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Managing uncertainty

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https://www.readbyqxmd.com/read/28803420/psychosocial-needs-and-facilitators-of-mothers-caring-for-children-with-duchenne-becker-muscular-dystrophy
#1
Holly L Peay, Bettina Meiser, Kathleen Kinnett, Aad Tibben
Care guidelines for Duchenne/Becker muscular dystrophy (DBMD) include recommendations for assessment of caregivers of patients with DBMD followed by proactive psychosocial interventions. To inform clinical assessment, this study described appraisals of psychosocial needs and caregiving facilitators of mothers of individuals with DBMD. Two hundred and five mothers completed an online survey. More than 50% endorsed unmet needs for managing uncertainty about the future and managing DBMD fears. Higher levels of unmet need were associated with less disease progression/earlier stage of DBMD (rho = -0...
August 12, 2017: Journal of Genetic Counseling
https://www.readbyqxmd.com/read/28803161/on-line-prognosis-of-fatigue-crack-propagation-based-on-gaussian-weight-mixture-proposal-particle-filter
#2
Jian Chen, Shenfang Yuan, Lei Qiu, Hui Wang, Weibo Yang
Accurate on-line prognosis of fatigue crack propagation is of great meaning for prognostics and health management (PHM) technologies to ensure structural integrity, which is a challenging task because of uncertainties which arise from sources such as intrinsic material properties, loading, and environmental factors. The particle filter algorithm has been proved to be a powerful tool to deal with prognostic problems those are affected by uncertainties. However, most studies adopted the basic particle filter algorithm, which uses the transition probability density function as the importance density and may suffer from serious particle degeneracy problem...
July 25, 2017: Ultrasonics
https://www.readbyqxmd.com/read/28801749/cancer-risk-assessment-of-polycyclic-aromatic-hydrocarbons-in-the-soils-and-sediments-of-india-a-meta-analysis
#3
Abhrajyoti Tarafdar, Alok Sinha
A carcinogenic risk assessment of polycyclic aromatic hydrocarbons in soils and sediments was conducted using the probabilistic approach from a national perspective. Published monitoring data of polycyclic aromatic hydrocarbons present in soils and sediments at different study points across India were collected and converted to their corresponding BaP equivalent concentrations. These BaP equivalent concentrations were used to evaluate comprehensive cancer risk for two different age groups. Monte Carlo simulation and sensitivity analysis were applied to quantify uncertainties of risk estimation...
August 11, 2017: Environmental Management
https://www.readbyqxmd.com/read/28800591/frequencies-of-decision-making-and-monitoring-in-adaptive-resource-management
#4
Byron K Williams, Fred A Johnson
Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring...
2017: PloS One
https://www.readbyqxmd.com/read/28799483/ethical-application-of-precision-medicine-to-schizophrenia-management
#5
Steven Daws
A recent effort has been made to better characterize the genetic architecture of schizophrenia, and apply a precision medicine model to its treatment. In pursuing this approach, it is likely that ethical concerns regarding cost-benefit uncertainties, the duty to inform and confidentiality will arise. Due to the complexity of schizophrenia's genetic profile, research efforts must be weighed against the risk to human subjects and the required consumption of valuable healthcare resources. Genetic risk profiles must be judged in conjunction with actionability and must be fully explained to patients and others potentially affected...
July 2017: New Bioethics: a Multidisciplinary Journal of Biotechnology and the Body
https://www.readbyqxmd.com/read/28799452/syncope-current-knowledge-uncertainties-and-strategies-for-management-optimisation-in-the-emergency-department
#6
Filippo Numeroso, Gianluigi Mossini, Giuseppe Lippi, Gianfranco Cervellin
Admission rates and expenditures for syncope remain high. This unsatisfactory management could be due to several factors, including lack of evidence-based strategy, poor accuracy of clinical decision rules, difficulty in disseminating guidelines, as well as uncertainties concerning management of intermediate-risk patients and role of observation protocols and syncope units. To optimise management, it has been proposed to adopt a pragmatic, symptoms-based definition of syncope and a classification related to the underlying mechanism rather than suspected aetiology...
August 11, 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28799179/what-are-the-dietary-treatment-research-priorities-for-inflammatory-bowel-disease-a-short-report-based-on-a-priority-setting-partnership-with-the-james-lind-alliance
#7
M C Lomer, A L Hart, A Verjee, A Daly, J Solomon, J Mclaughlin
BACKGROUND: Treatment of inflammatory bowel disease (IBD) involves a multidisciplinary approach comprising medical management and sometimes surgery. Although diet is central to IBD management, the optimal diet for patients with IBD is uncertain. A UK collaborative partnership within the James Lind Alliance was set up between patients, clinicians and other stakeholders to develop research priorities in IBD. The aim of this short report is to provide a comprehensive summary of the research priority findings relating to diet in the treatment of IBD...
August 10, 2017: Journal of Human Nutrition and Dietetics: the Official Journal of the British Dietetic Association
https://www.readbyqxmd.com/read/28799081/the-psychosocial-impact-of-carrying-a-debated-variant-in-the-gla-gene
#8
Sarah Macklin, Dawn Laney, Emily Lisi, Andrea Atherton, Elizabeth Smith
The clinical significance of the c.427G>A (p.A143T) variant in GLA is a topic of debate within the lysosomal storage disease community. A review of the literature and published case reports found the clinical impact of the variant to range from classic Fabry symptoms to healthy unaffected males with normal alpha- galactosidase enzyme levels, leaving clinicians unsure of how to manage these individuals. As the number of states testing for Fabry disease on their newborn screening panel has increased, more people with this variant are being identified...
August 10, 2017: Journal of Genetic Counseling
https://www.readbyqxmd.com/read/28798906/cerebral-sinovenous-thrombosis
#9
REVIEW
Rebecca Ichord
Cerebral sinovenous thrombosis (CSVT) is a rare but serious cerebrovascular disorder affecting children from the newborn period through childhood and adolescence. The incidence is estimated at 0.6/100,000/year, with 30-50% occurring in newborns. Causes are diverse and are highly age dependent. Acute systemic illness is the dominant risk factor among newborns. In childhood CSVT, acute infections of the head and neck such as mastoiditis are most common, followed by chronic underlying diseases such as nephrotic syndrome, cancer, and inflammatory bowel disease...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28798016/bayesian-analysis-a-practical-approach-to-interpret-clinical-trials-and-create-clinical-practice-guidelines
#10
John A Bittl, Yulei He
Bayesian analysis is firmly grounded in the science of probability and has been increasingly supplementing or replacing traditional approaches based on P values. In this review, we present gradually more complex examples, along with programming code and data sets, to show how Bayesian analysis takes evidence from randomized clinical trials to update what is already known about specific treatments in cardiovascular medicine. In the example of revascularization choices for diabetic patients who have multivessel coronary artery disease, we combine the results of the FREEDOM trial (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) with prior probability distributions to show how strongly we should believe in the new Class I recommendation ("should be done") for a preference of bypass surgery over percutaneous coronary intervention...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28795254/an-efficient-method-for-kidney-allocation-problem-a-credibility-based-fuzzy-common-weights-data-envelopment-analysis-approach
#11
Sahar Ahmadvand, Mir Saman Pishvaee
Given the perennial imbalance and chronic scarcity between the demand for and supply of available organs, organ allocation is one of the most critical decisions in the management of organ transplantation networks. Organ allocation systems undergo rapid revisions for the sake of improved outcomes in terms of both equity and medical efficiency. This paper presents a Data Envelopment Analysis (DEA)-based model to evaluate the efficiency of possible patient-organ pairs for kidney allocation in order to enhance the fitness of organ allocation under inherent uncertainty in such problem...
August 9, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28794862/case-report-an-incidentaloma-that-catches-your-eye-adrenal-myelolipoma
#12
Rosanna D'Addosio, Joselyn Rojas, Valmore Bermúdez, Flor Ledesma, Kyle Hoedebecke
Background: Adrenal incidentaloma refers to the incidental finding of a tumor in the adrenal gland, where nonfunctional forms are the most common variant. Myelolipoma is a rare (0.08-0.4%) occurrence characterized by adipose and hematopoietic tissue. The aim of this case report is to describe the diagnosis and appropriate management of a myelolipoma in an asymptomatic patient, which was originally considered an incidental hepatic hemangioma prior to being identified as a giant adrenal adenoma. Case description: The patient was a 54 year old obese female with a recent diagnosis of diabetes type II and dyslipidemia with recent ultrasound imaging suggestive of a hepatic hemangioma...
2017: F1000Research
https://www.readbyqxmd.com/read/28794645/asthma-referrals-a-key-component-of-asthma-management-that-needs-to-be-addressed
#13
REVIEW
David Price, Leif Bjermer, David A Bergin, Rafael Martinez
Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient's health status...
2017: Journal of Asthma and Allergy
https://www.readbyqxmd.com/read/28793057/noninvasive-intracranial-pressure-monitoring-for-hiv-associated-cryptococcal-meningitis
#14
V R Bollela, G Frigieri, F C Vilar, D L Spavieri, F J Tallarico, G M Tallarico, R A P Andrade, T M de Haes, O M Takayanagui, A M Catai, S Mascarenhas
Mortality and adverse neurologic sequelae from HIV-associated cryptococcal meningitis (HIV-CM) remains high due to raised intracranial pressure (ICP) complications. Cerebrospinal fluid (CSF) high opening pressure occurs in more than 50% of HIV-CM patients. Repeated lumbar puncture with CSF drainage and external lumbar drainage might be required in the management of these patients. Usually, there is a high grade of uncertainty and the basis for clinical decisions regarding ICP hypertension tends to be from clinical findings (headache, nausea and vomiting), a low Glasgow coma scale score, and/or fundoscopic papilledema...
August 7, 2017: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/28792580/-mental-health-in-primary-care-applying-psychiatric-knowledge-to-primary-care-or-a-whole-different-practice
#15
Philippe Karazivan, Marie Leclaire, Cédric Andres
BACKGROUND: In Canada and several other countries, large cohorts of patients who used to be followed in psychiatric clinics are now steered toward primary care. To support this new reality, measures have been taken and investments made in service organization, collaborative work arrangements, and teaching geared toward primary care clinicians. However, these initiatives were implemented when little was known about GPs' needs. METHODS: Using a qualitative approach, we analyzed the content of GPs' statements to explore when, why, and for what concerns GPs are inclined to collaborate with or seek advice from psychiatrists...
2017: Santé Mentale Au Québec
https://www.readbyqxmd.com/read/28791693/atypical-antipsychotics-for-disruptive-behaviour-disorders-in-children-and-youths
#16
REVIEW
Jik H Loy, Sally N Merry, Sarah E Hetrick, Karolina Stasiak
BACKGROUND: This is an update of the original Cochrane Review, last published in 2012 (Loy 2012). Children and youths with disruptive behaviour disorders may present to health services, where they may be treated with atypical antipsychotics. There is increasing usage of atypical antipsychotics in the treatment of disruptive behaviour disorders. OBJECTIVES: To evaluate the effect and safety of atypical antipsychotics, compared to placebo, for treating disruptive behaviour disorders in children and youths...
August 9, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28789623/the-cost-effectiveness-of-active-surveillance-compared-to-watchful-waiting-and-radical-prostatectomy-for-low-risk-localised-prostate-cancer
#17
Chunhuan Lao, Richard Edlin, Paul Rouse, Charis Brown, Michael Holmes, Peter Gilling, Ross Lawrenson
BACKGROUND: Radical prostatectomy is the most common treatment for localised prostate cancer in New Zealand. Active surveillance was introduced to prevent overtreatment and reduce costs while preserving the option of radical prostatectomy. This study aims to evaluate the cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy. METHODS: Markov models were constructed to estimate the life-time cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy for low risk localised prostate cancer patients aged 45-70 years, using national datasets in New Zealand and published studies including the SPCG-4 study...
August 8, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28783547/impact-of-soil-organic-carbon-on-monosodium-methyl-arsenate-msma-sorption-and-species-transformation
#18
Ling Ou, Travis W Gannon, Matthew L Polizzotto
Monosodium methyl arsenate (MSMA), a common arsenical herbicide, is a major contributor of anthropogenic arsenic (As) to the environment. Uncertainty about controls on MSMA fate and the rates and products of MSMA species transformation limits effective MSMA regulation and management. The main objectives of this research were to quantify the kinetics and mechanistic drivers of MSMA species transformation and removal from solution by soil. Laboratory MSMA incubation studies with two soils and varying soil organic carbon (SOC) levels were conducted...
July 28, 2017: Chemosphere
https://www.readbyqxmd.com/read/28783497/incorporating-model-uncertainty-into-the-evaluation-of-interventions-to-reduce-microcontaminant-loads-in-rivers
#19
P Gimeno, R Marcé, Ll Bosch, J Comas, Ll Corominas
Models of microcontaminant fate and transport in wastewater treatment plants (WWTPs) and rivers have been developed and used to assist decision-making in the field of water management. These models come with parameter uncertainties that must be properly incorporated in the decision-making process. The main goal of this study is to evaluate how the magnitudes of key model parameter uncertainties influence the selection of end-of-pipe interventions (at WWTPs) designed to reduce the microcontaminant loads in rivers...
July 17, 2017: Water Research
https://www.readbyqxmd.com/read/28780156/assessing-and-reporting-uncertainties-in-dietary-exposure-analysis-part-ii-application-of-the-uncertainty-template-to-a-practical-example-of-exposure-assessment
#20
David Tennant, Diána Bánáti, Marc Kennedy, Jürgen König, Cian O'Mahony, Susanne Kettler
A previous publication described methods for assessing and reporting uncertainty in dietary exposure assessments. This follow-up publication uses a case study to develop proposals for representing and communicating uncertainty to risk managers. The food ingredient aspartame is used as the case study in a simple deterministic model (the EFSA FAIM template) and with more sophisticated probabilistic exposure assessment software (FACET). Parameter and model uncertainties are identified for each modelling approach and tabulated...
August 2, 2017: Food and Chemical Toxicology
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