), before a brief conclusion emphasizes the continuing relevance of presidential personal diplomacy, notably that of Donald Trump. In doing so, Chavez traces the evolution of presidential personal diplomacy from an occasional duty to a fundamental tool of presidential power, albeit one that is not always easy to wield.

Database discrepancies in understanding the burden of mass shootings in the United States, 2013–2020

The United States experiences more mass shootings than any other nation in the world. Various entities have sought to collect data on this phenomenon, but there is no scholarly consensus regarding how best to define mass shootings. As a result, existing datasets include different incidents, limiting our understanding of the impact of mass gun violence in the U.S. We compared five datasets of mass shootings for each year included in five databases (2013-2020) and identified overlaps between each database's incidents. These overlaps and divergences between datasets persisted after applying the strictest fatality threshold (four or more) in mass shootings scholarship and policy. The datasets collectively include 3155 incidents, but the number of incidents included in each individual dataset varies from 57 to 2955 incidents. Only 25 incidents (0.008% of all incidents) are included in all five datasets. This finding persists even when applying the strictest criteria for mass shootings (four or more fatalities). Data discrepancies prevent us from understanding the public health impact of mass gun violence. These discrepancies result from a lack of scholarly consensus on how to define mass shootings, likely the downstream consequence of the politicization of gun violence research. We argue for a broad definition of a mass shooting and a government-supported data collection program to remedy these discrepancies. Such steps can improve the quality of research and support policy-making and journalism on the subject. This research was supported by the Pahl Initiative on the Study of Critical Social Issues, University of California, Santa Barbara.