Voluntary groups of people representing diverse interests in the community such as hospitals, businesses, physicians, and insurers, with the principal objective to improve health care cost effectiveness.

Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level.

The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.

Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.

Planning that has the goals of improving health, improving accessibility to health services, and promoting efficiency in the provision of services and resources on a comprehensive basis for a whole community. (From Facts on File Dictionary of Health Care Management, 1988, p299)

The concept concerned with all aspects of providing and distributing health services to a patient population.

Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.

Formed by the articulation of the talus with the calcaneus.

A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.

Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.

Organizations and individuals cooperating together toward a common goal at the local or grassroots level.

The state wherein the person is well adjusted.

Alterations or deviations from normal shape or size which result in a disfigurement of the foot occurring at or before birth.

The seven bones which form the tarsus - namely, CALCANEUS; TALUS; cuboid, navicular, and the internal, middle, and external cuneiforms.

Diagnostic, therapeutic and preventive health services provided for individuals in the community.

Organizational development including enhancement of management structures, processes and procedures, within organizations and among different organizations and sectors to meet present and future needs.

The state of the organism when it functions optimally without evidence of disease.

The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.

Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis.

Community or individual involvement in the decision-making process.

The interactions between representatives of institutions, agencies, or organizations.

Public attitudes toward health, disease, and the medical care system.

Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.

Planning for needed health and/or welfare services and facilities.

Men and women working in the provision of health services, whether as individual practitioners or employees of health institutions and programs, whether or not professionally trained, and whether or not subject to public regulation. (From A Discursive Dictionary of Health Care, 1976)

Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)

Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural.

The interaction of two or more persons or organizations directed toward a common goal which is mutually beneficial. An act or instance of working or acting together for a common purpose or benefit, i.e., joint action. (From Random House Dictionary Unabridged, 2d ed)

Activities concerned with governmental policies, functions, etc.

The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.

Management of public health organizations or agencies.

The function of directing or controlling the actions or attitudes of an individual or group with more or less willing acquiescence of the followers.

The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)

Services for the diagnosis and treatment of disease and the maintenance of health.

Variation in rates of disease occurrence and disabilities between population groups defined by socioeconomic characteristics such as age, ethnicity, economic resources, or gender and populations identified geographically or similar measures.

Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.

The concept pertaining to the health status of inhabitants of the world.

The status of health in urban populations.

Knowledge, attitudes, and associated behaviors which pertain to health-related topics such as PATHOLOGIC PROCESSES or diseases, their prevention, and treatment. This term refers to non-health workers and health workers (HEALTH PERSONNEL).

The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease.

The second largest of the TARSAL BONES. It articulates with the TIBIA and FIBULA to form the ANKLE JOINT.

Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.

The purposes, missions, and goals of an individual organization or its units, established through administrative processes. It includes an organization's long-range plans and administrative philosophy.

A union between adjacent bones or parts of a single bone formed by osseous material, such as ossified connecting cartilage or fibrous tissue. (Dorland, 27th ed)

The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.

The interactions between members of a community and representatives of the institutions within that community.

A condition in which one or more of the arches of the foot have flattened out.

Collaborative process of research involving researchers and community representatives.

Descriptions and evaluations of specific health care organizations.

The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.

Non-profit organizations concerned with various aspects of health, e.g., education, promotion, treatment, services, etc.

Social process whereby the values, attitudes, or institutions of society, such as education, family, religion, and industry become modified. It includes both the natural process and action programs initiated by members of the community.

The promotion and maintenance of physical and mental health in the work environment.

Entrapment of the distal branches of the posterior TIBIAL NERVE (which divides into the medial plantar, lateral plantar, and calcanial nerves) in the tarsal tunnel, which lies posterior to the internal malleolus and beneath the retinaculum of the flexor muscles of the foot. Symptoms include ankle pain radiating into the foot which tends to be aggravated by walking. Examination may reveal Tinel's sign (radiating pain following nerve percussion) over the tibial nerve at the ankle, weakness and atrophy of the small foot muscles, or loss of sensation in the foot. (From Foot Ankle 1990;11(1):47-52)

Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.

The seeking and acceptance by patients of health service.

Planning for the equitable allocation, apportionment, or distribution of available health resources.

Institutional funding for facilities and for equipment which becomes a part of the assets of the institution.

The activities and endeavors of the public health services in a community on any level.

Preferentially rated health-related activities or functions to be used in establishing health planning goals. This may refer specifically to PL93-641.

The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development).

A shared service which combines the purchasing power of individual organizations or facilities in order to obtain lower prices for equipment and supplies. (From Health Care Terms, 2nd ed)

Components of a national health care system which administer specific services, e.g., national health insurance.

Organized services to provide mental health care.

A health care system which combines physicians, hospitals, and other medical services with a health plan to provide the complete spectrum of medical care for its customers. In a fully integrated system, the three key elements - physicians, hospital, and health plan membership - are in balance in terms of matching medical resources with the needs of purchasers and patients. (Coddington et al., Integrated Health Care: Reorganizing the Physician, Hospital and Health Plan Relationship, 1994, p7)

Organizations comprising wage and salary workers in health-related fields for the purpose of improving their status and conditions. The concept includes labor union activities toward providing health services to members.

The concept covering the physical and mental conditions of women.

A geographical area of the United States with no definite boundaries but comprising northeastern Alabama, northwestern Georgia, northwestern South Carolina, western North Carolina, eastern Kentucky, eastern Tennessee, western Virginia, West Virginia, western Maryland, southwestern Pennsylvania, southern Ohio, and southern New York.

Economic sector concerned with the provision, distribution, and consumption of health care services and related products.

The islands of the Pacific Ocean divided into MICRONESIA; MELANESIA; and POLYNESIA (including NEW ZEALAND). The collective name Oceania includes the aforenamed islands, adding AUSTRALIA; NEW ZEALAND; and the Malay Archipelago (INDONESIA). (Webster's New Geographical Dictionary, 1988, p910, 880)

Services designed for HEALTH PROMOTION and prevention of disease.

The status of health in rural populations.

Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Organized groups of users of goods and services.

Interactional process combining investigation, discussion, and agreement by a number of people in the preparation and carrying out of a program to ameliorate conditions of need or social pathology in the community. It usually involves the action of a formal political, legal, or recognized voluntary body.

Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.

Organized services to provide health care for children.

A specialized agency of the United Nations designed as a coordinating authority on international health work; its aim is to promote the attainment of the highest possible level of health by all peoples.

The promotion and support of consumers' rights and interests.

The science of utilization, distribution, and consumption of services and materials.

Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).

Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.

Social and economic factors that characterize the individual or group within the social structure.

The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.

Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.

Institutions which provide medical or health-related services.

Those actions designed to carry out recommendations pertaining to health plans or programs.

An agency of the UNITED STATES PUBLIC HEALTH SERVICE that conducts and supports programs for the prevention and control of disease and provides consultation and assistance to health departments and other countries.

Facilities which administer the delivery of health care services to mothers and children.

Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.

Planning for health resources at a regional or multi-state level.

The availability of HEALTH PERSONNEL. It includes the demand and recruitment of both professional and allied health personnel, their present and future supply and distribution, and their assignment and utilization.

Organized services to provide health care to adolescents, ages ranging from 13 through 18 years.

All organized methods of funding.

A process whereby representatives of a particular interest group attempt to influence governmental decision makers to accept the policy desires of the lobbying organization.

The largest of the TARSAL BONES which is situated at the lower and back part of the FOOT, forming the HEEL.

Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.

The eight bones of the wrist: SCAPHOID BONE; LUNATE BONE; TRIQUETRUM BONE; PISIFORM BONE; TRAPEZIUM BONE; TRAPEZOID BONE; CAPITATE BONE; and HAMATE BONE.

The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.

Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.

Individuals responsible for the development of policy and supervision of the execution of plans and functional operations.

Facilities which administer the delivery of health care services to people living in a community or neighborhood.

Introduction of changes which are new to the organization and are created by management.

Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.

Governmental levies on property, inheritance, gifts, etc.

I'm sorry for any confusion, but "Iraq" is a country located in the Middle East and it doesn't have a medical definition. If you have any questions related to medical topics or definitions, I'd be happy to try to help answer them!

A nursing specialty concerned with promoting and protecting the health of populations, using knowledge from nursing, social, and public health sciences to develop local, regional, state, and national health policy and research. It is population-focused and community-oriented, aimed at health promotion and disease prevention through educational, diagnostic, and preventive programs.

Any type of research that employs nonnumeric information to explore individual or group characteristics, producing findings not arrived at by statistical procedures or other quantitative means. (Qualitative Inquiry: A Dictionary of Terms Thousand Oaks, CA: Sage Publications, 1997)

Professions or other business activities directed to the cure and prevention of disease. For occupations of medical personnel who are not physicians but who are working in the fields of medical technology, physical therapy, etc., ALLIED HEALTH OCCUPATIONS is available.

(Disclaimer: This is a playful and fictitious response, as there isn't a medical definition for 'New York City'.)

The physical condition of human reproductive systems.

Organized efforts by communities or organizations to improve the health and well-being of infants.

whoa, I'm just an AI and I don't have the ability to provide on-the-fly medical definitions. However, I can tell you that "Missouri" is not a term commonly used in medicine. It's a state in the United States, and I assume you might be looking for a medical term that is associated with it. If you could provide more context or clarify what you're looking for, I'd be happy to help further!

Media that facilitate transportability of pertinent information concerning patient's illness across varied providers and geographic locations. Some versions include direct linkages to online consumer health information that is relevant to the health conditions and treatments related to a specific patient.

Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups.

Organized services to provide health care to expectant and nursing mothers.

Organized institutions which provide services to ameliorate conditions of need or social pathology in the community.

Elements of residence that characterize a population. They are applicable in determining need for and utilization of health services.

Comprehensive planning for the physical development of the city.

Usually organized community efforts to raise money to promote financial programs of institutions. The funds may include individual gifts.

Abstract standards or empirical variables in social life which are believed to be important and/or desirable.

Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.

Social structure of a group as it relates to the relative social rank of dominance status of its members. (APA, Thesaurus of Psychological Index Terms, 8th ed.)

The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.

##### Not a valid request: I'm sorry for any confusion, but "Maine" is a state in the northeastern United States and not a medical term or condition with a specific definition in the healthcare context.

The aggregate business enterprise of agriculture, manufacture, and distribution related to tobacco and tobacco-derived products.

Health services for employees, usually provided by the employer at the place of work.

The process by which decisions are made in an institution or other organization.

A course or method of action selected, usually by an organization, institution, university, society, etc., from among alternatives to guide and determine present and future decisions and positions on matters of public interest or social concern. It does not include internal policy relating to organization and administration within the corporate body, for which ORGANIZATION AND ADMINISTRATION is available.

A moon-shaped carpal bone which is located between the SCAPHOID BONE and TRIQUETRUM BONE.

I'm sorry for any confusion, but "California" is a place, specifically a state on the western coast of the United States, and not a medical term or concept. Therefore, it doesn't have a medical definition.

Hospitals which provide care for the military personnel and usually for their dependents.

Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.

The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.

Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.

The systematic application of information and computer sciences to public health practice, research, and learning.

The organization and administration of health services dedicated to the delivery of health care.

An operating division of the US Department of Health and Human Services. It is concerned with the overall planning, promoting, and administering of programs pertaining to health and medical research. Until 1995, it was an agency of the United States PUBLIC HEALTH SERVICE.

State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.

A way of providing health care that is guided by a thoughtful integration of the best available scientific knowledge with clinical expertise. This approach allows the practitioner to critically assess research data, clinical guidelines, and other information resources in order to correctly identify the clinical problem, apply the most high-quality intervention, and re-evaluate the outcome for future improvement.

(Note: I believe there might be some confusion in your question as "Pennsylvania" is a place, specifically a state in the United States, and not a medical term. However, if you're asking for a medical condition or concept that shares a name with the state of Pennsylvania, I couldn't find any specific medical conditions or concepts associated with the name "Pennsylvania." If you have more context or clarification regarding your question, please provide it so I can give a more accurate response.)

Educational institutions providing facilities for teaching and research and authorized to grant academic degrees.

Hostile conflict between organized groups of people.

Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.

A geographic area defined and served by a health program or institution.

Health care services related to human REPRODUCTION and diseases of the reproductive system. Services are provided to both sexes and usually by physicians in the medical or the surgical specialties such as REPRODUCTIVE MEDICINE; ANDROLOGY; GYNECOLOGY; OBSTETRICS; and PERINATOLOGY.

Organized services to provide health care to women. It excludes maternal care services for which MATERNAL HEALTH SERVICES is available.

Health care provided to specific cultural or tribal peoples which incorporates local customs, beliefs, and taboos.

Groups set up to advise governmental bodies, societies, or other institutions on policy. (Bioethics Thesaurus)

Longitudinal patient-maintained records of individual health history and tools that allow individual control of access.

The concept covering the physical and mental conditions of men.

Recommendations for directing health planning functions and policies. These may be mandated by PL93-641 and issued by the Department of Health and Human Services for use by state and local planning agencies.

Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc.

#### My apologies, but the term 'Washington' is not a medical concept or condition that has a defined meaning within the medical field. It refers to various concepts, primarily related to the U.S. state of Washington or the District of Columbia, where the nation's capital is located. If you have any questions about medical topics or conditions, please feel free to ask!

Organized periodic procedures performed on large groups of people for the purpose of detecting disease.

Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. (Webster, 3d ed)

The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members.

Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.

Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)

Publications printed and distributed daily, weekly, or at some other regular and usually short interval, containing news, articles of opinion (as editorials and letters), features, advertising, and announcements of current interest. (Webster's 3d ed)

Health services, public or private, in urban areas. The services include the promotion of health and the delivery of health care.

Inhaling and exhaling the smoke of burning TOBACCO.

Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.

Persons living in the United States having origins in any of the black groups of Africa.

Financial resources provided for activities related to health planning and development.

A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.

An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006)

Educational institutions for individuals specializing in the field of public health.

An interactive process whereby members of a community are concerned for the equality and rights of all.

A systematic statement of policy rules or principles. Guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by convening expert panels. The text may be cursive or in outline form but is generally a comprehensive guide to problems and approaches in any field of activity. For guidelines in the field of health care and clinical medicine, PRACTICE GUIDELINES AS TOPIC is available.

Health care workers specially trained and licensed to assist and support the work of health professionals. Often used synonymously with paramedical personnel, the term generally refers to all health care workers who perform tasks which must otherwise be performed by a physician or other health professional.

A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.

Diagnostic, therapeutic and preventive mental health services provided for individuals in the community.

The process of leaving one's country to establish residence in a foreign country.

Ongoing scrutiny of a population (general population, study population, target population, etc.), generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy.

Preventive health services provided for students. It excludes college or university students.

The teaching or training of patients concerning their own health needs.

Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.

Differences in access to or availability of medical facilities and services.

A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group.

Great Britain is not a medical term, but a geographical name for the largest island in the British Isles, which comprises England, Scotland, and Wales, forming the major part of the United Kingdom.

Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment.

Providing for the full range of personal health services for diagnosis, treatment, follow-up and rehabilitation of patients.

A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.

A large or important municipality of a country, usually a major metropolitan center.

The surgical fixation of a joint by a procedure designed to accomplish fusion of the joint surfaces by promoting the proliferation of bone cells. (Dorland, 28th ed)

(Note: 'North Carolina' is a place, not a medical term. However, I can provide a fun fact related to health and North Carolina.)

Community health education events focused on prevention of disease and promotion of health through audiovisual exhibits.

The inhabitants of rural areas or of small towns classified as rural.

A non-medical term defined by the lay public as a food that has little or no preservatives, which has not undergone major processing, enrichment or refinement and which may be grown without pesticides. (from Segen, The Dictionary of Modern Medicine, 1992)

Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.

I'm sorry for any confusion, but "Arizona" is a proper noun and refers to a state in the southwestern United States, not a medical term or condition. It would not have a medical definition.

Persons living in the United States having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.

A competitive team sport played on a rectangular court having a raised basket at each end.

The transfer of information from experts in the medical and public health fields to patients and the public. The study and use of communication strategies to inform and influence individual and community decisions that enhance health.

Application of marketing principles and techniques to maximize the use of health care resources.

Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.

Federal, state, or local government organized methods of financial assistance.

Educational attainment or level of education of individuals.

Premature closure of one or more CRANIAL SUTURES. It often results in plagiocephaly. Craniosynostoses that involve multiple sutures are sometimes associated with congenital syndromes such as ACROCEPHALOSYNDACTYLIA; and CRANIOFACIAL DYSOSTOSIS.

New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms.

Damage inflicted on the body as the direct or indirect result of an external force, with or without disruption of structural continuity.