Eliciting Low-Risk Thyroid Cancer Treatment Preferences Using Clinical Vignettes: A Pilot Study

ObjectiveWhile surgical resection has been the traditional standard treatment for small (≤1 cm), differentiated thyroid cancers, active surveillance (AS) and radiofrequency ablation (RFA) are increasingly considered. The aim of this study was to explore patient preferences in thyroid cancer treatment using a series of clinical vignettes.MethodsThyroid cancer survivors and general population volunteers were recruited to rank experience-driven clinical vignettes in order of preference. Rankings were compared using Wilcoxon signed rank. Formative qualitative methods were used to develop and refine clinical vignettes that captured 4 treatments—thyroid lobectomy (TL), total thyroidectomy (TT), AS, and RFA—along with 6 treatment complications. Content was validated via interviews with 5 academic subspecialists.ResultsNineteen volunteers participated (10 survivors, 9 general population). Treatment complications were ranked lower than uncomplicated counterparts in 99.0% of cases, indicating excellent comprehension. Counter to our hypothesis, among uncomplicated vignettes, median rankings were 1 for AS, 2 for RFA, 3.5 for TL, and 5 for TT. Trends were consistent between thyroid cancer survivors and the general population. AS was significantly preferred over RFA (P = .02) and TT (P < .01). Among surgical options, TL was significantly preferred over TT (P < .01).ConclusionWhen treatments for low-risk thyroid cancer are described clearly and accurately through clinical vignettes, patients may be more likely to choose less invasive treatment options over traditional surgical resection.     

A hybrid approach to identify the risk priority of sources of greenhouse gases

Abstract

Examination of greenhouse gas emissions is crucial for understanding the global warming. For this reason, identification of the sources of greenhouse gas emissions is crucial. This paper presents a hybrid multi criteria decision making method, which combines analytic hierarchy process and technique for order preference by similarity to ideal solution and compares this method with actual data for identifying the risk priority of sources of greenhouse gas emissions. For this purpose, the historical data of 25-years, for six-greenhouse gas sources and three-greenhouse gases (CO₂, CH_4, N₂O) are considered. Consequently, it was found that while incineration of wastes caused the minimum GHG emissions, energy sector caused the maximum GHG emissions. The results of this paper show that use of this hybrid method is easy and intelligible, and has a good potential for sorting the risk priority of sources of greenhouse gas emissions.     

Application typologies for life cycle assessment

Different lists of application areas for life cycle assessment are reviewed together with some suggestions for a typology of these application areas. It is concluded that the scope of a life cycle assessment is determined by the area of validity of the decision with respect to time, space, and interest groups affected. On this basis, six application areas are distinguished. It is further concluded that the application area has limited influence on the inventory analysis and impact assessment phases, although these may be influenced significantly by the decision-maker and the complexity of the trade-offs between the involved environmental impacts. The reporting format for a life cycle assessment depends on the socio-economic importance of the decision, the intended audience, and the time available for decision making.     

The effect of prey movement on attack behavior and patch residence decision rules of wolf spiders (Araneae: Lycosidae)

We used a video imaging technique to test the effects of prey movement on attack behavior and foraging patch residence time decision rules of wolf spiders. TwelveSchizocosa ocreata (Hentz) (Lycosidae) were tested in an artificial foraging patch stimulus chamber consisting of a microscreen television displaying a computer digitized, animated image of a cricket. Four prey movement treatments were used: (1) a blank screen, (2) a stationary cricket control, (3) a cricket moving for 1 min, and (4) a cricket moving for 10 min. Spiders stayed significantly longer in treatments with higher cricket activity. Spiders also stayed longer when they attacked the stimulus than when they did not. The distribution of patch residence times of spiders indicates a decision rule based on a fixed probability of leaving.     

Integrating life cycle cost analysis and LCA

The private sector decision making situations which LCA addresses mustalso eventually take theeconomic consequences of alternative products or product designs into account. However, neither the internal nor external economic aspects of the decisions are within the scope of developed LCA methodology, nor are they properly addressed by existing LCA tools. This traditional separation of life cycle environmental assessment from economic analysis has limited the influence and relevance of LCA for decision-making, and left uncharacterized the important relationships and trade-offs between the economic and life cycle environmental performance of alternative product design decision scenarios. Still standard methods of LCA can and have been tightly, logically, and practically integrated with standard methods for cost accounting, life cycle cost analysis, and scenario-based economic risk modeling. The result is an ability to take both economic and environmental performance — and their tradeoff relationships — into account in product/process design decision making.