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I offer a modified definition of sport. Some have claimed that it is impossible to define sport. I believe it is possible to give a definition, understood as articulating intuitive views about what correct usage of the word is. Through an examination of competitive cooking and Esports, I argue that a common definition of sport as a game of physical skill needs to be modified to account for why these should not be considered sports. Although cooking involves physical skill, what is judged in a cooking competition is a product, not physical skill itself. Esports do involve physical skill, but I claim that the common use of sport requires gross motor activity that uses most of the body, whereas the popular Esports only require hand and arm movement. My modified definition is that sports are games of gross motor skill which do not produce a product distinct from the skill itself. I conclude with consideration of some borderline cases. [ABSTRACT FROM AUTHOR]

Ensuring quality in healthcare calls for a coordinated, systematic, congruous, and sustained approach. Nevertheless, it demands defining what the quality of healthcare means in the local context. Presently, the Malaysian healthcare system utilizes various definitions of quality of healthcare across the different initiatives and levels of healthcare, which can lead to fragmented or ineffective quality improvement. The study aims to describe the process undertaken in developing an explicit definition of the quality of healthcare tailored to the Malaysian context, which is currently lacking. A pluralistic method was used to explore the different perspectives. Three distinct approaches were used to understand how quality is defined among the different stakeholder groups: (i) interactive policy-makers engagement sessions, (ii) a review of local quality-related documents, and (iii) an online survey engaging the public. The domains depicting quality of healthcare that emerged through these three approaches were mapped against a framework and synthesized to form the local definition of quality. A national quality-related technical working group convened on several sessions to achieve consensus and finalize the definition of quality of healthcare. Quality healthcare in Malaysia is defined as providing high-quality healthcare that is safe, timely, effective, equitable, efficient, people-centred, and accessible [STEEEPA] which is innovative and responsive to the needs of the people, and is delivered as a team, in a caring and professional manner in order to improve health outcomes and client experience. The consensus-driven local definition of healthcare quality will guide policies and ensure standardization in measuring quality, thereby steering efforts to improve the quality of healthcare services delivered in Malaysia.

Concern has been raised about the potential greenwashing/co-optation of regenerative agriculture (RA) due to a lack of consensus on its definition. While the academic literature has cataloged various approaches to defining RA, each definitional approach carries with it a relative concern for its likelihood for co-optation and the potential transformative power it can have within the sector. As the industrial agrifoods sector is taking interest in the field, lessons from the organic movement are worth highlighting. The corporate system has easily integrated the foundational pillar of growing food without chemicals, but left behind the pillars of alternative food distribution, and a focus on whole foods and unprocessed ingredients. Corporate interest in RA could be a major driver for scaled adaptation, yet it may lose its focus on the regeneration of agriculture resources, ecosystems functions, and the social systems required to reproduce the next generation of farmers. The greatest challenge is that the fundamental concern is a philosophical one, which entails a shift in how humans perceive the natural world and their role in it. As RA scales, will it hold to its values and remain obscure, or could its values merge with the predominant industrial system to have significance and affect real change in agriculture? [ABSTRACT FROM AUTHOR]

Sepsis, characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection, remains a significant challenge in clinical practice. Despite advancements in understanding host-bacterial interactions, molecular responses, and therapeutic approaches, the mortality rate associated with sepsis has consistently ranged between 10 and 16%. This elevated mortality highlights critical gaps in our comprehension of sepsis etiology. Traditionally linked to bacterial and fungal pathogens, recent outbreaks of acute viral infections, including Middle East respiratory syndrome coronavirus (MERS-CoV), influenza virus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among other regional epidemics, have underscored the role of viral pathogenesis in sepsis, particularly when critically ill patients exhibit classic symptoms indicative of sepsis. However, many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels. Moreover, these viruses not only activate conventional pattern recognition receptors (PRRs) and retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs) but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate (GMP-AMP) synthase (cGAS)-stimulator of interferon genes (STING) signaling and interferon response mechanisms. Such activations lead to cellular stress, metabolic disturbances, and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations. This complexity poses substantial challenges for the clinical management of affected cases. In this review, we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology, epidemiology, and pathophysiology, molecular mechanisms involved therein as well as their impact on immune-mediated organ damage. Additionally, we discuss clinical considerations related to both existing therapies and advanced treatment interventions, aiming to enhance the comprehensive understanding surrounding viral sepsis. [ABSTRACT FROM AUTHOR]

AbstractSmart homes have increasingly become subjects of frequent discussion in consumer and academic communities. Despite the decades-long advancement of smart homes, there is not a clear and consistent definition for a smart home that encompasses the diversity of research and development taking place in the field. The present work aims to provide a systematic evidence-based synthesis of ostensive and formal definitions over the past two decades. In addition, we investigate how these definitions have changed over time and whether these definitions differ based on academic discipline. There were 355 definitions analyzed across 333 articles. Most of these definitions were original and published by engineering, computer science, and/or mathematics researchers. The greatest changes in definitions over time are related to the types of popular smart home technologies present during the decade. Specifically, IoT home devices and sensors showed a considerable increase in mentions beginning in 2010. We conclude the publication by proposing a new roadmap for conceptualizing and defining smart homes. [ABSTRACT FROM AUTHOR]

BackgroundObjectivesDesignParticipantsResultsConclusionsManual therapy is routinely used in the management of upper back pain (UBP), a disabling condition. However, the approach to diagnosis and treatment techniques used by manipulative physiotherapists and osteopaths is largely unknown.To explore knowledge about UBP, including diagnosis and treatment, by New Zealand (NZ) osteopaths and manipulative physiotherapists and to investigate differences (if any) in the self-reported approaches to diagnosis and management of UBP between the professions.A cross-sectional survey administered through an online platform (Qualtrics) between September 2023 and January 2024.One hundred and ten NZ osteopaths and manipulative physiotherapists completed the survey.Forty-eight percent (n = 53) of respondents identified their profession as physiotherapists and 52% (n = 57) as osteopaths. Over three-quarters of respondents (77%) ‘strongly agreed’ that a multimodal approach is essential for effective UBP management. Osteopaths were significantly more likely to often proffer ‘wear and tear/degeneration’ (p < 0.01) and ‘visceral referred pain’ (p = 0.02) as the cause of a patient’s UBP. In terms of management, osteopaths were significantly more likely to use soft tissue techniques (p < 0.01), spinal manipulations (p < 0.01), rib manipulations (p < 0.01), rib mobilizations (p < 0.01), and visceral techniques (p < 0.01), compared to physiotherapists.The survey highlights a strong consensus among respondents that a multimodal approach is essential for effective UBP management. The survey also identified profession-specific approaches to the diagnosis and management of UBP. Future research using qualitative methods is required to further explore these profession-specific differences and explore outcomes of care. [ABSTRACT FROM AUTHOR]

Introduction: Cancer remains a leading cause of death globally, with patients frequently experiencing malnutrition due to both the disease and its treatment, which negatively affects their quality of life and treatment outcomes. Oral nutritional supplements (ONS) provide a noninvasive solution to improve nutritional status, but poor patient adherence limits their effectiveness. Studies on ONS adherence vary in their definitions and assessment tools, creating inconsistencies. A scoping review is essential to synthesize these studies and establish a foundation for future research and clinical practice. Method: We systematically searched six databases, including Web of Science, PubMed, and Scopus, up to August 2024. Our criteria focused on oncology patients, ONS interventions, and outcomes related to adherence definitions, assessment methods, and adherence rates. Results: 37 studies from 2005 to 2024 met the inclusion criteria. Definitions of ONS adherence and assessment methods vary widely, with the most common definition being the ratio of actual intake to the recommended amount. The assessment tools included self-reported ONS diaries, and MMAS scores, among others. Adherence rates also vary significantly, with some studies reporting a decline in adherence over time. Conclusion: The lack of standardized definitions and assessment methods for ONS adherence across studies hinders comparability. Future research should focus on developing standardized, comprehensive adherence assessment tools that incorporate both quantitative and qualitative data. This would allow for a better understanding of adherence factors and enable more targeted interventions to improve long-term adherence in cancer patients. [ABSTRACT FROM AUTHOR]

Reforms in the field of taxation and tax legislation are permanent in Ukraine. Since the restoration of the independence of our state, this important social process and its legal regulation have been focused on by both the society and the state. At the same time, the mentioned transformative activities have been accompanied with numerous problems, not least of which is related to the procedural regulation of tax relations. One of the key factors negatively affecting the general state of rulemaking and law enforcement in the field of taxation is the lack of a legal definition of such a system-forming financial and legal category as a tax procedure. The outlined gap provokes scientists to make debatable decisions and increases the level of conflictedness of sub-sectoral regulation. Therefore, working out and consolidating the definition of tax procedure in the current legislation will allow to minimize the mentioned defects and will make a positive contribution to the modernization of t axation. Critical scientific analysis of the existing doctrinal options for defining the legal (juridical) procedure and tax procedure has been carried out and the current state of regulatory and legal support of the specified categories has been revealed in the paper. It has been pointed out that the existence of several approaches to the scientific definition of the tax procedure, the difference in views on its essence and features, the scientists' proposals regarding possible options for the legislative definition of the analyzed category also differ significantly. Distinct from the two existing main scientific approaches (modelprogram and activity-based), an alternative (synthesized) approach to a meaningful understanding of the tax procedure and terms derived from it has been suggested. The author's vision of the system of tax procedures as a system of procedures for fulfilling tax obligations has been argued, the place of the procedure for paying taxes and fees as their component have been indicated. To arrive at the correct definition of the categories of 'tax procedure', 'procedure for fulfilling the tax obligation', and 'procedure for paying taxes and fees', we have recommended the effective steps. The amendments and supplements to both the Basic Law of our state and the Tax Code of Ukraine have been substantiated. The arguments for appropriateness of adopting the Tax Procedural Code of Ukraine in the future have been advanced. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were (1) to systematically review the currently used definitions of incidental 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography findings (IPFs) in the literature and (2) to propose an IPF definition. Methods: A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was guided by the question "How is IPF defined?" and was performed in MEDLINE, Embase, and the Cochrane Library. The retrieved studies were reviewed and analyzed. The definitions of IPFs in the included studies were compiled into two sets of categories based on the description of FDG uptake and the specification of clinical factors in defining IPFs. Results: The systematic literature search identified 4852 publications accessible for title–abstract screening, which yielded 395 studies for full-text assessment. Sixty-five studies met the eligibility criteria and were included. Sixty-two percent mentioned "FDG uptake" in their definition. In 40% of the definitions, "Focal FDG uptake" was specified, while "FDG uptake in the surrounding tissue" was included in 15%. Fifty-seven percent stated that IPFs were "Unrelated to PET/CT indication". Thirty-four percent specified IPFs as "Present in other organ than PET/CT indication", whereas 20% included "No known disease related to IPF". Seventeen percent of the definitions comprised a "New finding", while 15% and 11% encompassed a "Clinical asymptomatic patient" and "Not a metastasis", respectively. Finally, 5% of the definitions included "Potential clinical significance". Conclusions: No generally accepted definition of IPFs currently exists. We propose an IPF definition based on explicit FDG uptake and clinical patient-related factors. [ABSTRACT FROM AUTHOR]

While mental disorders have been broadly researched in people with intellectual disabilities (ID), comparatively less attention has been given to the conceptualisation of good mental health for this population. To capture existing concepts, definitions and measurement approaches of good mental health a systematic literature review was conducted following PRISMA guidelines. The search was carried out in eleven databases, using various synonyms of (i) intellectual disability, (ii) mental health, (iii) wellbeing, (iv) definition, and (v) assessment. A total of 2,046 datasets were identified, of which 37 met the inclusion criteria and were analysed using reflexive thematic analysis and content analysis. Results show four main themes: (1) environment, (2) absence of mental illness, (3) physical health, and (4) psychosocial functioning. The fourth was the most dominant theme and was further divided into five sub-themes: (1) emotionality, (2) interpersonal relations, (3) realise own potential, (4) personal resources, and (5) overall appraisal of life. Our findings reveal different conceptualisations of wellbeing, which is a vital part of good mental health, but highlight a notable research gap in the actual definition and conceptualisation of good mental health for people with ID. [ABSTRACT FROM AUTHOR]

Materials chemistry is focused on the design, preparation, and understanding of innovative materials. It is an emerging area of research where definitions are not well established. This document defines the area of materials chemistry for the benefit of chemistry communities and the general public worldwide interested in this discipline. This recommendation defines the term "materials chemistry" as the "scientific discipline that designs, synthesizes, and characterizes materials, with particular interest on processing and understanding of useful or potentially useful properties displayed by the materials designed and synthesized for specific applications." [ABSTRACT FROM AUTHOR]

The aim of this review is to summarize the current knowledge on the theoretical concept of elder neglect (EN), analyze definitions used by researchers and identify their characteristics with the view to consistent understanding of the phenomenon. The literature search was performed in PubMed, Web of Science and CINAHL using keywords associated with elder neglect. Articles published between 1990 and 2020, including a definition of EN, were taken into consideration. From 7,821 articles found in the initial search, 85 relevant studies were selected for the final evaluation. Most frequently, researchers described neglect as a form of elder abuse or mistreatment, within the framework of the official and internationally used definitions. The review demonstrates inconsistency in identification of EN, but common characteristics are possible to identify in its theoretical concepts. The selected conceptual elements allow to develop a new comprehensive definition of EN. [ABSTRACT FROM AUTHOR]

The third decade of this millennium has seen a growing interest in using the circular economy (CE) concept to achieve the broad goals of sustainable development. Still, like the latter, the former notion has different meanings to different audiences in general and in the construction sector in particular. This Brief Report assesses how the construction sector regards the CE concept, or more precisely, how it defines it. We draw on previous research, applying an existing generic framework to the construction sector, dividing the CE into its main components and subcomponents, and quantifying the extent of their acceptance. The main contribution of this work lies in establishing a benchmark for comparison with other industries and across time within the construction industry. We start with an analysis of the available literature and then focus on how the reviewed works perceive the scope of CE, its deployment systems, enablers, and its relationship with sustainable development. Our results confirm that the sector is embracing the linkage of CE to sustainable development while revealing a lesser concern for CE's social and future dimensions. This Brief Report also shows that the understanding of CE actions in terms of a hierarchy is still limited. However, its three main components (Reduce, Reuse, Recycle) are almost universally espoused, while the Recover component is mentioned by just over half of the reviewed works. [ABSTRACT FROM AUTHOR]

Many different approaches to classify wetlands at regional and global levels have been proposed, but their use of different classification parameters complicates comparisons of the results. Moreover, none of the international approaches cover global wetland variety with respect to size and environmental conditions. A comparison shows that hydrology is the only parameter that can be used for a hierarchic classification on a global scale. In the approach presented herein, differentiation between coastal, inland and anthropogenic wetlands is proposed. The use of higher classification units (systems, subsystems, orders, suborders and classes) is based on hydrological parameters. Wetlands are separated into small, simply structured types treated by all classification systems, and large wetscapes that, due to their complexity, are not. However, wetscapes represent well-defined landscape units, many of which are the focus of international organizations involved in wetland protection. They have to be treated using a holistic approach given the many interactions of their ecological subunits, their role in regional economies, their targeting by legislation and their value to humans. Considering the large gaps in knowledge about wetlands at a global scale, the new approach is a powerful tool for its classification, because it is flexible enough to include additional classification units, as required. Local classification systems can eliminate higher categories, which do not occur in their regions. Classification at lower rankings (functional units, subclasses, macrohabitats) can be introduced using additional classification parameters such as vegetation, soils and water chemistry. Examples from Brazil are provided. [ABSTRACT FROM AUTHOR]

Despite the critical role that both mothers and fathers play in guiding their children, relatively few studies have actively sought the perceptions of how fathers define bullying and what strategies they suggest when assisting their children with the challenges of bullying victimization. For the present study an anonymous online, questionnaire was administered in New Zealand and used to gain insight into 104 parents’ (73 mothers; 31 fathers) definitions of bullying as well as the strategies they would recommend to their children when dealing with four different types of bullying incidents (verbal, relational, physical and cyberbullying). Approximately half of the participants included just one of the three traditional criteria associated with bullying in their definition, with the majority of respondents mentioning ‘an intent to harm’. The most commonly cited strategy was to tell a teacher or school staff member followed by talk to the bully about their behaviour, while retaliation was the least likely strategy to be suggested. Significant gender differences were identified in the verbal bullying scenario, which is typically the most common type of bullying. Mothers were significantly more likely than fathers to suggest that their child ignore the bully and use retaliation. Implications for bullying prevention programmes are discussed. [ABSTRACT FROM AUTHOR]

The study defines copreneurs and presents a four decadal review on copreneurial literature. The purpose is to bring conceptualization and characterization of copreneurs, on surface from its fragmented literature. A structured literature review on copreneurship research published between 1984 and 2023 is conducted. The search is made adopting indexing (Scopus, Clarivate and ABDC), digital libraries including ProQuest and EBSCO, and research articles published in journals by renowned publishers namely Elsevier, Emerald, Inderscience, Sage, Springer, Taylor & Francis and Wiley. Inclusion/exclusion criteria was defined and duplicates were eliminated. Finally, using POWER review model, the existing literature is organized under six themes namely Gender Roles, Spousal Support & Relationship Satisfaction, Work Life Balance, Business Commitment & Motivation, Leadership & Decision Making and Division of Labour & Responsibilities in the Intertwined Worlds. Using Inter- Rater Reliability, five definitions of copreneurs were framed and rated by nine experts from academics and industry. Finally, the definition with highest score and acceptable I-CVI value for simplicity & clarity is proposed. The fragmented literature on copreneurs speaks volume about the need for more impactful research on them. By using the proposed definition of copreneurs, scholars can uniformly identify the copreneurs, with future opportunities for micro-level research on copreneurs. Policy makers can utilise the findings of these research and formulate schemes, policies & programmes for betterment of copreneurs. The study intends to bridge the disciplinary gaps existing for identifying copreneurs and serve as a foundation for information sharing, regarding copreneurs and their entrepreneurial practices. [ABSTRACT FROM AUTHOR]

Objective: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Design: Cross‐sectional survey. Setting: International. Population: Clinicians involved in the management of MCDA twin pregnancies with sFGR. Methods: A structured, self‐administered survey. Main Outcome Measures: Clinical practices and attitudes to diagnostic criteria and management strategies. Results: Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter‐twin EFW discordance of >25% for the diagnosis of sFGR. For early‐onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early‐onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early‐onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early‐onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide. Conclusions: There is significant variation in clinician practices and attitudes towards the management of early‐onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high‐level evidence to guide management. [ABSTRACT FROM AUTHOR]

The concept of acute-on-chronic liver failure （ACLF） has been introduced for nearly 30 years， and with extensive research on its pathogenesis， diagnostic criteria， and treatment strategies， related consensus statements and guidelines have been constantly updated in China and globally； however， there is still a lack of a unified definition of ACLF， and such differences in definition may inevitably hinder the application and implementation of various treatment methods， prognostic scoring systems， and clinical recommendations. In recent years， hepatology experts have continuously proposed methods to unify the definition of ACLF， seeking common ground while reserving differences and drawing on the strengths of various definitions， in order to achieve a more unified definition of ACLF. [ABSTRACT FROM AUTHOR]

Background: Recurrence is a key outcome to evaluate the treatment effect of differentiated thyroid carcinoma (DTC). However, no consistent definition of recurrence is available in current literature or international guidelines. Therefore, the primary aim of this systematic review was to delineate the definitions of recurrence of DTC, categorized by total thyroidectomy with radioactive iodine ablation (RAI), total thyroidectomy without RAI and lobectomy, to assess if there is a generally accepted definition among these categories. Methods: This study adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. In December 2023, a systematic literature search in MEDLINE and EMBASE was performed for studies reporting on the recurrence of DTC, from January 2018 to December 2023. Studies that did not provide a definition were excluded. Primary outcome was the definition of recurrence of DTC. Secondary outcome was whether studies differentiated between recurrence and persistent disease. Two independent investigators screened the titles and abstracts, followed by full-text assessment and data extraction. The study protocol was registered in PROSPERO, CRD42021291753. Results: In total, 1450 studies were identified. Seventy studies met the inclusion criteria, including 69 retrospective studies and 1 randomised controlled trial (RCT). Median number of patients in the included studies was 438 (range 25–2297). In total, 17 studies (24.3%) reported on lobectomy, 4 studies (5.7%) on total thyroidectomy without RAI, and 49 studies (70.0%) with RAI. All studies defined recurrence using one or a combination of four diagnostic modalities cytology/pathology, imaging studies, thyroglobulin (-antibodies), and a predetermined minimum tumor-free time span. The most common definition of recurrence following lobectomy was cytology/pathology-proven recurrence (47.1% of this subgroup), following total thyroidectomy with RAI was cytology/pathology-proven recurrence and/or anomalies detected on imaging studies (22.4% of this subgroup). No consistent definition was found following total thyroidectomy without RAI. Nine studies (12.9%) differentiated between recurrence and persistent disease. Conclusion: Our main finding is that there is no universally accepted definition for recurrence of DTC in the current studies across any of the treatment categories. The findings of this study will provide the basis for a future, international Delphi-based proposal to establish a universally accepted definition of recurrence of DTC. A uniform definition could facilitate global discussion and enhance the assessment of treatment outcomes regarding recurrence of DTC. [ABSTRACT FROM AUTHOR]

Background: Accurate definition and operational criteria for diagnosing Parkinson's disease (PD) are crucial for evidence-based, patient-centered care. Objective: To offer evidence-based recommendations for defining and diagnosing PD, incorporating contemporary clinical, imaging, biomarker, and genetic insights. Methods: The guideline development began with the steering committee establishing key PICO (patient, intervention, comparison, outcome) questions, which were refined by the coauthors. Systematic literature searches identified relevant studies, reviews, and meta-analyses. Recommendations were drafted, evaluated, optimized, and voted upon by the German Parkinson's Guideline Group. Results: Parkinson's disease (PD) is now understood to encompass a broader spectrum of etiologies than previously recognized. Advances in molecular pathogenesis, neuroimaging, and early clinical phenotypes suggest that PD is not a uniform disease entity and is often not idiopathic. This necessitates an updated framework for PD definition and diagnosis. The German Society for Neurology now endorses a broader concept of PD, incorporating both idiopathic and hereditary forms, as opposed to the previously narrower concept of "idiopathic Parkinson syndrome." The revised guidelines recommend using the 2015 Movement Disorders Society diagnostic criteria, emphasize the importance of long-term clinical follow-up for improved diagnostic accuracy, and highlight the significance of non-motor symptoms in clinical diagnosis. Specific recommendations are provided for the use of imaging and fluid biomarkers and genetic testing to support the clinical diagnosis. Conclusion: The updated guidelines from the German Society for Neurology enhance diagnostic accuracy for PD, promoting optimized clinical care. [ABSTRACT FROM AUTHOR]

Introduction: The term 'refractory migraine' (RM) is commonly used in clinical settings; however, it is not recognized in the International Classification of Headache Disorders, third edition. A growing need for a shared definition of refractoriness has been highlighted by a multidisciplinary expert group. Although definitions for RM currently exist, the key parameters for the definition of refractoriness (e.g., unresponsiveness to treatment, high frequency, severe disability, or all of these features) remain contentious. Thus, a consensus on the definition of RM is crucial. Methods: Calcitonin gene‐related peptide (CGRP) is a neuropeptide that plays an important role in migraine pathophysiology and is a target for migraine preventive therapies. Monoclonal antibodies targeting the CGRP (i.e., galcanezumab, fremanezumab, and eptinezumab) and its receptor (erenumab) have shown consistent efficacy for migraine prophylaxis with excellent safety profiles. Their effect on refractory cases has also been reported, offering promise to the many patients who have not found relief with existing treatments. Therefore, we anticipate a paradigm shift in migraine treatment. Results: Following the widespread use of monoclonal antibodies targeting the CGRP and its receptor, the European Headache Federation proposed a definition for two subsets of difficult‐to‐treat migraine—resistant and refractory migraine—that considers both the frequency and disability caused by single and frequent attacks. Conclusion: We expect that this definition will help resolve previous conflicts that have limited the use of earlier definitions. [ABSTRACT FROM AUTHOR]

Arts participation has been linked to positive health outcomes around the globe. As more research is taking place on this topic, there is heightened need for definitions for the complex concepts involved. While significant work to define "arts participation" has taken place in the arts sector, less work has been undertaken for the purpose of researching the arts in public health. This study developed a definition for "arts participation" to guide a national arts in public health research agenda and to advance and make more inclusive previous work to define the term. A convergent mixed-methods study design with sequential elements was used to iteratively develop a definition that integrated the perspectives of field experts as well as the general public. Literature review was followed by four iterative phases of data collection, analysis, and integration, and a proposed definition was iteratively revised at each stage. The final definition includes modes, or ways, in which people engage with the arts, and includes examples of various art forms intended to frame arts participation broadly and inclusively. This definition has the potential to help advance the quality and precision of research aimed at evaluating relationships between arts participation and health, as well as outcomes of arts-based health programs and interventions in communities. With its more inclusive framing than previous definitions, it can also help guide the development of more inclusive search strategies for evidence synthesis in this rapidly growing arena and assist researchers in developing more effective survey questions and instruments. [ABSTRACT FROM AUTHOR]

We compare the definition of virtue in philosophy with the definition and operationalization of virtue in psychology. We articulate characteristics that virtue is presented as possessing in the perennial western philosophical tradition. Virtues are typically understood as (a) dispositional (b) deep-seated (c) habits (d) that contribute to flourishing and (e) that produce activities with the following three features: they are (f) done well, (g) not done poorly, and (h) in accordance with the right motivation and reason. We form a definition from these characteristics and defend our exclusion of some other characteristics from the definition. Using our definition as a rubric, we evaluate conceptions of virtue in psychology, showing how many fall short at operationalizing at least one component of the philosophical notion of virtue. [ABSTRACT FROM AUTHOR]

Background: Recent US proposals suggest defining Alzheimer's disease (AD) based on β‐amyloidosis alone. This sparked debates that echoed historical ones about the significance of brain lesions and clinical phenotype. Methods: This review covers debates on AD nosology through three key periods: AD's discovery in German‐speaking countries in the early 20th century, its redefinition in Anglo‐Saxon countries in the 1960s–1980s, and current debates on the biological or clinicobiological definitions of AD. Key players' opinions are focused on. Results: At the beginning of the 20th century, AD was defined as a clinicopathological entity. Debates arose around the pathological anchor, which included extended neurofibrillary tangles versus neuritic plaques (Alzheimer vs. Fischer) and its association with senile dementia (Kraepelin). In the 1960s–1980s, the debate shifted towards whether AD could be diagnosed using qualitative or quantitative neuropathological features and whether it was a unique process (Terry and Katzman) or had subtypes (Roth). The current definition proposed by the US Alzheimer's Association is based purely on biological β‐amyloid abnormalities and represents a double break: from the historical clinicopathological definition of AD and from the historical emphasis on tau or combined tau and β‐amyloid high levels of pathology. Conversely, the clinicobiological proposal of the International Working Group remains aligned with historical concepts of AD. Conclusions: This historical perspective illustrates the unresolved questions surrounding AD pathogenesis, role of lesions, and the clinical phenotype, especially for sporadic cases. The intense nosological debates throughout the history of AD also illustrate the diversity of theoretical frameworks for defining disease in medicine. [ABSTRACT FROM AUTHOR]

Evidence-based treatment recommendations for psoriatic arthritis (PsA) suggest that treatment should be individualised but acknowledge the difficulty of correctly defining levels of activity (mild, moderate and severe). The aim of this study was to define the parameters or disease characteristics that should be included in a future definition of moderate PsA. Mixed. methods: (1) literature review to identify previous assessment tools used to classify patients into mild, moderate and severe forms, and (2) survey of rheumatologists, and experts in PsA, to obtain their opinion on the degree of validation and applicability of published definitions and tools, and on the parameters that should be included in a future definition of moderate PsA. We propose eight domains/items to be included in a definition of moderate PsA: number of active joints and inflamed entheses, physician global assessment (by visual analogue scale), dactylitis, body surface area (BSA) affected by psoriasis, psoriasis in special locations, and absence of hip involvement. The Disease Activity Index for Psoriatic Arthritis (DAPSA) score would be supported as part of this definition, as would the Psoriatic Arthritis Impact of Disease (PsAID) index. This study proposes a set of items/domains to be included in a definition of moderate PsA based on literature and expert opinion, which can be the starting point for further development and validation studies of the proposed items. [ABSTRACT FROM AUTHOR]

Surgical wound dehiscence (SWD) has various definitions, which complicates accurate and uniform diagnosis. To address this, the World Union Wound Healing Societies (WUWHS) presented a consensus based definition and classification for SWD (2018). This quasi-experimental pretest-posttest study investigates the inter-rater reliability among healthcare professionals (HCP) and wound care professionals (WCP) when assessing wound photos on the presence or absence of SWD before and after training on the WUWHS-definition. Wound expert teams compiled a set of twenty photos (SWD+: nineteen, SWD−: one), and a video training. Subsequently, 262 healthcare professionals received the pretest link to assess wound photos. After completion, participants received the posttest link, including a (video) training on the WUWHS-definition, and reassessment of fourteen photos (SWD+: thirteen, SWD−: one). 1) pretest-posttest inter-rater-reliability among participants in assessing photos in congruence with the WUWHS-definition 2) the impact of training on assessment scores. Secondary outcome: familiarity with the WUWHS-definition. One hundred thirty-one participants (65 HCPs, 66 WCPs) completed both tests. The posttest inter-rater reliability among participants for correctly identifying SWD was increased from 67.6 % to 76.2 %, reaching statistical significance (p- value: 0.001; 95 % Confidence Interval [1.8–2.2]). Sub-analyses per photo showed improved SWD posttest scores in thirteen photos, while statistical significance was reached in seven photos. Thirty-three percent of participants knew the WUWHS-definition. The inter-rater reliability among participants increases after training on the WUWHS-definition. The definition provides diagnostic criteria for accurate SWD diagnosis. Widespread use of the definition may improve uniformity in care for patients with SWD. [ABSTRACT FROM AUTHOR]

In this paper, I examine connections between the speech acts of assertion, denial, polar questions and justification requests, and the common ground. When we pay attention to the structure of norms governing polar questions, we can clarify the distinction between strong and weak denial, together with the parallel distinction between strong and weak assertion, and the distinct way that these speech acts interact with the common ground. In addition, once we pay attention to the distinct norms concerning justification requests, we can give a distinctive answer to Carroll’s puzzle concerning the force of the logical must and the sense in which certain rules for logical concepts can indeed count as definitions. [ABSTRACT FROM AUTHOR]

The agricultural and social landscape of rural Australia is changing, with many farmers interested in, and some actively moving towards, regenerative agriculture--but what do we understand of the farmers undertaking these transitions? Regenerative agriculture is a holistic way of managing landscapes that aims to move beyond sustainability to regenerate natural systems, while supporting farming system viability. While several authors have discussed the higher-level philosophical underpinnings of regenerative agriculture, there are few empirical studies exploring the motivators for farmers to implement a suite of practices within the regenerative agriculture tool-kit. By undertaking an online survey targeting regenerative farmers, this study identifies common attributes of regenerative farmers, as well as key motivators for, and barriers to change, including perceived benefits arising from the approach. An online survey was promoted through the social media pages of three farming groups, resulting in 96 self-identifying Australian regenerative farmers included in this analysis. Results demonstrate that a clear and recent shift has taken place for this group, who may feel ostracized within their local community, hence often rely on information from online and international sources of agricultural information. This article builds a core understanding of the goals, attributes, aspirations and challenges of regenerative farmers and offers a definition of regenerative agriculture that is derived from farmer responses. [ABSTRACT FROM AUTHOR]

The lack of a shared, operant definition for greenwashing has led to fragmented scholarly research, unclear guidelines for practice, inconsistent enforcement, and reactive policy frameworks; resulting in ineffective efforts to combat its growth. Using concept analysis, this research establishes a composite definition for greenwashing by identifying the constitutive attributes sourced across 79 scholarly definitions. The analysis finds six requirements necessary for identifying greenwashing: a claim on environmental performance by a private sector organization marketing a product or a service, which cannot be substantiated, made with deceptive intent, and done to establish a competitive advantage. Fulfilling these criteria warrants an accusation of greenwashing. With the aim to prevent its further spread and misuse, the article provides a diagnostic tool for separating similar but often conflated concepts from greenwashing to organize scholarly research, provide guidelines for practitioners, and support regulators' case analysis. [ABSTRACT FROM AUTHOR]

The article explores the need to redefine perioperative myocardial infarction (PMI) after cardiac surgery. It discusses different definitions of PMI and their implications for patient outcomes. The authors argue for updating the criteria for PMI diagnosis, particularly in non-coronary artery bypass graft surgeries, and emphasize the importance of considering the dynamics of cardiac biomarkers over time. They also highlight the challenges of using cardiac troponin to diagnose PMI and propose that a better definition should take into account the amount of myocardial injury associated with different procedures. Further research is needed to develop a more accurate and comprehensive definition of PMI. [Extracted from the article]

This study aims to establish a basic definition for micromuseums. Research was conducted among twenty-one micromuseums on eight Mediterranean islands guided by semi-structured interviews with curators of independent, private, and state micromuseums on the Maltese Islands, the Ragusan Province of Sicily, and other islands for comparative purposes. All gathered information was analysed, and the findings indicate that there are specific factors which contribute to defining a micromuseum and differentiate it from traditional establishment museums. In comparison to earlier literature on micromuseology, the study revealed that micromuseums, among other characteristics, focus on specific themes and collections not typically found in larger museums, operate with minimal visibility, have staff members who perform multiple roles, cater to niche audiences, employ curators who are experts in their field, and prioritize interactions between curators and visitors. [ABSTRACT FROM AUTHOR]

This revision of the da Vinci Medal Address delivered at SHOT's annual meeting in Los Angeles on October 28 2023 presents two valedictories. The first reviews fifty years in SHOT studying and teaching the history of technology and warfare. It argues that not only is technology a particularly useful category of analysis for understanding change in warfare over the course of human history but warfare is an equally useful category of analysis for studying technological change. The second valedictory invites SHOT members to clarify what they mean by the term "technology." There is no need for a single definition but the term is so widely and loosely used in contemporary discourse that it behooves SHOT members to explain what they mean by it. [ABSTRACT FROM AUTHOR]

Sarcopenic obesity is the co‐existence of obesity and sarcopenia in individuals aged 40–75 years. The Japanese Working Group on Sarcopenic Obesity has developed diagnostic criteria tailored for the Japanese population, considering their unique characteristics compared with European populations. Our algorithm consists of two steps: screening and diagnosis. The screening of obesity mandates using waist circumference and/or body mass index (BMI) based on national standards, while screening for sarcopenia involves the "finger ring test" in addition to the Asian Working Group for Sarcopenia 2019 criteria. The final diagnosis of sarcopenia involves handgrip strength for low muscle strength, the five‐times chair stand test for low physical function, and limb skeletal muscle mass (corrected for BMI) for low muscle mass. Obesity is assessed by visceral fat area or body fat percentage. Sarcopenic obesity is then categorized into Stage I, with muscle weakness/loss of function, loss of muscle mass, and obesity; or Stage II, which includes complications. Further clinical validation is needed to refine the consensus and age range. Geriatr Gerontol Int 2024; 24: 997–1000. [ABSTRACT FROM AUTHOR]

Introduction: In occupational therapy for children, collaborative practice with parents is crucial for meaningful family‐centred interventions, yet it remains undefined and inconsistently addressed. This study aimed to establish foundational concepts for collaborative practice with parents in occupational therapy for children in progressing the field with a universal description. Methods: This paper encompasses the second dataset of a larger scoping review and a preliminary validation of findings by an advisory panel. Data were gathered from indexed sources on collaborative practice with parents in occupational therapy for children (ages 0–10) using MedLine, PsychInfo, ERIC, Embase, OTSeeker, Scopus, and ProQuest Central. Data were extracted, charted, and descriptively analysed by paired independent reviewers. The Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis—extension for Scoping Reviews were used. A draft definition of collaborative practices, developed based on preliminary review findings and an operational definition, was validated by an advisory panel of 13 experienced Australian occupational therapists, whose input was integrated into a final, comprehensive description of collaborative practice. Results: The scoping review encompassed 299 sources, revealing three major components of collaborative practice: 'collaborative practice aims', 'parent–therapist partnership', and 'strategies for collaboration'. The advisory panel endorsed the draft definition, confirmed its professional relevance, and suggested some modifications. Conclusion: The major outcome of this study is an evidence‐based and discipline‐specific preliminary description of collaborative practice with parents in occupational therapy for children. This description provides a common language and foundational concepts for the future development of a collaborative practice framework to guide practice and research. Future studies can explore specific components, exploring their mechanisms and significance. Further expanded validation is required, incorporating the perspectives of a wider community of occupational therapists and families to enhance the description's applicability. PLAIN LANGUAGE SUMMARY: In occupational therapy for children, collaboration between parents and occupational therapists has been long acknowledged as important in the occupational therapy literature. It is an essential shift away from practices led by professionals to a practice that encourages parents to be engaged therapy partners. However, there has been little consistency in terms of a definition or description of collaborative practice and in what parts of therapy collaboration is used. To develop a draft definition of collaborative practice, we extracted relevant information from 299 papers between 1998 and 2022. Then, an advisory panel of 13 experienced Australian occupational therapists validated and enhanced our final description of collaborative practice. The data from the review was grouped into three major components of collaborative practice: 'collaborative practice aims', 'parent–therapist partnership', and 'strategies for collaboration'. The advisory panel confirmed the draft definition and its relevance and suggested some modifications, which were used to refine the description. The major outcome of this study is a preliminary description of collaborative practice with parents in occupational therapy for children that is based on the research evidence. This description provides a common language and foundational concepts for the future development of a collaborative practice framework to guide practice and research. Future studies are needed to explore specific components of collaborative practice, their relevance, and how they operate in practice. Further validation of the collaborative practice description is needed that would incorporate the perspectives of parents, families, and a wider community of occupational therapists to enhance the description's applicability. [ABSTRACT FROM AUTHOR]

Throughout the last two decades, research on poly-victimization (PV) has evolved from examinations of a core set of past-year victimization types in youth samples to investigations of a broad range of victimization types experienced during variable time intervals in diverse samples of varying ages. As the concept of PV expands, greater clarity regarding the definition and measurement of PV is needed to advance understanding of its risk and protective factors as well as its associated outcomes. This scoping review aimed to (a) identify approaches used to operationally define and measure PV across studies and (b) synthesize empirical findings concerning risk factors and outcomes associated with PV. A systematic search of peer-reviewed research published before 2022 across 12 databases yielded 98 studies that met inclusion criteria. Study characteristics including the research design, sample type, victimization timeframe, operational definition(s) of PV, measurement of PV, analytic methods, and key findings were synthesized across studies. Findings indicated that the majority of reviewed studies were cross-sectional investigations that utilized categorical measures of lifetime PV in samples of youth. Results also demonstrated that PV is robustly associated with a broad range of predictors, including mental health symptoms and diagnoses as well as family- and community-level factors. PV is also associated with numerous adverse outcomes including depression, anxiety, suicidality, substance use, and delinquency across diverse study types and populations. Future research that examines the conditional effects of PV is needed to identify subgroups of individuals at higher risk of adverse outcomes following PV and modifiable targets for interventions. [ABSTRACT FROM AUTHOR]

We provide a commentary on current debates about the definition of dyslexia. We agree with others that dyslexia is best thought of as a dimensional disorder with the best established causal risk factor being a deficit in phonological processing. Dyslexia is particularly common in children from families with a history of dyslexia and in children with preschool language difficulties. We argue that definitions may differ depending upon their purpose. Traditional discrepancy definitions may be useful for research purposes, but when considering the provision of educational services discrepancy definitions are not useful since all children with reading difficulties require reading intervention regardless of their level of IQ. [ABSTRACT FROM AUTHOR]

The International Dyslexia Association definition of dyslexia was updated 20 years ago and has been referenced frequently in research and practice. In this paper, researchers from the Florida Center for Reading Research consider the components of the definition and make recommendations for revisions. These include recognizing the persistence of word-reading, decoding, and spelling difficulties, acknowledging the multifactorial causal basis of dyslexia, clarifying exclusionary factors, and denoting comorbidity with other developmental disorders. It is also suggested that the academic and psychosocial consequences of dyslexia be highlighted to reinforce a preventive service delivery model. Lastly, the inclusion of dyslexia within a specific learning disability category is supported. [ABSTRACT FROM AUTHOR]

This study explores Taiwanese junior high school social studies teachers' definitions of sustainability, using a qualitative semi-structured interview approach. Three themes explaining these teachers' definitions are cycling, cultural sustainability, and balancing, harmony, and coexisting. These definitions unveil an alternative worldview that is non-Eurocentric-based and multifaceted dimensions of sustainability. Findings suggest that instead of claiming that we should have a consistent definition to guide teachers to implement environmental and sustainability education across different subjects, it is important to acknowledge the fact that teachers trained in different disciplines and of different cultural backgrounds need a whole range of support to incorporate sustainability goals successfully in their teaching. Supported by results of this study, social studies teachers can reasonably support the teaching of controversial issues about tensions between cultural sustainability and economic development. [ABSTRACT FROM AUTHOR]

Purpose: The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. Methods: The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). Results: Six hundred three patients (mean 54.0 years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p =.011), and number of comorbidities (p =.004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p <.001). Conclusion: The PCS score correlated with patients' QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities. Trail registration number: The cohort is registered at www.clinicaltrials.gov under NCT04768998. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis (NEC) is the most prevalent and potentially fatal intestinal injury mainly affecting premature infants, with significant long-term consequences for those who survive. This review explores the scale of the problem, highlighting advancements in epidemiology, the understanding of pathophysiology, and improvements in the prediction and diagnosis of this complex, multifactorial, and multifaced disease. Additionally, we focus on the potential role of metabolomics in distinguishing NEC from other conditions, which could allow for an earlier and more accurate classification of intestinal injuries in infants. By integrating metabolomic data with other diagnostic approaches, it is hoped to enhance our ability to predict outcomes and tailor treatments, ultimately improving care for affected infants. [ABSTRACT FROM AUTHOR]

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Objectives: To investigate the frequency of exceptional cognition (cognitive super-aging) in Australian older adults using different published definitions, agreement between definitions, and the relationship of super-aging status with function, brain imaging markers, and incident dementia. Design: Three longitudinal cohort studies. Setting: Participants recruited from the electoral roll, Australian Twins Registry, and community advertisements. Participants: Older adults (aged 65–106) without dementia from the Sydney Memory and Ageing Study (n = 1037; median age 78), Older Australian Twins Study (n = 361; median age 68), and Sydney Centenarian Study (n = 217; median age 97). Measurements: Frequency of super-aging was assessed using nine super-aging definitions based on performance on neuropsychological testing. Levels of agreement between definitions were calculated, and associations between super-aging status for each definition and functioning (Bayer ADL score), structural brain imaging measures, and incident dementia were explored. Results: Frequency of super-aging varied between 2.9 and 43.4 percent with more stringent definitions associated with lower frequency. Agreement between different criteria varied from poor (K = 0.04, AC1 =.24) to very good (K = 0.83, AC1 =.91) with better agreement between definitions using similar tests and cutoffs. Super-aging was associated with better functional performance (4.7–11%) and lower rates of incident dementia (hazard ratios 0.08–0.48) for most definitions. Super-aging status was associated with a lower burden of white matter hyperintensities (3.8–33.2%) for all definitions. Conclusions: The frequency of super-aging is strongly affected by the demographic and neuropsychological testing parameters used. Greater consistency in defining super-aging would enable better characterization of this exceptional minority. [ABSTRACT FROM AUTHOR]

This paper presents the ways of defining lexical units (including grammatical terms) used to describe the Polish language system recorded in Grzegorz Knapiusz's Thesaurus (ed. 1621, 1643, 1644) and in Nowy dykcjonarz by Michał Abraham Trotz (ed. 1764). The material analysed included units with synonymic definitions, having equivalents or extensive definitions in foreign languages only, as well as lexemes without Polish or foreign-language equivalents. The article attempts to determine to what extent the collected linguistic terms and the ways in which they are presented in both dictionaries may be relevant to diachronic studies of Polish grammatical terminology. [ABSTRACT FROM AUTHOR]

The paradigmatic relations of metalinguistics turn out to be one of the few manifestations of the systemic qualities of the verbal inventory of the natural language. In turn, to describe a natural language (“object language”), a metalanguage is used - the language of the “second” level, while the concept of “metalanguage” is much more voluminous than just the concept of “terminology (=terminosystem)”. This article examines the elements of the linguistics terminological system, first of all, paradigmatic relations are associative relations based on partial similarity between lexical units of the same type by some attribute, while at the same time distinguishing by some other attributes. The metalanguage of linguistics is not an initially defined (preceding scientific research) system, but is the final stage of a linguistic phenomenon, which is based on systemic relations between lexical units (including between terms), explicitly reflecting the principle of unity of expression and content.

Abstract Introduction Cancer remains a leading cause of death globally, with patients frequently experiencing malnutrition due to both the disease and its treatment, which negatively affects their quality of life and treatment outcomes. Oral nutritional supplements (ONS) provide a noninvasive solution to improve nutritional status, but poor patient adherence limits their effectiveness. Studies on ONS adherence vary in their definitions and assessment tools, creating inconsistencies. A scoping review is essential to synthesize these studies and establish a foundation for future research and clinical practice. Method We systematically searched six databases, including Web of Science, PubMed, and Scopus, up to August 2024. Our criteria focused on oncology patients, ONS interventions, and outcomes related to adherence definitions, assessment methods, and adherence rates. Results 37 studies from 2005 to 2024 met the inclusion criteria. Definitions of ONS adherence and assessment methods vary widely, with the most common definition being the ratio of actual intake to the recommended amount. The assessment tools included self-reported ONS diaries, and MMAS scores, among others. Adherence rates also vary significantly, with some studies reporting a decline in adherence over time. Conclusion The lack of standardized definitions and assessment methods for ONS adherence across studies hinders comparability. Future research should focus on developing standardized, comprehensive adherence assessment tools that incorporate both quantitative and qualitative data. This would allow for a better understanding of adherence factors and enable more targeted interventions to improve long-term adherence in cancer patients.

a diachronic perspective, highlights, on the one hand, a clear evidence of its belonging to the category of inflexible parts of speech. On the other hand, the semantic constant of the interjection with reference to the notion of state of mind is observable. Controversial situations appear only in the inclusion of other parts of speech in the interjection class.

Objective: This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’ perspectives in the literature. These insights will help update existing tools and create new ones to capture moral distress better, guiding the development and implementation of strategies to support nurses in addressing this challenge. Methods: Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases (EBSCO Medline, CINAHL, and PubMed). Additionally, two journals, Bioethics and Nursing Ethics, were manually searched to reduce search bias. The included studies were primary resources published in English between 2018 and 2023, utilizing quantitative, qualitative, or mixed methods to examine moral distress’s characteristics, components, and definitions. All of identified studies were screened, extracted, and analyzed independently by two researchers. Results: Nineteen studies were included. The results were grouped into five themes shaping the main characteristics of moral distress: 1) experiencing a moral situation, with five ethically conflicted situations identified, including treatment plans, professional and personal moral values, team dynamics, complex contexts, clinical practices, and patient-centered care; 2) making a moral judgment, where nurses experience moral distress when they cannot act consistently with their values, ethical principles, and moral duties; 3) the presence of constraints, categorized at three levels: individual factors related to the nurse, patient, and patient’s family; team factors related to the team or unit involved; and system factors, including institutional and policy elements; 4) moral wrongdoing, which occurs when nurses are unable to perform the right moral action; and 5) moral suffering, with studies showing that moral distress impacts physical, emotional, and psychological well-being. Conclusion: The findings enhance the understanding of moral distress characteristics among nursing staff, highlighting the concept of the crescendo effect, which underscores the cumulative and escalating nature of unresolved moral distress, emphasizing the need to address moral conflicts proactively to prevent the erosion of moral integrity and professional satisfaction.