Predicting risk of malignancy in patients with indeterminate thyroid nodules

Thyroid cancer is the most prevalent endocrine cancer (1). The prevalence of palpable thyroid nodules in the general adult population is 4% to 7% (2). Ultrasound imaging detects thyroid nodules in 19%-68% of randomly selected individuals (3). The rate of thyroid cancer in nodules found on US is 4% to 15% (4). In order to evaluate thyroid nodules patients undergo thyroid ultrasonography and, if needed, a fine-needle aspiration biopsy. Of all fine-needle aspiration biopsies, 15-30% are indeterminate on cytology (5). While only 3% of these nodules are malignant on average, a much higher percentage of nodules are surgically removed in order to rule out malignancy after indeterminate FNA results. Our goal is to identify clinical and ultrasound predictors of benign results in indeterminate nodules, to assist physicians in selecting nodules for surgical removal versus monitoring with ultrasound imaging. Between October 2010 and November 2017 there were 129 patients with 134 thyroid nodules from Temple University Hospital, Jeanes Hospital, and Fox Chase Cancer Center who had a total or partial thyroidectomy after a cytology report of at least one AUS or FLUS thyroid nodule. These patients were evaluated for age, sex, BMI, TSH, fT4, tT3, nodule size, and ultrasonography features to determine if any features were predictive of a benign or malignant thyroid nodule. Additionally, we looked at whether any of these features were more likely to occur in an AUS nodule or a FLUS nodule. We found that none of the demographic factors, thyroid function tests, or ultrasound features were good predictors of malignancy in AUS or FLUS thyroid nodules. We found that AUS nodules are more likely to be malignant than FLUS nodules, and this held true when we accounted for age, sex, smoking history, and BMI. We concluded that demographic factors and thyroid function tests are unable to predict increased risk of malignancy in Bethesda category III nodules, AUS nodules are more likely to be malignant that FLUS nodules, and nodules with at least one suspicious ultrasound feature are more likely to be AUS nodules than FLUS nodules due to AUS nodules having nuclear atypia and FLUS nodules having architectural atypia

The rich get elected – but it’s not because voters necessarily prefer them

We elect politicians who are far better-off than ourselves – in Europe, those who come from blue-collar backgrounds make up only a tenth of national parliaments. Is this because voters favour the rich? A new study by Nicholas Carnes and Noam Lupu suggests they are slightly more likely to opt for working-class candidates over business owners. Blue-collar candidates just don’t get onto the ballot paper in the first place

Does Paying Politicians More Promote Economic Diversity in Legislatures?

If politicians in the United States were paid better, would more middle- and working-class people become politicians? Reformers often argue that the low salaries paid in state and local governments make holding office economically infeasible for lower-income citizens and contribute to the enduring numerical under-representation of the working class in our political institutions. Of course, raising politicians’ salaries could also make political office more attractive to affluent professionals, increasing competition for office and ultimately discouraging lower-income citizens from running and winning. In this article, we test these hypotheses using data on the salaries and economic backgrounds of state legislators. Contrary to the notion that paying politicians more promotes economic diversity, we find that the descriptive representation of the working class is the same or worse in states that pay legislators higher salaries. These findings have important implications for research on descriptive representation, political compensation, and political inequality

What Happens When Insurers Make the Insurance Laws? State Legislative Agendas and the Occupational Makeup of Government

Do the occupational backgrounds of politicians affect the government’s agenda? Businesses have long thought so. The first occupational data on state legislators were collected by the Insurance Information Institute, an interest group representing major insurance companies. In this paper, we test one potential motive for these kinds of efforts: the idea that the occupational makeup of governments affects the agendas they pursue, an argument that has been largely neglected in research on politicians’ occupational backgrounds. We focus here on the insurance industry. Using original data, we find that state legislatures with more former insurers consider fewer bills regulating insurance (negative agenda control), that former insurers play a disproportionate role in drafting the insurance bills that are introduced (positive agenda control), and that the bills former insurers introduce tend to be more favorable to the industry than those that their colleagues introduce (positive agenda control). The occupational makeup of legislatures may indeed affect their agendas, as industry groups have long suspected

Why Do Members of Congress Support Agricultural Protection?

It seems paradoxical that developed countries continue subsidizing agriculture even though their agricultural sectors have been declining in relative importance since the middle of the 20th century. What drives support for agricultural protection in developed countries? We answer this question by testing three competing hypotheses about what drives support for agricultural protection in the US: (i) legislator preferences, (ii) electoral incentives, or (iii) lobbying. Using data on the roll call votes of the members of the 106th through the 110th Congresses (1999-2009) and the scores given to each legislator by the Farm Bureau, our findings suggest electoral incentives explain a great deal of the variation in support for agricultural protection, but that legislator preferences and lobbying play a role, too. Moreover, legislator preferences and electoral incentives appear to be substitutes for one another. Why does Congress support agricultural protection? Because many members have electoral incentives to—and because many of those who do not still have other personal or strategic interests at stake

Why Do Members of Congress Support Agricultural Protection?

It seems paradoxical that developed countries continue subsidizing agriculture even though their agricultural sectors have been declining in relative importance since the middle of the 20th century. What drives support for agricultural protection in developed countries? We answer this question by testing three competing hypotheses about what drives support for agricultural protection in the US: (i) legislator preferences, (ii) electoral incentives, or (iii) lobbying. Using data on the roll call votes of the members of the 106th through the 110th Congresses (1999-2009) and the scores given to each legislator by the Farm Bureau, our findings suggest electoral incentives explain a great deal of the variation in support for agricultural protection, but that legislator preferences and lobbying play a role, too. Moreover, legislator preferences and electoral incentives appear to be substitutes for one another. Why does Congress support agricultural protection? Because many members have electoral incentives to—and because many of those who do not still have other personal or strategic interests at stake

Why Local Party Leaders Don't Support Nominating Centrists

Would giving party leaders more influence in primary elections in the United States decrease elite polarization? Some scholars have argued that political party leaders tend to support centrist candidates in the hopes of winning general elections. In contrast, the authors argue that many local party leaders - especially Republicans - may not believe that centrists perform better in elections and therefore may not support nominating them. They test this argument using data from an original survey of 1,118 county-level party leaders. In experiments, they find that local party leaders most prefer nominating candidates who are similar to typical co-partisans, not centrists. Moreover, given the choice between a more centrist and more extreme candidate, they strongly prefer extremists: Democrats do so by about 2 to 1 and Republicans by 10 to 1. Likewise, in open-ended questions, Democratic Party leaders are twice as likely to say they look for extreme candidates relative to centrists; Republican Party leaders are five times as likely. Potentially driving these partisan differences, Republican leaders are especially likely to believe that extremists can win general elections and overestimate the electorate's conservatism by double digits

What Happens When Insurers Make Insurance Laws? State Legislative Agendas and the Occupational Makeup of Government

Do the occupational backgrounds of politicians affect the government's agenda? Businesses have long thought so. The first occupational data on state legislators were collected by the Insurance Information Institute, an interest group representing major insurance companies. In this paper, we test one potential motive for these kinds of efforts: the idea that the occupational makeup of governments affects the agendas they pursue, an argument that has been largely neglected in research on politicians' occupational backgrounds. We focus here on the insurance industry. Using original data, we find that state legislatures with more former insurers consider fewer bills regulating insurance (negative agenda control), that former insurers play a disproportionate role in drafting the insurance bills that are introduced (positive agenda control), and that the bills former insurers introduce tend to be more favorable to the industry than those that their colleagues introduce (positive agenda control). The occupational makeup of legislatures may indeed affect their agendas, as industry groups have long suspected

Discovery and Functional Annotation of SIX6 Variants in Primary Open-Angle Glaucoma

Glaucoma is a leading cause of blindness worldwide. Primary open-angle glaucoma (POAG) is the most common subtype and is a complex trait with multigenic inheritance. Genome-wide association studies have previously identified a significant association between POAG and the SIX6 locus (rs10483727, odds ratio (OR) = 1.32, p = 3.87×10−11). SIX6 plays a role in ocular development and has been associated with the morphology of the optic nerve. We sequenced the SIX6 coding and regulatory regions in 262 POAG cases and 256 controls and identified six nonsynonymous coding variants, including five rare and one common variant, Asn141His (rs33912345), which was associated significantly with POAG (OR = 1.27, p = 4.2×10−10) in the NEIGHBOR/GLAUGEN datasets. These variants were tested in an in vivo Danio rerio (zebrafish) complementation assay to evaluate ocular metrics such as eye size and optic nerve structure. Five variants, found primarily in POAG cases, were hypomorphic or null, while the sixth variant, found only in controls, was benign. One variant in the SIX6 enhancer increased expression of SIX6 and disrupted its regulation. Finally, to our knowledge for the first time, we have identified a clinical feature in POAG patients that appears to be dependent upon SIX6 genotype: patients who are homozygous for the SIX6 risk allele (His141) have a statistically thinner retinal nerve fiber layer than patients homozygous for the SIX6 non-risk allele (Asn141). Our results, in combination with previous SIX6 work, lead us to hypothesize that SIX6 risk variants disrupt the development of the neural retina, leading to a reduced number of retinal ganglion cells, thereby increasing the risk of glaucoma-associated vision loss

Theory-driven group-based complex intervention to support self-management of osteoarthritis and low back pain in primary care physiotherapy: Protocol for a cluster randomised controlled feasibility trial (SOLAS)

Introduction: International clinical guidelines consistently endorse the promotion of selfmanagement (SM), including physical activity for patients with chronic low back pain (CLBP) and osteoarthritis (OA). Patients frequently receive individual treatment and advice to self-manage from physiotherapists in primary care, but the successful implementation of a clinical and cost-effective group SM programme is a key priority for health service managers in Ireland to maximise long-term outcomes and efficient use of limited and costly resources. Methods/analysis: This protocol describes an assessor-blinded cluster randomised controlled feasibility trial of a group-based education and exercise intervention underpinned by self-determination theory designed to support an increase in SM behaviour in patients with CLBP and OA in primary care physiotherapy. The primary care clinic will be the unit of randomisation (cluster), with each clinic randomised to 1 of 2 groups providing the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) intervention or usual individual physiotherapy. Patients are followed up at 6 weeks, 2 and 6 months. The primary outcomes are the (1) acceptability and demand of the intervention to patients and physiotherapists, (2) feasibility and optimal study design/procedures and sample size for a definitive trial. Secondary outcomes include exploratory analyses of: point estimates, 95% CIs, change scores and effect sizes in physical function, pain and disability outcomes; process of change in target SM behaviours and selected mediators; and the cost of the intervention to inform a definitive trial. Ethics/dissemination: This feasibility trial protocol was approved by the UCD Human Research Ethics- Sciences Committee (LS-13-54 Currie-Hurley) and research access has been granted by the Health Services Executive Primary Care Research Committee in January 2014. The study findings will be disseminated to the research, clinical and health service communities through publication in peerreviewed journals, presentation at national and international academic and clinical conferences. Trial registration number: ISRCTN 49875385; Pre-results