Subclinical hypothyroidism and cardiovascular risk: how to end the controversy

The indications for screening and TSH threshold levels for treatment of subclinical hypothyroidism have remained a clinical controversy for over 20 years. Subclinical thyroid dysfunction is a common finding in the growing population of older adults, occurring in 10–15% among those age 65 and older, and may contribute to multiple common problems of older age, including cardiovascular disease, muscular impairment, mood problems, and cognitive dysfunction (1). In 2004, both the U.S. Preventive Services Task Force (2) and a clinical consensus group of experts (3) concluded that the existing evidence about the association between subclinical hypothyroidism and cardiovascular risks, primarily cross-sectional or case-control studies (4), was insufficient. For example, a frequently cited analysis from the Rotterdam study found a cross-sectional association between subclinical hypothyroidism and atherosclerosis, as measured by abdominal aortic calcification (odds ratio, 1.7; 95% confidence interval [CI], 1.1–2.6) and prevalent myocardial infarction (MI) (odds ratio, 2.3; 95% CI, 1.3–4.0) (5). Conversely, the prospective part of this study included only 16 incident MIs; the hazard ratio (HR) for subclinical hypothyroidism was 2.50, with broad 95% CIs (0.70–9.10). Potential mechanisms for the associations with cardiovascular diseases among adults with subclinical hypothyroidism include elevated cholesterol levels, inflammatory markers, raised homocysteine, increased oxidative stress, insulin resistance, increased systemic vascular resistance, arterial stiffness, altered endothelial function, and activation of thrombosis and hypercoagulability that have all been reported to be associated with subclinical hypothyroidism (1, 6).

The controversy in the management of the N0 neck for squamous cell carcinoma of the maxillary sinus

Squamous cell carcinoma (SCC) of the maxillary sinus is a relatively rare disease. As the reported incidence of regional metastasis varies widely, controversy exists as to whether or not the N0 classified neck should be treated electively. In this review, the data from published series are analyzed to decide on a recommendation of elective treatment of the neck in maxillary SCC. The published series consist of heterogeneous populations of different subsites of the paranasal sinuses, different histological types, different staging and treatment modalities used and different ways of reporting the results. These factors do not allow for recommendations based on high levels of evidence. Given this fact, the relatively high incidence rate of regional metastasis at presentation or in follow-up in the untreated N0 neck, and the relatively low toxicity of elective neck irradiation, such irradiation in SCC of the maxillary sinus should be considered.

Vulnerability Following a Critical Life Event: Temporary Crisis or Chronic Distress? A Psychological Controversy, Methodological Considerations, and Empirical Evidence

This contribution deals with psychological vulnerability resulting from marital breakup after a long-term relationship. Despite the existing vast body of consolidated knowledge on divorce and psychological adaptation, there are still several controversies concerning the vulnerabilizing impact of marital breakup. One major issue refers to the question of whether vulnerability after marital breakup is a temporary crisis or rather a chronic strain. In this chapter we want to present two possible methodological options to tackle this question: First, comparing a sample of almost 1000 middle-aged persons, who were married on average 19 years, and who experienced a marital split within the last 5 years (4 time groups), with a group of age-matched married controls with regard to various indicators of psychological vulnerability (such as depression and hopelessness). Second, comparing within the divorced group the most vulnerable individuals (in terms of depression, hopelessness, life satisfaction) with those who were the least affected, regarding intra-personal resources (personality, resilience), divorce circumstances, post-divorce situation, and socio-economic resources. The study results underline the vulnerabilizing impact of marital breakup, but at the same time they reveal individual differences in psychological adaptation especially due to personality, new partnership, economic resources, and last but not least due to time. Furthermore our data strongly suggest that there is not a generalized psychological vulnerability after marital breakup, but that the emotional dimensions such as depression or feelings of not overcoming the loss are more affected than the more cognitive ones such as life satisfaction.

Controversy Total War

Total war is a controversial term used in the past by politicians, publicists and military officers as well as by computer specialists and academics in the present. Since its conception by French politicians during the First World War in a time of severe crisis (1916/17), it has become a term used by historians and other academics to cover a wide array of elements when looking at wars of the past. A real total war was and is impossible. Elements of total war – total war aims, total methods of warfare, total mobilization and total control – can, however, be identified and can serve as a useful tool for further transnational research on war.

Sectio caesarea: actual controversy

Caesarean section is one of the most frequently performed operations in human medicine. It has become a routine procedure with a very low morbidity and mortality. Over the centuries, it has emerged an essential achievement in obstetric medicine. In the presence of cephalo-pelvic-disproportion, cervical dystocia, malpresentation, preterm birth, macrosomia, placental insufficiency, placenta praevia or fetal distress it is crucial to improve the perinatal morbiditiy and mortality of mother and child. The procedure has become much more frequent over the past 20 years for multiple reasons. There is variety in incidence between countries but also regional differences. It's occurrence is being influenced by level of education and socio-economic status of the pregnant woman. In the meantime, also the longterm consequences of cesarean section are well known. The potential hazards for future pregnancies and deliveries are well described. Actual controversy addresses cesarean section on demand without any medical indication, which in fact is only seldom performed in Switzerland. The ethical justification of this procedure needs to be discussed in view of the current tendency towards autonomy and self-determination of the pregnant woman.

On the Controversy About the Presence of Grain Boundary Sliding in Mg AZ31

Highly-textured, rolled AZ31 sheet material shows a significant drop in the plastic anisotropy (r-value; r=εw/εt) in tension between 25°C and 200°C. This behavior was initially explained as a result of the increased activity of non-basal slip with increased temperature. Other authors suggested, however, that the mechanism resp onsible for this phenomenon was the activation of grain boundary sliding (GBS). Here, in-situ ten sile tests have been carried out in an SEM at various temperatures in order to obtain further evi dence of the role of GBS during moderate to high temperature deformation of Mg alloys, which remains highly controversial.

The Affective Dimensions of Social Controversy

Social controversy is a sustained, mediated debate between at least two oppositional parties which is more than just a difference of opinion; rather it is a persistent conflict over the political and cultural implications that dominant forms of communicative reasoning, practices, and norms have for a public. Simply put, during social controversies the norms guiding public life can be negotiated, reaffirmed, negated, and/or transformed. This can lead to progressive political, cultural, and/or social change in some instances, while establishing or reifying conservative and even oppressive norms, practices, and laws in others. Building upon Olson and Goodnight's (1994) theoretical and methodological framework of social controversy, this dissertation argues that scholars should analyze the role affect plays in this type of conflict as a means to address the regulation of public conduct as well as public discourse. The rhetorical and argumentative significance of the affective dimensions of social controversy have been conceptualized and analyzed via an examination of emotion-based claims and affective states that have become salient, discernable and/or apprehendable during specific public disagreements. Such a conceptualization demonstrates that critical insights regarding the norms that guide public conduct, the role risk and vulnerability play in the regulation of individuals' public behavior, and the relationship between affect and citizenship can be gained by focusing on a controversy's affective dimensions. To highlight the importance of the study of affect in social controversy as well as better understand the larger critical significance affect theory has for rhetorical and argumentation studies, this dissertation has analyzed the affective dimensions of three conflicts. They are: the Abu Ghraib prisoner abuse social controversy, the International Freedom Center social controversy, and the controversy over the 2004 French ban on conspicuous religious attire in public schools. The findings from this dissertation that have specific and general implications for future work in the field of controversy as well as rhetoric and argumentation, respectively.

Controversy between curriculum design and curriculum development of online "highly specialized" education in the field of construction

Nowadays, on a global level, the Higher Education System has a complex and broad horizon of curricular tools to use in the teaching and learning process. In addition to these new educational instruments, full of possibilities, we face specific socio-economic conditions that affect in a significantly way the Curriculum Development in certain knowledge areas (areas traditionally built on a methodology based on a physical presence of students in the classroom). Some areas such as Restoration, Rehabilitation or Construction Pathologies, and the construction sector in general, require very defined and particular knowledge that only a small number of experts claim as specialized training. All these aspects condition the teaching methodology performed in a physical classroom at a university campus (the only option used until recent years) and made us consider the integration of online teaching in these areas too. The present work shows the teaching methodology used for the development of two online courses, where we offer distance learning for "highly specialized" formation in the Edification area (an area where traditionally there was only classroom training). At the beginning, both courses were designed by classroom training, but got a really small number of applications due to the specialized topic proposed. Later, we proposed a "Curriculum Redesign" of the contents, offering an online modality, which implied a significant demand both within and outside the university area. A notable feature of this educational experience is the great spectrum opened for attendees of both courses in the online version. This situation improved significantly the "Curriculum Development" for the student and implied an interesting new proposal on the offered contents and materials (what would have been really difficult to get in a face to face classroom). In conclusion, the absence of certain types of specialized contents in the academic university curricula makes essential to raise new methodologies to save the gap in this area through additional training courses as those analyzed in this paper. Thus, our experience opens a debate on the appropriateness of implementing online training in relation to the face to face training in constructive content subjects and, especially, presents a new scheme, not without controversy, for the curriculum design.

No Move without Free Movement: The EU-Swiss controversy over quotas for free movement of persons. CEPS Policy Brief No. 331, 23 April 2015

The focus of this Policy Brief is the Swiss referendum of 2014 against ‘mass immigration’ in Switzerland. It identifies the challenges that a quota on EU citizens’ free movement rights to Switzerland would pose to EU-Swiss relations, considering: i) the value of freedom of movement in the EU and its indivisibility from the internal market and other economic freedoms; ii) the specificity of the EU legal system following the Lisbon Treaty that established democratic and judicial accountability mechanisms; iii) the lack of supranational judicial oversight of the EU-Switzerland agreements framework; and iv) the existence of the so-called guillotine mechanism, according to which the termination of the Free Movement Agreement would entail the automatic termination of the other agreements with the EU. The authors set out a number of options and consider their implications for EU-Swiss relations.