Go to the following link to read the article: http://eebweb.arizona.edu/Courses/Ecol409_509/levy.pdf.)
Based on the information you received from the article discuss the following in two paragraphs (a paragraph should be minimum of five sentences).
Foundation Thyroid disease is a nearly uncommon malignancy speaking to under 1% of all malignancies in the United Kingdom (UK)  and 3.1% of every single new harm in the United States (US) . Thyroid disease is generally asymptomatic and is frequently found unexpectedly by means of imaging reads performed for another explanation, or when patients present with an enormous obvious knob in the neck . Be that as it may, the frequency of thyroid malignant growth is expanding overall , to a limited extent because of improved indicative and discovery strategies . Separated thyroid malignant growth (DTC) represents around 94% of thyroid diseases [6, 7]. DTC is a particular sort of thyroid malignant growth made up of various subtypes including papillary carcinoma (PTC), follicular carcinoma (FTC) and Hürthle cell carcinoma. PTC is the most widely recognized kind of DTC, representing roughly 83%  to 86%  all things considered. FTC represents around 10%  to 13% , and Hürthle cell carcinoma represents roughly 3%  to 4% , all things considered. Treatment of DTC for the most part includes medical procedure to expel all or part of the thyroid organ (thyroidectomy) trailed by long lasting utilization of thyroxine for thyroid invigorating hormone (TSH) concealment [9-12]. Following introductory medical procedure, it is evaluated that somewhere in the range of 5% and 20% of patients with DTC create nearby or provincial repeats and somewhere in the range of 10% and 15% of patients with DTC create inaccessible metastases [9, 11]. These patients are normally treated with radioactive iodine. For some patients, treatment with radioactive iodine is powerful. Roughly 33% of patients with cutting edge DTC can be restored by treatment with radioactive iodine and numerous others accomplish long haul illness adjustment . The 10-year endurance rate for patients with removed metastases that react to radioactive iodine treatment has been accounted for to be 92% . Be that as it may, a few patients become unfit to securely endure visit dosages of radioactive iodine and, for some others, their infection gets impervious to treatment. These patients are considered to have radioactive iodine hard-headed separated thyroid malignant growth (RR-DTC). Appraisals of the extent of patients who become stubborn differ, maybe mirroring the absence of an exact agreement meaning of RR-DTC , yet regularly exist in the scope of 5% to 15% of individuals with DTC [6, 8, 14, 16-18]. For patients with RR-DTC, treatment choices have been constrained. Chemotherapy is once in a while or never prescribed by the creators of clinical rules [9-12] and along these lines, for some, patients, best strong consideration (BSC) has been the main treatment alternative. Be that as it may, the creators of distributed clinical rules have noticed the guarantee of focused treatments including tyrosine kinase inhibitors (TKIs). Lenvatinib is the latest TKI to be authorized for treating RR-DTC, accepting a permit in the US in February 2015  and in the European Union (EU) in May 2015 . The main other authorized TKI is sorafenib, which was authorized for the treatment of RR-DTC in the US in November 2013  and in the EU in January 2015 . The creators of the US National Comprehensive Cancer Network (NCCN) rules presently suggest that lenvatinib and sorafenib ought to be considered for treating dynamic as well as symptomatic RR-DTC . The creators, be that as it may, alert against their utilization for patients with stable or gradually dynamic lethargic illness . The creators of the American Thyroid Association (ATA) rules alert that patients who are possibility for TKI treatment "ought to be completely directed on the potential dangers and advantages of this treatment just as elective remedial methodologies including best strong consideration" . Lenvatinib and sorafenib are accessible for treating RR-DTC in a few nations. In any case, the degree to which they are accessible to patients fluctuates. For instance, lenvatinib and sorafenib are right now accessible through the National Health Service (NHS) in Scotland [23, 24] however are accessible for patients in uncommon conditions in the NHS in England. Before lenvatinib and sorafenib can be routinely utilized in the NHS in England, a positive suggestion is required from the National Institute for Health and Care Excellence (NICE). In this manner, we, the Liverpool Reviews and Implementation Group (LRiG), were charged, in our ability as an autonomous Assessment Group, to give a free survey of the clinical and cost adequacy proof as a feature of a numerous innovation examination (MTA). In this paper, we report our methodical audit of the clinical viability proof for lenvatinib and sorafenib and talk about how the proof has affected on suggestions for clinical practice. Techniques As per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) rules, our precise survey convention was enrolled with PROSPERO, the worldwide imminent register of methodical audits (enlistment number CRD42017055516). The survey was directed as per the Center for Reviews and Dissemination (CRD) distributed direction on leading orderly audits in medicinal services  and the survey is accounted for as per PRISMA rules . Quest techniques for distinguishing proof of studies On 10 January 2017, four electronic databases (Embase (Ovid), MEDLINE (Ovid), PubMed and the Cochrane Library) were scanned for contemplates distributed since 1 January 1999. On 16 May 2017, the clinicaltrials.gov site (an assistance of the US National Institutes of Health), the International Clinical Trials Registry Platform and the European Union Clinical Trials Register, were scanned for data on thinks about in progress. To recognize important investigations, a blend of file terms for the sickness (for example thyroid neoplasms) and free content words (for example lenvatinib or Lenvima or E7080 or Sorafenib or Nexavar or bay439006) were utilized. The database look were restricted to human research and English language contemplates. No other inquiry limitations were applied. The hunt methodologies utilized are given in Online Resource 1. Proof entries from the backers of lenvatinib  and sorafenib  that were submitted to NICE as a major aspect of the MTA procedure were considered for incorporation in our survey. The arrangements of references from the organization entries and every single significant investigation recognized by means of the writing look were cross-checked to distinguish any papers not distinguished by the electronic quests. Study determination and information extraction Randomized controlled preliminaries (RCTs), imminent observational investigations and orderly surveys/backhanded examinations (in the future alluded to as proof audits) of lenvatinib or sorafenib were chosen for incorporation in the survey. To be incorporated, the populace probably included grown-ups with dynamic, privately progressed or metastatic thyroid malignancy unmanageable to radioactive iodine, of which in any event a subgroup of patients had DTC, A synopsis of the from the earlier consideration and rejection criteria are given in Table 1. Two commentators freely screened all titles and digests (screening stage 1). Full-content articles of all conceivably significant references recognized during screening stage 1 were recovered and surveyed for qualification dependent on the consideration criteria (screening stage 2). Where fundamental, any inconsistencies or vulnerabilities were settled by exchange or meeting with a third analyst. Information from the examinations were freely extricated and checked by two analysts utilizing a pre-tried information extraction structure. For RCTs and observational examinations, information were extricated identifying with study structure, quiet attributes, and results (generally endurance [OS], movement free endurance [PFS], target tumor reaction rate [ORR], unfavorable occasions [AEs] and wellbeing related personal satisfaction [HRQoL]). From the included proof audits, information on the number and sort of concentrates remembered for each survey, the kind of examination led (for example elucidating investigation, meta-examination, backhanded correlation) and the general discoveries/ends were extricated. For all investigation types, information revealed in numerous distributions were removed and announced as a solitary report. Quality appraisal The nature of included RCTs and proof audits was surveyed by the criteria set out in the Center for Review and Dissemination's Guidance  for undertaking surveys in social insurance. Two commentators autonomously evaluated the nature of these investigations and, where essential, differences were settled by counsel with a third analyst. As per the convention, quality appraisal of the planned observational investigations was not led. Information blend Information from the included RCTs were considered to give essential clinical adequacy proof. Information from observational examinations and from proof surveys were considered to give supporting proof. Results Writing search and screening The procedure of study choice is appeared in Figure 1. The electronic database look through yielded 2358 papers and six extra references were distinguished through searches of different sources. Altogether, 93 papers giving an account of 24 separate investigations and audits were distinguished. These included two RCTs [the SELECT preliminary  and DECISION preliminary ], nine imminent observational examinations [31-39] and 13 proof surveys [15, 27, 28, 40-49]. For the RCTs, notwithstanding the essential distributed papers [29, 30], information were separated from different sources distinguished from the quests, as suitable. In this paper, extra data for the SELECT preliminary was extricated from the organization accommodation from Eisai Ltd , the clinical investigation report (CSR) (unpublished), three meeting abstracts [50-52] and the European open appraisal report (EPAR) for lenvatinib . For the DECISION preliminary, extra data was separated from the organization accommodation from Bayer HealthCare , an extra distributed paper with valuable wellbeing information , the CSR>GET ANSWER