International Definition Research Articles

Do palliative care research priorities match those for its care? A journals content analysis 2021–22

Background Most international definitions of palliative care in the worlds of policy and practice emphasize the ‘holistic’ dimensions of end-of-life experience and its care. Aim To discover whether the definitions of palliative care are reflected in the field’s research priorities. Design and Setting A content analysis of two research journals, one British and the other American, is described to provide a simple indicative answer to this question. The abstracts of 609 research papers drawn from these two journals between the years 2021–22 were examined thematically. Results The categories of physical alone, physical, and psychological, and psychological alone, when combined accounted for 69% of all research reports. The broader social aspects of care, outside of communication and advance care planning, were largely unaddressed. The social domain accounted for 29%, but 78% of this figure was about advance care planning and communication. Likewise, the role of spirituality, present in most of the definitions, was under researched and under reported. Even within this context, the results were disappointing. Spiritual care accounted for only 2% of reports. Conclusion Examination of research publications of two major palliative care research journals showed a significant overemphasis on symptom management and health service delivery assessments. This significant dearth of investigation in the major areas of social and spiritual domains is a call to action for researchers, grant making bodies, researchers, ethics committees, and journal editorial teams.

O41 - Developing an evidence-based international definition of woman-centred care to inform practice

O41 - Developing an evidence-based international definition of woman-centred care to inform practice

Implementation of AI in international law and administrative law (in the context of human rights protection)

The purpose of the article is to analyze the possibility of introducing artificial intelligence into the rules of international and administrative law in the context of ensuring human rights, in particular through the activities of public administration bodies and the consideration of administrative cases. Research results. The article outlines the problems of the international legal definition of artificial intelligence using the examples of resolutions of the United Nations, the Council of Europe, the Code of Ethics of transnational corporations and legal instruments of individual States. Practical meaning. The authors analyze the state of international legal regulation and the possibility of using AI, provided that human rights are respected at the national level, including in the activities of bodies authorized to consider cases of administrative offenses, implementation of electronic justice in administrative and procedural court practice. Value/originality. Scientific proposals regarding the relevance of the international legal definition of the concept of artificial intelligence, the problems of observing human rights in its application both at the international and national level, in particular, the use of its opportunities in justice for the purpose of more effective consideration of cases, and at the same time reducing the burden on judicial systems are formulated, ability to conduct legal proceedings using AI is analyzed.

International standardization and optimization group for intersphincteric resection (ISOG-ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome.

Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future. A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol. Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements. This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.

Predicting sepsis using deep learning across international sites: a retrospective development and validation study

When sepsis is detected, organ damage may have progressed to irreversible stages, leading to poor prognosis. The use of machine learning for predicting sepsis early has shown promise, however international validations are missing. This was a retrospective, observational, multi-centre cohort study. We developed and externally validated a deep learning system for the prediction of sepsis in the intensive care unit (ICU). Our analysis represents the first international, multi-centre in-ICU cohort study for sepsis prediction using deep learning to our knowledge. Our dataset contains 136,478 unique ICU admissions, representing a refined and harmonised subset of four large ICU databases comprising data collected from ICUs in the US, the Netherlands, and Switzerland between 2001 and 2016. Using the international consensus definition Sepsis-3, we derived hourly-resolved sepsis annotations, amounting to 25,694 (18.8%) patient stays with sepsis. We compared our approach to clinical baselines as well as machine learning baselines and performed an extensive internal and external statistical validation within and across databases, reporting area under the receiver-operating-characteristic curve (AUC). Averaged over sites, our model was able to predict sepsis with an AUC of 0.846 (95% confidence interval [CI], 0.841-0.852) on a held-out validation cohort internal to each site, and an AUC of 0.761 (95% CI, 0.746-0.770) when validating externally across sites. Given access to a small fine-tuning set (10% per site), the transfer to target sites was improved to an AUC of 0.807 (95% CI, 0.801-0.813). Our model raised 1.4 false alerts per true alert and detected 80% of the septic patients 3.7h (95% CI, 3.0-4.3) prior to the onset of sepsis, opening a vital window for intervention. By monitoring clinical and laboratory measurements in a retrospective simulation of a real-time prediction scenario, a deep learning system for the detection of sepsis generalised to previously unseen ICU cohorts, internationally. This study was funded by the Personalized Health and Related Technologies (PHRT) strategic focus area of the ETH domain.

An international consensus definition for contextual factors: findings from a nominal group technique.

Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers. The study used a multi-stage virtual Nominal Group Technique (vNGT) to create and rank contextual factor definitions. Nominal group techniques are a form of consensus-based research, and are beneficial for identifying problems, exploring solutions and establishing priorities. International. The initial stages of the vNGT resulted in the creation of 14 independent contextual factor definitions. After a prolonged discussion period, the initial definitions were heavily modified, and 12 final definitions were rank ordered by the vNGT participants from first to last. The 10 international vNGT participants had a variety of clinical backgrounds and research specializations and were all specialists in contextual factors research. A sixth round was used to identify a final consensus, which reflected the complexity of contextual factors and included three primary domains: (1) an overall definition; (2) qualifiers that serve as examples of the key areas of the definition; and (3) how contextual factors may influence clinical outcomes. Our consensus definition of contextual factors seeks to improve the understanding and communication between clinicians and researchers. These are especially important in recognizing their potential role in moderating and/or mediating clinical outcomes.

Freedom of speech in the context of desecrating the Qur’an with an emphasis on international law

Freedom of speech has different scientific, logical and international definitions and it is one of the main foundations of human rights. On the international level, the question of human rights and freedom of speech is mentioned in different documents from which common indicators may be identified such as the unrestricting through restrictions, and unrestrictedness not even in the case of insulting and useless speech as long as it does not cross the allowable boundaries of freedom, etc. However, some limitations are emphasized in international documents when it comes to freedom, such as the explicitness of law in the prohibition of actions by which the rights and freedoms of others are endangered. In discussion of the recent desecration of the sanctity of Muslims in Europe and the repetition of those actions, exactly this question is used as a basis for the non-confrontation with the burning of the Qur’an and the repetition of that action. That happens despite the fact that it is logical that freedom of speech cannot lead to insults and the bringing of harm to others. Excluding the rational, religious and ethical observations in judging the desecration of the sacred, especially of a great religion such as Islam, which can lead to the prompting of hatred, encouragement to violence and discrimination, in international documents every type of action which leads to prompting, discrimination, animosity and violence is forbidden, but on the other hand, the practice of some European countries to forbid the question of burning the Qur’an can become grounds for canonical systems of other countries to proclaim the prohibition of this act. As a result of that, in the canonical sense and in the voluminous form it is proclaimed and accepted that if the application of the laws of freedom of speech function as a threat to the general good and common interests, it is the duty of countries to intervene and to act so that they may limit these foundational rights. With this in mind, the principle of support of “the common good” and “universal ethics” are the interests which may be used to limiting the freedoms of speech and human rights. It cannot be the case, that while expressing worry out of the indefinity of the category of limiting the freedom of speech which bends towards dictatorship and repression, that the definitive category of human consciousness and logical ethic is to be ignored, as well as that the duty of respect towards the convictions of others and the respect of humanity to be disregarded. Key words: human rights, freedom of speech, universal ethics, the burning of the Qur’an, international law and the covenant of human rights.

A model of porcine polymicrobial septic shock

BackgroundSepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality of patients with sepsis is high and largely unchanged throughout the past decades. Animal models have been widely used for the study of sepsis and septic shock, but translation into effective treatment regimes in the clinic have mostly failed. Pigs are considered as suitable research models for human diseases due to their high comparability and similarity to human anatomy, genetics, and the immune system. We here evaluated the previously reported models of septic shock in pigs and established a novel model of polymicrobial sepsis that meets the clinical criteria of septic shock in pigs.Materials and methodsThe literature search was performed using the keywords “pig”, “sepsis” and “septic shock”. For the establishment of septic shock in n = 10 German landrace pigs, mechanical ventilation was initiated, central venous and arterial lines and invasive hemodynamic monitoring via pulse contour cardiac output measurement (PiCCO) established. Peritoneal polymicrobial faecal sepsis was induced by application of 3 g/kg body weight faeces into the abdominal cavity. Septic shock was defined according to the third international consensus definitions (Sepsis-3). Upon shock, pigs underwent the 1-h bundle for the treatment of human sepsis. Cytokine levels were measured by ELISA.ResultsPublished porcine sepsis models exhibited high methodological variability and did not meet the clinical criteria of septic shock. In our model, septic shock developed after an average of 4.8 ± 0.29 h and was associated with a reproducible drop in blood pressure (mean arterial pressure 54 ± 1 mmHg) and significant hyperlactatemia (3.76 ± 0.65 mmol/L). Septic shock was associated with elevated levels of interleukin-6 (IL6) and initial cardiac depression followed by a hyperdynamic phase with significant loss of systemic vascular resistance index after initial resuscitation. In addition, organ dysfunction (acute kidney injury) occurred.ConclusionsWe here established a model of septic shock in pigs that meets the clinical criteria of septic shock utilized in human patients. Our model may thus serve as a reference for clinically relevant sepsis research in pigs.

Novel biomarkers to predict chronic kidney disease and hypertension at 3 and 12 months post-cisplatin.

e22003 Background: Urine kidney injury biomarkers measured during cisplatin therapy may help identify patients at risk for adverse long-term kidney outcomes. In children treated for cancer, we examined associations of urine tubular injury biomarkers collected during two cisplatin cycles, with chronic kidney disease (CKD) and hypertension at 3 and 12 months post-cisplatin. Methods: We analyzed data from the Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) Nephrotoxicity Study: a twelve-center prospective cohort of 159 children receiving cisplatin. Urine tubular injury biomarkers (by ELISA: neutrophil gelatinase-associated lipocalin [NGAL]; kidney injury molecule-1 [KIM-1]; tissue inhibitor of metalloproteinase-2 [TIMP-2]; insulin-like growth factor-binding protein-7 [IGFBP-7]) were measured at three timepoints (pre-infusion; 12-24 hours post-infusion; discharge after cisplatin cycle) during an early cisplatin cycle (EarlyCisP: first or second cycle of therapy) and a later cycle (LateCisP: last or second-to-last cycle). Area under the curve (AUC) for biomarkers to predict CKD (estimated glomerular filtration rate below normal or urine albumin/creatinine above normal for age, per international definition) and hypertension (3 blood pressures; per American Academy of Pediatrics guidelines) at 3 and 12 months post-cisplatin was calculated. AUC change from adding biomarkers to a published clinical prediction model for 3-month outcomes was evaluated (DeLong method). Results: 156 patients were available for analysis (mainly solid tumors). 3-month (median 90 days) outcomes were 52/118 (44%) CKD; 17/125 (14%) hypertension. 12-month (median 335 days) outcomes were 47/118 (40%) CKD; 15/125 (12%) hypertension. AUCs for all biomarkers to predict 3 and 12-month CKD and hypertension were poor to modest (best AUC = 0.70, 95% CI 0.60-0.80 for pre-infusion EarlyCisP TIMP-2*IGFBP-7 to predict 3-month hypertension). Biomarkers did not improve the clinical prediction model for 3-month CKD (AUC change not statistically significant with vs. without biomarkers). Adding pre-infusion EarlyCisP NGAL and TIMP-2*IGFBP-7 to the clinical prediction model for 3-month hypertension led to AUC change from 0.81 (0.72-0.91) to 0.89 (0.83-0.95) (p < 0.05). Conclusions: Tubular injury biomarkers we studied were individually not strong predictors of 3 or 12-month post-cisplatin kidney outcomes. Adding biomarkers to existing clinical prediction models may help predict post-therapy hypertension development or identify higher kidney-risk patients.

Sarcopenia vs body mass index (BMI) as a prognostic biomarker in patients with metastatic clear cell renal cell carcinoma (mCCRCC) in the era of first line immune checkpoint inhibitors (ICIs).

e16515 Background: ICIs are an important systemic treatment option for patients with mCCRCC. Sarcopenia, defined as low muscle mass, is associated with inferior outcomes in mCCRCC. However, there is limited data regarding sarcopenia and overall survival (OS) in patients receiving treatment with ICI-based regimens. Our objective was to evaluate associations between sarcopenia and BMI with OS in patients with mCCRCC receiving first line ICIs. Methods: A retrospective review of patients with mCCRCC receiving first line ICI-based therapy at Fred Hutchinson Cancer Center between 1/2015 to 4/2022 was performed. Patients without CT scans within 75 days of treatment initiation were excluded. Skeletal muscle index (SMI) at the level of L3 was measured using validated techniques. Sarcopenia was classified according to an international definition (SMI < 55 cm2/m2 for men and SMI < 39 cm2/m2 for women). BMI was defined as underweight ( < 19 kg/m2), normal (19-24.99kg/m2), overweight (25-29.99 kg/m2), and obese ( > 30 kg/m2). OS was estimated using the Kaplan-Meier method. Associations with OS were evaluated with Cox proportional hazard model analysis. Results: A total of 96 patients (25% female) with a median age of 62 (Interquartile range, IQR 55-68), met inclusion criteria. Due to missing CT images, 9 (9%) patients were excluded. 10 (11%), 43 (49%), and 22 (25%) were International Metastatic RCC Database Consortium (IMDC) favorable, intermediate, and poor risk respectively (12 unknown). Median follow up was 23 months (IQR 12-35). First-line therapy included ICI monotherapy (N = 15), ipilimumab/nivolumab (N = 49) or ICI/VEGF targeted therapy (N = 23). In total, 43 (49%) patients were sarcopenic. Median OS overall was 42.6 months (IQR 15.9-NR). Two-year OS was 57% in sarcopenic vs 76% in non-sarcopenic patients (Log-Rank p = 0.06). On multivariable analysis adjusted for IMDC risk criteria, age, and gender, SMI (continuous) was independently associated with survival (HR 0.94, 95%CI 0.90-0.99, p = 0.03) while BMI was not significantly associated with OS on univariate or multivariable analyses (p > 0.05). Among the 49 patients receiving ipilimumab/nivolumab combination therapy, sarcopenia was significantly associated with decreased 2-year OS (47% vs. 77%, p = 0.02). Across IMDC risk strata, sarcopenia was significantly associated with decreased 2-year OS in the intermediate risk group only (44% vs. 83%, p = 0.01). Conclusions: Sarcopenia, but not BMI, is independently associated with OS among patients with mCCRCC receiving first line ICI-based regimens. This finding is consistent with the literature suggesting that muscle mass measurement provides an important prognostic biomarker for patients with mCCRCC. SMI could inform treatment selection and adoption of muscle measures when risk-stratifying this population should be considered.

Fully Automated Tumor Bud Assessment in Hematoxylin and Eosin-Stained Whole Slide Images of Colorectal Cancer

Tumor budding (TB), the presence of single cells or small clusters of up to 4 tumor cells at the invasive front of colorectal cancer (CRC), is a proven risk factor for adverse outcomes. International definitions are necessary to reduce interobserver variability. According to the current international guidelines, hotspots at the invasive front should be counted in hematoxylin and eosin (H&E)-stained slides. This is time-consuming and prone to interobserver variability; therefore, there is a need for computer-aided diagnosis solutions. In this study, we report an artificial intelligence-based method for detecting TB in H&E-stained whole slide images. We propose a fully automated pipeline to identify the tumor border, detect tumor buds, characterize them based on the number of tumor cells, and produce a TB density map to identify the TB hotspot. The method outputs the TB count in the hotspot as a computational biomarker. We show that the proposed automated TB detection workflow performs on par with a panel of 5 pathologists at detecting tumor buds and that the hotspot-based TB count is an independent prognosticator in both the univariate and the multivariate analysis, validated on a cohort of n = 981 patients with CRC. Computer-aided detection of tumor buds based on deep learning can perform on par with expert pathologists for the detection and quantification of tumor buds in H&E-stained CRC histopathology slides, strongly facilitating the introduction of budding as an independent prognosticator in clinical routine and clinical trials.

Clinical ground truth in machine learning for early sepsis diagnosis

Clinical ground truth in machine learning for early sepsis diagnosis

Association Between Obesity and Circulating Tumor Cells in Early Breast Cancer Patients

BackgroundObesity and the presence of circulating tumor cells (CTCs) before and/or after chemotherapy are associated with poor outcome in breast cancer (BC) patients. The activation of oncogenic pathways in fatty tissue leads to cell proliferation, suggesting a possible link between obesity and CTCs. Materials and MethodsIn the phase III SUCCESS A trial, 3754 patients with early BC were randomized to 3 cycles of fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel with or without gemcitabine. Data of 1088 patients with CTC assessments (CellSearch-System; Menarini Silicon Biosystems, Italy) and body mass index (BMI) measurements both before and after chemotherapy were available. Patients were classified according to the WHO's international definitions as underweight, normal weight, overweight, or obese, and according to their weight-change during chemotherapy into a weight-loss group (> 5% decrease), stable-weight group (≤ 5% weight-change) or weight-gain group (>5% increase). Associations between CTC positivity and, BMI or weight-change group were analyzed using frequency-table methods. ResultsAt study entry, 47.4% patients were underweight or normal weight, 33.6% were overweight and 18.9% were obese. Before and after chemotherapy, CTCs were detected in 20.1% and 22.6% of patients, respectively. There was no association between CTC positivity and BMI before (P = 0.104) or after (P = 0.051) chemotherapy. Furthermore, there was no association between weight-change group and CTC status before/after chemotherapy (P = 0.332). ConclusionsAccording to our analysis, the risk factors obesity and prevalence of CTCs are not associated and may represent independent prognostic factors.

Utility of apolipoprotein ratio in predicting metabolic risk and microvascular complications in Indian children and young adults with type 1 diabetes mellitus.

To assess the relationship of apolipoproteins with glycemic control and insulin resistance (IR) in Indian children and youth with type-1 diabetes (T1D) and to assess its utility in predicting metabolic risk (MR) and microvascular complications in these subjects. This cross-sectional study included 152 participants aged 6-23 years with T1D. Demographic, anthropometric, clinical, biochemical and body composition data were obtained using standard protocols. IR was calculated using estimated glucose disposal rate (eGDR) and metabolic syndrome (MS) was diagnosed using the international diabetes federation consensus definition 2017. Apolipoprotein ratio in subjects with T1D had negative and positive correlation with eGDR and HbA1c respectively. Positive correlation of Apolipoproten B and apolipoprotein ratio with urinary albumin creatinine ratio is noted. The ratio had area under curve of 0.766 and 0.737 to predict MR and microvascular complications respectively. The ratio cut-off of 0.536 yielded 77.1 % sensitivity and 61 % specificity to predict MR. On adding the apolipoprotein ratio as a predictor to the regression model developed to predict MR, the R2 and accuracy improved. The apolipoprotein ratio had significant correlation with IR, microalbuminuria and glycaemic control. The ratio also predicts risk of development of microvascular complications and maybe used to predict MR in subjects with T1D.

A contextual definition of longitudinal integrated clerkships within the UK and Ireland: A bi-national modified Delphi study

ABSTRACT Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team’s experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants’ qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation.

International Comparison of Ambulance Times Terminology and Definitions: A Benchmarking Study

Introduction:Ambulance times are internationally recognized Key Performance Indicators (KPI) for prehospital care. International benchmarking by comparing ambulance times between countries is a valuable method to help to identify strengths and weaknesses across healthcare systems. However, ambulance times are not standardized across or sometimes even within countries. Thus, this benchmarking study aims to compare terminology and definitions of ambulance times from the ambulance services of a range of countries to facilitate international benchmarking.Method:A 23-point questionnaire was developed and pilot-tested on members of international emergency care organizations. The final questionnaire was administered to domestic and international Ambulance Services, who use the Advanced Medical Priority Dispatch System, asking for the terminology and definitions for times from “call received” to “arrival at hospital”. This included “clock start” and “clock stop” times. We asked for the ambulance terms and related variable names in the computer aided dispatch/reporting system. We engaged with clinical stakeholders and Patient and Public Involvement Contributors throughout the process.Results:We gathered information from 10 international ambulance services, representing nine countries, and three continents. Some services in the United Kingdom have standardized ambulance times terminology and definitions. However, in the majority of cases terminology differed greatly between countries, and at times within countries and between reports. Definitions of ambulance times varied between countries and regions, with some having different clock start and stop times and others not collecting data on the same time periods.Conclusion:The current level of variation in international ambulance times terminology and definitions poses a challenge for international benchmarking and research. International consensus or harmonization of language and definitions would result in more efficient and accurate global comparison. On a smaller scale, defining terms in publications and reports would begin facilitating this process.

Diagnosis of Nocturnal Hypoventilation in Pediatric Neuromuscular Disorders: A Survey of Clinical Practice in Australia and New Zealand

Objectives: Nocturnal hypoventilation is a complication of neuromuscular disorders. There are various recommendations for measuring pCO<sub>2</sub> during polysomnography and numerous national and international definitions of hypoventilation that could contribute to significant variations in clinical practice. We therefore aimed to determine clinical practices implemented by Australasian pediatric sleep physicians.Methods: Pediatric sleep physicians completed an electronic survey for information regarding pCO<sub>2</sub> measurements and definitions of hypoventilation that are followed for children with neuromuscular disorders.Results: It was found that transcutaneous measurement of pCO<sub>2</sub> was performed in all centers, with 25% of the centers simultaneously performing capnography. Twelve definitions of hypoventilation were used, including published definitions from the American Academy of Sleep Medicine (AASM) manual and recommendations of the pediatric Australasian Sleep Association/Australasian Sleep Technologists Association. The most commonly used definition of hypoventilation (9/17, 53%) was the 2012 pediatric AASM definition (pCO<sub>2</sub> >50 mmHg for >25% of the total sleep time). There was a discrepancy between centers and individuals within the same center when defining hypoventilation. Answers stating the use of the Australasian definitions (rise in pCO<sub>2</sub> ≥10 mmHg from wake to sleep, average rise in pCO<sub>2</sub> ≥3 mmHg from non rapid eye movement to rapid eye movement sleep) were more frequent when asked specifically via a checkbox (yes/no) compared to free text.Conclusions: These results confirm the heterogeneity and lack of standardization of clinical practice within Australasia when measuring pCO<sub>2</sub> during polysomnography and defining hypoventilation. The Australasian definitions were not used as frequently as anticipated.

BIM technologies in engineering network design

There are several definitions of BIM available from Wikipedia to the International Organization for Standardization (ISO) that more or less consistently describe BIM as follows: a process or method of managing information about objects and projects to coordinate inputs and outputs using shared digital representations of physical and functional characteristics of any built object, including buildings, bridges, roads, industrial facilities. Despite the common definition, we often observe that BIM has different meanings to different people. There is no single international standard or definition of the activities that must be performed within a project to be considered a BIM project. Very often we come across the idea that BIM is a software, a 3D model or a system. This inconsistency creates confusion and disagreement between government customers and private sector providers, creating barriers to successful implementation. Experience from the EUBIMTG suggests that a clear and specific definition of measures and characteristics, combined with a phased implementation of the strategy in a realistic time frame, has proven to be the most promising approach to the successful transformation of the construction sector. The following "EU Common Performance Level" characteristics describe the activities that must be consistently performed within a project to be considered an EU BIM project. They should be considered as minimum criteria for the procurement and implementation of construction projects consistently throughout Europe. The implementation of BIM design in the process of higher education in Ukraine is just beginning, especially in the area of designing engineering networks. If BIM design courses for future architects are the norm rather than the exception, it is difficult to find suitable specialists, let alone teachers, in the area of designing water supply networks.

Towards a Chinese definition of higher education internationalisation? A systematic review of the Chinese and English literature

ABSTRACT The definitions of internationalisation have been contested and require contextualisation. Despite the long-standing practice of and research on higher education internationalisation in Mainland China, ambiguities regarding the concept persist. This study examines academic discourses on the internationalisation of Chinese higher education. It draws on a systematic literature review of 240 journal articles published in Mandarin Chinese and English. Findings reveal the prevalence of defining internationalisation using Western discourses and attempts to provide Chinese definitions of internationalisation. The review also identifies the coexistence of educational, economic, political, and cultural logic clusters in the discourses on the internationalisation of Chinese higher education. In addition, the article discusses temporality, spatiality, affectivity and relationality in the discourses and their corresponding themes. It concludes with a discussion on the ‘Chinese characteristics’ of higher education internationalisation, and reflections on the common dichotomies and myth in the existing literature.

Standardized reporting of pulmonary transfusion complications: Development of a model reporting form and flowchart.

Pulmonary complications of blood transfusion, including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and transfusion-associated dyspnea, are generally underdiagnosed and under-reported. The international TRALI and TACO definitions have recently been updated. Currently, no standardized pulmonary transfusion reaction reporting form exists and most of the hemovigilance forms have not yet incorporated the updated definitions. We developed a harmonized reporting form, aimed at improved data collection on pulmonary transfusion reactions for hemovigilance and research purposes by developing a standardized model reporting form and flowchart. Using a modified Delphi method among an international, multidisciplinary panel of 24 hemovigilance experts, detailed recommendations were developed for a standardized model reporting form for pulmonary complications of blood transfusion. Two Delphi rounds, including scoring systems, took place and several subsequent meetings were held to discuss issues and obtain consensus. Additionally, a flowchart was developed incorporating recently published redefinitions of pulmonary transfusion reactions. In total, 17 participants completed the first questionnaire (70.8% response rate) and 14 participants completed the second questionnaire (58.3% response rate). According to the results from the questionnaires, the standardized model reporting form was divided into various subcategories: general information, patient history and transfusion characteristics, reaction details, investigations, treatment and supportive care, narrative, and transfused product. In this article, we present the recommendations from a global group of experts in the hemovigilance field. The standardized model reporting form and flowchart provide an initiative that may improve data collected to address pulmonary transfusion reactions.