Controversial Category Research Articles

Patient outcomes following surgical management of thyroid nodules classified as Bethesda category III (AUS/FLUS)

Introduction: The Bethesda classification system for reporting thyroid cytopathology is the standard for interpreting fine needle aspirate (FNA). Because of its heterogeneity and inconsistent reporting, atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), known as Bethesda category III, is the most controversial category. Thyroid nodules that fall within Bethesda categories III-IV have an overall risk of malignancy of between 15-40%. The aim of this study was to determine the malignancy rate in Bethesda III nodules.

The impact of repeat fine-needle aspiration in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance: A single center experience.

Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is the most controversial category of the Bethesda System. The present study was conducted to compare the histological findings in a series of thyroid nodules diagnosed with AUS/FLUS after single or repeat fine needle aspiration (FNA) cytology. Retrospective analysis of our institution's series of 514 patients with an initial diagnosis of AUS/FLUS between 11/2011 and 02/2020. Of 4887 FNA samples, 11.8% were classified as AUS/FLUS. Of patients with an initial AUS/FLUS diagnosis, 11.5% (59/514) underwent surgery after a single FNA, 55.4% (285/514) had a repeat FNA, and 32.7% (168/514) were either observed or lost to follow-up. Surgical pathology was available in 123 cases (23.9%), and malignancy was confirmed in 32.5% (40/123) cases, with similar rates in the single 32.2% (19/59) and repeat FNA 32.8% (21/64) groups. Repeat FNA reclassified 78.9% of the AUS/FLUS cases to a different category: 57.2% were reclassified as benign, 10.5% as follicular neoplasm, and 5.6% as suspicious for malignancy or malignant. The rates of nonneoplastic benign lesions were 52.5% (31/59) and 31.2% (20/64) in the single and repeat FNA groups, respectively (P = .018). The rates of follicular adenomas were higher when repeat FNA was performed (23/64, 35.9%) compared with a single FNA (9/59; 15.2%) (P = .013). In this series, a repeat FNA in cases of AUS/FLUS increased detection of follicular adenomas but not the detection of malignancy. Repeat FNA reduced the rate of benign nonneoplastic lesions by 40% in the surgical samples.

Dualism of the legal status of the head of the organization

The status of the head of a business company is a controversial legal category. The relevance of this issue is determined by the complexity of the nature of legal relations that develop at the intersection of labor and corporate law. The ambiguity of judicial practice in the qualification of the position of a person who is both a separate part of a legal entity and an employee makes it necessary to search for priority rules of law.

Retrospect and Prospect of the Research on Finiteness

Finiteness has long been a controversial category. In particular, on its cross-language definition criteria, the academia has not reached a consensus so far. An examination of the trend of the research on finiteness can provide reference for its further study. The paper makes a systematic investigation into the research on finiteness, and finds that the research of finiteness has a tendency from phenotype to cryptotype, from verb to clause, from syntax to function, from monolingual perspective to typological one. From this trend, it can be inferred that the definition criteria of finiteness can be made more explicit if these features are integrated into its future study.

Ritual, Sex and the Body: Heterodox Ritual Practices at Pilgrimage Sites in Central Java

This article compares three pilgrimage sites in Central Java known for heterodox ritual practices. These practices include sexual activities between partners who are not married to each other (ritual seks). Since the sexual partners meet each other as strangers, they ignore the possible differences of rank and status between them and encounter each other as equals. These practices are part of a ritual repertoire that is constitutive of a current within Islam for which the controversial category abangan has established itself in anthropological discourse. The fact that these ritual practices have been enjoying an unprecedented boom in the context of local pilgrimages since the 1980s sheds a different light on the widely held thesis of a decline in this social category. Rather, this boom makes it clear that the Islamisation of Indonesia is not a linear process, but is ambivalent and contradictory.

Oral bisphosphonates as the therapy of choice in patients with moderate risk of fractures

Nowadays clinicians have access to high-quality diagnostic algorithms to determine the risk of fractures and the need for treatment, as well as the ability to choose the most advanced drug therapy that will be the most suitable, comfortable and safe for the patient with osteoporosis. This algorithm for the selection of therapy is based on an assessment of the fracture risk, which is determined by the presence and severity of low-energy fractures, the level of bone mineral density (BMD), and the 10-year probability of fractures. Patients with a moderate risk of osteoporotic fractures are the most controversial category of patients regarding the choice and assessment of the prognosis of treatment, since they either have no history of fractures or have suffered only one low-energy fracture due to osteopenia or normal BMD. In such cases, oral bisphosphonates with a planned treatment duration of 5 years were recommended as starting therapy for osteoporosis. Alendronic acid is the most well-known and widely prescribed oral bisphosphonate, characterized by financial availability and a favorable profile of clinical efficacy in the treatment of osteoporosis. The effectiveness of treatment with oral bisphosphonates is largely determined by the tolerability of the drug and patient adherence to treatment. Gastrointestinal side effects and the lack of patient motivation are the main reasons for the low adherence to anti-osteoporotic therapy. Due to the low incidence of adverse events and the convenient pharmacological form for enhancing treatment compliance, alendronate buffer solution in soluble effervescent tablets may be preferred in patients with a moderate risk of fractures. Solubilized in a buffer solution alendronate less contacts the mucous membrane of the esophagus and stomach, minimizing contact between the particles of the drug and the mucous membrane of the upper gastrointestinal tract, and ultimately reducing the local irritating effect and the likelihood of gastroesophageal reflux.

Risk Stratification of Thyroid Nodules with Bethesda III Category: The Experience of a Territorial Healthcare Hospital.

BackgroundThe Bethesda System for Reporting Thyroid Cytolopathology (TBSRTC) is the standardized category-based reporting system for thyroid nodule (TN) aspirations; however, atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda category III, AUS/FLUS) is the most controversial category. The aim of this study was to identify the degree of malignancy risk and the related risk factors in the surgical pathology of the Bethesda Category III thyroid nodules. MethodsA total of 4074 patients (15-90 years, 81.5% of females) were subjected to retrospective analysis, and a total of 463 nodules were classified as Bethesda Class III and included in the analysis. Once all the thyroid cytopathological slides and ultrasound (US) reports were reviewed, they were classified according to the Bethesda System for Reporting Thyroid Cytology, the American College of Radiology (ACR) and the Thyroid Imaging Reporting and Data System (TI-RADS).ResultsAmong the 463 Bethesda class III nodules, 167 nodules were surgically excised, showing an overall malignancy of 27.6% (n = 46/167). Patients having thyroid-stimulating hormone (TSH) levels of >4.5 mIU/L (35%), TN <2 cm (34.6%), solid or nearly solid (28.7%), highly hypoechoic (58.3%), longer than wide (50%), lobulated (45.5%), punctate echogenic (48.6%), ACR TI-RAD 5 (55.2%) and falling under the ATA category of high suspicion (50%), displayed a higher risk of malignancy (ROM). The chi-square test revealed a strong association between the echogenicity, echogenic foci, ACR TI-RAD and American Thyroid Association (ATA) category between the malignant and benign nodules. The papillary thyroid carcinoma (PTC) follicular variant (39%) and PTC classical (27%) were identified, in this study population, as the commonest forms of thyroid cancer.ConclusionThe nodules with AUS/FLUS cytology malignancy rate are comparable with the earlier estimations of other countries. The ACR TI-RAD displayed more accurate diagnostic performances in predicting malignancy in the Bethesda III nodules. However, to confirm the accuracy of the molecular marker tests in specific cytological scenarios, more extensive studies are required in the future.

TEORIJA ODRAZA: KAŽNJAVANJE ŽENSKOG NARCIZMA U TEKSTOVIMA LAVA NIKOLAJEVIČA TOLSTOJA

Even though Lev Nikolayevich Tolstoy is mostly known as an opponent of (female) sexuality, this essay argues that female narcissism is an equally controversial category. As plots of three texts –the novellas “TheKreutzer Sonata” and “Family Happiness”,and the novel Anna Karenina –show, female characters have to convert ego-libido into object-libido in order to, while overcoming disappointment, reach Tolstoy’s idea of living for others. The first part of the essay is based on a close reading of Tolstoy’s novellas, and the second part examines the female characters of Anna Karenina. Instead of pointing out the differences between Kitty, Dolly and Ana, I am trying to foreground the ways in which they reflect each other, while linking Anna’s intertextual representations, two portraits, to Tolstoy’s remarks on the social functionof art. .

Shareholder Class Actions in Australia – Myths v Facts

Shareholder class action litigation is the most discussed and controversial category of class actions but, unfortunately, much of the analysis and commentary on shareholder class actions has been inaccurate. The purpose of this report is to provide comprehensive and accurate data with respect to the first 27 years and four months of shareholder class actions in Australia so as to facilitate an accurate evaluation of (or even an accurate general dialogue with respect to) shareholder class actions. The period in question - the review period - goes from 4 March 1992 to 30 June 2019. In light of the claims that have been made on numerous occasions over the last few weeks that there has been an explosion of class actions over the last 12 months or so, I will also provide some data on all Australian class actions filed over the review period.

The Insurability of Cyber Risk

In June 2017, the food and beverage conglomerate Mondelez International became a victim of the NotPetya ransomware attack. Around 1,700 of its servers and 24,000 of the company’s laptops were suddenly and permanently unusable. Commercial supply and distribution disruptions, theft of credentials from many users, and unfulfilled customer orders soon followed, leading to losses that totaled more than $100 million. Unfortunately, Zurich, which had sold the company a property insurance policy that included a variety of coverages, informed Mondelez in 2018 that cyber coverage would be denied under the policy based on the “war exclusion clause.” This case, now pending, will be a watershed moment for the cyber insurance industry, highlighting the great ambiguity around the insurability of certain types of cyber risk and the scope of coverage that insurers will provide in the case of a cyber incident. The literature on the insurability of cyber risk has focused all of its attention on questions of economic efficiency and viability. Scholarship has, for example, examined the actuarial challenges in cyber risk modeling and the likelihood for adverse selection resulting from information asymmetries and lack of historical claims data. Scholars have so far avoided a different set of considerations rooted not in economics but rather in public policy analysis of societal values. This paper lays the framework for such an analysis. Relying on traditional insurance and torts jurisprudence the paper makes the public policy case for limited legal interventions in the indemnification of three controversial categories of cyber harm: (1) acts of cyber terrorism or state-sponsored cyber operations; (2) extortion payments for ransomware attacks; and (3) administrative fines for violations of statutory data protection regulations. In so doing, the paper highlights systemic challenges to cyber insurance underwriting while explaining insurers’ role in increasing societal cyber posture by reducing the likelihood of moral hazard and suboptimal cyber-norms enforcement.

Evaluation of thyroid nodules classified as Bethesda category III on cytology and their malignancy rate: An institutional experience.

Background:Thyroid gland nodules are common and fine-needle aspiration (FNA) is the gold standard for screening those nodules. The Bethesda system for reporting thyroid cytolopathology standardized reporting thyroid nodules aspirations, but atypia of undetermined significance or follicular lesion of undetermined significance (Bethesda category III) was the most controversial category. The aim of our study is to review our institutional experience and analyze the clinical implications of making a diagnosis of AUS/FLUS (Bethesda category III).Methods:This is a retrospective study of an 889 thyroid FNAs from 825 patients in Salmaniya Medical Complex, during (January 2013–December 2017).Results:The most common cause for designating cases as AUS/FLUS (Bethesda category III) was the presence of features suggestive of papillary thyroid carcinoma, but not quite fulfilling the criteria for such diagnosis. Ninety-six cases were diagnosed as AUS/FLUS (10.7%), in which 26 (27%) patients underwent surgery without repeating the FNA, 25 (26%) underwent a second FNA and 43 (44.7%) patients were followed up by ultrasound. On repeating the FNA, 1 (4%) was unsatisfactory, 13 (52%) were benign, 10 (40%) were AUS/FLUS, and only 1 (4%) was categorized as malignant. Thirty cases were surgically excised, in which 4 (13.3%) were diagnosed as follicular adenoma, 2 (6.6%) as Hurthle cell adenoma, 9 (30%) as multinodular goiter, 5 (16.6%) as multinodular goiter with Hashimoto thyroiditis, 1 (3.3%) as colloid nodule with Hashimoto thyroiditis, and 9 (30%) as papillary thyroid carcinoma. Among all the cases diagnosed initially as AUS/FLUS (Bethesda category III), 9 (9.3%) cases were diagnosed as papillary thyroid carcinoma.Conclusion:Diagnostically, we almost meet the international standards of designating cases with AUS/FLUS (Bethesda category III) and approximate the risk of malignancy. However, the clinical management's guidelines should be followed to decrease the risk of unnecessary surgeries and their complications. There is a statistically significant correlation between the age and gender with the final histopathology report, respectively.

The Fate of Statues of Stalin in post-Soviet Countries: Some Critical Reflections on the Management of Contested Cultural Heritage

ABSTRACT The statues of Stalin can be inscribed in the controversial category of contested cultural heritage: they are simultaneously important resources of historical memory that celebrate the “man who defeated Nazism” as well as inconvenient symbols of a totalitarian leader who executed millions of people. In post-Soviet countries these statues have received drastically diverse treatments: a few have been preserved in situ, many have been toppled down, some have been removed from public accession, while others have been relocated in parks and museums. Still, identifying and enforcing an appropriate method of management for these statues remains a thorny issue. By critically analysing the cases of Asht (Tajikistan), Gori (Georgia), and Grūtas Park (Lithuania), this article provides some preliminary reflections on the complex dilemmas associated with the management of contested cultural heritage.

Prospective Study of Bethesda Categories III and IV Thyroid Nodules: Outcomes and Predictive Value of BRAFV600E Mutation.

Introduction:Atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has emerged as the most controversial category because of its heterogeneity and inconsistent reporting. There is a definite paucity in data available from the Indian subcontinent about the outcome of nodules carrying Bethesda category III or Bethesda category IV diagnoses.Aims and Objectives:The primary objective of our study was to determine the malignancy rate in Bethesda categories III and IV nodules. The secondary objectives were to determine predictive value of BRAFV600E mutation analysis on indeterminate thyroid nodules, predictive value of Thyroid image reporting and data system (TI-RADS) in malignancy prediction and to study the common histological variants in indeterminate nodules.Materials and Methods:This prospective study included 176 consecutive nodules of Bethesda categories III and IV, diagnosed over a period of 2 years from August 2015 to August 2017. A part of the fine needle aspirate was used to perform the BRAFV600E mutation analysis. The malignancy risk associated with these Fine needle aspiration Cytology categories were discussed with the patients. Those with Bethesda category IV diagnosis was advised surgery, whereas those with Bethesda category III were given the options of close follow-up with repeat FNA in 3 months or immediate surgery.Results:In our prospective study, there were 176 consecutive samples of categories III (140/79.5%) and IV (36/20.5%). Seventy-five (53.6%) category III nodules and 29 (80.6%) category IV nodules underwent immediate surgical excision. Fifty-five consecutive indeterminate cytology nodules were subjected for BRAFV600E. One of the samples was found to be positive for BRAF T1799A (V600E) mutation. The second sample harboured a missense mutation at position 1819 (TCC--GCC), wherein the codon 607 (TCC) coding for serine was substituted by alanine (GCC) which is a variant of unknown significance. In our study, the malignancy rate of Bethesda categories III and IV, which were triaged for immediate surgery were 54.6% and 72.4%, respectively.Conclusion:Malignancy rate in Category III at our center was much higher than that described by ATA and by other studies published from centers around the world, including the only two studies from India. In view of the strikingly high malignancy rate in these indeterminate nodules, strong consideration to surgery should be given to patients with FNA results suggesting these two categories. BRAFV600E mutation analysis in FNA specimen has limited utility in improving the preoperative diagnostic rate for malignancy.

Некоторые подходы к оценке феномена злоупотребления правом в уголовном процессе

Introduction. A wide discussion in the science of criminal procedure of the controversial category of “abuse of law” requires its careful study and reflection. Available in the doctrine of criminal procedure of the facts raise the question of the need for its normative consolidation. Purpose. The study of various options for understanding the essence of abuse of law, forms of its consolidation and implementation in the current legislation without disturbing the balance of rights and interests of participants in the criminal process. The main ways of normative consolidation of this category is seen as its consideration as a principle or a separate institution. Methods. The study used such methods as formal - legal, which allowed us to explore the possibility of integration of the concept of abuse of law as a principle of the criminal process, as well as comparative-legal, which have been mapped in existing literature the ways of counteracting abuse of law. Results. Approaches to the evaluation of the concept of abuse of rights in the criminal process, it is advisable to indicate the following: required the search of optimal balance of interests and rights of participants in criminal proceedings (which we mentioned above), fundamental (value), limited rights arising from the General principle of ensuring the right to protection and assessment of impacts of doctrinal and practical way. Conclusion. The authors propose to take into account as conditions of application of the studied category the balance of rights of participants of criminal proceedings, reduction of subjectivity, convergence of the picture of doctrinal and practical implementation. Such requirements are real under the condition of detailed regulation of each type of the revealed abuse of the right in the criminal procedure legislation by analogy of the part 3 Art. 217 of the Criminal Procedure Code.

At the origins of a tenacious narrative: Jacob Thomasius and the history of double truth

ABSTRACTThis article enquires into the origins of the historiographical notion of double truth, a prominent and controversial category in the modern study of medieval philosophy. I believe that these origins are to be found in a short text by Jacob Thomasius from 1663, entitled De duplici & contradictoria veritate, which stands as a very early and highly original example of a history of double truth. I propose a detailed analysis of this document in order to shed light on the mechanisms that transformed duplex veritas from a keyword in Thomasius’s Protestant milieu into a historiographical category. As I show, the De duplici & contradictoria veritate provides a historical legitimation of Thomasius’s own brand of Lutheran Aristotelianism. It does so in a highly ambiguous fashion, namely by bringing together the Lutheran theologian and proponent of double truth Daniel Hofmann with anonymous medieval “Averroists”. I venture an explanation for Thomasius’s line of action by uncovering two of his implicit sources.

Stroke : Highlights of Selected Articles

<i>Stroke</i> : Highlights of Selected Articles

Tax Preferences, Fiscal Transparency, and the Meaning of Welfare: An Experimental Study

What is the effect of providing personally tailored budgetary information on public attitudes to tax and spending? We address this question with a survey experiment based on the annual tax summaries introduced by the UK tax authorities in 2014. By subtly manipulating the categories of state spending – in particular, the controversial category of ‘welfare’ – to invoke a sense of unfairness, we show how budget information in general and the United Kingdom’s annual tax summaries in particular impact support for state spending. Though the stated aim of providing personalised tax receipts to income taxpayers is to enhance fiscal transparency, doing so may also damage support for state spending if the information provides a sense that existing redistribution is unfair. The article contributes to political science debates about public attitudes to tax and spending, the character and trade-offs of fiscal transparency, and the framing effects of welfare.

GENTRIFICACIÓN EN CENTROS HISTÓRICOS: UNA DISCUSIÓN CONCEPTUAL

El presente artículo busca la comprensión de la gentrificación en Latinoamérica a partir de un aná- lisis conceptual que plantea que esta no puede tratarse como un asunto aislado, sino que está vin- culada a la gestión urbano-patrimonial –en tanto efecto frecuente de la planificación urbana– y al centro histórico –en tanto área de la ciudad con cierta particularidad, no solo de carácter histórico sino, además, de historicidad de la ciudad–. La gentrificación tiende a desarrollarse en otras latitu- des en los espacios centrales; de ahí surge el interés por comprender las posibilidades de que los centros históricos latinoamericanos sean o no espacios generadores de gentrificación. Además de buscar profundizar en conceptos y teorías, el propósito de este texto es determinar, a partir ciertas casuísticas latinoamericanas, si resulta objetivo hablar de gentrificación en los centros históricos de América Latina, y qué particularidades de la región determinan cómo se desarrollan allí los procesos de ese tipo. La gentrificación en la actualidad es una categoría controversial debido a su origen an- glosajón, puesto que toda conceptualización euro-norteamericana genera cuestionamientos entre muchos autores latinoamericanos respecto de la idoneidad de su uso.

Malignancy rate in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance - An institutional experience.

Introduction:Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) of Bethesda system for reporting thyroid cytopathology has emerged as most controversial category due to its heterogeneity and inconsistent usage. Initially associated risk of malignancy was estimated to be about 5–15%, but eventually different results have been obtained across institutions due to variable follow-ups and interpretation. The present study was conducted to evaluate the rate of malignancy along with appropriate management in this category.Materials and Methods:The study included AUS/FLUS cases diagnosed over period of 4 years on thyroid fine needle aspiration cytology (FNAC). Detailed clinical history and radiological examination were recorded along with follow-ups and management of all cases. Histopathology was available for cases which underwent surgery due to high clinical suspicion, worrisome radiological features or two consecutive AUS/FLUS reports.Results:The incidence of AUS/FLUS was 6.4% with repeat FNAC done in 39.6%, immediate surgery in 49.2% and follow-up without intervention in 11.1% cases. The overall malignancy rate was 28.5% with most common malignancy being follicular variant of papillary carcinoma (FVPC). Malignancy rate was more in cases (24.1%) which morphologically showed atypical nuclear features in comparison to architectural atypia.Conclusion:AUS/FLUS is associated with higher risk of malignancy than previously anticipated. Surgical intervention may have greater implication than repeat FNAC in appropriate management of this category. Substratification of this category according to nuclear features and architecture may be more useful in predicting malignancy risk and reducing the variability in the group.

A Comparative Study of Refuge in Iran and Australia under Principles of Geneva Convention

The refuge and its rights are considered as one of the controversial categories and issues of the human rights. In this regard, the Geneva International Convention and the attached protocol can be referred as the most important international document and the most important and valuable measurement criterion related to the refugees.In this research, the rules of Iran and Australia under the Geneva Convention and the attached protocol are compared, that the Iran and Australia’s government have joined it. It seems that considering the accession of both Iran and Australia countries to the Geneva Convention, the domestic rules of these countries are perfectly conformed to this international document. Also, it seems that considering the reports of the Australia human rights commission and other defenders’ authorities of human rights, the approval of the Australia new rule about prohibition of the arrival of the refugees who arrived by boat illegally on seashore of this country and transferring them to other countries, is contrary to the principle of " not returning ", that has been mentioned in the related documents.