Exploring physicians and patients' perspectives for current interventions on thyroid nodules using a MCDA method.

BACKGROUND: The detection of thyroid cancer has rapidly increased over last few decades without an increase in disease specific mortality. Several studies claim that the diagnose of thyroid nodules through routine ultrasound imaging is often the trigger for cascade effects leading to unnecessary follow-up over many years or to invasive treatment. The objective of this study was to explore physicians' and patients' insights and preferences regarding the current interventions on thyroid nodules. METHODS: An online survey was developed using a comprehensive multi-criteria decision analysis (MCDA) framework, the EVIdence based Decision-Making (EVIDEM). The EVIDEM core model used in this study encompassed 13 quantitative criteria and four qualitative criteria. Participants were asked to provide weights referring to what matters most important in general for each criterion, performance scores for appraising the interventions on thyroid nodules and their consideration of impact of contextual criteria. Normalized weights and standardized scores were combined to calculate a value contribution across all participants, additionally differences across physicians and patients' group were explored. RESULTS: 48 patients and 31 physicians were included in the analysis. The value estimate of the interventions on thyroid nodules reached 0.549 for patients' group and 0.5 was reported by the physicians' group, compared to 0.543 for all participants. The highest value contributor was 'Comparative effectiveness' (0.073 ± 0.020). For the physicians' group, 'Comparative safety' (0.050 ± 0.023) was given with higher value. And for the patients' group, 'Type of preventive benefits' (0.059 ± 0.022) contributed more positively to the value estimation. 51% participants considered 'Population priorities and access' having a negative impact on the interventions of nodules.66% participants thought that the 'system capacity' had a negative impact. CONCLUSION: Our study shows participants' preferences on each criterion, i.e., physician indicated keeping the interventions safe and effective more important, patients indicated quality of life after receiving interventions more important. Through comparison among participants, differences have been highlighted, which can make better communication between physicians and patients. This study provides a supportive decision-making for healthcare providers when they explored the interventions on thyroid nodules.

Developmental cascade effects of a parenting-focused program for divorced families on competence in emerging adulthood.

This 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families examined cascade models of program effects on offsprings' competence. It was hypothesized that intervention-induced improvements in parenting would lead to better academic, work, peer, and romantic competence in emerging adulthood through effects on behavior problems and competencies during adolescence. Families (N = 240) participated in the 11-session program or literature control condition when children were ages 9-12. Data were drawn from assessments at pretest, posttest, and follow-ups at 3 and 6 months and 6 and 15 years. Results showed that initial intervention effects of parenting on externalizing problems in adolescence cascaded to work outcomes in adulthood. Parenting effects also directly impacted work success. For work outcomes and peer competence, intervention effects were moderated by initial risk level; the program had greater effects on youths with higher risk at program entry. In addition, intervention effects on parenting led to fewer externalizing problems that in turn cascaded to better academic outcomes, which showed continuity into emerging adulthood. Results highlight the potential for intervention effects of the New Beginnings Program to cascade over time to affect adult competence in multiple domains, particularly for high-risk youths.

Insectivorous birds disrupt biological control of cereal aphids.

Insect-feeding birds may interfere with trophic interactions in plant-insect food webs, which may be particularly important in agroecosystems. Here, we studied how Eurasian Tree Sparrows (Passer montanus) affect aphids and their predators in cereal fields using bird exclusion experiments. The Tree Sparrows fed their nestlings with aphid antagonists. Hoverflies and ladybird beetles accounted for 77% of the food for the nestlings during peak aphid density. When birds were excluded, densities of hoverfly larvae, which were the most abundant aphid predator group in the cereals, were 4% higher in wheat and 45% higher in oat, while aphid densities were 24% lower in wheat and 26% lower in oat. The demonstrated disruption of biological control by mesopredators through bird predation may be a common phenomenon in cropping systems characterized by small-sized and abundant pest species. Management of biotic interactions such as biological control needs a broad food-web perspective, even in simplified agroecosystems.

Risky cascading transitions in international relationships.

Changing attitudes in diplomatic relations is a common feature of international politics. However, such changes may trigger risky domino-like cascades of "friend-to-enemy" transitions among other counties and yielding catastrophic damage that could reshape the global network of international relationships. While previous attention has been focused on studying single pairs of international relationships, due to the lack of a systematic framework, it remains still unknown whether, and how, a single transition of attitude between two countries could trigger a cascade of attitude transitions among other countries. Here, we develop such a framework and construct a global evolving network of relations between country pairs based on 70,756,728 international events between 1,225 country pairs from January 1995 to March 2020. Our framework can identify and quantify the cascade of transitions following a given original transition. Surprisingly, weaker transitions are found to initiate most of the largest cascades. We also find that transitions are not only related to the balance of the local environment, but also global network properties such as betweenness centrality. Our results suggest that these transitions have a substantial impact on bilateral trade volumes and scientific collaborations. Our results reveal reaction chains of international relations, which could be helpful for designing early warning signals and mitigation methods for global international conflicts.

Stability trophic cascades in food chains.

While previous studies have evaluated the change in stability for the addition or removal of individual species from trophic food chains and food webs, we know of no study that presents a general theory for how stability changes with the addition or removal of trophic levels. In this study, we present a simple model of a linear food chain and systematically evaluate how stability-measured as invariability-changes with the addition or removal of trophic levels. We identify the presence of trophic cascades in the stability of species. Owing to top-down control by predation and bottom-up regulation by prey, we find that stability of a species is highest when it is at the top of the food chain and lowest when it is just under the top of the food chain. Thus, stability shows patterns identical to those of mean biomass with the addition or removal of trophic levels in food chains. Our results provide a baseline towards a general theory of the effect of adding or removing trophic levels on stability, which can be used to inform empirical studies.

Can salinity trigger cascade effects on streams? A mesocosm approach.

Human activities have greatly increased the salt concentration of the world's rivers, and this might be amplified by water scarcity in the future. While the lethal effects of salinity have been documented for a wide variety of stream invertebrates, the sub-lethal effects (i.e. changes in biological condition without mortality) are not deeply understood yet. One important sub-lethal effect that has yet to be investigated is changes in predation efficiency, which could trigger cascade effects associated to the abundance of herbivorous invertebrates that control algae biomass. In this study we combined the use of biomarkers with community-level data in a stream mesocosm to evaluate the potential cascade effect of increased salinity on the trophic food web. Both predation and salt treatments had an effect on the aquatic invertebrate abundance, richness and community composition. The presence of predators had a clear cascade effect, it reduced herbivorous invertebrate abundance and richness leading to higher chlorophyll a concentrations. The salt treatment significantly reduced taxa richness, but only in the gravel bed. The predators were significantly stressed by salt addition, as shown by the different analyzed biomarkers. Concordantly, in the presence of predators, Tanytarsini registered higher abundances and chlorophyll a showed a lower concentration when salt was added. However, none of these changes was significant. Therefore, although salt addition significantly stressed Dina lineata, our results suggest that a longer exposure time is needed to fully capture cascading effects (e.g. a decrease in chlorophyll a due to a relaxation of predation on herbivorous invertebrates). We suggest that the potential cascade effects of salinization need to be evaluated when addressing the impacts of water scarcity (as caused by climate change and increasing water demand) on river ecosystems, since flow reductions will lead to higher salt concentrations.