Formal Criteria Research Articles

Mavacamten in a real-world hypertrophic cardiomyopathy population: how many may be eligible?

Abstract Introduction Mavacamten is a newly approved drug for obstructive hypertrophic cardiomyopathy (oHCM) and is currently being studied in non-obstructive HCM (nHCM). Our goal was to evaluate how often patients with oHCM and nHCM in a real-world cohort would be eligible for the main mavacamten trials: EXPLORER-HCM, VALOR-HCM and MAVERICK-HCM. Methods Single-centre retrospective study enrolling consecutive patients with confirmed HCM, as per the 2023 ESC Guidelines, with at least yearly follow-up in our center, from 2017-2023. Key inclusion criteria from the three trials were considered: NYHA class II-III for all; obstructive forms (defined as peak left ventricle outflow tract [LVOT] gradient ≥50 mmHg at rest, after Valsalva manoeuvre or exercise) for EXPLORER-HCM and VALOR-HCM; left ventricular ejection fraction (LVEF) ≥55% for EXPLORER-HCM and MAVERICK-HCM; LVEF ≥60% and formal criteria for septal reduction therapy for VALOR-HCM, and NT-proBNP ≥300pg/mL for MAVERICK-HCM. Key exclusion criteria (estimated glomerular filtration rate [eGFR] <30mL/kg/1.73m2, QTc using the Fridericia’s formula >500ms, paroxysmal or intermittent atrial fibrillation present on screening electrocardiograph) were also considered. Results Overall, 410 patients were diagnosed with HCM, of whom 361 (88%) were alive at follow-up and included in the analysis: mean age of 63 ± 16 years, 196 (54%) were male, 272 (75%) with septal HCM and 60 (17%) with oHCM. According to the criteria of EXPLORER-HCM, VALOR-HCM and MAVERICK-HCM, 35 (10%), 6 (2%) and 27 (7%) patients would be eligible for enrolment, respectively. In patients with oHCM, 35 (58%) would be eligible for the EXPLORER-HCM trial. In the overall cohort, 65 (18%) would have criteria for at least one of the trials. The main reasons for exclusion were as follows: 191 (53%) NYHA I, 43 (12%) with NYHA IV, 12 (3%) had a LVEF <55%, 8 (2%) had both HCM and infiltrative myocardial disease and/or moderate-to-severe aortic stenosis and 8 (2%) had an eGFR <30mL/kg/1.73m2. In patients with nHCM, 16 (5%) would have been excluded due to NT-proBNP <300pg/mL and 8 (3%) due to paroxysmal atrial fibrillation. Conclusion In a real-word HCM cohort, we found that approximately 1 in every 5 patients would have criteria for either of the mavacamten trials, with more than half of oHCM being potential candidates for the EXPLORER-HCM. The main reasons for non-eligibility were NYHA I and LVEF <55%.

Tremor after solid organ transplantation: Results from the TransplantLines Biobank and Cohort Study.

Tremor is a frequent complaint of solid organ transplant recipients. We report on the largest population investigated with clinical neurophysiological methods. Our aim is to objectively establish the tremor prevalence and syndrome in the largest population of solid organ transplant recipients. Tremor was measured in heart, kidney, liver, and lung recipients, using accelerometers during rest, postural, and weight-loaded conditions. The 95th percentile of healthy kidney donors' tremor amplitude was used as the cutoff to determine the presence of tremor in transplant recipients. Tremor frequency, frequency variability, and effect of loading were used to investigate enhanced physiological tremor as the likely tremor syndrome. Impact on activities of daily life was assessed, and correlations with tacrolimus blood levels were investigated. Tremor was present in 52% of 246 transplant recipients, typically in postural positions. Mean tremor frequency was 6.1 (±2.0) Hz; mean tremor variability was 2.6 (±1.8) Hz. A frequency decrease upon loading was found in 83% of patients with tremor. Sixty-five percent of patients met formal clinical neurophysiological criteria for enhanced physiological tremor. Tremor-related impairment was present in 55% and correlated with tremor amplitude (ρ = 0.23, p ≤ 0.001). In a binominal regression analysis, tacrolimus blood levels were independently associated with tremor prevalence (p = 0.009). More than half of solid organ transplant recipients experience a tremor that best fits the syndrome of enhanced physiological tremor. This is the first objective study on tremor that has established a better understanding of the neurophysiological mechanisms of tremor in a large population of solid organ transplant recipients.

The Impact of Social Media and Socio-Cultural Attitudes toward Body Image on the Risk of Orthorexia among Female Football Players of Different Nationalities.

Orthorexia Nervosa (ON) is an emerging behavioral pattern characterized by an obsessive focus on healthy eating. Despite its prevalence, ON lacks formal diagnostic criteria in major classification systems like the DSM-5 and the ICD-10. This study aims to investigate the impact of socio-cultural attitudes towards body image and the role of social media on the risk of ON among female football players from Poland, Turkey, and India. This study hypothesizes that socio-cultural pressures and media usage significantly influence the risk of developing ON, particularly in cultures more exposed to Western beauty ideals. The study was conducted from May to August 2024, employing the Computer-Assisted Web Interview method. A total of 142 female football players aged 16-36 from Poland, Turkey, and India participated. Data were collected using a structured questionnaire that included demographic information and health metrics, the Socio-Cultural Attitudes Towards Appearance Questionnaire, and the Duesseldorf Orthorexia Scale. Statistical analyses included an ANOVA, the Kruskal-Wallis test, the chi-square test, and Pearson's correlation coefficient. The study found that nearly half of the participants were at risk of or presented with ON, with the highest prevalence being among Indian athletes. Statistically significant relationships were observed between the risk of ON and factors such as age, dietary exclusions, social media usage, and sources of nutritional information. However, no significant correlation was found between socio-cultural attitudes and the risk of ON, suggesting that other factors may play a more critical role. While socio-cultural pressures and media use are contributing factors to the risk of ON, psychological factors and individual behaviors appear to be equally, if not more, significant. This study highlights the importance of targeted educational programs and psychological support for young athletes, with a focus on promoting healthy dietary practices and positive body image perceptions across varying cultural contexts. Additionally, the results suggest the need for further research into the specific psychological and behavioral mechanisms underlying ON.

Modeling serum M-protein response for early detection of biochemical relapse in myeloma patients treated with bortezomib, lenalidomide and dexamethasone.

Multiple myeloma (MM) treatment guidelines recommend waiting for formal progression criteria (FPC) to be met before proceeding to the next line of therapy. As predicting progression may allow early switching to next-line therapy while the disease burden is relatively low, we evaluated the predictive accuracy of a mathematical model to anticipate relapse 180 days before the FPC is met. A subset of 470/1143 patients from the IA16 dataset who were initially treated with VRd (Velcade (bortezomib), Revlimid (lenalidomide), and dexamethasone) in the CoMMpass study (NCT01454297) were randomly split 2:1 into training and testing sets. A model of M-protein dynamics was developed using the training set and used to predict relapse probability in patients in the testing set given their response histories up to 12 or more months of treatment. The predictive accuracy of this model and M-protein "velocity" were assessed via receiver operating characteristics (ROC) analysis. The final model was a two-population tumor growth inhibition model with additive drug effect and transit delay compartments for cell killing. The ROC area under the curve value of relapse prediction 180 days ahead of observed relapse by FPC was 0.828 using at least 360 days of response data, which was superior to the M-protein velocity ROC score of 0.706 under the same conditions. The model can predict future relapse from early M-protein responses and can be used in a future clinical trial to test whether early switching to second-line therapy results in better outcomes in MM.

The Problem of Visual Complexity: Criteria for Analysis and Evaluation

The article analyses the concept of visual complexity, highlighted by different researchers as a significant characteristic of contemporary visual communication and culture. The problem of ambiguity of the concept and its dependence on different objective and subjective factors and perception variables is posed. Formal categories and criteria for assessing visual complexity are defined, its stable patterns in the subject area of corporate identity —logo, are revealed. With the help of the identified categories visual complexity is analyzed through specific formal universal attributes that can be systematized, which makes it possible to answer the question of what makes a logo complex. The concept of complexity of corporate identity is meaningfully revealed from the point of view of designers — its direct developers, who determine the visual-graphic, constructive and plastic character of the brand logo. For the first time in the Russian-speaking scientific space, an empirical study of the position of professional designers regarding the significance of the proposed criteria was conducted. The quantitative survey method allowed objectifying the point of view of the professional audience: the data is characterized by stability in comparison with the data obtained from the general audience. Visual complexity is thus conceptualized and empirically operationalized without a gap between the theory and practice of visual communication. It is concluded that, as an expressive design tool, visual complexity is a positive characteristic in contemporary media communication.

Reliable delineation of Bacillus cytotoxicus from other members of the Bacillus cereus group by MALDI-TOF MS – An extensive validation study

Bacillus cytotoxicus is classified as a thermotolerant member of the Bacillus cereus group, producing the diarrhoea causing cytotoxin K1. This species came into the focus of food microbiologists when the type strain was isolated as the cause of a fatal food-borne outbreak. However, knowledge of the role of B. cytotoxicus as a food-borne microbe and data on its prevalence in food is still limited today. One reason for this is the lack of an easy to perform method of identification at the species level other than PCR, due to the highly similar phenotype of many B. cereus group representatives. Matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) is widely used for the identification of microorganism species. This study describes the formal validation of a MALDI-TOF MS system for a reliable differentiation between B. cytotoxicus and other members of the B. cereus group. An extensive number of well-supported individual spectra from B. cytotoxicus, several other species of the B. cereus group, and 652 other microorganism species in a taxonomically wide range served as data sets. These were used to perform the validation for two database compilations: the commercial MALDI-Biotyper version K, and an extended compilation, including reference spectra from an open collection of spectra created by several users. Using both database combinations, the obtained values fulfil the formal criteria for the targeted identification of B. cytotoxicus in accordance with a national guideline for the validation of MALDI-TOF MS parameters in food analysis, with significant improvements due to the expanded database. By using 183 single spectra from 170 isolates, created in eleven different laboratories, the number of samples significantly exceeded the sample sizes for validation currently specified for ISO 16140–4:2020 for the validation of identification methods in food microbiology by single laboratories. Therefore, the method is suitable for routine application in an accredited laboratory context.

Physicians' knowledge, attitudes, and practices regarding fibromyalgia: A systematic review and meta-analysis of cross-sectional studies.

The diagnosis, etiology, and optimal management of fibromyalgia remains contentious. This uncertainty may result in variability in clinical management. We conducted a systematic review and meta-analysis of cross-sectional studies examining physicians' knowledge, attitudes, and practices regarding fibromyalgia. We searched MEDLINE, Embase, and PubMed from inception to February 2023 for cross-sectional surveys evaluating physicians' attitudes toward, and management of, fibromyalgia. Pairs of independent reviewers conducted article screening, data extraction, and risk of bias assessment in duplicate. We used random-effects meta-analysis to pool proportions for items reported by more than one study and the Grading of Recommendations Assessment, Development, and Evaluation approach to summarize the certainty of evidence. Of 864 citations, 21 studies (8904 participants) were eligible for review. Most physicians endorsed fibromyalgia as a distinct clinical entity (84%; 95% confidence interval [CI], 74-92), and half (51%; 95% CI, 40-62) considered fibromyalgia a psychosocial condition. Knowledge of formal diagnostic criteria for fibromyalgia was more likely among rheumatologists (69%, 95% CI, 45-89) versus general practitioners (38%, 95% CI, 24-54) (P = .04). Symptom relief was endorsed as the primary management goal by most physicians (73%, 95% CI, 52-90). Exercise, physiotherapy, antidepressants, nonsteroidal anti-inflammatory drugs, and non-opioid analgesics were most endorsed for management of fibromyalgia, but with wide variability between surveys. Opioids and most complementary and alternative interventions (e.g., homeopathy, chiropractic, and massage) received limited endorsement. There is moderate certainty evidence to suggest that physicians are divided regarding whether fibromyalgia is a biomedical or psychosocial disorder. Physicians typically prioritize symptom relief as the primary goal of management, and often endorse management with exercise, non-opioid analgesics, nonsteroidal anti-inflammatory drugs, antidepressants, and physiotherapy (moderate to high certainty evidence); however, important practice variation exists.

Daniel 9.24-27: Poetry, “Elevated Prose,” or Something Else?

Daniel 9.24-27 is addressed as a case study for testing a widely accepted list of formal criteria for diagnosing where a passage gravitates toward within the prose/poetry continuum. A close reading of the passage reveals a dense condensation of lineated discourse markers corroborated by linguistic opposition with its immediate context. Taking Berlin’s “perceptibility” principles into account (proximity, similarity, quantity, expectation), such a convergence of poetic features favors a lineated discourse reading over its alternative, “elevated prose.” Bible translators would have sound exegetical grounds for printing or performing Dan 9.24-27 in other creative ways for promoting the perception and appreciation of this highlighted line-crafted revelatory discourse.

Can Lesions in the Right Basal Ganglia Cause Aphasia? Crossed Aphasia in a Right-Handed Patient.

Aphasia is a common neurocognitive disorder caused by impaired speech and language, with stroke being the most frequent cause. The neuroanatomical mechanism underlying this condition is not yet fully understood. This case describes a 74-year-old Caucasian woman admitted with a clinical picture of right total anterior circulation infarct (TACI) and aphasia, scoring 17 on the National Institutes of Health Stroke Scale. Neuroimaging showed a large cortico-subcortical frontotemporoparietal and insular infarct involving the basal ganglia of the right hemisphere and bilateral focal atherosclerotic stenosis on the M1 segment of the middle cerebral artery. There was no left hemispheric lesion or abnormal electric activity on the electroencephalogram. A formal evaluation was compatible with transcortical motor aphasia. The aetiological study revealed atrial fibrillation, and the case was admitted as an ischaemic stroke of undetermined aetiology with two possible causes - intracranial atherosclerotic stenosis or atrial fibrillation. Our patient fulfilled all the formal criteria for crossed aphasia in dextral (CAD): aphasia, a lesion in the right hemisphere coupled with the structural integrity of the left hemisphere, an established preference for right-hand use without a familial history of left-handedness individuals, and an absence of brain damage in childhood. Our patient's case adds to the evidence that deep structures - alone or in combination with cortical structures - are primarily affected in CAD. The diagnostic criteria for crossed aphasia in dextral (CAD) are derived from clinical case studies and include aphasia, a lesion in the right hemisphere, a strong preference for using the right hand, the structural integrity of the left hemisphere and no history of brain damage during childhood.The right lentiform nucleus was found to be the most frequent anatomical substrate involved in CAD patients, consistent with our case description.Our patient experienced transcortical motor aphasia due to a stroke in the right hemisphere, adding to the evidence that in CAD patients, deep structures are primarily affected. In contrast, in left hemispheric lesions, cortical structures seem to be the main culprits.

한국판 지속적 비탄 척도 개정판(K-PG13-R)의 타당화 연구

Objectives The purpose of this study was to adapt and validate the revised version of the Prolonged Grief Scale (PG-13-R), developed in accordance with the diagnostic criteria for Prolonged Grief Disorder inserted in DSM-5-TR, into Korean. The study aimed to confirm the factor structure, validity, and reliability of the scale. Methods Through translation and back-translation processes, the Korean version of the Prolonged Grief Scale (K-PG13-R) was constructed. The study participants were adults aged 18 and above who had experienced bereavement, with a bereavement period ranging from 1 to 5 years. Exploratory factor analysis, reliability, and validity testing were conducted with a sample of 266 bereaved individuals, and confirmatory factor analysis was performed with a separate sample of 402 bereaved individuals. Results Through exploratory factor analysis, it was confirmed that the scale consists of a single factor. This is consistent with findings from the development of the PG-13-R scale using samples from the United States, the Netherlands, and the United Kingdom. As a result of conducting confirmatory factor analysis using a different sample, it was verified that the single-factor structure model extracted through exploratory factor analysis was appropriate. Additionally, the scale demonstrated high internal consistency, as well as high convergent and concurrent validity, confirming that its reliability and validity are at acceptable levels. Conclusions This study holds significance in adapting and validating the PG-13-R revised in accordance with the formal diagnostic criteria for Prolonged Grief Disorder in DSM-5-TR into Korean. It is anticipated that this scale will contribute to evaluating and providing timely treatment for bereaved individuals in need of therapy.

Streamlined two-step fragment analysis PCR and exome sequencing of RFC1 for diagnostic testing of suspected CANVAS patients.

Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) is caused by biallelic pathogenic expansions, or compound heterozygosity with other pathogenic variants in the RFC1 gene. CANVAS is estimated to be underdiagnosed, both because of the lack of formal diagnostic criteria and molecular challenges that translate to lesser access and high cost of routine testing. Our aim was to address the need for making CANVAS genetic testing routine, by designing a streamlined two-step PCR consisting of a short-allele screening PCR and a confirmatory PCR with fragment capillary electrophoresis detection. Exome sequencing of RFC1 was additionally foreseen to resolve potential compound heterozygosity cases. Specificity of our approach was evaluated using ataxia patients with known non-CANVAS diagnoses, and optimized using Southern blot confirmed CANVAS patients. We evaluated our approach by testing patients consecutively referred for clinically suspected CANVAS using first the two-step PCR, followed by exome sequencing. Our approach was able to accurately identify negative and confirm positive cases in prospectively collected suspected CANVAS patients presenting with at least three typical clinical signs. The proposed testing approach provides an alternative method able to clearly distinguish between CANVAS negative and positive cases and can be easily incorporated into the genetic diagnostic laboratory workflow.

Bidirectional Relationships between Eating Disorders and Type 1 and 2 Diabetes: A Scoping Review

Eating disorders (ED) represent complex conditions with multifactorial etiopathogenesis. Recent scientific findings suggest that diabetes, a chronic disease profoundly influencing eating habits, could significantly contribute to the risk of developing ED. Both type 1 diabetes (T1DM) and type 2 diabetes (T2DM) patients are identified as susceptible to developing binge eating disorder (BED) and other dysfunctional eating behaviors, such as diabulimia, a condition not yet officially recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Diabulimia is characterized by a deliberate choice to omit or limit necessary insulin doses, with the aim of losing weight or limiting weight gain. This scoping review aims to consolidate the latest evidence on the bidirectional relationship between ED and diabetes, as well as their impact on patients’ quality of life. The findings from various studies reveal varied prevalence estimates, as diabetic patients often do not meet the formal diagnostic criteria for ED. Nonetheless, having diabetes appears to increase the risk of developing dysfunctional eating patterns. Simultaneously, the presence of an ED may heighten the risk of developing T2DM. Given this bidirectional relationship between ED and diabetes, this evidence underscores the importance for healthcare professionals, particularly those in diabetes care, to implement screening programs aimed at preventing and/or treating ED. Such initiatives could significantly improve patient outcome and quality of life.

Failure envelope prediction of 2D SiCf/SiC composites based on XGBoost model

In this paper, a multiple failure mechanisms-based progressive damage model is developed to capture the mechanical response and defect-induced nonlinear behavior of 2D SiCf/SiC composites. This model is then adopted to simulate the stress–strain response of a representative volume element model under uniaxial loading, showing excellent agreement with experimental results. The effects of the volume fraction of SiC fibers, as well as those of the porosity and microcrack density of SiC matrix, on the deformation and damage behaviors of SiCf/SiC composites are predicted. Based on this, the failure envelopes related to micro-mesoscopic characteristics under combined loadings are generated as the database for the eXtreme Gradient Boosting (XGBoost) model training. Finally, a data-driven failure model is established for 2D SiCf/SiC composites, whose prediction is compared with the formal failure criteria. The results demonstrate that the data-driven 2D SiCf/SiC composite failure model is reliable in constructing the failure criteria related to micro-mesoscopic features.

A note on negation inconsistent variants of FDE-negation

H. Omori and H. Wansing introduced in a recent paper possible alternatives for the negation of the logic of first-degree entailment. One of their observations with regard to these alternative negations is that some of them turn out to induce negation inconsistency, meaning that some contradictions become provable (under an arbitrary premise) when used in place of the original negation. Omori and Wansing also considered a non-deterministic generalisation of such operators, but it was left open whether the generalised negation similarly induces negation inconsistency. In this paper, we provide an answer to this question in the positive, and moreover look into further generalisation and characterisation of non-deterministic operators which satisfy the formal criteria of negation inconsistency and its pair notion of negation incompleteness in the setting of Omori and Wansing.

Параметрирование содержания коммуникации в бизнес-дискурсе (на материале русского и английского языков)

The aim of the study is to identify the possibility of parameterization of data and the means of parameterization of the multilevel system of business discourse, based on its inherent models of communication, distributive analysis, contextual translations, stereotypes and realities, units of categorical and axiological semantics, the frame structure, and discourse constraints. The article reviews the representation of parameters in terms of the content of business discourse in a comparative-contrastive aspect. The scientific novelty of the research is that for the first time, based on the material of the Russian and English languages, it presents a comprehensive structure of business discourse, describes some of its components, and practically creates an algorithm for working with text or information, which allows, according to formal criteria, provided that the parameters are met, to classify the text as business discourse. In the future, it may be possible to create special software that will be able, in addition to analytics for semantics, sentiment, and content, to process texts, including spoken texts, for compliance with a certain type of discourse. Such algorithms in the form of a set of rules, tasks, and parameters can contribute to the automation of business processes, in particular within the framework of business discourse, generate scenarios for the interaction of actors in it, and search for the most favorable course of discourse for intentional purposes. As a result of the study, a multilevel structure of business discourse was recorded, due to its frame nature; the most important parameters of the discourse space were classified. It has been established that under the influence of changing geopolitical conditions, there is a conscious emotional and evaluative rethinking of business processes and phenomena, which causes changes in the speech activity of communicators in the fields of discourse. It has been proved that discourse as a process of linguistic activity is a system and, like any system, can be modeled and parameterized.

Delphi Consensus on Diagnostic Criteria for LUMBAR Syndrome

To develop consensus on diagnostic criteria for LUMBAR syndrome, the association of segmental infantile hemangiomas that affect the Lower body with Urogenital anomalies, Ulceration, spinal cord Malformations, Bony defects, Anorectal malformations, Arterial anomalies and/or Renal anomalies. These diagnostic criteria were developed by an expert multidisciplinary and multi-institutional team based on analysis of peer-reviewed data, followed by electronic-Delphi consensus of a panel of 61 international pediatric specialists. After two Delphi rounds, a 92% or higher level of agreement was reached for each Delphi statement. 98% of panelists agreed with the diagnostic criteria, and 100% agreed the criteria would be useful in clinical practice. The diagnosis of LUMBAR requires the presence of a segmental, or patterned, infantile hemangioma of the lumbosacral, sacrococcygeal, or pelvic cutaneous regions plus one additional criterion of the urogenital, spinal, bony, anorectal, arterial, or renal organ systems. These diagnostic criteria will enhance clinical care by improving screening, detection, and overall awareness of this poorly understood neurocutaneous disorder. The criteria can be utilized by a wide variety of pediatric subspecialists. In addition, formal criteria will improve phenotypic uniformity among LUMBAR syndrome cohorts and a patient registry, allowing investigators to assess clinical features, long-term outcomes, and results of genetic sequencing in a standardized manner. Finally, these criteria will serve as a starting point for prospective studies to establish formal screening and management guidelines.

Certain problems of protecting the constitutional rights of the individual when considering complaints by the courts in accordance with Article 125 of the Code of Criminal Procedure of the Russian Federation

Based on the conceptual characteristics of the institute of judicial control in accordance with Article 125 of the CCP of the Russian Federation, separate problems of protecting the constitutional rights of an individual using this means of judicial protection are identified: lack of uniformity in the interpretation of norms on the subject and ambit of judicial control; lack of clear standards of proof when considering complaints by courts in accordance with Article 125 of the CCP of the Russian Federation; lack of regulatory provisions defining formal criteria for the admissibility of submitted complaints, which entails limiting the right of interested persons to judicial protection in cases of arbitrary interpretation of the provisions of the law by the courts. As measures to improve judicial practice, it is proposed to refine the subject, ambit and standards of judicial control by referring to them the issues of validity and proportionality of restrictions on constitutional rights of the individual, as well as assessing the sufficiency of evidence in favor of the introduction of such restrictions; regulatory clarification of the requirements for the content of complaints, as well as the powers of the court to make decisions on refusal to accept formally unacceptable complaints for production.

An Epidemiological Study to Assess the Risk Factors and Symptoms of PCOS

The aim to present this study was to assess the most affected age group of girls from PCOD and to make them aware by our questionnaire in this descriptive study, 200 girls were selected randomly from hostels of MMDU, MULLANA. A questionnaire was formulated to obtain information regarding symptoms, changes, dietary patterns, etc. This data was differentiated, tabulated, and tested. The data collected shows that the majority of the respondents who participated in the survey were on the edge of PCOD. Stein and Leventhal are regarded to have been the first investigators of polycystic ovary syndrome however, in 1721 Vallisneri, an Italian scientist; he described a married, infertile woman with shiny ovaries with a white surface, and the size of pigeon eggs. It was not until early 1990 at a national institute of Health (NIH) sponsored conference on PCOD that formal diagnostic criteria were proposed and afterward largely utilized. Many scientists tried to explain the pathophysiology of PCOS and many studies were made. It is now accepted that it is multifactorial, partly genetic, however, a number of candidate genes have been postulated. Insulin resistance has been noted consistently among many women with PCOS, especially in those with Hyperandrogenism, but it is not included in any of the diagnostic criteria. Now there is strong evidence that cardiovascular diseases risk factors and disturbances in carbohydrate metabolism are all increased in patients with PCOS compared to healthy populations. The criteria was established by a group of experts during a conference in ROTTERDAM held in 2003 are obligatory. The subsequent ROTTERDAM CRITERIA incorporated the size and morphology as determined by an ultrasound of the ovary into the diagnostic criteria. The Center for Disease Control and Prevention, obesity among children in the U.S. has tripled since 1980 due to various factors like bad eating habits, and lack of physical exercise, and many more children are getting more and more obese. Many researchers have found that PCOD findings are increasing with time. Finding insulin resistance in obese adolescents gave a different diagnosis of PCOD. Upon further clinical testing, many other symptoms are found like Hirsutism, acne, and menstrual abnormalities. Emans (2005) described PCOS as a diagnosis related to the diagnosis of insulin resistance, not being overweight. For insulin resistance, females don't need to be overweight, they will have insulin resistance even a normal weight female adolescents also have insulin resistance.

The Impact of the European Union on the Endorsement of the Justice Reform in Albania

European integration has been the primary goal of Albanian foreign policy since the collapse of the communist regime, regardless of the ruling political party. The political elite and the Albanian people embrace and support the integration process. Also, the European Union has grown as a transformative power in Albania, fostering democracy, influencing structural reforms, and impacting the rule of law through the promise of future accession. However, the enlargement process has been slow due to internal and external factors. The article analyzes the EU as a transformative power and the use of Conditionality in Albania as an essential diffusion channel of the EU's values and norms, using the adoption of justice reform as a key study. The article's objective is to examine how the EU perspective membership has influenced the endorsement of justice reform in Albania. The paper argues that the EU approach has succeeded in fostering compliance with formal accession criteria but has yet to implement the justice reform due to internal factors and a not linear enlargement perspective. Progress Reports, literature, surveys, and media articles will be analyzed to fulfill the paper's objective. Received: 10 February 2024 / Accepted: 20 April 2024 / Published: 5 May 2024

Formal Housing Livability Criteria in the Peri-Urban Area of Taman District, Sidoarjo Regency

Livability is an environmental system that contributes to physical, social, and mental well-being and is related to the satisfaction of living in a specific location. Taman District in Sidoarjo Regency, as one of the peri-urban areas near Surabaya, has residential areas that are experiencing positive growth, including 22 formal housing developments built by developers. The residents of these formal housing developments in the Taman District face several issues that affect their quality of life, including river pollution from industrial waste, road surface damages, poor water quality, and power outages. While there have been many institutions and studies discussing livability, specific research on livability in formal housing within peri-urban areas is still limited. Given this situation, there is a research gap in the field of livability assessment within the context of formal housing in peri-urban areas. Therefore, this research aims to formulate criteria that influence the livability of formal housing in the Taman District, Sidoarjo Regency. The research method used is the Delphi analysis technique conducted through three rounds of interviews with experts in housing and development field. By using this method, experts are able to provide considerations related to criteria that affect livability based on their knowledges and experiences. The whole analysis process resulted in the identification of 28 criteria, which are divided into five indicators: physical environments, economics, socials, facilities, and utilities. This research is important to help the government and developers in addressing livability issues in the research area.