General Practitioners’ Experiences of,and Responses to,Uncertainty in Prostate Cancer Screening: Insights from a Qualitative Study

BackgroundProstate-specific antigen (PSA) testing for prostate cancer is controversial. There are unresolved tensions and disagreements amongst experts, and clinical guidelines conflict. This both reflects and generates significant uncertainty about the appropriateness of screening. Little is known about general practitioners’ (GPs’) perspectives and experiences in relation to PSA testing of asymptomatic men. In this paper we asked the following questions: (1) What are the primary sources of uncertainty as described by GPs in the context of PSA testing? (2) How do GPs experience and respond to different sources of uncertainty?MethodsThis was a qualitative study that explored general practitioners’ current approaches to, and reasoning about, PSA testing of asymptomatic men. We draw on accounts generated from interviews with 69 general practitioners located in Australia (n = 40) and the United Kingdom (n = 29). The interviews were conducted in 2013–2014. Data were analysed using grounded theory methods. Uncertainty in PSA testing was identified as a core issue.FindingsAustralian GPs reported experiencing substantially more uncertainty than UK GPs. This seemed partly explainable by notable differences in conditions of practice between the two countries. Using Han et al’s taxonomy of uncertainty as an initial framework, we first outline the different sources of uncertainty GPs (mostly Australian) described encountering in relation to prostate cancer screening and what the uncertainty was about. We then suggest an extension to Han et al’s taxonomy based on our analysis of data relating to the varied ways that GPs manage uncertainties in the context of PSA testing. We outline three broad strategies: (1) taking charge of uncertainty; (2) engaging others in managing uncertainty; and (3) transferring the responsibility for reducing or managing some uncertainties to other parties.ConclusionOur analysis suggests some GPs experienced uncertainties associated with ambiguous guidance and the complexities of their situation as professionals with responsibilities to patients as considerably burdensome. This raises important questions about responsibility for uncertainty. In Australia in particular they feel insufficiently supported by the health care system to practice in ways that are recognisably consistent with ‘evidence based’ professional standards and appropriate for patients. More work is needed to clarify under what circumstances and how uncertainty should be communicated. Closer attention to different types and aspects of the uncertainty construct could be useful.     

Estimating Uncertainty in Ecosystem Budget Calculations

Ecosystem nutrient budgets often report values for pools and fluxes without any indication of uncertainty, which makes it difficult to evaluate the significance of findings or make comparisons across systems. We present an example, implemented in Excel, of a Monte Carlo approach to estimating error in calculating the N content of vegetation at the Hubbard Brook Experimental Forest in New Hampshire. The total N content of trees was estimated at 847 kg ha⁻¹ with an uncertainty of 8%, expressed as the standard deviation divided by the mean (the coefficient of variation). The individual sources of uncertainty were as follows: uncertainty in allometric equations (5%), uncertainty in tissue N concentrations (3%), uncertainty due to plot variability (6%, based on a sample of 15 plots of 0.05 ha), and uncertainty due to tree diameter measurement error (0.02%). In addition to allowing estimation of uncertainty in budget estimates, this approach can be used to assess which measurements should be improved to reduce uncertainty in the calculated values. This exercise was possible because the uncertainty in the parameters and equations that we used was made available by previous researchers. It is important to provide the error statistics with regression results if they are to be used in later calculations; archiving the data makes resampling analyses possible for future researchers. When conducted using a Monte Carlo framework, the analysis of uncertainty in complex calculations does not have to be difficult and should be standard practice when constructing ecosystem budgets.     

Contribution of crop model structure,parameters and climate projections to uncertainty in climate change impact assessments

Climate change impact assessments are plagued with uncertainties from many sources, such as climate projections or the inadequacies in structure and parameters of the impact model. Previous studies tried to account for the uncertainty from one or two of these. Here, we developed a triple‐ensemble probabilistic assessment using seven crop models, multiple sets of model parameters and eight contrasting climate projections together to comprehensively account for uncertainties from these three important sources. We demonstrated the approach in assessing climate change impact on barley growth and yield at Jokioinen, Finland in the Boreal climatic zone and Lleida, Spain in the Mediterranean climatic zone, for the 2050s. We further quantified and compared the contribution of crop model structure, crop model parameters and climate projections to the total variance of ensemble output using Analysis of Variance (ANOVA). Based on the triple‐ensemble probabilistic assessment, the median of simulated yield change was ?4% and +16%, and the probability of decreasing yield was 63% and 31% in the 2050s, at Jokioinen and Lleida, respectively, relative to 1981–2010. The contribution of crop model structure to the total variance of ensemble output was larger than that from downscaled climate projections and model parameters. The relative contribution of crop model parameters and downscaled climate projections to the total variance of ensemble output varied greatly among the seven crop models and between the two sites. The contribution of downscaled climate projections was on average larger than that of crop model parameters. This information on the uncertainty from different sources can be quite useful for model users to decide where to put the most effort when preparing or choosing models or parameters for impact analyses. We concluded that the triple‐ensemble probabilistic approach that accounts for the uncertainties from multiple important sources provide more comprehensive information for quantifying uncertainties in climate change impact assessments as compared to the conventional approaches that are deterministic or only account for the uncertainties from one or two of the uncertainty sources.     

Multi‐model comparison highlights consistency in predicted effect of warming on a semi‐arid shrub

A number of modeling approaches have been developed to predict the impacts of climate change on species distributions, performance, and abundance. The stronger the agreement from models that represent different processes and are based on distinct and independent sources of information, the greater the confidence we can have in their predictions. Evaluating the level of confidence is particularly important when predictions are used to guide conservation or restoration decisions. We used a multi‐model approach to predict climate change impacts on big sagebrush (Artemisia tridentata), the dominant plant species on roughly 43 million hectares in the western United States and a key resource for many endemic wildlife species. To evaluate the climate sensitivity of A. tridentata, we developed four predictive models, two based on empirically derived spatial and temporal relationships, and two that applied mechanistic approaches to simulate sagebrush recruitment and growth. This approach enabled us to produce an aggregate index of climate change vulnerability and uncertainty based on the level of agreement between models. Despite large differences in model structure, predictions of sagebrush response to climate change were largely consistent. Performance, as measured by change in cover, growth, or recruitment, was predicted to decrease at the warmest sites, but increase throughout the cooler portions of sagebrush's range. A sensitivity analysis indicated that sagebrush performance responds more strongly to changes in temperature than precipitation. Most of the uncertainty in model predictions reflected variation among the ecological models, raising questions about the reliability of forecasts based on a single modeling approach. Our results highlight the value of a multi‐model approach in forecasting climate change impacts and uncertainties and should help land managers to maximize the value of conservation investments.     

Error propagation and scaling for tropical forest biomass estimates

The above-ground biomass (AGB) of tropical forests is a crucial variable for ecologists, biogeochemists, foresters and policymakers. Tree inventories are an efficient way of assessing forest carbon stocks and emissions to the atmosphere during deforestation. To make correct inferences about long-term changes in biomass stocks, it is essential to know the uncertainty associated with AGB estimates, yet this uncertainty is rarely evaluated carefully. Here, we quantify four types of uncertainty that could lead to statistical error in AGB estimates: (i) error due to tree measurement; (ii) error due to the choice of an allometric model relating AGB to other tree dimensions; (iii) sampling uncertainty, related to the size of the study plot; (iv) representativeness of a network of small plots across a vast forest landscape. In previous studies, these sources of error were reported but rarely integrated into a consistent framework. We estimate all four terms in a 50 hectare (ha, where 1 ha = 10(4) m2) plot on Barro Colorado Island, Panama, and in a network of 1 ha plots scattered across central Panama. We find that the most important source of error is currently related to the choice of the allometric model. More work should be devoted to improving the predictive power of allometric models for biomass.     

Partitioning and mapping uncertainties in ensembles of forecasts of species turnover under climate change

Forecasts of species range shifts under climate change are fraught with uncertainties and ensemble forecasting may provide a framework to deal with such uncertainties. Here, a novel approach to partition the variance among modeled attributes, such as richness or turnover, and map sources of uncertainty in ensembles of forecasts is presented. We model the distributions of 3837 New World birds and project them into 2080. We then quantify and map the relative contribution of different sources of uncertainty from alternative methods for niche modeling, general circulation models (AOGCM), and emission scenarios. The greatest source of uncertainty in forecasts of species range shifts arises from using alternative methods for niche modeling, followed by AOGCM, and their interaction. Our results concur with previous studies that discovered that projections from alternative models can be extremely varied, but we provide a new analytical framework to examine uncertainties in models by quantifying their importance and mapping their patterns.     

Propagating Uncertainty in Plot-based Estimates of Forest Carbon Stock and Carbon Stock Change

Ecosystem science increasingly relies on highly derived metrics to synthesize across large datasets. However, full uncertainty associated with these metrics is seldom quantified. Our objective was to evaluate measurement error and model uncertainty in plot-based estimates of carbon stock and carbon change. We quantified the measurement error associated with live stems, deadwood and plot-level variables in temperate rainforest in New Zealand. We also quantified model uncertainty for height–diameter allometry, stem volume equations and wood-density estimates. We used Monte Carlo simulation to assess the net effects on carbon stock and carbon change estimated using data from 227 plots from throughout New Zealand. Plot-to-plot variation was the greatest source of uncertainty, amounting to 9.1% of mean aboveground carbon stock estimates (201.11 MgC ha^?1). Propagation of the measurement error and model uncertainty resulted in a 1% increase in uncertainty (0.1% of mean stock estimate). Carbon change estimates (mean ?0.86 MgC ha^?1 y^?1) were more uncertain, with sampling error equating to 56% of the mean, and when measurement error and model uncertainty were included this uncertainty increased by 35% (22.1% of the mean change estimate). For carbon change, the largest sources of measurement error were missed/double counted stems and fallen coarse woody debris. Overall, our findings show that national-scale plot-based estimates of carbon stock and carbon change in New Zealand are robust to measurement error and model uncertainty. We recommend that calculations of carbon stock and carbon change incorporate both these sources of uncertainty so that management implications and policy decisions can be assessed with the appropriate level of confidence.     

Measurement error in a random walk model with applications to population dynamics

Population abundances are rarely, if ever, known. Instead, they are estimated with some amount of uncertainty. The resulting measurement error has its consequences on subsequent analyses that model population dynamics and estimate probabilities about abundances at future points in time. This article addresses some outstanding questions on the consequences of measurement error in one such dynamic model, the random walk with drift model, and proposes some new ways to correct for measurement error. We present a broad and realistic class of measurement error models that allows both heteroskedasticity and possible correlation in the measurement errors, and we provide analytical results about the biases of estimators that ignore the measurement error. Our new estimators include both method of moments estimators and "pseudo"-estimators that proceed from both observed estimates of population abundance and estimates of parameters in the measurement error model. We derive the asymptotic properties of our methods and existing methods, and we compare their finite-sample performance with a simulation experiment. We also examine the practical implications of the methods by using them to analyze two existing population dynamics data sets.     

A collaboratively-derived science-policy research agenda

The need for policy makers to understand science and for scientists to understand policy processes is widely recognised. However, the science-policy relationship is sometimes difficult and occasionally dysfunctional; it is also increasingly visible, because it must deal with contentious issues, or itself becomes a matter of public controversy, or both. We suggest that identifying key unanswered questions on the relationship between science and policy will catalyse and focus research in this field. To identify these questions, a collaborative procedure was employed with 52 participants selected to cover a wide range of experience in both science and policy, including people from government, non-governmental organisations, academia and industry. These participants consulted with colleagues and submitted 239 questions. An initial round of voting was followed by a workshop in which 40 of the most important questions were identified by further discussion and voting. The resulting list includes questions about the effectiveness of science-based decision-making structures; the nature and legitimacy of expertise; the consequences of changes such as increasing transparency; choices among different sources of evidence; the implications of new means of characterising and representing uncertainties; and ways in which policy and political processes affect what counts as authoritative evidence. We expect this exercise to identify important theoretical questions and to help improve the mutual understanding and effectiveness of those working at the interface of science and policy.     

Disentangling effects of uncertainties on population projections: climate change impact on an epixylic bryophyte

Assessment of future ecosystem risks should account for the relevant uncertainty sources. This means accounting for the joint effects of climate variables and using modelling techniques that allow proper treatment of uncertainties. We investigate the influence of three of the IPCC's scenarios of greenhouse gas emissions (special report on emission scenarios (SRES)) on projections of the future abundance of a bryophyte model species. We also compare the relative importance of uncertainty sources on the population projections. The whole chain global climate model (GCM)-regional climate model-population dynamics model is addressed. The uncertainty depends on both natural- and model-related sources, in particular on GCM uncertainty. Ignoring the uncertainties gives an unwarranted impression of confidence in the results. The most likely population development of the bryophyte Buxbaumia viridis towards the end of this century is negative: even with a low-emission scenario, there is more than a 65 per cent risk for the population to be halved. The conclusion of a population decline is valid for all SRES scenarios investigated. Uncertainties are no longer an obstacle, but a mandatory aspect to include in the viability analysis of populations.     

Treatments of Uncertainty and Variability in Ecological Risk Assessment of Single-Species Populations

The selection of the most appropriate model for an ecological risk assessment depends on the application, the data and resources available, the knowledge base of the assessor, the relevant endpoints, and the extent to which the model deals with uncertainty. Since ecological systems are highly variable and our knowledge of model input parameters is uncertain, it is important that models include treatments of uncertainty and variability, and that results are reported in this light. In this paper we discuss treatments of variation and uncertainty in a variety of population models. In ecological risk assessments, the risk relates to the probability of an adverse event in the context of environmental variation. Uncertainty relates to ignorance about parameter values, e.g., measurement error and systematic error. An assessment of the full distribution of risks, under variability and parameter uncertainty, will give the most comprehensive and flexible endpoint. In this paper we present the rationale behind probabilistic risk assessment, identify the sources of uncertainty relevant for risk assessment and provide an overview of a range of population models. While all of the models reviewed have some utility in ecology, some have more comprehensive treatments of uncertainty than others. We identify the models that allow probabilistic assessments and sensitivity analyses, and we offer recommendations for further developments that aim towards more comprehensive and reliable ecological risk assessments for populations.     

Urgent need for warming experiments in tropical forests

Although tropical forests account for only a fraction of the planet's terrestrial surface, they exchange more carbon dioxide with the atmosphere than any other biome on Earth, and thus play a disproportionate role in the global climate. In the next 20 years, the tropics will experience unprecedented warming, yet there is exceedingly high uncertainty about their potential responses to this imminent climatic change. Here, we prioritize research approaches given both funding and logistical constraints in order to resolve major uncertainties about how tropical forests function and also to improve predictive capacity of earth system models. We investigate overall model uncertainty of tropical latitudes and explore the scientific benefits and inevitable trade‐offs inherent in large‐scale manipulative field experiments. With a Coupled Model Intercomparison Project Phase 5 analysis, we found that model variability in projected net ecosystem production was nearly 3 times greater in the tropics than for any other latitude. Through a review of the most current literature, we concluded that manipulative warming experiments are vital to accurately predict future tropical forest carbon balance, and we further recommend the establishment of a network of comparable studies spanning gradients of precipitation, edaphic qualities, plant types, and/or land use change. We provide arguments for long‐term, single‐factor warming experiments that incorporate warming of the most biogeochemically active ecosystem components (i.e. leaves, roots, soil microbes). Hypothesis testing of underlying mechanisms should be a priority, along with improving model parameterization and constraints. No single tropical forest is representative of all tropical forests; therefore logistical feasibility should be the most important consideration for locating large‐scale manipulative experiments. Above all, we advocate for multi‐faceted research programs, and we offer arguments for what we consider the most powerful and urgent way forward in order to improve our understanding of tropical forest responses to climate change.     

Uncertainty in life cycle costing for long-range infrastructure. Part I: leveling the playing field to address uncertainties

Purpose

Life cycle costing (LCC) is a state-of-the-art method to analyze investment decisions in infrastructure projects. However, uncertainties inherent in long-term planning question the credibility of LCC results. Previous research has not systematically linked sources and methods to address this uncertainty. Part I of this series develops a framework to collect and categorize different sources of uncertainty and addressing methods. This systematization is a prerequisite to further analyze the suitability of methods and levels the playing field for part II.

Methods

Past reviews have dealt with selected issues of uncertainty in LCC. However, none has systematically collected uncertainties and linked methods to address them. No comprehensive categorization has been published to date. Part I addresses these two research gaps by conducting a systematic literature review. In a rigorous four-step approach, we first scrutinized major databases. Second, we performed a practical and methodological screening to identify in total 115 relevant publications, mostly case studies. Third, we applied content analysis using MAXQDA. Fourth, we illustrated results and concluded upon the research gaps.

Results and discussion

We identified 33 sources of uncertainty and 24 addressing methods. Sources of uncertainties were categorized according to (i) its origin, i.e., parameter, model, and scenario uncertainty and (ii) the nature of uncertainty, i.e., aleatoric or epistemic uncertainty. The methods to address uncertainties were classified into deterministic, probabilistic, possibilistic, and other methods. With regard to sources of uncertainties, lack of data and data quality was analyzed most often. Most uncertainties having been discussed were located in the use stage. With regard to methods, sensitivity analyses were applied most widely, while more complex methods such as Bayesian models were used less frequently. Data availability and the individual expertise of LCC practitioner foremost influence the selection of methods.

Conclusions

This article complements existing research by providing a thorough systematization of uncertainties in LCC. However, an unambiguous categorization of uncertainties is difficult and overlapping occurs. Such a systemizing approach is nevertheless necessary for further analyses and levels the playing field for readers not yet familiar with the topic. Part I concludes the following: First, an investigation about which methods are best suited to address a certain type of uncertainty is still outstanding. Second, an analysis of types of uncertainty that have been insufficiently addressed in previous LCC cases is still missing. Part II will focus on these research gaps.

     

Phylogenetic uncertainty revisited: Implications for ecological analyses

Ecologists and biogeographers usually rely on a single phylogenetic tree to study evolutionary processes that affect macroecological patterns. This approach ignores the fact that each phylogenetic tree is a hypothesis about the evolutionary history of a clade, and cannot be directly observed in nature. Also, trees often leave out many extant species, or include missing species as polytomies because of a lack of information on the relationship among taxa. Still, researchers usually do not quantify the effects of phylogenetic uncertainty in ecological analyses. We propose here a novel analytical strategy to maximize the use of incomplete phylogenetic information, while simultaneously accounting for several sources of phylogenetic uncertainty that may distort statistical inferences about evolutionary processes. We illustrate the approach using a clade‐wide analysis of the hummingbirds, evaluating how different sources of uncertainty affect several phylogenetic comparative analyses of trait evolution and biogeographic patterns. Although no statistical approximation can fully substitute for a complete and robust phylogeny, the method we describe and illustrate enables researchers to broaden the number of clades for which studies informed by evolutionary relationships are possible, while allowing the estimation and control of statistical error that arises from phylogenetic uncertainty. Software tools to carry out the necessary computations are offered.     

Applying stable isotopes to examine food‐web structure: an overview of analytical tools

Stable isotope analysis has emerged as one of the primary means for examining the structure and dynamics of food webs, and numerous analytical approaches are now commonly used in the field. Techniques range from simple, qualitative inferences based on the isotopic niche, to Bayesian mixing models that can be used to characterize food‐web structure at multiple hierarchical levels. We provide a comprehensive review of these techniques, and thus a single reference source to help identify the most useful approaches to apply to a given data set. We structure the review around four general questions: (1) what is the trophic position of an organism in a food web?; (2) which resource pools support consumers?; (3) what additional information does relative position of consumers in isotopic space reveal about food‐web structure?; and (4) what is the degree of trophic variability at the intrapopulation level? For each general question, we detail different approaches that have been applied, discussing the strengths and weaknesses of each. We conclude with a set of suggestions that transcend individual analytical approaches, and provide guidance for future applications in the field.     

Source Partitioning Using Stable Isotopes: Coping with Too Much Variation

Background

Stable isotope analysis is increasingly being utilised across broad areas of ecology and biology. Key to much of this work is the use of mixing models to estimate the proportion of sources contributing to a mixture such as in diet estimation.

Methodology

By accurately reflecting natural variation and uncertainty to generate robust probability estimates of source proportions, the application of Bayesian methods to stable isotope mixing models promises to enable researchers to address an array of new questions, and approach current questions with greater insight and honesty.

Conclusions

We outline a framework that builds on recently published Bayesian isotopic mixing models and present a new open source R package, SIAR. The formulation in R will allow for continued and rapid development of this core model into an all-encompassing single analysis suite for stable isotope research.     

Incorporating climate change into ecosystem service assessments and decisions: a review

Climate change is having a significant impact on ecosystem services and is likely to become increasingly important as this phenomenon intensifies. Future impacts can be difficult to assess as they often involve long timescales, dynamic systems with high uncertainties, and are typically confounded by other drivers of change. Despite a growing literature on climate change impacts on ecosystem services, no quantitative syntheses exist. Hence, we lack an overarching understanding of the impacts of climate change, how they are being assessed, and the extent to which other drivers, uncertainties, and decision making are incorporated. To address this, we systematically reviewed the peer‐reviewed literature that assesses climate change impacts on ecosystem services at subglobal scales. We found that the impact of climate change on most types of services was predominantly negative (59% negative, 24% mixed, 4% neutral, 13% positive), but varied across services, drivers, and assessment methods. Although uncertainty was usually incorporated, there were substantial gaps in the sources of uncertainty included, along with the methods used to incorporate them. We found that relatively few studies integrated decision making, and even fewer studies aimed to identify solutions that were robust to uncertainty. For management or policy to ensure the delivery of ecosystem services, integrated approaches that incorporate multiple drivers of change and account for multiple sources of uncertainty are needed. This is undoubtedly a challenging task, but ignoring these complexities can result in misleading assessments of the impacts of climate change, suboptimal management outcomes, and the inefficient allocation of resources for climate adaptation.     

Propagating aleatory and epistemic uncertainty in land cover change prediction process

An objective of satellite remote sensing is to predict or characterize the land cover change (LCC) over time. Sometimes we are capable of describing the changes of land cover with a probability distribution. However, we need sufficient knowledge about the natural variability of these changes, which is not always possible. In general, uncertainties can be subdivided into aleatory and epistemic. The main problem is that classical probability theory does not make a clear distinction between aleatory and epistemic uncertainties in the way they are represented, i.e., both of them are described with a probability distribution. The aim of this paper is to propagate the aleatory and epistemic uncertainty associated with both input parameters (features extracted from satellite image object) and model structure of LCC prediction process using belief function theory. This will help reducing in a significant way the uncertainty about future changes of land cover. In this study, the changes prediction of land cover in Cairo region, Egypt for next 16 years (2030) is anticipated using multi-temporal Landsat TM5 satellite images in 1987 and 2014. The LCC prediction model results indicated that 15% of the agriculture and 6.5% of the desert will be urbanized in 2030. We conclude that our method based on belief function theory has a potential to reduce uncertainty and improve the prediction accuracy and is applicable in LCC analysis.