Expanded Definition Research Articles

Expanded Fetal Growth Restriction Definition Identifies High Proportion of Umbilical Artery Doppler Anomalies.

Fetal growth restriction (FGR) increases the risk for perinatal morbidity and mortality. The Society for Maternal-Fetal Medicine expanded the definition of FGR to independently include abdominal circumference (AC) < 10th percentile for gestational age (GA), regardless of estimated fetal weight (EFW). While studies have shown increased detection of small for GA neonates with expanded definition, no studies have evaluated the likelihood of abnormal umbilical artery Dopplers (UAD) detection with expanded definition. The objective of this study was to compare the likelihood of identifying UAD abnormalities in fetuses with normal EFW and restricted AC versus those by EFW alone. Single-institution retrospective cohort study of fetal growth ultrasounds meeting criteria for FGR either by EFW < 10th percentile or AC < 10th percentile with normal EFW. Those with FGR by AC alone were compared with those with FGR by EFW. Primary outcome was prevalence of UAD abnormalities, including elevated systolic/diastolic ratio, and absent and/or reversed end diastolic velocity. Receiver operator characteristic curves were generated to compare predictive value of UAD abnormalities by FGR definition. A total of 619 scans met criteria for FGR between November 2020 and June 2021, with 441 (71%) meeting definition by EFW and 178 (29%) by AC criteria alone. Baseline characteristics were similar between groups. FGR by AC alone was identified earlier (30.4 ± 3.3 vs. 35.4 ± 3.0 weeks' gestation, p < 0.001) with higher proportion identified before 32 weeks (70 vs. 11%, p < 0.001). Proportion of abnormal UAD were similar between groups (15 vs. 15%, adjusted odds ratio: 1.12, 95% confidence interval: 0.61-2.23). Use of EFW alone would have failed to identify 29% of abnormal UAD. A combined definition of FGR had the highest detection of abnormal UAD (area under curve: 0.78 vs. AC alone 0.73 vs. EFW alone 0.69). A definition of FGR that considers both EFW and AC improves detection of abnormal UAD. · Fetuses with restricted AC are equally likely to exhibit abnormal UAD indices compared with those that meet criteria by EFW.. · Earlier GA of FGR detection and improved detection of abnormal UAD with expanded growth definition.. · Expanded definition of FGR significantly improves detection of abnormal UAD as compared with those diagnosed with EFW criteria alone.. · Expanded growth restriction definition improves Doppler identification..

Comparison of different definitions of traumatic brain injury: implications for cohort characteristics and survival in women, Philadelphia, USA

BackgroundTraumatic brain injury (TBI) is an acute injury that is understudied in civilian cohorts, especially among women, as TBI has historically been considered to be largely a condition of athletes...

Combating organized crime with criminal legal measures

One of the main functions of the state is to ensure the safety of the individual, society and the state. In Ukraine, organized crime is one of the primary threats to national security. Criminal law norms, which are norms - prohibitions, affect the effectiveness of counteraction by law enforcement agencies and special services to organized crime as a socially dangerous, historically changing, relatively mass, social phenomenon. It should be noted that in the conditions of martial law, manifestations of terrorism, banditry, the creation of illegal paramilitary, armed formations, and criminal communities pose a direct threat to national security. Changes in its level, structure, and dynamics (increasingly) are evidenced by statistical data, in particular, the number of recorded criminal offenses. The purpose of the article is to analyze the criminal law norms that establish criminal responsibility for the commission of offenses in organized forms, and based on the analysis to show a comprehensive vision of the possible criminal law consequences for the person guilty of committing the specified illegal acts.&#x0D; Elucidation of the concept of organized crime as a criminological phenomenon, identification of organized forms of committing criminally illegal acts, limits of responsibility of each of the accomplices (perpetrator, organizer, accomplice, instigator). Determination of the specifics of criminal liability and the rules for imposing punishment on persons who, as part of an organized group or criminal organization, committed a serious or particularly serious crime, combined with violence against the victim, during the performance of a special task to prevent or uncover the criminally illegal activities of these associations. Expanded definition of the concept of «organizer», analysis of articles of the Criminal Code establishing responsibility for various types of organized associations (criminal organization, criminal community, gang, terrorist group or terrorist organization, paramilitary or armed formation), determination of dispositions of criminal law norms, where «organized group» is a qualifying or particularly qualifying feature of the composition of a criminal offense undoubtedly affects the effectiveness of combating the phenomenon of organized crime. But the terminological inconsistency of individual normative legal acts does not help, and in some places complicates it, and does not provide an opportunity to clearly define all the components of organized crime in order to increase the effectiveness of the application of criminal law measures to combat crime as one of the directions of state policy.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

Impact of an Expanded Definition of Family History on Outcomes of Active Surveillance for Prostate Cancer.

Despite family history being an established risk factor for prostate cancer, the role of a broader definition of family history inclusive of not just prostate cancer but other genetically related malignancies has not been investigated in the active surveillance population. Here, we evaluate the impact of an expanded definition of family history on active surveillance outcomes. Patients undergoing active surveillance for prostate cancer at Massachusetts General Hospital from 1997-2019 with detailed data available on family cancer history were identified. Primary outcome was biopsy progression-free survival, and secondary outcomes were treatment-free survival, adverse pathological features at prostatectomy, and biochemical recurrence after treatment. Statistical analyses were conducted using the Kaplan-Meier method and Cox regression. Among 855 evaluable patients, 300 (35.1%) patients had any family history of prostate cancer, and 95 (11.1%) had a family history of related malignancies suggestive of a hereditary cancer syndrome. Family history of prostate cancer alone was not associated with biopsy progression, whereas family history suggestive of a hereditary cancer syndrome was associated with a significantly increased risk of biopsy progression (HR 1.43, 95%CI 1.01-2.02), independent of other known clinicopathological risk factors in multivariable analysis. Similarly, family history suggestive of a hereditary cancer syndrome was associated with significantly lower treatment-free survival (HR 1.58, 95%CI 1.14-2.18) in multivariable analysis. No significant association was found between family history and adverse features on surgical pathology or biochemical recurrence. An expanded family history suggestive of a hereditary cancer syndrome is an independent predictor of biopsy progression during active surveillance. Men with such a family history may still be offered active surveillance but should be counseled regarding the higher risk of disease progression.

농업경영체 등록 시 농업인 확인서의 농업인 정의 문제 연구

The Ministry of Agriculture, Food and Rural Affairs is granting various benefits to farmers in order to strengthen the competitiveness of farmers and to stably supply agricultural and fishery products to the people. In particular, according to the Act On Fostering And Supporting Agricultural And Fisheries Business Entities, various policies are implemented for farmers and agricultural corporations registered as agricultural business entities with the National Agricultural Products Quality Management Service, and benefits such as subsidies and loans are given. However, according to the registration of agricultural business entity, the standards for farmers are frequently changed and different from the laws, so there is confusion over the interpretation of the laws. there is a situation. Although the Enforcement Decree Of the Framework Act On Agriculture, Rural Community And Food Industry has provisions for the definition of a farmer, the Enforcement Decree of the Farmland Act also has more expanded definition of a farmer. It is problematic in the whole legal system that the same term “farmer” is used differently in related laws with similar purposes in the field of agriculture-related laws and regulations. Moreover, in a situation in which a farmers’ certificate is essential to register as an agricultural business entity and receive farmer benefits, the issuance regulation of the farmers’ certificate stipulates that the purpose is to identify the farmer of the Enforcement Decree of the Framework Act On Agriculture, Rural Community And Food Industry, and at the same time, the scope of the farmer who issues the farmers’ certificates is wider than that of the law, and it is gradually expanding. In addition, through the revision of the notice, the scope of farmers is continuously expanding. However, whether or not the farmer is eligible is not just a profit regulation that grants benefits, but it is necessary to clarify this because if a false farmers’ certificate is issued, it may be subject to fines, penalties, and even criminal dispositions. In order to solve this problem, in this paper, the Farmland Act and the issuance regulations of the farmers’ certificate are in accordance with the Framework Act On Agriculture, Rural Community And Food Industry with respect to the definition of a farmer, and the target regulation according to the example of the 'Agricultural and Rural Public Interest Direct Payment Act' It proposes a plan to separate the 'Agricultural, Rural and Food Industry Act' and to revise the enforcement ordinance of the 'Agricultural, Rural and Food Industry Framework Act'. It will be able to have a system.

Application of the 2019 ESC/EAS guidelines for the management of dyslipidaemia to the French population: Impact of lowering intervention thresholds on prevalence and treatment of hypercholesterolemia

The 2019 recommendations for the management of dyslipidaemia by the ESC/EAS modified slightly criteria for CV risk level and lowered significantly the intervention thresholds (lifestyle and/or drugs intervention). To evaluate, at a population level, the impact of the 2019 lowering intervention thresholds on prevalence and treatment of LDL hypercholesterolemia in France. Data from Esteban, a cross sectional study conducted on a representative sample of the French population between 2014 and 2016 were used. Data were collected with questionnaires and a clinical exam. An individual evaluation of cardiovascular risk using calculated SCORE for 10 year risk of fatal CVD and criteria defined in the 2019 ESC/EAS recommendations. People were considered having LDL hypercholesterolemia if their LDL level were higher than the threshold specified in the 2019 recommendations: 0.55 mg/dl for very high risk and secondary prevention; 0.7 for high risk; 1.0 for moderate risk and 1.16 for low risk. An estimate of the prevalence of hypercholesterolemia, based on those new 2019 recommendations with expanded definition of hypercholesterolemia due to lowered thresholds, yields a prevalence rate of 72.1% in France. Results by risk group shown that the prevalence was 57.3% in the low risk group, 89.7% in the moderate risk group and was ≥ 90% in the high, very high and secondary prevention group. Expanded definition of disease by lowering thresholds in 2019 recommendations led to 3/4 of the French population needing a lifestyle and/or drugs interventions. These elements raise the question of a hierarchical organisation of prevention strategies, particularly in low-risk groups or in younger populations. These results highlight the impact, in terms of quantifying the burden of the 2019 ESC/EAS recommendations, but also the impact on care, with 3 of 4 patients needed to be treated using health-diet and/or medication measures.

Design, Acceptance and Capacity of Subsea Open Cables

This article will discuss the collaboratively formed cross-industry open cables concept for characterizing optical performance of undersea cables with the intent of assessing and understanding their capacity potential. The article proposes definitions of two critical nonlinear and linear performance metrics for open cables: GSNR (Gaussian or generalized signal to noise ratio) and SNR <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ASE</sub> (Signal to noise ratio amplified spontaneous emission), including effects such as GAWBS (guided acoustic wave Brillouin scattering) and signal droop. Measurement methodologies for these metrics are proposed, with considerations for limitations and impact of the test conditions and characteristics of the transponders used. Expanded definitions are offered to enable variable symbol rate transponders to be used for measurement, with considerations for scaling of SNR values. Considerations for using these metrics for capacity assessment and applying these techniques to concatenated multi-segment systems are introduced. Recommendations on key parameters for system specification, system characterization, and proposals for SNR-based performance budgeting tables are also discussed as foundational elements to enabling accurate estimation of the capacity potential of a subsea open cable.

Expanded Definition of Health Care Workers Creates Large Gaps in Emergency Paid Sick Leave Coverage.

Expanded Definition of Health Care Workers Creates Large Gaps in Emergency Paid Sick Leave Coverage.

The Role of Hospital and Community Pharmacists in the Management of COVID-19: Towards an Expanded Definition of the Roles, Responsibilities, and Duties of the Pharmacist.

Since late December 2019, a novel, emerging coronavirus was identified as the infectious agent responsible for a generally mild but sometimes severe and even life-threatening disease, termed as “coronavirus disease 2019” (COVID-19). The pathogen was initially named as “2019 novel coronavirus” (2019-nCoV) and later renamed as “Severe Acute Respiratory Coronavirus type 2” (SARS-CoV-2). COVID-19 quickly spread from the first epicenter, the city of Wuhan, province of Hubei, mainland China, into neighboring countries, and became a global pandemic. As of July 15th 2020, the outbreak is still ongoing, with SARS-CoV-2 affecting 213 countries and territories. The coronavirus has caused a dramatic toll of deaths and imposed a severe burden, both from a societal and economic point of view. COVID-19 has challenged health systems, straining and overwhelming healthcare facilities and settings, including hospital and community pharmacies. On the other hand, COVID-19 has propelled several changes. During the last decades, pharmacy has shifted from being products-based and patient-facing to being services-based and patient-centered. Pharmacies have transitioned from being compounding centers devoted to the manipulation of materia medica to pharmaceutical centers, clinical pharmacies and fully integrated “medical-pharmaceutical networks”, providing a significant range of non-prescribing services. Moreover, roles, duties and responsibilities of pharmacists have paralleled such historical changes and have known a gradual expansion, incorporating new skills and reflecting new societal demands and challenges. The COVID-19 outbreak has unearthed new opportunities for pharmacists: community and hospital pharmacists have, indeed, played a key role during the COVID-19 pandemic, suggesting that a fully integrated, inter-sectoral and inter-professional collaboration is necessary to face crises and public health emergencies. Preliminary, emerging evidence seems to suggest that, probably, a new era in the history of pharmacies (“the post-COVID-19 post-pharmaceutical care era”) has begun, with community pharmacists acquiring more professional standing, being authentic heroes and frontline health workers.

Food Environment Typology: Advancing an Expanded Definition, Framework, and Methodological Approach for Improved Characterization of Wild, Cultivated, and Built Food Environments toward Sustainable Diets.

The food environment is a critical place in the food system to implement interventions to support sustainable diets and address the global syndemic of obesity, undernutrition, and climate change, because it contains the total scope of options within which consumers make decisions about which foods to acquire and consume. In this paper, we build on existing definitions of the food environment, and provide an expanded definition that includes the parameter of sustainability properties of foods and beverages, in order to integrate linkages between food environments and sustainable diets. We further provide a graphical representation of the food environment using a socio-ecological framework. Next, we provide a typology with descriptions of the different types of food environments that consumers have access to in low-, middle-, and high-income countries including wild, cultivated, and built food environments. We characterize the availability, affordability, convenience, promotion and quality (previously termed desirability), and sustainability properties of food and beverages for each food environment type. Lastly, we identify a methodological approach with potential objective and subjective tools and metrics for measuring the different properties of various types of food environments. The definition, framework, typology, and methodological toolbox presented here are intended to facilitate scholars and practitioners to identify entry points in the food environment for implementing and evaluating interventions that support sustainable diets for enhancing human and planetary health.

An Expanded Definition of the Odd Oxygen Family for Tropospheric Ozone Budgets: Implications for Ozone Lifetime and Stratospheric Influence

AbstractModels of tropospheric ozone commonly define an “odd oxygen” family (Ox), comprising ozone and species with which it rapidly cycles, in order to compute tropospheric ozone budgets and lifetimes. A major Ox loss is the O(1D) + H2O → 2OH reaction, but this may not be an actual loss because the resulting hydrogen oxide (HOx) radicals regenerate ozone in the presence of nitrogen oxides. Here we introduce an expanded odd oxygen family, Oy≡ Ox + Oz, to include both Ox and an additional subfamily, Oz, consisting of HOx and its reservoirs. We incorporate this new accounting into the GEOS‐Chem model, revealing a longer global mean ozone lifetime (73 days vs. 24 days) and greater stratospheric contribution (26% vs. 9%) under present‐day conditions than derived from the standard Ox budget. Tracking the Oy budget may provide better understanding of the discrepancies between global models in their computations of ozone sources and sinks.

Biomarkers in Inflammatory Myopathies-An Expanded Definition.

Biomarkers as parameters of pathophysiological conditions can be of outmost relevance for inflammatory myopathies. They are particularly warranted to inform about diagnostic, prognostic, and therapeutic questions. As biomarkers become more and more relevant in daily routine, this review focusses on relevant aspects particularly addressing myopathological features. However, the level of evidence to use them in daily routine at presence is low, still since none of them has been validated in large cohorts of patients and rarely in independent biopsy series. Hence, they should be read as mere expert opinions. The evaluation of biomarkers as well as key biological parameters is an ongoing process, and we start learning about relevance of them, as we must recognize that pathophysiology of myositis is biologically incompletely understood. As such this approach should be considered an essay toward expansion of the definition “biomarker” to myositis, an emerging field of interest in biomedical research.

Expanded definitions of the 'good death'? Race, ethnicity and medical aid in dying.

The range of end-of-life options is expanding across North America. Specifically, medical aid in dying (AID), or the process by which a patient with a terminal illness may request medical assistance with hastening death, has recently become legal in eight jurisdictions in the United States and all of Canada. Debates about AID often rely on cultural constructions that define some deaths as 'good' and others as 'bad'. While research has found commonalities in how patients, family members and health care providers define good and bad deaths, these constructions likely vary across social groups. Because of this, the extent to which AID is seen as a route to the good death also likely varies across social groups. In this article, we analyse qualitative data from six focus groups (n=39) across three racial and ethnic groups: African American, Latino and white Californians, just after a medical AID law was passed. We find that definitions of the 'good death' are nuanced within and between groups, suggesting that different groups evaluate medical AID in part through complex ideas about dying. These findings further conversations about racial and ethnic differences in choices about end-of-life options.

Media Coverage of the Benefits and Harms of the 2017 Expanded Definition of High Blood Pressure

This study examines the media coverage of the expanded definition of hypertension associated with the new guidelines from the American College of Cardiology and the American Heart Association.

Advancements in Plasma Control Supervision

Early fusion projects were small enough with so few control variables that it was possible to define and execute experiments without sophisticated software tools. The session leaders/engineers-in-charge knew the key settings well enough that they could tell that the experiment was “safe”. If something went wrong, then they learned to check for it in the future. As projects grew in size and experiments grew in complexity, the number of control variables grew significantly, and it became standard to use software tools to support the definition, set-up, validation and execution of experiment programs (i.e. the pre-planned set of tasks that defines what the machine must do). However, in all cases, the tools typically still only applied to the experiment. One of these tools is the familiar “plasma control system” (PCS) which is the real-time software that typically has responsibility for operating the fusion machine during a pulse. Other tools handle system configuration definition and experiment program editing. Future fusion projects like ITER and DEMO will be even more complex than current projects. The high infrastructure and human resource running costs means that these fusion projects will need to be efficient, and not waste resources or time. Such fusion projects will therefore benefit from a suite of integrated supervision and control software tools that facilitates the operation of the machine over its entire lifetime. These software tools would include a more capable PCS together with expanded system configuration definition and experiment program editing tools, and additional tools to support operations outside of the experimental phase.

Detecting cancer in primary care: Where does early diagnosis stop and overdiagnosis begin?

Detecting cancer in primary care: Where does early diagnosis stop and overdiagnosis begin?

Pathway analysis by randomization incorporating structure-PARIS: an update.

We present an update to the pathway enrichment analysis tool 'Pathway Analysis by Randomization Incorporating Structure (PARIS)' that determines aggregated association signals generated from genome-wide association study results. Pathway-based analyses highlight biological pathways associated with phenotypes. PARIS uses a unique permutation strategy to evaluate the genomic structure of interrogated pathways, through permutation testing of genomic features, thus eliminating many of the over-testing concerns arising with other pathway analysis approaches. We have updated PARIS to incorporate expanded pathway definitions through the incorporation of new expert knowledge from multiple database sources, through customized user provided pathways, and other improvements in user flexibility and functionality. PARIS is freely available to all users at https://ritchielab.psu.edu/software/paris-download jnc43@case.edu Supplementary data are available at Bioinformatics online.

Abstract WP299: An Expanded Definition of Caregiving Among Elderly US Stroke Survivors: Have We Understated the Problem?

Introduction: Previous studies exploring stroke caregiving have estimated that the average stroke survivor receives as many as 16 hours per week hours of informal caregiving at a societal cost of as much as $26.8 billion per year. However, these studies have focused on basic and instrumental activities of daily living, and have not included healthcare and transportation activities. We sought to determine whether, and at what cost, caregiving differs between stroke survivors and matched controls using an expanded definition of caregiving. Methods: A total of 892 stroke survivors were drawn from the 2011 wave of the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries. One-to-one propensity matching was performed on demographics and comorbidities to create a sample of matched non-stroke controls. Caregivers were identified by detecting all helpers for NHATS respondents who had help with self-care or mobility activities or with household activities due to health or functioning. Stroke survivors and controls were compared using survey-weighted chi-square tests and Wald tests. The annual cost of caregiving was estimated using reported paid caregiving data and estimates of informal caregiving costs. Results: On average, stroke survivors received about 10 hours of additional caregiving per week compared to controls (22 hours vs. 12 hours, p&lt;0.01). We estimate that the average annual cost for caregiving for an elderly stroke survivor is approximately $11,300. This extrapolates to a total cost of about $40 billion annually among all Medicare beneficiaries. Conclusion: Our expanded definition of caregiving suggests that prior studies may underestimate both the time and costs invested in caregiving to older stroke survivors.

Valuing All Knowledges Through an Expanded Definition of Access

Historical racial injustices as well as more recent public and economic policies have culminated in the displacement of supermarkets from some central city neighborhoods. With this displacement, many low-income and minority neighborhoods not only have been deprived of affordable healthful food, but also have experienced prolonged exposure to energy-dense and highly processed snack foods. Partly as a consequence of this loss of supermarkets, diet-related diseases have become prevalent. Our current policies to improve this health issue address only objective measures of access, with little input from community residents, and they are having limited results. In response, I have reconceptualized access as a construct with five dimensions: acceptability, accessibility, accommodation, affordability, and availability. This new expanded view supports both objective and perceived aspects of access and values the knowledge of residents through community-based participatory research, thereby providing a more complete understanding of access.