Third universal definition of myocardial infarction

"Myocardial infarction (MI) can be recognised by clinical features, including electrocardiographic (ECG) findings, elevated values of biochemical markers (biomarkers) of myocardial necrosis, and by imaging, or may be defined by pathology. It is a major cause of death and disability worldwide. MI may be the first manifestation of coronary artery disease (CAD) or it may occur, repeatedly, in patients with established disease. Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that distinguishes between incident and recurrent events. From the epidemiological point of view, the incidence of MI in a population can be used as a proxy for the prevalence of CAD in that population. The term ‘myocardial infarction’ may have major psychological and legal implications for the individual and society. It is an indicator of one of the leading health problems in the world and it is an outcome measure in clinical trials, observational studies and quality assurance programmes. These studies and programmes require a precise and consistent definition of MI. In the past, a general consensus existed for the clinical syndrome designated as MI. In studies of disease prevalence, the World Health Organization (WHO) defined MI from symptoms, ECG abnormalities and cardiac enzymes. However, the development of ever more sensitive and myocardial tissue-specific cardiac biomarkers and more sensitive imaging techniques now allows for detection of very small amounts of myocardial injury or necrosis. Additionally, the management of patients with MI has significantly improved, resulting in less myocardial injury and necrosis, in spite of a similar clinical presentation. Moreover, it appears necessary to distinguish the various conditions which may cause MI, such as ‘spontaneous’ and ‘procedure-related’ MI. Accordingly, physicians, other healthcare providers and patients require an up-to-date definition of MI.

Third universal definition of myocardial infarction

"Myocardial infarction (MI) can be recognised by clinical features, including electrocardiographic (ECG) findings, elevated values of biochemical markers (biomarkers) of myocardial necrosis, and by imaging, or may be defined by pathology. It is a major cause of death and disability worldwide. MI may be the first manifestation of coronary artery disease (CAD) or it may occur, repeatedly, in patients with established disease. Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that distinguishes between incident and recurrent events. From the epidemiological point of view, the incidence of MI in a population can be used as a proxy for the prevalence of CAD in that population. The term ‘myocardial infarction’ may have major psychological and legal implications for the individual and society. It is an indicator of one of the leading health problems in the world and it is an outcome measure in clinical trials, observational studies and quality assurance programmes. These studies and programmes require a precise and consistent definition of MI. In the past, a general consensus existed for the clinical syndrome designated as MI. In studies of disease prevalence, the World Health Organization (WHO) defined MI from symptoms, ECG abnormalities and cardiac enzymes. However, the development of ever more sensitive and myocardial tissue-specific cardiac biomarkers and more sensitive imaging techniques now allows for detection of very small amounts of myocardial injury or necrosis. Additionally, the management of patients with MI has significantly improved, resulting in less myocardial injury and necrosis, in spite of a similar clinical presentation. Moreover, it appears necessary to distinguish the various conditions which may cause MI, such as ‘spontaneous’ and ‘procedure-related’ MI. Accordingly, physicians, other healthcare providers and patients require an up-to-date definition of MI.

Gender injustice in compensating injury to autonomy in English and Singaporean negligence law

The extent to which English law remedies injury to autonomy (ITA) as a stand-alone actionable damage in negligence is disputed. In this article I argue that the remedy available is not only partial and inconsistent (Keren-Paz in Med Law Rev, 2018) but also gendered and discriminatory against women. I first situate the argument within the broader feminist critique of tort law as failing to appropriately remedy gendered harms, and of law more broadly as undervaluing women’s interest in reproductive autonomy. I then show by reference to English remedies law’s first principles how imposed motherhood cases—Rees v Darlington and its predecessor McFarlane v Tayside Health Board—result in gender injustice when compared with other autonomy cases such as Chester v Afshar and Yearworth v North Bristol NHS Trust: A minor gender-neutral ITA is better remedied than the significant gendered harm of imposing motherhood on the claimant; men’s reproductive autonomy is protected to a greater extent than women’s; women’s reproductive autonomy is protected by an exceptional, derisory award. Worst of all, courts refuse to recognise imposed motherhood as detriment; and the deemed, mansplained, nonpecuniary joys of motherhood are used to offset pecuniary upkeep costs, forcing the claimant into a position she sought to avoid and thus further undermining her autonomy. The recent Singaporean case ACB v Thomson Medical Pte Ltd, awarding compensation for undermining the claimant’s genetic affinity in an IVF wrong-sperm-mix-up demonstrates some improvement in comparison to English law, and some shared gender injustices in the context of reproductive autonomy. ACB’s analysis is oblivious to the nature of reproductive autonomy harm as gendered; and prioritises the father’s interest in having genetic affinity with the baby over a woman’s interest in not having motherhood imposed upon her

Locus of control orientation and acceptance of disability

The purpose of this study was to determine if differences existed in acceptance of disability scores between individuals with internal locus of control and external locus of control orientations. Ninety-seven out of 200 randomly-chosen participants with disabilities from a southern California community college completed the Reactions to Impairment and Disability Inventory (RIDI), Rotter\u27s I-E Locus of Control Scale, and a demographic profile sheet. Acceptance of disability was defined as both acknowledgment and adjustment to a disability. Adjustment scores were found to be higher among those with an internal locus of control orientation but only among participants with mental/psychiatric disabilities. Also, differences in adjustment scores were found to be influenced by the domain of locus of control items. Implications for theory and research are briefly suggested

Top Percentile Network Pricing and the Economics of Multi- Homing

Under multi-homing an Internet Service Provider (ISP) connects to the Internet via multiplicity of network providers. This allows the provider to receive proper quality of service when one of the networks fails. An ISP that uses multihoming is subject to extra charges due to the use of multiple networks. Such extra costs can be very drastic under fixed cost pricing and non-meaningful under per-usage pricing. This work deals with the question of how large are these costs under top-percentile pricing, a relatively new and popular pricing regime. We provide a general formulation of this problem as well as its probabilistic analysis, and derive the expected cost faced by the ISP. We numerically examine several typical scenarios and demonstrate that despite the fact that this pricing aims at the peak traffic of the ISP (similarly to fixed cost), the bandwidth cost of multi-homing is not much higher than that of single-homing. Keywords: Pricing, Traffic-Engineering, Multi-Homing, Top-Percentile pricing.

Sizing Exit Buffers in ATM Networks: An Intriguing Coexistence of Instability and Tiny Cell Loss Rates

Abstract — This paper deals with the sizing of end buffers in ATM networks for sessions subject to constant bit rate (CBR) traffic. Our objective is to predict the cell-loss rate at the end buffer as a function of the system parameters. We introduce the DCG/D/1 queue as a generic model to represent exit buffers in telecommunications networks under constant rate traffic, and use it to model the end buffer. This is a queue whose arrival rate is equal to its service rate and whose arrivals are generated at regular intervals and materialize after a generally distributed random amount of time. We reveal that under the infinite buffer assumption, the system possesses rather intriguing properties: on the one hand, the system is instable in the sense that the buffer content is monotonically nondecreasing as a function of time. On the other hand, the likelihood that the buffer contents will exceed certain level f by time � diminishes with f. Improper simulation of such systems may therefore lead to false results. We turn to analyze this system under finite buffer assumption and derive bounds on the cell-loss rates. The bounds are expressed in terms of simple formulae of the system parameters. We carry out the analysis for two major types of networks: 1) datagram networks, where the packets (cells) traverse the network via independent paths and 2) virtual circuit networks, where all cells of a connection traverse the same path. Numerical examination of ATM-like examples show that the bounds are very good for practical prediction of cell loss and the selection of buffer size. Index Terms—ATM, buffer sizing, CBR, DCG/D/1 queue, endto-end loss rate