Areas Of Controversy Research Articles

Better data for budgetary surveillance: EU law on statistics as key to unlocking the potential of public sector accounting

The quality of the data available for monitoring budgetary discipline of the Member States has been a hot topic within the European Union (EU) institutions and in the literature ever since the beginning of the economic crisis in 2008. The COVID-19 pandemic has shown the inadequacy, not only of the data, but also of the policy instruments available for coordinating efforts and decision-making. In this paper, we attempt to unlock the potential of public sector accounting (PSA) for contributing to the improvement of EU surveillance mechanisms. We look beyond the idea of standardised accounting rules for the entire EU public sector (European Public Sector Accounting Standards) into a less controversial area of EU competence, and we explore the conditions for introducing reporting obligations based on PSA data as part of EU law on statistics. Points for practitioners The current succession of crises might create momentum for a change in EU fiscal policy-making. New instruments for the monitoring of the budgetary situation in the Member States could become necessary. The EU institutions cannot impose the European Public Sector Accounting Standards. However, a new standardised reporting instrument could become binding EU law if it would come in the shape of a statistical methodology. Basic principles of EU law guarantee that any new statistical reporting obligations are limited to what is necessary, proportionate and cost-effective.

The Role of Confirmatory Testing in Carpal Tunnel Syndrome: Electrodiagnostic Study, Ultrasound and CTS-6.

Carpal tunnel syndrome (CTS) is the most common upper extremity compressive neuropathy. The reference standard for the diagnosis of CTS remains an area of controversy. The diagnosis can be established clinically, but options for confirmatory testing include electrodiagnostic studies, ultrasound and diagnostic aids such as the CTS-6 score. This review article summarises the current evidence for each confirmatory testing modality, contrasts their advantages and disadvantages and discusses future directions for investigation. Level of Evidence: Level V (Diagnostic).

Controversies in the Management of Acute Pulmonary Embolism in the Emergency Department

Backgroundacute pulmonary embolism is frequently diagnosed in the Emergency Department, and the management approach can be nuanced. Objective: in this narrative review, we synthesize the literature in selected areas of ongoing controversy regarding the diagnostic and management approaches for acute pulmonary embolism (PE) in the Emergency Department, and provide evidence-based recommendations to empower emergency physicians to provide optimal care in these situations. DiscussionD-dimer is used to clinically exclude the diagnosis of PE patients who are stratified as low risk. However by utilizing likelihood ratio and with certain scoring tools, patient historically considered moderate or high risk for PE may safely be able to have the diagnosis excluded with a negative D-dimer. Traditional risk stratification and management strategies can be cautiously applied to patients with concomitant Coronavirus-19 infection while awaiting more definitive studies. There is an increasing trend in the diagnosis of isolated subsegmental PE, and many patients receiving this diagnosis may be treated without anticoagulation provided that they have no evidence of associated DVT and can be closely followed as an outpatient. There is a persistent hesitancy to discharge patients with newly-diagnosed acute PE, and existing well-supported risk stratification tools and clinical decision frameworks can support the emergency physician's decision to safely discharge low-risk patients. Conclusion: this review of the literature empowers emergency clinicians to manage challenging PE cases in the ED.

Inguinal hernias in children: Update on management guidelines.

Inguinal hernia repair is one of the most performed procedures in children, but aspects of care remain controversial. The aim of this review was to provide a critical appraisal of recently published guidelines on the management of inguinal hernias in children, by the American Academy of Pediatrics (2023) and the European Pediatric Surgeons' Association Evidence and Guideline Committee (2022). This was achieved by delineating areas of controversy and reviewing the most relevant recent literature on these topics. Currently available moderate-to-low quality evidence recommends postponing hernia repair in premature infants until after discharge, to reduce the risk of respiratory difficulties and recurrence. Laparoscopic repair provides similar outcomes to open but may shorten operative time in bilateral cases. No clear recommendation can be made for contralateral exploration, therefore should be evaluated case by case. In preterm infants, consideration of regional anaesthesia may reduce post-operative apnoea and pain, with no difference in neurodevelopment outcomes.

Oligometastatic Urothelial Cancer and Stereotactic Body Radiotherapy: A Systematic Review and an Updated Insight of Current Evidence and Future Directions.

Stereotactic body radiation therapy (SBRT) is the most commonly used metastasis-directed therapy (MDT) for oligometastatic urothelial carcinoma (omUC). Despite efforts in defining this disease entity, open questions remain concerning the role of MDT and the use of biomarkers, imaging, and its combination with systemic therapies. The aim of the present systematic review is to provide an updated overview of the current clinical evidence on SBRT for omUC in terms of survival and local control benefits. We also aim to provide updates on controversial areas and future directions in this emerging field. With a systematic approach, following PRISMA recommendations, we searched two databases to identify and select articles published up until March 2024 reporting the use of SBRT for omUC with or without concomitant systemic therapies. Prospective randomized or non-randomized studies as well as retrospective studies were included. Eight studies were selected for data extraction and 293 omUC patients treated with SBRT were collectively analyzed. In metachronous omUC patients, SBRT delivered with ablative doses (BED10 ≥ 78 Gy) was associated with a 2-year overall survival (OS) rate of 50.7% (95% CI 35.1-64.4%). The use of sub-ablative SBRT doses (BED10 = 43.2 Gy) in combination with immunotherapy did not demonstrate significant clinical outcome improvement in two prospective studies. The overall tolerance was good, with only one study reporting toxicity of grade 3 in up to 18% of the patients treated with SBRT in combination with immunotherapy. SBRT is an effective and widely available MDT option in omUC, although this is based on a limited number of studies. Despite the attempt to use SBRT as an immune response trigger in combination with immunotherapy, no significant improvement in survival outcomes has been observed. The integration of new systemic agents with MDT will likely define a new scenario for the treatment of omUC. The review protocol was registered in PROSPERO, ID: CRD42024522381.

The mechanical coupling effect of α and β phases in Ti6Al4V alloy undergoing laser shock peening: A molecular dynamics study

In the dual- or multi-phase metallic materials, the influence of different microstructural constituents on the plastic strain/stress distribution is still an area of great controversy. Herein, the heterogeneous deformation behavior of α and β phases in Ti6Al4V duplex titanium alloy undergoing laser shock peening (LSP) has been investigated by molecular dynamics simulations, and the corresponding typical microstructural features are characterized at varied strains. Also, the relationship between the theoretical microstructural morphologies and the micro stress is revealed. It evidently indicates that, the grain refinement process can be summarized as: (i) dislocation motions1 interacting with deformation twins in α phases, (ii) a combination of dislocation propagations and the deformation-induced phase transition from β phase to α phase. In addition, unlike the α single-phase titanium alloy, the representative stress – strain curve of α + β titanium alloy presents a gentle fluctuation trend with smaller amplitude value, suggesting an occurrence of the coupling deformation behavior between α and β phases. The initial interfacial dislocation nucleation prefers to site in the α/α interface rather than the α/β interface, then emitting to the interior of α grains. Features of dislocation slip, twin growth, stacking fault, and phase transformation dominate the release of LSP-generated micro stress, while grain and interphase boundaries, as well as dislocation locks, contribute to the increment of the LSP-generated micro stress.

Advances in the management of intraocular foreign bodies.

Intraocular foreign bodies (IOFBs) remain a severe complication of ocular trauma commonly encountered worldwide. This literature review aimed to discuss current practice patterns, areas of controversy, and advances in the management of IOFBs. Injuries involving IOFBs carry significant ocular morbidity and management can be extremely challenging. A systematic approach to preoperative evaluation and IOFB surgical management is detailed in this article and should be applied in each case. The location and composition of an IOFB have important implications on surgical approach and timing, especially in cases of toxic metals and vegetable matter. The advantages, disadvantages, and previous literature regarding immediate versus delayed foreign body removal are presented. Surgical approaches are described, with an emphasis on posterior chamber IOFB management and removal via pars plana vitrectomy. Final visual acuity is variable, but approaches have been used to prognosticate outcomes including the Ocular Trauma Score. By synthesizing current IOFB literature, the goal is to provide practitioners with guidance that will maximize the chances of surgical success and patient outcomes.

Postoperative Atrial Fibrillation: A Review.

Atrial fibrillation (AF) in the postoperative phase is a manifestation of numerous factors, including surgical stress, anesthetic effects, and underlying cardiovascular conditions. The resultant cardiac hyperactivity can induce new onset or exacerbate existing AF. A common phenomenon, postoperative atrial fibrillation (POAF) affects nearly 40% of patients and is associated with longer hospitalization stays, and increased mortality, heart failure, stroke, and healthcare costs. Areas of controversy in POAF include whether to anticoagulate patients who have short-lived POAF, especially given their higher bleeding risk in the postoperative period, and the identification of patients who would benefit the most from preventive drug therapy for POAF. This review discusses the pathophysiology and management of POAF, and strategies to reduce its occurrence.

Management of Indeterminate Thyroid Nodules: A Model Comparing Surgery, Molecular Testing, and Observation.

Optimal management of indeterminate nodules remains a controversial area of endocrine surgery. The purpose of this study is to compare observation, molecular testing, and immediate thyroid surgery for the management of Bethesda Classes III and IV nodules in patients age 50 to 90 years. A decision analysis was performed from April 22, 2021, to September 29, 2023, using a Markov model constructed with TreeAgePro 2023. Model variables and ranges were selected based on literature review data. TreeAgePro. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each management pathway, immediate thyroid surgery, additional molecular testing, or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis was performed 5 times with model patients assigned starting ages of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would impact model results. Outcomes were measured with quality-adjusted life-years and accounted for perioperative complications including permanent recurrent laryngeal nerve injury, permanent hypoparathyroidism, and medical complications. In the study models, molecular testing was more beneficial than surgery and observation across all ages. The age threshold at which observation became more beneficial than surgery as the next best option was 83.1 years. However, the clinical difference between all 3 treatment algorithms was relatively minimal. Decision-making regarding indeterminate thyroid nodules is complex. Given the clinically similar results across all 3 treatment algorithm, this study reinforces that treatment modalities should be individually tailored and based on shared physician-patient decision making.

Update on the ethical, legal and technical challenges of translating xenotransplantation

This manuscript reports on a landmark symposium on the ethical, legal and technical challenges of xenotransplantation in the UK. King’s College London, with endorsement from the British Transplantation Society (BTS),...

Removal of mandibular third molars: An overview of risks, a proposal for international community and guidance.

The aim of this proposal is to (1) review the current literature, (2) shed light on the importance of creating universally accepted guidelines, (3) provide help and guidance in the decision-making process with regard to the removal of mandibular third molars (M3Ms), and (4) reduce the risk of exposing the patient to unnecessary harm and complications due to the inappropriate removal or retention of M3Ms.It is obvious that the indications for the extraction of M3Ms will continue to be an area of controversy and strong debate. The evidence for or against prophylactic extraction is ambivalent; there is evidence to accept or reject the stance against prophylactic extraction in some specific cases, and there are published articles to support both opposing views. The available guidelines on the extraction of third molars are limited in number, and are mostly tailored to fit specific settings or countries. There are no available guidelines that might be widely used to help in the decision-making process for the international community. We hope this proposal will constitute an important first step toward creating universally accepted guidance.

Diagnosis, management and follow-up of follicular lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance.

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma subtype, accounting for 15-20% of all lymphoma diagnoses. Although typically slow-growing and responsive to frontline therapies, advanced-stage FL remains incurable with current treatments and typically follows a chronic relapsing/remitting course with increasingly shorter responses to subsequent lines of therapy. Outcomes are highly variable; some patients experience prolonged first remissions that may approximate a 'functional cure'. By contrast, a significant minority of patients experience disease progression shortly after frontline treatment resulting in high rates of lymphoma-related mortality. Reflecting on the heterogeneous natural history of FL, clinical practice varies widely, particularly in controversial areas, including appropriate disease staging, selection of management strategies and duration of clinical follow-up. This position statement presents an evidence-based synthesis of the literature for application in Australasian practice.

Public Opinion and Implications of Nepal’s Involvement in Hydropower Cooperation with India

As two neighboring but power-divided countries, Nepal and India not only have deep historical ties but also have experienced many fluctuations in the development of bilateral relations. The water issue has always been one of the sensitive factors affecting the bilateral relationship between Nepal and India. In recent years, with the increase in Nepal’s power generation capacity and India’s focus on energy issues, hydropower has gradually become an important and controversial area of cooperation between the two countries. India’s use of Nepal’s hydropower as a tool for strategic competition with China and its attempts to increase its control over Nepal’s hydropower has also sparked multiple discussions in Nepal.

The problem of the efficiency of criminal-legal protection of taxation in Ukraine

The paper analyzes the doctrinal definition of the taxation system of Ukraine as an object of criminal law protection. It was established that the criminal offenses provided for by Articles 204 of the Criminal Code and 212 of the Criminal Code encroach on one type of social relations - the taxation system. It is noted that the institution of legal responsibility, including criminal responsibility, is considered the most effective. It was determined that the resolution of conflicts and practical problems that arise during the qualification of the specified offenses is extremely important and precisely in today's realities and will contribute to increasing the effectiveness of criminal law protection in the field of taxation in Ukraine. Tax and contribution evasion are purposeful actions by taxpayers aimed at significantly reducing or completely avoiding the required payment to the relevant budget or trust fund. It should be noted that tax legislation is one of the most controversial and dynamic areas in Ukraine, constantly changing, supplementing, interpreting and adapting to new challenges of an economic and social nature in the country, while regulating and shaping tax policy. Changes and additions are often made to legislative acts in this area, which ensures flexibility of legal regulation of tax relations and at the same time violates such principles of construction and purpose of the taxation system as stability and affordability. We support the position of scientists that the object of criminal law protection is those social relations that are under the protection of criminal law. In the case of committing a tax criminal offense, on the basis of the norms of the criminal law, the criminal law qualification of the criminal act is carried out and the criminal law measures of influence are applied to the guilty person. Therefore, the issue of increasing the effectiveness of criminal law protection in the field of taxation in Ukraine, solving conflicts and practical problems that arise in the qualification of the specified offenses and legal assessment of committed actions, improving the conceptual apparatus is extremely important and relevant precisely in today's realities, because the financial security of the country is not the most important component of ensuring the possibility of implementation of state programs.

COVID-19 Coagulopathy.

Coronavirus disease of 2019 (COVID-19) is the respiratory viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite being a primary respiratory illness, it is commonly complicated by systemic involvement of the vasculature leading to arterial and venous thrombosis. In this review, we will focus on the association between COVID-19 and thrombosis. We will highlight the pathophysiology of COVID-19 coagulopathy. The clinical manifestations of COVID-19 vasculopathy will be discussed with a focus on venous and arterial thromboembolic events. COVID-19 vasculopathy and disseminated intravascular coagulation (DIC) are distinguished within, as well as areas of controversy, such as "long COVID". Finally, the current professional guidelines on prevention and treatment of thrombosis associated with SARS-CoV-2 infection will be discussed.

Measuring the Impact of Written Corrective Feedback (WCF): The Methodological ins and outs

The interest in the study of written corrective feedback (WCF) has led to the identification of two controversial areas: the impact of the different types of WCF and the methods used in the studies. The present study aims to contribute to the clarification of the latter by examining the methods section of recently published research articles. Its objective is to review the current state of the experimental research designs in WCF studies. For this, eleven published studies were randomly selected and analyzed considering as inclusion criteria that they were empirical studies published in journals indexed in Web of Science and/or Scopus during the last eight years. The findings have been grouped into two categories: research designs and data analysis procedures. Regarding research design, there is a growing concern for ecological validity, the inclusion of delayed post-tests, and the implementation of training on feedback types for students. Concerning data analysis, the choice of a specific formula for error quantification was identified as a crucial decision researchers interested in WCF must make. It is hoped that this study will guide future research, ensuring a solid methodological design in line with current publications in prestigious journals. By following the trends identified in recent prestigious research, it is more likely that research can address the concerns surrounding the effectiveness of different types of WCF.

725 Delphi Consensus to Improve Patient Safety in the Aesthetic Injectables Market: Consensus, Controversies and the 5Ps Framework

Abstract Aim The rapid growth of the aesthetic injectables sector presents a public health challenge given limited regulations to date. This study aimed to establish agreed proposals from industry experts and practitioners to uphold and safeguard patient safety. Method A Delphi consensus design was adopted comprising three survey rounds. Industry practitioners and experts were invited to suggest proposals to improve patient safety. We used the MoSCoW prioritization technique to aid practitioners in attributing importance and significance to proposals. Consensus was defined a priori as 75%. Results One-hundred-and-twenty-two practitioners completed Round 1, 100 completed Round 2 and 51 completed Round 3. A total of 38 proposals were identified after consolidation and removal of duplicates from Round 1. Round 2 established consensus on 16 items, and 18 items went to Round 3 but consensus was not achieved on all these items. Of the 38 proposals initially made, a series of five overarching themes emerged as fundamental for stakeholders. Issues relating to patients, practitioner skills or competence, product type and storage, place of practice and promotion techniques were the key themes. From these we propose and evaluate the five Ps framework: Patient, Practitioner, Product, Place and Promotion. Conclusions Our Delphi consensus study establishes consensus for 16 key proposals to improve patient safety. The study also highlights areas of controversy and proposes the novel 5Ps framework to help appraise the aesthetics industry.

O-117 Advances in PGT diagnostics - technologies beyond copy number

Abstract Genetic abnormalities are well recognised as the main factor contributing to the high rate of infertility, pregnancy loss and congenital abnormalities in humans. A prime example of this can be seen from recent studies showing that embryos identified as uniformly aneuploid following PGT-A have little to no reproductive potential. However, embryos shown to have no gross chromosomal abnormalities after PGT are not a guarantee of healthy pregnancy and many other undetected genetic issues are likely to influence embryo competence. Developments in both sample preparation and methods for DNA analysis are driving ever-increasing data yield from PGT platforms, permitting not only DNA quantitation, but also allowing qualitative evaluation of genotyping data in parallel. This opens the door to the possibility of overcoming some of the previous limitations of PGT, leading to a more comprehensive assessment of the genetic health and reproductive potential of embryos. How to use this increasing amount of information, and if it can tangibly improve test accuracy and clinical outcomes, remains open to debate. There is, for instance, no consensus on how to interrogate genotyping data for better distinction of clinically relevant aneuploidy as well as genome wide (ploidy) abnormalities and exogenous DNA contamination, which could impact the correct reporting of PGT results. There is also no consensus on the potential benefit of genotyping data to be used for the accurate distinction of meiotic recombination by linkage analysis, nor for fingerprinting of embryos to identify rare, but catastrophic, lab error events as a routine part of treatment. Finally, there is no clear path on how to utilise these improvements in embryo genotyping, to detect sub-chromosomal de novo genetic abnormalities that could impact embryo viability beyond the scope of current testing for chromosomal abnormalities alone. The aim of this presentation is therefore to focus on the current state of the ART and address the current and potential future uses of genotyping in PGT. Topics covered will include identification of biopsy sample contamination to determine the truth from the noise, through to how we can rescue embryos by utilising PGT as a molecular fertilisation check and how fingerprinting of embryo can be an invaluable tool in the clinic. The origin of aneuploidy will be explored and how genotyping is reshaping our understanding of aneuploidy landscape of the preimplantation embryo. From a more basic science perspective, the potential of genotyping to identify meiotic recombination will be discussed and how this fundamental element of human reproduction could be an important biomarker for reproductive competence. Lastly future perspectives on how the evolution of PGT technologies can bring us closer to the accurate detection of de novo genomic changes will be explored and how this is taking PGT-A beyond just aneuploidy detection. It is no secret that PGT for embryo selection continues to be a controversial area of reproductive medicine, and the field of PGT-A especially continues to show disquieting inconsistency in data analysis and reporting. This new era of genotyping brings with it information that can be used as a standardization tool helping to focus and facilitate improvements in the field of PGT for better and more consistent clinical reporting and outcomes.

Molecular and cellular neurocardiology in heart disease.

This paper updates and builds on a previous White Paper in this journal that some of us contributed to concerning the molecular and cellular basis of cardiac neurobiology of heart disease. Here we focus on recent findings that underpin cardiac autonomic development, novel intracellular pathways and neuroplasticity. Throughout we highlight unanswered questions and areas of controversy. Whilst some neurochemical pathways are already demonstrating prognostic viability in patients with heart failure, we also discuss the opportunity to better understand sympathetic impairment by using patient specific stem cells that provides pathophysiological contextualization to study 'disease in a dish'. Novel imaging techniques and spatial transcriptomics are also facilitating a road map for target discovery of molecular pathways that may form a therapeutic opportunity to treat cardiac dysautonomia.

Surgical treatment of colorectal endometriosis: an updated review.

This review aims to summarize recent literature on the surgical treatment of colorectal endometriosis. The last decade has seen a surge in the number of studies on bowel endometriosis, with a focus on preoperative evaluation, perioperative management, surgical approach, and surgical outcomes. Many of these studies have originated from large-volume referral centers with varying surgical approaches and philosophies. Colorectal surgery for endometriosis seems to have a positive impact on patient symptoms, quality of life, and fertility. However, these benefits must be weighed against a significant risk of postoperative complications and the potential for long-term bowel or bladder dysfunction, especially for more radical procedures involving the lower rectum. Importantly, most studies regarding surgical technique and outcomes have been limited by their observational design. The surgical management of bowel endometriosis is complex and should be approached by a multidisciplinary team. Methodical preoperative evaluation, including appropriate imaging, is vital for surgical planning and patient counseling. The decision to perform a more conservative or radical excision is nuanced and remains an area of controversy. High quality studies in the form of multicenter randomized controlled trials are needed before clear recommendations can be made.