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Managing uncertainty

Stina Lou, Camilla P Nielsen, Lone Hvidman, Olav B Petersen, Mette B Risør
BACKGROUND: It is well documented that pregnant women experience increased worry and uncertainty following a high-risk prenatal screening result. While waiting for diagnostic results this worry continues to linger. It has been suggested that high-risk women put the pregnancy mentally 'on hold' during this period, however, not enough is known about how high-risk women and their partners cope while waiting for diagnostic results. The aim of this study was to identify the strategies employed to cope with worry and uncertainty...
October 21, 2016: BMC Pregnancy and Childbirth
T Lavender, S Wakasiaka, L McGowan, M Moraa, J Omari, W Khisa
AIM: this study aimed to gain understanding of the views of community members in relation to obstetric fistula. DESIGN AND METHOD: a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data. SETTING: participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta...
October 4, 2016: Midwifery
Amanda M West, Paul H Evangelista, Catherine S Jarnevich, Nicholas E Young, Thomas J Stohlgren, Colin Talbert, Marian Talbert, Jeffrey Morisette, Ryan Anderson
Early detection of invasive plant species is vital for the management of natural resources and protection of ecosystem processes. The use of satellite remote sensing for mapping the distribution of invasive plants is becoming more common, however conventional imaging software and classification methods have been shown to be unreliable. In this study, we test and evaluate the use of five species distribution model techniques fit with satellite remote sensing data to map invasive tamarisk (Tamarix spp.) along the Arkansas River in Southeastern Colorado...
October 11, 2016: Journal of Visualized Experiments: JoVE
Megan K Creutzburg, Robert M Scheller, Melissa S Lucash, Stephen D LeDuc, Mark G Johnson
Balancing economic, ecological and social values has long been a challenge in the forests of the Pacific Northwest, where conflict over timber harvest and old-growth habitat on public lands has been contentious for the past several decades. The Northwest Forest Plan, adopted two decades ago to guide management on federal lands, is currently being revised as the region searches for a balance between sustainable timber yields and habitat for sensitive species. In addition, climate change imposes a high degree of uncertainty on future forest productivity, sustainability of timber harvest, wildfire risk, and species habitat...
October 21, 2016: Ecological Applications: a Publication of the Ecological Society of America
Xue Li, Jianfeng Feng, Christopher Wellen, Yuqiu Wang
In this study, a modeling framework based on the theory of SPAtially Referenced Regression On Watershed attributes (SPARROW) model was developed to identify impaired river reaches with respect to total nitrogen (TN) and estimate the TN sources in the Xin'anjiang River basin, which had limited monitoring sites. A Bayesian approach was applied to estimate the mean values and uncertainties of parameters, including land use export coefficients and in-stream attention rates. Based on the parameters, the midranges (25-75 %) of annual TN concentrations were assessed by the model and 4...
October 20, 2016: Environmental Science and Pollution Research International
T A Tomsick, J Carrozzella, L Foster, M D Hill, R von Kummer, M Goyal, A M Demchuk, P Khatri, Y Palesch, J P Broderick, S D Yeatts, D S Liebeskind
BACKGROUND AND PURPOSE: Uncertainty persists regarding the safety and efficacy of endovascular therapy of M2 occlusions following IV tPA. We reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1-M2 segment anatomic features. MATERIALS AND METHODS: Perfusion of any M2 branch distinguished M2-versus-M1 occlusion. Prespecified modified TICI and arterial occlusive lesion revascularization and clinical mRS 0-2 end points at 90 days for endovascular therapy-treated M2 occlusions were analyzed...
October 20, 2016: AJNR. American Journal of Neuroradiology
Nicoletta Staropoli, Domenico Ciliberto, Silvia Chiellino, Francesca Caglioti, Teresa Del Giudice, Simona Gualtieri, Angela Salvino, Alessandra Strangio, Cirino Botta, Sandro Pignata, Pierfrancesco Tassone, Pierosandro Tagliaferri
OBJECTIVES: The current gold-standard for the first-line treatment in IIIb/IV stages of epithelial ovarian cancer (EOC) is the combination of carboplatin and paclitaxel plus bevacizumab in some countries. In the era of personalized medicine, there is still uncertainty on the impact of several molecularly targeted agents, which have been investigated for the management of this disease. To shed light on the actual role of targeted therapy in EOC, a systematic review and meta-analysis was performed...
October 13, 2016: Oncotarget
C Andres Benatti, Natalie A Afshari
PURPOSE OF REVIEW: The review updates the mechanisms, clinical presentation, diagnosis, and management of Descemet membrane detachment after cataract surgery, particularly during cataract surgery. RECENT FINDINGS: The advent of new imaging techniques like the anterior segment optical coherence tomography and a better comprehension of the clinical and pathological aspects of detachment, has improved the diagnosis and treatment of this complication to the extent that the first algorithms and protocols have been proposed...
October 19, 2016: Current Opinion in Ophthalmology
Elisa Bruno, Alessandra Nicoletti, Graziella Quattrocchi, Graziella Filippini, Carlo Colosimo, Mario Zappia
BACKGROUND: Essential tremor is one of the most common movement disorders. Treatment primarily consists of pharmacological agents. While primidone and propranolol are well-established treatments in clinical practice, they may be ineffective in 25% to 55% of patients and can produce serious adverse events in a large percentage of them. For these reasons, it is worth evaluating the treatment alternatives for essential tremor. Some specialists have suggested that pregabalin could be a potentially useful agent, but there is uncertainty about its efficacy and safety...
October 20, 2016: Cochrane Database of Systematic Reviews
R J Duintjer Tebbens, K M Thompson
If the world can successfully control all outbreaks of circulating vaccine-derived poliovirus that may occur soon after global oral poliovirus vaccine (OPV) cessation, then immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) from rare and mostly asymptomatic long-term excretors (defined as ⩾6 months of excretion) will become the main source of potential poliovirus outbreaks for as long as iVDPV excretion continues. Using existing models of global iVDPV prevalence and global long-term poliovirus risk management, we explore the implications of uncertainties related to iVDPV risks, including the ability to identify asymptomatic iVDPV excretors to treat with polio antiviral drugs (PAVDs) and the transmissibility of iVDPVs...
October 20, 2016: Epidemiology and Infection
Nicholas J Lunn, Sabrina Servanty, Eric V Regehr, Sarah J Converse, Evan Richardson, Ian Stirling
Changes in the abundance and distribution of wildlife populations are common consequences of historic and contemporary climate change. Some Arctic marine mammals, such as the polar bear (Ursus maritimus), may be particularly vulnerable to such changes due to the loss of Arctic sea ice. We evaluated the impacts of environmental variation on demographic rates for the Western Hudson Bay (WH), polar bear subpopulation from 1984 to 2011 using live-recapture and dead-recovery data in a Bayesian implementation of multistate capture-recapture models...
July 2016: Ecological Applications: a Publication of the Ecological Society of America
Perry J Williams, Mevin B Hooten
Statistical decision theory (SDT) is a sub-field of decision theory that formally incorporates statistical investigation into a decision-theoretic framework to account for uncertainties in a decision problem. SDT provides a unifying analysis of three types of information: statistical results from a data set, knowledge of the consequences of potential choices (i.e., loss), and prior beliefs about a system. SDT links the theoretical development of a large body of statistical methods, including point estimation, hypothesis testing, and confidence interval estimation...
September 2016: Ecological Applications: a Publication of the Ecological Society of America
Ryan M Bright, Wiley Bogren, Pierre Bernier, Rasmus Astrup
Surface albedo is an important physical property by which the land surface regulates climate. A wide and growing body of literature suggests that failing to account for surface albedo can result in suboptimal or even counterproductive climate-motivated policies of the land-based sectors. As such, albedo changes are increasingly included in climate impact assessments of forestry and other land sector projects through conversion of radiative forcings into carbon or carbon dioxide equivalents. However, the prevailing methodology does not sufficiently accommodate dynamic albedo changes on land or CO2 in the atmosphere...
September 2016: Ecological Applications: a Publication of the Ecological Society of America
Helen R Sofaer, Susan K Skagen, Joseph J Barsugli, Benjamin S Rashford, Gordon C Reese, Jennifer A Hoeting, Andrew W Wood, Barry R Noon
Climate change poses major challenges for conservation and management because it alters the area, quality, and spatial distribution of habitat for natural populations. To assess species' vulnerability to climate change and target ongoing conservation investments, researchers and managers often consider the effects of projected changes in climate and land use on future habitat availability and quality and the uncertainty associated with these projections. Here, we draw on tools from hydrology and climate science to project the impact of climate change on the density of wetlands in the Prairie Pothole Region of the USA, a critical area for breeding waterfowl and other wetland-dependent species...
September 2016: Ecological Applications: a Publication of the Ecological Society of America
James Sharman
With every cardiac contraction, a pressure wave is generated and propagated within the central large arteries. The characteristic shape of proximal aortic pressure waves (central blood pressure) has been shown to contain prognostic information on cardiovascular risk that is independent from conventional upper arm blood pressure, yet the mechanisms explaining differences in central blood pressure wave shape remain controversial. Uncertainty in this field requires resolution if central blood pressure is to be a target of hypertension management...
September 2016: Journal of Hypertension
Carlos M Mery, Keila N Lopez, Silvana Molossi, S Kristen Sexson-Tejtel, Rajesh Krishnamurthy, E Dean McKenzie, Charles D Fraser, Scott B Cantor
OBJECTIVES: The goal of this study was to use decision analysis to evaluate the impact of varying uncertainties on the outcomes of patients with anomalous aortic origin of a coronary artery. METHODS: Two separate decision analysis models were created: one for anomalous left coronary artery (ALCA) and one for anomalous right coronary artery (ARCA). Three strategies were compared: observation, exercise restriction, and surgery. Probabilities and health utilities were estimated on the basis of existing literature...
November 2016: Journal of Thoracic and Cardiovascular Surgery
Sarah Brudler, Karsten Arnbjerg-Nielsen, Michael Zwicky Hauschild, Martin Rygaard
Expected increases in pluvial flooding, due to climatic changes, require large investments in the retrofitting of cities to keep damage at an acceptable level. Many cities have investigated the possibility of implementing stormwater management (SWM) systems which are multi-functional and consist of different elements interacting to achieve desired safety levels. Typically, an economic assessment is carried out in the planning phase, while environmental sustainability is given little or no attention. In this paper, life cycle assessment is used to quantify environmental impacts of climate change adaptation strategies...
October 11, 2016: Water Research
Anthony C Umeh, Luchun Duan, Ravi Naidu, Kirk T Semple
Risk-based approaches to managing contaminated land, rather than approaches based on complete contaminant removal, have gained acceptance as they are likely to be more feasible and cost effective. Risk-based approaches aim to minimise risks of exposure of a specified contaminant to humans. However, adopting a risk-based approach over alternative overly-conservative approaches requires that associated uncertainties in decision making are understood and minimised. Irrespective of the nature of contaminants, a critical uncertainty is whether there are potential risks associated with exposure to the residual contaminant fractions in soil to humans and other ecological receptors, and how they should be considered in the risk assessment process...
October 13, 2016: Environment International
Helen A Hamilton, Eva Brod, Ola Hanserud, Daniel B Müller, Helge Brattebø, Trond K Haraldsen
The plant-availability of phosphorus (P) plays a central role in the ability of secondary P resources to replace mineral fertilizer. This is because secondary P plant-availability varies, often with large fractions of residual P that has no immediate fertilization effect. Therefore, if low quality secondary P fertilizers are applied, they will accumulate in soils that, in the long run, may increase the risk of P runoff and eutrophication. Substance flow analyses (SFA), used to identify potentials for improved P management, have not considered this well-known quality barrier...
October 13, 2016: Science of the Total Environment
Savita Katbamna, Lisa Manning, Amit Mistri, Mark Johnson, Thompson Robinson
OBJECTIVES: This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers' experiences of caring, factors contributing to their stress, and strategies used to overcome stress. DESIGN: A qualitative approach involving in-depth interviews was used to explore informal carers' experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers...
October 15, 2016: Ethnicity & Health
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