Hard Cases Research Articles

LVI-PathNet: Segmentation-classification pipeline for detection of lymphovascular invasion in whole slide images of lung adenocarcinoma

Lymphovascular invasion (LVI) in lung cancer is a significant prognostic factor that influences treatment and outcomes, yet its reliable detection is challenging due to interobserver variability. This study aims to develop a deep learning model for LVI detection using whole slide images (WSIs) and evaluate its effectiveness within a pathologist's information system. Experienced pathologists annotated blood vessels and invading tumor cells in 162 WSIs of non-mucinous lung adenocarcinoma sourced from two external and one internal datasets. Two models were trained to segment vessels and identify images with LVI features. DeepLabV3+ model achieved an Intersection-over-Union of 0.8840 and an area under the receiver operating characteristic curve (AUC-ROC) of 0.9869 in vessel segmentation. For LVI classification, the ensemble model achieved a F1-score of 0.9683 and an AUC-ROC of 0.9987. The model demonstrated robustness and was unaffected by variations in staining and image quality. The pilot study showed that pathologists' evaluation time for LVI detecting decreased by an average of 16.95%, and by 21.5% in “hard cases”. The model facilitated consistent diagnostic assessments, suggesting potential for broader applications in detecting pathological changes in blood vessels and other lung pathologies.

Vague Disagreements: Vagueness Without Arbitrary Stipulation

Abstract According to Ruth Chang (2002, 2022), incommensurability in hard cases cannot be cases of vagueness. This is because vagueness, unlike hard cases, can always be resolved by arbitrary stipulation, leaving no resolutional remainder or substantive disagreement. Contrary to this, I argue that Chang’s argument fails because proponents of the vagueness view are in no way necessarily committed to the claim that vagueness always can be resolved by arbitrary stipulation. In fact, there seems to be no reason to assume that vagueness could not accommodate our intuitions about resolutional remainder and substantive disagreements in a satisfying way. If we want a simple theory, and if at least some incommensurability is vagueness, this could then be a reason for understanding incommensurability as vagueness; and perhaps even rejecting parity.

Automated, administrative decision‐making and good governance: Synergies, trade‐offs, and limits

AbstractAutomated, administrative decision‐making (AADM) is a key component in digital government reforms. It represents an aspiration for a better and more efficient administration but also presents challenges to values of public administration. We systematically review the emerging literature on use of AADM from the perspective of good governance. Recognizing the inherent tensions of values of public administration, the broad review identifies key synergies, trade‐offs, and limits of AADM and good governance associated with nine values: Accountability, efficiency, equality, fairness, resilience, responsiveness, right‐to‐privacy, rule‐of‐law, and transparency. While synergies represent “low‐hanging fruits”, trade‐offs and limits are “hard cases” representing challenges to good governance. Taking the specific decision‐making context into account, practitioners and scholars should attempt to nurture the “fruits” and lessen the tensions of the “hard‐cases” thereby increasing the desirable societal outcomes of use of AADM.

Does Norwegian Aid Reward Equitable Access to Health in Recipient States? Assessing a ‘Moral Superpower’s’ Aid to Pro-Poor Development, 1990–2019

We assess if Norwegian aid policies, widely heralded for being morally driven, rewards pro-poor governance. If higher levels of equitable access to health attracts higher levels of Norwegian aid, one might argue that Norwegian aid prioritizes the poor, which is both morally good and instrumentally valuable. We find that total Norwegian aid and aid for health and social development are economically less valuable to recipients with greater equity of access to health. Yet, one may argue that this result is due to Norway picking the hard cases, those resistant to change. Our results show, however, that Norwegian aid increases to places that have become more equitable over time while simultaneously remaining lower to currently equitable locations. Whether Norway is ‘chasing success’ or actually ‘rewarding reform’ is hard to untangle although, in our opinion, a sound donor strategy should be one that targets currently favorable policy, signaling to laggards that change is rewarded. Granger causality tests for assessing the likelihood of reverse causality suggest that higher levels of equity are more likely to ‘Granger cause’ aid (negatively) than the other way around, suggesting that aid flows are unlikely to be causing equity in the short run. If in fact a country such as Norway fails the poor, at least on this important dimension of equity, then it is hardly reasonable to expect differently from others. The results taken together support critics who suggest that aid often bypasses the poor.

Statutory interpretation and the administrative state: refocusing the purposivist/intentionalist debate

Abstract Questions of statutory interpretation form a significant portion of administrative law cases. Accordingly, judicial methodology in this area requires careful consideration by public law commentators. The core aim of this paper is to question the general orthodoxy that statutory interpretation is invariably a question for judges. In recent times, one prominent argument has been that between jurists arguing that interpretation should be the realisation of Parliament's intention (‘intentionalist’), and those who prefer the closely related but subtly distinct focus on its objective purpose (‘purposivist’). I contend that this argument, framed as a question over the inter-institutional relationship between Parliament and the courts, focuses on how interpretation is carried out without considering who is best placed to do the interpreting. Given, as I demonstrate with a series of case studies, that in hard cases the distinction between interpretation and discretion/policymaking can become obscure to the point of nullity, the debate fails to consider institutional arguments for judicial deference on questions of law. Moreover, and counterintuitively, the arguments of the intentionalists/purposivists can be used to bolster an argument for deference. My conclusion adopts a wider lens, setting out a broader constitutional argument for, and addressing objections against, cautious and context-sensitive deference.

Spatial-Temporal Graph Enhanced DETR Towards Multi-Frame 3D Object Detection.

The Detection Transformer (DETR) has revolutionized the design of CNN-based object detection systems, showcasing impressive performance. However, its potential in the domain of multi-frame 3D object detection remains largely unexplored. In this paper, we present STEMD, a novel end-to-end framework that enhances the DETR-like paradigm for multi-frame 3D object detection by addressing three key aspects specifically tailored for this task. First, to model the inter-object spatial interaction and complex temporal dependencies, we introduce the spatial-temporal graph attention network, which represents queries as nodes in a graph and enables effective modeling of object interactions within a social context. To solve the problem of missing hard cases in the proposed output of the encoder in the current frame, we incorporate the output of the previous frame to initialize the query input of the decoder. Finally, it poses a challenge for the network to distinguish between the positive query and other highly similar queries that are not the best match. And similar queries are insufficiently suppressed and turn into redundant prediction boxes. To address this issue, our proposed IoU regularization term encourages similar queries to be distinct during the refinement. Through extensive experiments, we demonstrate the effectiveness of our approach in handling challenging scenarios, while incurring only a minor additional computational overhead. The code is publicly available at https://github.com/Eaphan/STEMD.

Prevalence of Dental Hard Tissue Diseases Before and During the Pandemic in South Sumatera Dental Hospital

Introduction: The most common dental problems in Indonesia are broken/cavities/toothache. Dental hard tissue disease is one of the ten biggest outpatient diseases in South Sumatera Dental Hospital. The dental practice has been limited since the COVID-19 pandemic occurred. The frequency of permanent dental hard tissue disease cases at South Sumatera Dental Hospital has increased due to limited treatment access. Purpose: This study aims to find out the prevalence of permanent dental hard tissue disease before and during the pandemic at South Sumatera Dental Hospital. Methods: This study was a descriptive observational study with a cross-sectional design. Data were collected using the total sampling method, a medical record data on SIMRS BPJS application with a diagnosis of dental hard tissue disease at South Sumatera Dental Hospital. Results: The prevalence of dental hard tissue disease before and during the pandemic at South Sumatera Dental Hospital has decreased with the number before the pandemic being 2380 cases and during the pandemic was 770 cases. Conclusion: The prevalence of dental hard tissue disease at South Sumatera Dental Hospital has decreased during the pandemic. It is because the number of visits to health facilities has decreased due to the risk of spreading COVID-19 infection.

Primary care training needs about dementia. A Qualitative study

AbstractIntroductionThe prevalence of dementia in Chile is 1.06%, and it is expected to triple in the next 30 years. The current regulations establish that over 80% of the people living with dementia and their care partners should receive care in primary care with only the hard or atypical cases. However, the knowledge and confidence of primary care teams are low, and there is no current training scheme for them.ObjectivesTo identify the training needs of primary care teams, people living with dementia and their care partners, gathering information to create a course on dementia for primary care teams.MethodologyQualitative research methods were used, including focus group interviews for health professionals and individual interviews for people living with dementia and their care partners. A complete analysis of the recorded interviews was performed.ResultsDisregarding their previous training or background, all primary care professionals recognise the importance of continuous instruction. There is also a lack of preparation for interpersonal skills, like providing bad news and empathy. Caregivers and people living with dementia highlight a lack of continuity in their care team, being unaware of their diagnosis and low support.ConclusionsOur study supports the need for training for primary care on dementia. Even more, it finds some areas, like interpersonal skills, that are usually not covered in dementia education. Adding the patient’s and care partners' voices will allow our course to be adapted to their reality and expectations.

Trying to be heard – the voices of first nation People in Herzog’s Where the Green Ants Dream

ABSTRACT This article examines how speech and speech acts are central to Othering First Nations people in Australia. Werner Herzog’s film, Where the Green Ants Dream (1984), centres around a fictional Dreaming story about green ants, which connect individual ancestral beings with the creation process, as well as forming the basis of First Nation law and culture. The Dreaming story projected in this film is intertwined with a specific nation of First Nations people and their connection and relationship to their Country (land). The film reveals an uneasy relationship between Dreaming and the positive law. In projecting First Nations people’s speech and speech acts within the context of a trial, the film illustrates how the adversarial nature of the law (English common law versus First Nation laws and culture) does not always adequately deal with hard cases. This film manifests the trauma and violence of the white settler state upon First Nations people to illustrate the shortcomings of Australian legality and how the state reckons with the Other.

Judicial search for a legal definition of religion

A prerequisite for the proper application of the law is a certain definition of the terms used in the law. A variable definition of a concept undermines the requirement of legal certainty, and an overly narrow or broad definition of a concept (compared with the general idea of its content) may lead to doubts about the fairness of legal regulation. Although the legal system uses the term “religion” relatively frequently, it does not generally define it explicitly. In most cases, this does not cause problems because there is no reasonable doubt as to whether we are dealing with a religious element. In hard cases, however, there is no choice but to decide where to draw the line between religion and other types of beliefs. The alternative is to stop distinguishing between them, thus depriving the religious element of its special legal status. The social sciences distinguish four basic approaches to the definition of a religious phenomenon. The substantive definition seeks to capture the content that a particular belief must satisfy in order to be labelled religious. The essentialist approach emphasises the experience of the believer. The functionalist definition notes the function that religion serves in the life of the believer. The analogical approach does not seek to capture the essence of religion but rather notes its manifestations and what different religions have in common. This article offers examples of the application of these theoretical approaches in jurisprudential practice. It also highlights the fact that courts work flexibly with the concept of religion and often give it a different content depending on the context under consideration.

Assessment of deep learning-based image analysis for disaster waste identification

Accurately predicting different types and quantities of wastes is crucial for proper waste management and sustainable growth and development. High levels of disaster waste (DW) can negatively impact emergency responses, public health, and recovery and rebuilding processes, making the effective management of DW highly important. Most existing waste identification methods cannot suitably identify DW since it is highly subjective in form. In this study, we examined the applicability of different deep learning-based image recognition techniques for DW recognition. A DW image dataset was collected and categorized into normal and hard cases. Then, experiments were conducted using these three network models: DeepLabV3+, ResNeSt-50, and ResNeSt-101. The experimental results indicated that the mean intersection over union (mIoU) of the DeepLabV3+ model was 0.802 for the normal case and that of the ResNeSt-101 model was 0.676 for the hard case, indicating favorable performances. Overall, the deep learning-based image analysis method is more robust than existing methods, particularly in terms of its ability to accurately identify waste in various forms, such as mixed or piled up waste.

The role of human dignity in the jurisprudence of the African Commission on Human and Peoples’ Rights

Human dignity is a concept that is often mentioned in core human rights treaties and national constitutions as the foundation of human rights. At its core it demands respect for the life and integrity of the human person, recognition of the equal worth of human beings and respect for their autonomy or self-determination. Many national and supra-national courtsalso use the concept to explicate the meaning and limitations of human rights. The constitutional court of Germany, South Africa and the European Court on Human Rights are notable in this regard. In recent years, the US Supreme Court has also increasingly used the concept in resolving hard cases and expanding the scope constitutional rights. Though, the role andapplication of human dignity has received considerable scholarly attention, it is mainly confined to the European constitutional orders and the US constitutional system. With respect to regional human rights systems, scholars have largely focused on examining the role of human dignity in the jurisprudence of European Court of Human Rights and the Inter-AmericanCourt. As such, little is known about what role human dignity is playing or could play in the interpretation of rights in the African human rights system. This is alarming considering the poor status of protection of human rights and weak constitutional right jurisprudence in many countries of Africa. Accordingly, this article seeks to fill the lacuna by examining the role of human dignity in the African human rights system by exploring its place in religious and cultural value systems of different African societies.

Prudence, Rules, and Regulative Epistemology

Following Ballantyne, we can distinguish between descriptive and regulative epistemology. Whereas descriptive epistemology analyzes epistemic categories such as knowledge, justified belief, or evidence, regulative epistemology attempts to guide our thinking. In this paper, we argue that regulative epistemologists should focus their attention on what we call epistemic prudence. Our argument proceeds as follows: First, we lay out an objection to virtue-based regulative epistemology that is analogous to the no-guidance objection to virtue ethics. According to this objection, virtue-based regulative epistemology cannot offer us useful guidance in our deliberations, because an abstract knowledge of virtue does not tell us what we should do here and now, especially in hard cases. We respond to this objection by showing that our making good epistemic decisions cannot simply be a matter of our following the right epistemic rules. In order to reliably inquire and deliberate well, we need epistemic prudence. Thus, while virtue-based regulative epistemology fails to determine how we should inquire and resolve deliberation here and now, this is also true of norm-based regulative epistemology. The upshot of this argument is that regulative epistemologists should focus their attention on understanding the nature of epistemic prudence and on understanding how we can promote its development in ourselves and others.

In Defense of Standard Approach to Logico-Semantic Explication of Non-Specific Transparent Interpretation of Propositional Attitude Reports

This study explores the phenomenon of the so-called “third reading” of propositional attitude reports. This reading, which was originally explored in the dissertation of J. Fodor (1973) and has since become one of the significant problems in the formal semantics of natural languages, differs from the more well-known de re and de dicto readings by being an intermediate case. If the de re interpretation can be referred to as transparent specific, and the de dicto interpretation as opaque non-specific, then the third reading is transparent non-specific. Fodor's standard solution has been the subject of much discussion in the literature and has given rise to a series of widely accepted counterexamples that are thought to demonstrate the limitations of Fodor's solution. At the same time, alternative approaches to the explication of these readings also suffer from formal shortcomings (for example, some of them did not satisfy the requirement of meaning compositionality, which is a basic requirement in formal semantic literature). This study points out that the analysis of all complex cases of the third reading did not fully take into account their syntactic structure. This remained unnoticed due to the ellipsis in many of these cases. It is shown that a restoration of the ellided syntactic structure makes it possible to analyze all hard cases as basic ones using the classical standard analysis proposed by Fodor supplemented by the principles of admissibility of substitution of L-equivalent expressions in intensional contexts (known since G. Frege and R. Carnap). In the final part of the work, it is demonstrated how exactly the main complex cases of the “third reading” are explicated in terms of the standard approach.

A DEMOCRACIA CONSTITUCIONAL CONTEMPORÂNEA: ESTUDOS PRELIMINARES SOBRE A PROCEDURALIZAÇÃO

This article intends to present the procedural system as a coordination mechanism of State action, which fits within the separation of powers, and it is a response to the paradoxical cases arising from post-modern society. In this way, the limits of constitutional law resulting from post-modern complexity will be presented, along with the problem of paradoxical cases, which are not those called "hard cases", and the paradigm of proceduralization as a measure of contemporary constitutional democracy. In addition, the stages and aspects of social structural construction that have built post-modern society will be presented, and that have raised the social problems of litigious cases, whose Judiciary has full capacity to decide them, to undecidable cases, especially with the process of extinction of metanarratives and the transition from the society of organizations to the society of platforms.

Parole populism and hard cases

Parole populism and hard cases

Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification.

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

Hard Cases Make Bad Law: Reflections on the South African Constitutional Court’s Jurisprudence on the Development of African Customary Law in South Africa

Judicial interpretation and adjudication are complex and controversial processes that the judiciary has been grappling with for centuries. This persists in modern constitutional judicial processes, particularly when adjudicating ‘hard cases.’ African customary law cases are indeed hard or difficult cases. This is especially so when it comes to the development of African customary law. This article reflects on the jurisprudence of the Constitutional Court of South Africa regarding the development of African customary law. It is concluded that although there were some commendable strides in the development of African customary law in a few cases at its inception, the court has in subsequent judgments faltered. In these ‘hard cases’ the court has, in many instances, adopted a conservative, formalistic, literalistic approach, often using technicalities to either avoid the development of African customary law or simply abdicate its judicial responsibility. This flies in the face of the project of transformative constitutionalism and produces bad law when it comes to the court’s jurisprudence on the development of customary law.

On the Dales–Żelazko conjecture for Beurling algebras on discrete groups

AbstractLet G be a group that is either virtually soluble or virtually free, and let ω be a weight on G. We prove that if G is infinite, then there is some maximal left ideal of finite codimension in the Beurling algebra $\ell^1(G, \omega)$, which fails to be (algebraically) finitely generated. This implies that a conjecture of Dales and Żelazko holds for these Banach algebras. We then go on to give examples of weighted groups for which this property fails in a strong way. For instance, we describe a Beurling algebra on an infinite group in which every closed left ideal of finite codimension is finitely generated and which has many such ideals in the sense of being residually finite dimensional. These examples seem to be hard cases for proving Dales and Żelazko’s conjecture.

Two Questions about Judaism with Answers for Christians

Two issues often trouble people trying to understand traditional Judaism: (1) If the Torah explicitly mentions sacrifice as an element in attaining atonement for sin, how can Judaism provide atonement for sin when sacrifice has been unavailable since the destruction of the Jerusalem Temple? (2) How can rabbinic law be legitimate when it clearly expands and deviates from the plain meaning of the Torah's legal passages? I address the first question by showing that much of Hebrew Scripture does not relate to sacrifice as a necessary or central element in the achievement of atonement. Ritual sacrifice is barely mentioned in the narratives and poems relating to sin and atonement in Hebrew Scripture. Furthermore, biblical texts relating to the period following the destruction of the First Temple (when sacrifice was unavailable) express no concern that without sacrifices atonement is impossible. I address the second question by demonstrating that Scripture does not set out its laws in sufficient detail for their practical observance. These details must have been available in a body of unwritten interpretation and explication that accompanied the revelation of biblical law and which was eventually preserved in rabbinic law. Furthermore, Scripture authorizes judges to decide hard cases and describes the creation of new yet legitimate religious practices unmentioned in the Torah. More generally, rabbinic tradition views the explication and expansion of Torah law as a central project of the Jewish people that expresses true respect for Torah law as a living body of religious knowledge and practice.