Comparison of the Efficacy and Safety of the American Thyroid Association Guidelines and American College of Radiology TI-RADS

ObjectiveTo evaluate the 2015 American Thyroid Association (ATA) guidelines and 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) for their efficacy in predicting malignant thyroid nodules and safety in recommending fine needle aspiration (FNA).MethodsWe reviewed data of 970 thyroid nodules from 908 patients with core needle biopsy pathology. We calculated the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for each guideline to predict malignancies. We compared the areas under the curve and FNA recommendations between the 2 guidelines.ResultsAccording to the core needle biopsy pathology, 59.9% (581/970) of the thyroid nodules were malignant. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value was 68%, 91%, 33%, 67%, and 70%, respectively, for the ATA guidelines and 70%, 84%, 49%, 71%, and 68%, respectively, for the ACR TI-RADS. Areas under the curve (ATA: 0.71 vs ACR TI-RADS: 0.74; P = .054) were similar when predicting malignancies. For the 545 nodules with maximum diameter ≥1.0 cm, the ACR TI-RADS recommended FNA less often than the ATA guidelines (83.3% [454/545] vs 87.7% [478/545]; P = .01). For the 321 malignant nodules with maximum diameter ≥1.0 cm, the proportions of FNA recommendations were not significantly different (ACR TI-RADS: 90.7% [291/321] vs ATA: 92.5% [297/321]; P = .06).ConclusionThe 2015 ATA guidelines and 2017 ACR TI-RADS showed a similar ability in predicting malignancies. Reducing FNA recommendations by the ACR TI-RADS would not lead to a significant decrease in the FNA recommendations given for malignancies with maximum diameter ≥1.0 cm.     

The genomics of micronutrient requirements

Healthy nutrition is accepted as a cornerstone of public health strategies for reducing the risk of noncommunicable conditions such as obesity, cardiovascular disease, and related morbidities. However, many research studies continue to focus on single or at most a few factors that may elicit a metabolic effect. These reductionist approaches resulted in: (1) exaggerated claims for nutrition as a cure or prevention of disease; (2) the wide use of empirically based dietary regimens, as if one fits all; and (3) frequent disappointment of consumers, patients, and healthcare providers about the real impact nutrition can make on medicine and health. Multiple factors including environment, host and microbiome genetics, social context, the chemical form of the nutrient, its (bio)availability, and chemical and metabolic interactions among nutrients all interact to result in nutrient requirement and in health outcomes. Advances in laboratory methodologies, especially in analytical and separation techniques, are making the chemical dissection of foods and their availability in physiological tissues possible in an unprecedented manner. These omics technologies have opened opportunities for extending knowledge of micronutrients and of their metabolic and endocrine roles. While these technologies are crucial, more holistic approaches to the analysis of physiology and environment, novel experimental designs, and more sophisticated computational methods are needed to advance our understanding of how nutrition influences health of individuals.     

The BEG Expert System – a multimedia identification system for arbuscular mycorrhizal fungi

 Knowledge of the biodiversity of arbuscular mycorrhizal fungi is limited and keys for their identification are not in a user-friendly format for the non-expert. An Expert System, linked to the BEG (La Banque Européenne des Glomales), has been developed on a CD-ROM to produce a multimedia identification system for these fungi. Accepted: 12 March 1996     

Predictive feedback in human simulated pendulum balancing

In studies of human balance, it is common to fit stimulus-response data by tuning the time-delay and gain parameters of a simple delayed feedback model. Many interpret this fitted model, a simple delayed feedback model, as evidence that predictive processes are not required to explain existing data on standing balance. However, two questions lead us to doubt this approach. First, does fitting a delayed feedback model lead to reliable estimates of the time-delay? Second, can a non-predictive controller provide an explanation compatible with the independently estimated time delay? For methodological and experimental clarity, we study human balancing of a simulated inverted pendulum via joystick and screen. A two-step approach to data analysis is used: firstly a non-parametric model—the closed-loop impulse response—is estimated from the experimental data; second, a parametric model is fitted to the non-parametric impulse-response by adjusting time-delay and controller parameters. To support the second step, a new explicit formula relating controller parameters to closed-loop impulse response is derived. Two classes of controller are investigated within a common state-space context: non-predictive and predictive. It is found that the time-delay estimate arising from the second step is strongly dependent on which controller class is assumed; in particular, the non-predictive control assumption leads to time-delay estimates that are smaller than those arising from the predictive assumption. Moreover, the time-delays estimated using the non-predictive control assumption are not consistent with a lower-bound on the time-delay of the non-parametric model whereas the corresponding predictive result is consistent. Thus while the goodness of fit only marginally favoured predictive over non-predictive control, if we add the additional constraint that the model must reproduce the non-parametric time delay, then the non-predictive control model fails. We conclude (1) the time-delay should be estimated independently of fitting a low order parametric model, (2) that balance of the simulated inverted pendulum could not be explained by the non-predictive control model and (3) that predictive control provided a better explanation than non-predictive control.     

Qualitatively distinct phenotypes in the design space of biochemical systems

Although characterization of the genotype has undergone revolutionary advances as a result of the successful genome projects, the chasm between our understanding of a fully characterized gene sequence and the phenotypic repertoire of the organism is as broad and deep as it was in the pre-genomic era. There are two fundamental unsolved problems that provide the context for the challenges in relating genotype to phenotype. We address one of these and describe a generic method for constructing a system design space in which qualitatively distinct phenotypes can be identified and counted, their relative fitness analyzed and compared, and their tolerance to change measured.     

Diabetes mellitus modeling and short-term prediction based on blood glucose measurements

Insulin-Dependent Diabetes Mellitus (IDDM) is a chronic disease characterized by the inability of the pancreas to produce sufficient amounts of insulin. Daily compensation of the deficiency requires 4-6 insulin injections to be taken daily, the aim of this insulin therapy being to maintain normoglycemia - i.e., a blood glucose level between 4 and 7 mmol/l. To determine the quantity and timing of these injections, various different approaches are used. Currently, mostly qualitative and semi-quantitative models and reasoning are used to design such a therapy. Here, an attempt is made to show how system identification and control may be used to estimate predictive quantitative models to be used in design of optimal insulin regimens.The system was divided into three subsystems, the insulin subsystem, the glucose subsystem and the insulin-glucose interaction. The insulin subsystem aims to describe the absorption of injected insulin from the subcutaneous depots and the glucose subsystem the absorption of glucose from the gut following a meal. These subsystems were modeled using compartment models and proposed models found in the literature. Several black-box models and grey-box models describing the insulin/glucose interaction were developed and analyzed. These models were fitted to real data monitored by an IDDM patient. Many difficulties were encountered, typical of biomedical systems: Non-uniform and scarce sampling, time-varying dynamics and severe nonlinearities were some of the difficulties encountered during the modeling. None of the proposed models were able to describe the system accurately in all aspects during all conditions. However, all the linear models shared some dynamics. Based on the estimated models, short-term blood glucose predictors for up to two-hour-ahead blood glucose prediction were designed. Furthermore, we explored the issues that arise when applying prediction theory and control to short-term blood glucose prediction.     

Digital interpretation and management of land cover - a case study of Cyprus

Knowledge based methods using Geographic Information System and Remote Sensing for land cover classification and future land allocation in Cyprus are presented. Land cover was categorized combining statistical classification and expert rules, using multi-temporal Landsat TM and MSS data, and digitized maps of elevation and geology. Land needed for future infrastructure was allocated using multi-criteria evaluation. Reforestation area were identified for Pinus brutia and P. nigra comparing expert rules and multi-criteria evaluation.     

Spatial analysis of marine categorical information using indicator kriging applied to georeferenced video mosaics of the deep-sea Håkon Mosby Mud Volcano

The exact area calculation of irregularly distributed data is in the focus of all territorial geochemical balancing methods or definition of protection zones. Especially in the deep-sea environment the interpolation of measurements into surfaces represents an important gain of information, because of cost- and time-intensive data acquisition. The geostatistical interpolation method indicator kriging therefore is applied for an accurate mapping of the spatial distribution of benthic communities following a categorical classification scheme at the deep-sea submarine Håkon Mosby Mud Volcano. Georeferenced video mosaics were obtained during several dives by the Remotely Operated Vehicle Victor6000 in a water depth of 1260 m. Mud volcanoes are considered as significant source locations for methane indicated by unique chemoautotrophic communities as Beggiatoa mats and pogonophoran tube worms. For the detection and quantification of their spatial distribution 2840 georeferenced video mosaics were analysed by visual inspection. Polygons, digitised on the georeferenced images within a GIS, build the data basis for geostatistically interpolated mono-parametric surface maps. Indicator kriging is applied to the centroids of the polygons calculating surface maps. The quality assessment of the surface maps is conducted by leave-one-out cross-validation evaluating the fit of the indicator kriging variograms by using statistical mean values. Furthermore, the estimate was evaluated by a validation dataset of the visual inspection of 530 video mosaics not included within the interpolation, thus, proving the interpolated surfaces independently. With regard to both validating mechanisms, we attained satisfying results and we provided each category applied for the identification of biogeochemical habitats with a percentage probability value of occurrence.     

Military Uses of Ocean Space and the Law of the Sea in the New Millennium

Military uses of ocean space consist of both movement rights and operational rights. Only movement rights, which include all rights associated with the mobility of seaborne forces, were codified in the LOS Convention. Operational rights, on the other hand, are primarily customary rights that are governed by the regime of freedom of the seas and defended by the naval power of the United States. This article begins by examining freedom of the seas as a principle of international law, as a bundle of user rights, and as a doctrine. It next examines the major challenges to freedom of the seas in terms of a construct called controlled access. After summarizing the major historical elements of controlled access, the article closes with a brief analysis of the threats to freedom of the seas for military purposes that are posed by multipolarity, the shift in U.S. naval strategy from the open seas to the coastal littorals, and in the withering away of U.S. naval superiority. The major arguments advanced throughout the article are that military uses of ocean space are hegemonic in nature, that their preservation depends on clear maritime superiority, and that they will come under increasing challenge and restriction as the balance of power at sea shifts from unipolarity to multipolarity by the middle of the new millennium.     

The ubiquitin-proteasome system and autophagy: Coordinated and independent activities

The living cell is an ever changing, responsive, and adaptive environment where proteins play key roles in all processes and functions. While the scientific community focused for a long time on the decoding of the information required for protein synthesis, little attention was paid to the mechanisms by which proteins are removed from the cell. We now realize that the timely and proper activity of proteins is regulated to a large extent by their degradation; that cellular coping with different physiological cues and stress conditions depends on different catabolic pathways; and that many pathological states result from improper protein breakdown.There are two major protein degradation systems in all eukaryotic cells—the ubiquitin- proteasome and the autophagy-lysosome. The two systems are highly regulated, and—via degradation of a broad array of proteins—are responsible for maintenance of protein homeostasis and adaptation to environmental changes. Each is comprised of numerous components responsible for its coordinated function, and together they encompass a considerable fraction of the entire genome.In this review, we shall discuss the common and diverse characteristics of the ubiquitin-proteasome system (UPS) and autophagy—their substructure, mechanisms of action, function and concerted regulation under varying pathophysiological conditions.