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Background Analysis of cytologically indeterminate thyroid nodules with Afirma Gene Expression Classifier (GEC) and Genomic Sequencing Classifier (GSC) can reduce surgical rate and increase malignancy rate of surgically resected indeterminate nodules. Methods Retrospective cohort analysis of all adults with cytologically indeterminate thyroid nodules from January 2013 through December 2019. We compared surgical and malignancy rates of those without molecular testing to those with GEC or GSC, analyzed test performance between GEC and GSC, and identified variables associated with molecular testing. Results 468 indeterminate thyroid nodules were included. No molecular testing was performed in 273, 71 had GEC, and 124 had GSC testing. Surgical rate was 68% in the group without molecular testing, 59% in GEC, and 40% in GSC. Malignancy rate was 20% with no molecular testing, 22% in GEC, and 39% in GSC (P = 0.022). GEC benign call rate (BCR) was 46%; sensitivity, 100%; specificity, 61%; and positive predictive value (PPV), 28%. GSC BCR was 60%; sensitivity, 94%; specificity, 76%; and PPV, 41%. Those with no molecular testing had larger nodule size, preoperative growth of nodules, and constrictive symptoms and those who underwent surgery in the no molecular testing group had higher body mass index, constrictive symptoms, higher Thyroid Imaging Reporting and Data System and Bethesda classifications. Type of provider was also associated with the decision to undergo surgery. Conclusion Implementation of GEC showed no effect on surgical or malignancy rate, but GSC resulted in significantly lower surgical and higher malignancy rates. This study provides insight into the factors that affect the real-world use of these molecular markers preoperatively in indeterminate thyroid nodules.

Doubly fed induction generator (DFIG) based wind turbines have been found to be very sensitive to asymmetrical grid fault, wherein the harmful oscillations in the electromagnetic torque has being made a big concern. What makes things harder is that latest grid codes require grid-connected wind turbines to possess the ability of positive- and negative-sequence reactive current supporting. Hence, it becomes a guide mechanism to meet the grid codes and to ensure the operation safety of the wind turbines. Even though a tradeoff could be made between them, it is still quite difficult to coordinate the current dispatch of the DFIG’s rotor- and grid-side converters (RSC and GSC), since there are totally eight currents needing to be carefully designed, i.e., the positive- and negative-sequence active and reactive currents in each converter. To address this issue, this article analyzes the reactive current constraints in detail, based on which a coordinated reactive current control strategy is put forward for the DFIG-based wind turbines during asymmetrical grid condition. Simulation studies demonstrate the effectiveness of the proposed strategy.

Context Molecular tests have improved the accuracy of preoperative diagnosis of indeterminate thyroid nodules. The Afirma Gene Sequencing Classifier (GSC) was developed to improve the specificity of the Gene Expression Classifier (GEC). Independent studies are needed to assess the performance of GSC. Objective The aim was to compare the performance of GEC and GSC in the assessment of indeterminate nodules. Design, Settings, and Participants Retrospective analysis of Bethesda III and IV nodules tested with GEC or GSC in an academic center between December 2011 and September 2018. Benign call rates (BCRs) and surgical outcomes were compared. Histopathologic data were collected on nodules that were surgically resected to calculate measures of test performance. Results The BCR was 41% (73/178) for GEC and 67.8% (82/121) for GSC (P < .001). Among specimens with dominant Hürthle cell cytology, the BCR was 22% (6/27) for GEC and 63.2% (12/19) for GSC (P = .005). The overall surgery rate decreased from 47.8% in the GEC group to 34.7% in the GSC group (P = .025). One GEC-benign and 3 GSC-benign nodules proved to be malignant on surgical excision. GSC had a statistically significant higher specificity (94% vs 60%, P < .001) and positive predictive value (PPV) (85.3% vs 40%, P < .001) than GEC. While sensitivity and negative predictive value (NPV) dropped with GSC (97.0% vs 90.6% and 98.6% vs 96.3%, respectively), these differences were not significant. Conclusions GSC reclassified more indeterminate nodules as benign and improved the specificity and PPV of the test. These enhancements appear to be resulting in fewer diagnostic surgeries.

This letter proposes a switching controller (SC) for the grid-side converter (GSC) of doubly-fed induction generator-based wind turbines (DFIGWTs) to improve the disturbance rejection capability of the GSC based on bang–bang funnel control. A bang–bang funnel controller (BBFC) is designed and activated in the cases where the dc-link voltage of a DFIGWT is disturbed far away from its nominal value. A conventional vector controller (VC) is switched on operation when the tracking error of dc-link voltage converges within a prespecified error funnel. The BBFC and the VC constitute a SC. The disturbance rejection performance of the SC was tested through hardware-in-the-loop experiments.

BackgroundMolecular tests are being used increasingly as an auxiliary diagnostic tool so as to avoid a diagnostic surgery approach for cytologically indeterminate thyroid nodules (ITNs). Previous test versions, Thyroseq v2 and Afirma Gene Expression Classifier (GEC), have proven shortcomings in malignancy detection performance.ObjectiveThis study aimed to evaluate the diagnostic performance of the established Thyroseq v3, Afirma Gene Sequencing Classifier (GSC), and microRNA-based assays versus prior iterations in ITNs, in light of “rule-in” and “rule-out” concepts. It further analyzed the impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification and Bethesda cytological subtypes on the performance of molecular tests.MethodsPubmed, Scopus, and Web of Science were the databases used for the present research, a process that lasted until September 2020. A random-effects bivariate model was used to estimate the summary sensitivity, specificity, positive (PLR) and negative likelihood ratios (NLR), and area under the curve (AUC) for each panel. The conducted sensitivity analyses addressed different Bethesda categories and NIFTP thresholds.ResultsA total of 40 eligible studies were included with 7,831 ITNs from 7,565 patients. Thyroseq v3 showed the best overall performance (AUC 0.95; 95% confidence interval: 0.93–0.97), followed by Afirma GSC (AUC 0.90; 0.87–0.92) and Thyroseq v2 (AUC 0.88; 0.85–0.90). In terms of “rule-out” abilities Thyroseq v3 (NLR 0.02; 95%CI: 0.0–2.69) surpassed Afirma GEC (NLR 0.18; 95%CI: 0.10–0.33). Thyroseq v2 (PLR 3.5; 95%CI: 2.2–5.5) and Thyroseq v3 (PLR 2.8; 95%CI: 1.2–6.3) achieved superior “rule-in” properties compared to Afirma GSC (PLR 1.9; 95%CI: 1.3–2.8). Evidence for Thyroseq v3 seems to have higher quality, notwithstanding the paucity of studies. Both Afirma GEC and Thyroseq v2 performance have been affected by NIFTP reclassification. ThyGenNEXT/ThyraMIR and RosettaGX show prominent preliminary results.ConclusionThe newly emerged tests, Thyroseq v3 and Afirma GSC, designed for a “rule-in” purpose, have been proved to outperform in abilities to rule out malignancy, thus surpassing previous tests no longer available, Thyroseq 2 and Afirma GEC. However, Thyroseq v2 still ranks as the best rule-in molecular test.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO, identifier CRD42020212531.

The European GNSS Service Centre (GSC) is the single ground interface between the Galileo system and its users. It is in continuous evolution with the aim of satisfying the needs and expectation of the users and help to the consolidation of Galileo as a system that provides the users with high performance. Currently, the Centre is delivering different services, such as the Helpdesk, the Web Portal, an Electronic Library, Galileo System Data, User Notices, System and Service Reports or Orbital products for Search and Rescue (SAR) users. At the same time, the Centre is paving the way for the Galileo High Accuracy Service (HAS) by supporting the necessary testing. In the near future, further enhancements and services will be declared operational, including Galileo HAS and Open Service Navigation Message Authentication (OSNMA), and the GSC will play a fundamental role in their deployment and provision. This paper presents the current status of the GSC and its prospects for the next years.

Objective: Evaluation and management of thyroid nodules with cytologically indeterminate results remain challenging in clinical practice. Despite the implementation of molecular testing in an attempt to avoid surgical intervention, diagnostic thyroidectomy still occurs due to the relatively low positive predictive value of these molecular testing. We conducted a study to analyze whether combining US characteristics and results of molecular testing would better elucidate predicting true positive results. Methods: We retrospectively reviewed thyroid ultrasound images of 172 nodules in 162 patients (mean age, 55 years +/- 14) with indeterminate cytology results (Bethesda III and IV) that underwent Afirma Gene Sequencing Classifier (GSC) testing at a single academic medical center between 2017–2019. All nodules were classified according to 2015 American Thyroid Association (ATA) and 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Results: A total of 172 with subsequent Afirma GSC molecular testing were included in the study. There were 127 nodules with Bethesda III (AUS/FLUS) (73.8%), and 45 nodules with Bethesda IV (SFN/HCN) (26.2%) results. The mean nodule volume was 5.4 +/- 10 cm3. Afirma GSC identified 129 nodules (75%) as benign and 43 nodules (25%) as suspicious. Per ATA classification, 10.4% (18) of nodules were classified as very low risk, 40.7% (70) as low risk, 36.5% (62) as intermediate and 12.8% (22) as high risk for malignancy. There was a significant association between ATA classification and Afirma benign nodules (P=0.002). All nodules were also classified per TIRADS system with the following distribution: 5 (1.16%) TIRADS 1, 7 (4%) TIRADS 2, 54 (31%) TIRADS 3, 90 (52%) TIRADS 4, and 16 (9.3%) TIRADS 5. We did not observe the similar association between TIRADS system and benign nodules as we did with ATA classification (P=0.4). 35 patients (79.5%) with Afirma suspicious results underwent surgery, of which 18 (51.4%) surgical pathology were malignant. 8 patients with Afirma suspicious results decided to proceed with ultrasound surveillance. The malignancy rates of nodules with low, intermediate and high suspicion for malignancy classified by the ATA guidelines were 44% (9 of 18), 33% (56 of 18) and 22% (4 of 18). The malignancy rates of TIRADS category 3, 4 and 5 nodules were 44% (8 of 18 nodules), 44% (8 of 18 nodules) and 11% (2 of 18 nodules). Subset analysis of surgical pathology benign and cancerous nodules did not show significant association between ATA (P=0.5) or TIRADS (P=0.4) classification systems. Conclusion: Our study showed that Afirma benign nodules were associated with a lower risk of malignancy per ATA classification but not with TIRADS system. We did not find a significant association between pathology proven cancer cases and high-risk ATA or TIRADS ultrasound classification systems.

Green supply chain management is attracting attention as a way to decrease the adverse environmental effects of industries worldwide. GSCM practices are considered as environmentally friendly practices, which include water efficiency, energy efficiency, waste management, environment conservation, recycling and reuse, toxic substance management and hazardous and optimization of transportation. However, considering the context of an emerging economy, green supply chain management is still in its inception and has not been widely embraced yet. In this research, the researcher demonstrated the important and the impact of Technology-Organization-Environment (TOE) dimensions, firm practices and supply chain practices on the supply chain practices and the green supply chain adoption and the Supplier Relationship Management and Customer Relationship Management. This research aims to develop and understand a framework for different drivers and barriers that affect the green supply chain adoption in the process as well as identifying the role of TOE dimensions in enhancing the process. In this research, the researcher tried to provide a critical review and identify gaps in the literature related to GSCM, its drivers and barriers, GSCM adoption, and the TOE dimensions, develop an appropriate research methodology to collect and analyze data to address the research question. Empirically examine how all of the variables of the research are statistically related which are Customer Relationship, Supplier Relationship, Supplier Selection, Internal collaboration, Top Management Support, Green Supply Chain Management, Coercive Pressure, Normative Pressure, Mimetic Pressure, Market Pressure, Green purchasing, Barrier for GSCM, and Drivers for GSCM using the statistical tools. Critically discuss findings of current research, compare them to prior findings within the literature, Highlight the theoretical contributions and practical implications of the study, and identify limitations and areas for future research. The deduction approach has been utilized in this research as well as the quantitative method using structured questionnaire has been collected from 405 respondents. The research indicated that there is significant relationship between the environmental, organizational, and Technological dimensions and firm practices and supply chain practices, there is significant relationship between drivers, barriers and firm practices and supply chain practices and the green supply chain adoption. There is significant relationship between Green Supply Chain Adoption and both Supplier Relationship Management and Customer Relationship Management.