Central hypogonadism due to a giant, “silent” FSH-secreting,atypical pituitary adenoma: effects of adenoma dissection and short-term Leydig cell stimulation by luteinizing hormone (LH) and human chorionic gonadotropin (hCG)

We present a case report of an atypical giant pituitary adenoma secreting follicle-stimulating hormone (FSH). A 55-year-old patient presented for erectile dysfunction, loss of libido and fatigue. The biochemical evaluation showed very high FSH serum levels in the presence of central hypogonadism. Neither testicular enlargement nor increased sperm count was observed, thus a secretion of FSH with reduced biological activity was supposed. The histological examination after neuro-surgery showed an atypical pituitary adenoma with FSH-positive cells. Hypogonadism persisted and semen analyses impaired until azoospermia in conjunction with the reduction in FSH levels suggesting that, at least in part, this gonadotropin should be biologically active. Thus, we hypothesized a concomitant primary testicular insufficiency. The patient underwent short-term treatment trials with low doses of either recombinant luteinizing hormone (LH) or human chorionic gonadotropin (hCG) in three consecutive treatment schemes, showing an equal efficacy in stimulating testosterone (T) increase. This is the first case of atypical, giant FSH-secreting pituitary adenoma with high FSH serum levels without signs of testicular hyperstimulation, in presence of hypogonadism with plausible combined primary and secondary etiology. Hypophysectomized patients may represent a good model to assess both pharmacodynamics and effective dose of LH and hCG in the male.     

Governing multicultural Brussels: paradoxes of a multi-level,multi-cultural,multi-national urban anomaly

ABSTRACT

Updating our earlier work on Brussels as the paradigm of a multi-level, multi-cultural, multi-national city, and in the context of Brussels’s recent troubled emergence as the epicentre of violent conflict between radical political Islam and the West, this paper sets out the paradoxical intersection of national (i.e. Flemish and Francophone), non-national and ethnic minority politics in a city placed as a multi-cultural and multi-national ‘urban anomaly’ at the heart of linguistic struggle of the two dominant Belgian communities. Brussels is one of the three Regions of the Belgian federal model alongside Flanders and Wallonia. It is also an extraordinarily diverse and cosmopolitan city, in which a mixed language Belgian population lives alongside very high numbers of resident non-nationals, including European elites, other European immigrant workers, and immigrants from Africa and Asia. After laying out the complex distribution of power and competences within the Belgian federal structure, we explore whether these structures have worked over the years to include or exclude disadvantaged ethnic groups. To better understand these processes, we introduce our view of the multi-level governance perspective.     

International migration and the rise of the ‘civil’ nation

Scholars largely agree that immigration policies in Western Europe have switched to a liberal, civic model. Labelled as ‘civic turn’, ‘civic integration’ or ‘liberal convergence’, this model is not identically applied across countries, since national institutions, traditions and identifications still matter. Even so, the main focus is on processes which allow or prevent migrants to be incorporated into nations usually taken for granted in their meanings. Moving from policies to discourses, this article aims to interrogate what kind of nation is behind these policies as a way to further scrutinise the ‘civic turn’. Exploring how the term ‘civility’ and its adjectivisations are discursively deployed in Italian parliamentary debates on immigration and integration issues, the article points to two opposite narratives of nation. While one mobilises civility in order to rewrite the nation in terms of a common, inclusive, civic ‘we’, the other uses civility to reaffirm the conflation between national identity and the identity of the ethno-cultural majority. These findings suggest the importance of exploring the ‘civic turn’ not only across countries, but also across political parties within the same country to capture the ways in which a liberal, civic convergence in political discourses might hide divergent national boundary mechanisms.     

The forward search: Theory and data analysis

The Forward Search is a powerful general method, incorporating flexible data-driven trimming, for the detection of outliers and unsuspected structure in data and so for building robust models. Starting from small subsets of data, observations that are close to the fitted model are added to the observations used in parameter estimation. As this subset grows we monitor parameter estimates, test statistics and measures of fit such as residuals. The paper surveys theoretical development in work on the Forward Search over the last decade. The main illustration is a regression example with 330 observations and 9 potential explanatory variables. Mention is also made of procedures for multivariate data, including clustering, time series analysis and fraud detection.     

A Resampling Algorithm for Chaotic Time Series

In the field of chaotic time series analysis, there is a lack of a distributional theory for the main quantities used to characterize the underlying data generating process (DGP). In this paper a method for resampling time series generated by a chaotic dynamical system is proposed. The basic idea is to develop an algorithm for building trajectories which lie on the same attractor of the true DGP, that is with the same dynamical and geometrical properties of the original data. We performed some numerical experiments on some short noise-free and high-noise series confirming that we are able to correctly reproduce the distribution of the largest finite-time Lyapunov exponent and of the correlation dimension.     

A finite mixture model for multivariate counts under endogenous selectivity

We describe a selection model for multivariate counts, where association between the primary outcomes and the endogenous selection source is modeled through outcome-specific latent effects which are assumed to be dependent across equations. Parametric specifications of this model already exist in the literature; in this paper, we show how model parameters can be estimated in a finite mixture context. This approach helps us to consider overdispersed counts, while allowing for multivariate association and endogeneity of the selection variable. In this context, attention is focused both on bias in estimated effects when exogeneity of selection (treatment) variable is assumed, as well as on consistent estimation of the association between the random effects in the primary and in the treatment effect models, when the latter is assumed endogeneous. The model behavior is investigated through a large scale simulation experiment. An empirical example on health care utilization data is provided.     

External audit and bankruptcy prediction

In this paper, we investigate the relationship between external auditor characteristics and the likelihood of bankruptcy. We use a sample of US public companies to analyse whether auditor attributes are associated with default. We also test whether the inclusion of such attributes in bankruptcy prediction models improves their predictive ability. We find that firms audited by industry-expert auditors, large audit firms and long-tenured auditors are less likely to default. Firms with higher audit fees are more likely to default. Our results also show that the inclusion of auditor attributes significantly increases the predictive ability of bankruptcy prediction models. This paper contributes to the literature about auditing and bankruptcy prediction. Our results suggest that the auditor attributes can provide predictive signals concerning a default risk and that an external audit can play a relevant role in early warnings of financial distress. Our study also suggests that bankruptcy prediction models can become more effective if they are complemented with audit data. Our results are of interest to market participants, auditors, regulating authorities, banks and other financial institutions that are interested in credit risk assessment.     

Antecedents of board involvement and its consequences on organisational effectiveness in non-profit organisations: a study on European corporate foundations

Journal of Management and Governance - The governance of non-profit organisations is complex, as these organisations are not only intended to create value for third parties but also dependent on...     

Science for Policy: A Case Study of Scientific Polarization,Values, and the Framing of Risk and Uncertainty

It is well documented that more research can lead to hardened positions, particularly when dealing with complex, controversial, and value‐laden issues. This study is an attempt to unveil underlying values in a contemporary debate, where both sides use scientific evidence to support their argument. We analyze the problem framing, vocabulary, interpretation of evidence, and policy recommendations, with particular attention to the framing of nature and technology. We find clear differences between the two arguments. One side stress that there is no evidence that the present approach is causing harm to humans or the environment, does not ruminate on uncertainties to that end, references nature's ability to handle the problem, and indicates distrust in technological solutions. In contrast, the other side focuses on uncertainties, particularly the lack of knowledge about potential environmental effects and signals trust in technological development and human intervention as the solution. Our study suggests that the two sides’ diverging interpretations are tied to their perception of nature: vulnerable to human activities versus robust and able to handle human impacts. The two sides also seem to hold diverging views of technology, but there are indications that this might be rooted in their perception of governance and economy rather than about technology per se. We conclude that there is a need to further investigate how scientific arguments are related to worldviews, to see how (if at all) worldview typologies can help us to understand how value‐based judgments are embedded in science advice, and the impact these have on policy preferences.