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Rigorous uncertainty assessment in contaminant transport inverse modelling: a case study of fluoride diffusion through clay liners.

Inverse methods used in assessing landfill liner design have not yet taken advantage of current developments in inverse procedures. Here, a method for inverting contaminant transport models is presented including a general error model and procedures for differentially weighted multiple response regression. General error models are employed in cases where the residuals are heteroscedastic and correlated, and lead to valid inference on model parameter and predictive uncertainty. The Shuffled Complex Evolution algorithm is used to optimise model parameters. Model parameter uncertainty is assessed by exploring the posterior probability distribution with the Metropolis algorithm, a Markov chain Monte Carlo sampling method. The inverse method is applied to simultaneously determine the sorption and diffusion parameters from laboratory diffusion cell experiments. In these experiments, fluoride migration through kaolin clays was measured by sampling the source and collector cells over time. To uniquely determine the transport model parameters, it was necessary to simultaneously fit the observed data from two independent diffusion cell experiments with different initial concentrations. The jointly fitted transport model parameters compared well with those fitted to independent batch experiments.

Aluminum Silicates↗

[Comparison of 2 methods for calculating uncertainty in laboratory analysis].

OBJECTIVE: To compare two methods in the estimation of the uncertainty in laboratory quality control. METHODS: A computerized simulation is performed to compare the delta method (suggested by the International Organization for Standardization and the Entidad Nacional de Acreditación) and a bootstrap-based method. The simulation includes several situations with different environmental conditions and different relationships between the analyzed variables. RESULTS: The mean in the coverage obtained by the estimated confidence intervals is higher and closer to the nominal using the bootstrap than using the delta method. The most important differences are observed in the coverage percent distribution: while using the bootstrap, a great number of simulations obtain coverage near the nominal of 95%; using the delta method the coverage are more dispersed, including coverage of 100% in some occasions and lesser than 80% in others. The bootstrap offers very similar results under different conditions, including in the presence of unknown and unmeasured variables or when the analyzed variables are correlated. The delta method shows poorer results in both situations. CONCLUSION: The uncertainty in the laboratory quality control can be estimated more accurately with bootstrapping than with the delta method.

Clinical Laboratory Techniques↗

Scientific uncertainty and the role of expert advice: the case of health checks for coronary heart disease prevention by general practitioners in the UK.

This paper examines some of the ways in which scientific evidence influenced the development of the policy for the payment of general practitioners for coronary heart disease (CHD) prevention in the UK, in particular the introduction of 'health checks'. The specific policy events which are examined are the 1990 and 1993 contracts for health promotion by general practitioners. Data for this paper were provided by oral history interviews with key informants including general practitioners, public health doctors, civil servants and academics. The study shows the way in which complex scientific evidence interacted with other, professional and political, factors to produce a policy for which there was variable scientific evidence. The relationship between science and policy was complicated and tortuous but two aspects were particularly salient, the way in which scientific uncertainty influenced the content of the policy and the contribution of expert advice to policy making. The existence of social and technical uncertainty about the effectiveness of health checks allowed different players to hold different views depending on their professional affiliation or other agendas. The mechanisms by which scientific advice was given to policy makers were primarily by medical civil servants and through informal contacts and networks. There was no independent systematic formal system to assess and disseminate scientific advice to policy makers, for instance by an expert committee. These factors in turn allowed policy makers to ignore or misinterpret scientific evidence according to other policy imperatives.

Coronary Disease↗

Uncertainty factors for chemical risk assessment. human variability in the pharmacokinetics of CYP1A2 probe substrates.

A 100-fold uncertainty factor is used to derive acceptable daily intakes for compounds causing thresholded toxicity. The 10-fold factor for human variability can be further subdivided into two factors of 10(0.5) (3.16) to allow for toxicokinetics and toxicodynamics. The validity of the human kinetic subfactor has been analysed in relation to CYP1A2 metabolism using published in vivo pharmacokinetic parameters selected to reflect chronic exposure (metabolic and total clearances and area under the plasma concentration-time curve: CLm, CL and AUC) and acute exposure (the peak plasma concentration, C(max)). The variability in CYP1A2 activity in healthy adults, based on data after oral and intravenous dosage (CLm, CL and AUC), ranged from 34 to 42%. The variability in C(max) was 21%. The default kinetic factor of 3.16 would cover at least 99% of the healthy adult population, assuming that the data were log-normally distributed, but would give lower protection for some subgroups (pregnant women at term, healthy elderly, patients with liver disease), and was inadequate for neonates. This analysis of in vivo kinetic data for CYP1A2 substrates illustrates the importance of quantifying human variability in specific metabolic pathways, and of identifying potentially susceptible subgroups of the human population, in order to determine the scientific validity of uncertainty factors.

Adult↗

Uncertainty factors for chemical risk assessment: interspecies differences in the in vivo pharmacokinetics and metabolism of human CYP1A2 substrates.

The 100-fold default uncertainty factor is used to convert a no-observed-adverse-effect level (NOAEL) from a animal toxicity study, to a "safe" value for human intake. The composite uncertainty factor (100) has to allow for interspecies (10-fold) and interindividual (10-fold) differences in toxicokinetics and toxicodynamics. The aim of the current study was to assess the validity of the interspecies default for toxicokinetics (4.0) for each of the test species (dog, rabbit, rat and mouse), using published data for compounds eliminated by CYP1A2 in humans (caffeine, theobromine, theophylline and paraxanthine). An analysis of the published literature showed that the absorption, bioavailability and route of excretion were generally similar between humans and the test species, for each probe substrate. However, interspecies differences in the route of metabolism, and the enzymes involved in this process, were identified. The magnitude of difference in the internal dose, between species, showed that values for the mouse (10.6) and rat (5.4) exceed the 4.0-fold default, whereas the rabbit (2.6) and dog (1.6) were below this value. This work supports the need to replace the generic default factors by a compound-related value derived from specific, relevant, quantitative data; this would result in more relevant and reliable non-cancer risk assessments.

Animals↗

Human variability in glucuronidation in relation to uncertainty factors for risk assessment.

The appropriateness of the default uncertainty factor for human variability in kinetics has been investigated for glucuronidation using an extensive database of substrates metabolised primarily by this pathway. Inter-individual variability was quantified for 15 compounds from published pharmacokinetic studies (after oral and intravenous dosing) in healthy adults and other subgroups using parameters relating to chronic exposure (metabolic and total clearances, area under the plasma concentration time-curve (AUC)) and acute exposure (C(max)). Low inter-individual variability (about 30-35%) was found for all parameters (clearance corrected or not corrected for body weight, metabolic clearance, oral AUC and C(max)) after either iv or oral administration to healthy adults. The overall variability of 31% for glucuronidation in healthy adults supported the validity of the default kinetic uncertainty factor of 3.16 for this group, because it would cover more than 99% of individuals. Comparisons between potentially sensitive subgroups and healthy adults using differences in means and variability indicated that neonates showed the greatest impairment of glucuronidation, and that the 3.16 kinetic default factor applied to the mean data for adults would be inadequate for this subpopulation. The in vivo data have been used to derive pathway-related default factors for compounds eliminated largely via glucuronidation.

Administration, Oral↗

Human variability in polymorphic CYP2D6 metabolism: is the kinetic default uncertainty factor adequate?

Human variability in the kinetics of CYP2D6 substrates has been quantified using a database of compounds metabolised extensively (>60%) by this polymorphic enzyme. Published pharmacokinetic studies (after oral and intravenous dosing) in non-phenotyped healthy adults, and phenotyped extensive (EMs), intermediate or slow-extensive (SEMs) and poor metabolisers (PMs) have been analysed using data for parameters that relate primarily to chronic exposure (metabolic and total clearances, area under the plasma concentration time-curve) and primarily to acute exposure (peak concentration). Similar analyses were performed with the available data for subgroups of the population (age, ethnicity and disease). Interindividual differences in kinetics for markers of oral exposure were large for non-phenotyped individuals and for EMs (coefficients of variation were 67-71% for clearances and 54-63% for C(max)), whereas the intravenous data indicated a lower variability (34-38%). Comparisons between EMs, SEMs and PMs revealed an increase in oral internal dose for SEMs and PMs (ratio compared to EMs=3 and 9-12, respectively) associated with lower variability than that for non-phenotyped individuals (coefficients of variation were 32-38% and 30% for SEMs and PMs, respectively). In relation to the uncertainty factors used for risk assessment, most subgroups would not be covered by the kinetic default of 3.16. CYP2D6-related factors necessary to cover 95-99% of each subpopulation ranged from 2.7 to 4.1 in non-phenotyped healthy adults and EMs to 15-18 in PMs and 22-45 in children. An exponential relationship (R(2)=0.8) was found between the extent of CYP2D6 metabolism and the uncertainty factors. The extent of CYP2D6 involvement in the metabolism of a substrate is critical in the estimation of the CYP2D6-related factor. The 3.16 kinetic default factor would cover PMs for substrates for which CYP2D6 was responsible for up to 25% of the metabolism in EMs.

Adult↗

Clues and uncertainties in the risk assessment of arsenic in drinking water.

On the basis of studies of the prevalence of skin cancer among users of As-rich well water in Taiwan, WHO experts recommended in 1984 a maximum As concentration of 50 microg/litre in drinking water. Since that time, a plethora of non-cancer as well as cancer effects has been observed in several other populations sustaining a chronic exposure to various As concentrations in drinking water. This prompted a revision of the standard and a provisional guideline of 10 microg/litre was recommended in 1993. While the uncertainty linked to the statistical inferences leading to the guideline are reduced by the fact that they are directly estimated from human data and result from extrapolations made relatively close to observed exposure levels, developed guideline depends strongly on the choice of the dose-response model (linear, quadratic, hockey-stick) and the accuracy of the exposure data. The potential exposure to As sources other than drinking water, dietary habits and genetic characteristics of the populations may also make more difficult the inference of a recommendation for As concentration in drinking water. Owing to the huge cost of strongly reducing the current As in water standard, many efforts are presently made to clarify the quantitative aspects of As-induced cancers, particularly at low dose levels. New data on the metabolism and carcinogenic mechanism of As in humans along with the results of epidemiological studies presently under way in several countries will help to reduce the uncertainty in the risk assessment of As.

Arsenic↗

Use of immunotoxicity data in health risk assessments: uncertainties and research to improve the process.

A number of environmental contaminants can suppress immune responses and enhance susceptibility to infectious and/or neoplastic disease. Most of the evidence for immunotoxicity of such contaminants has been obtained from laboratory animal studies and risk assessors must make decisions about risk to the human population based on these studies. Uncertainties associated with this process include determining what level of immune suppression is adverse, extrapolating across species from rodent to human, and across levels of biologic organization from effects on immune function at the cellular level to effects on incidence of disease at the population level, accounting for intra-species variability, and assessing the relationship between effects following acute, subchronic, and chronic exposure. This paper reviews immunotoxicity data that may be applied to the development of risk assessment methods and models designed to reduce some of these uncertainties.

Animals↗

Limiting dilution analysis for estimating the frequency of hematopoietic stem cells: uncertainty and significance.

The ability to predict accurately the number of hematopoietic stem cells (HSCs) in a graft is important for the success of HSC transplantation. Limiting dilution analysis (LDA) in vitro and in vivo is widely used to enumerate HSCs. However, there have been few attempts to standardize this approach. Particularly, the role of statistical and experimental errors in the performance and evaluation of LDA has received little attention. Since these errors directly affect the interpretation, validity, and significance of the LDA results, we have here performed a systematic analysis of the contribution of different types of errors.Long-term culture-initiating cells (LTC-IC) in the bone marrow of C57BL/6 (B6) mice were measured. Experiments were designed to exclude systematically different types of experimental errors. Computer simulations were performed to estimate the statistical error. Analysis of 137 LTC-IC assays showed 2.8 +/- 1.06 LTC-IC per 10(5) cells in the bone marrow of B6 mice. The major components of the uncertainty were derived from variations introduced by performing the experiments at different time points and by the statistical error. Surprisingly, operator errors and mouse-to-mouse error, including age and sex of the animals, contributed little to the overall uncertainty. As expected, the errors were found to decrease when increasing numbers of replica were analyzed. A computer program was developed to assist with the optimal design of the assay. The analysis presented here provides rational strategies for standardizing the experimental design and for gauging the accuracy of LDA-based HSC measurements.

Animals↗

Pointing to a target from an upright position in human: tuning of postural responses when there is target uncertainty.

Human subjects performed, from a standing position, rapid hand pointings to visual targets located within or beyond the prehension space. To examine the interaction between posture and the goal-directed movement we introduced a visual double-step perturbation requiring a reprogramming of the hand movement. Trials directed towards the same spatial goal but differentiated only by the likeliness of a visual double-step were compared. The hand kinematics was not affected by the uncertainty of the visual perturbation; an increased trunk bending, however, was observed. This suggests that uncertainty constraints are integrated in a predictive manner for the optimal coordination of the hand and postural control systems.

Adult↗

Estimating uncertainties of the geometrical range of particle radiotherapy during respiration.

PURPOSE: To propose a method for estimating uncertainties of the range calculation in particle radiotherapy associated with patient respiration. MATERIALS AND METHODS: A set of sequential CT images at every 0.2 s was reconstructed from continuous X-ray projection data accumulated by dynamic helical scanning. At the same time that CT data was acquired, the respiratory signal of the patient and the X-ray on/off signal on CT scanner were recorded. Each CT image was timed according to the phase of respiration waveform. Conversion of the CT number to the water equivalent path length (WEL) was performed with our treatment planning system that included a conversion table. As an illustration, the CT images of a patient with liver cancer at the right upper lobe were analyzed. The geometric size of the liver and WELs from body surface to isocenter were measured in each CT image. RESULTS: Variations of WEL from body surface to isocenter at the anterior-posterior and posterior-anterior direction were 6.2 mm and 18.9 mm, respectively. Liver size changed by 35.2 mm. However, these variations were shown to be considerably reduced by gated irradiation. CONCLUSIONS: A method using sequential CT images with respiration waveform was proposed. It appeared to be useful in evaluating the uncertainties of the range calculation associated with patient breathing.

Artifacts↗

A numerical simulation of organ motion and daily setup uncertainties: implications for radiation therapy.

PURPOSE: In radiotherapy planning, the clinical target volume (CTV) is typically enlarged to create a planning target volume (PTV) that accounts for uncertainties due to internal organ and patient motion as well as setup error. Margin size clearly determines the volume of normal tissue irradiated, yet in practice it is often given a set value in accordance with a clinical precedent from which variations are rare. The (CTV/PTV) formalism does not account for critical structure dose. We present a numerical simulation to assess (CTV) coverage and critical organ dose as a function of treatment margins in the presence of organ motion and physical setup errors. An application of the model to the treatment of prostate cancer is presented, but the method is applicable to any site where normal tissue tolerance is a dose-limiting factor. METHODS AND MATERIALS: A Monte Carlo approach was used to simulate the cumulative effect of variation in overall tumor position, for individual treatment fractions, relative to a fixed distribution of dose. Distributions of potential dose-volume histograms (DVHs), for both tumor and normal tissues, are determined that fully quantify the stochastic nature of radiotherapy delivery. We introduce the concept of Probability of Prescription Dose (PoPD) isosurfaces as a tool for treatment plan optimization. Outcomes resulting from current treatment planning methods are compared with proposed techniques for treatment optimization. The standard planning technique of relatively large uniform margins applied to the CTV, in the beam's eye view (BEV), was compared with three other treatment strategies: (a) reduced uniform margins, (b) nonuniform margins adjusted to maximize normal tissue sparing, and (c) a reduced margin plan in which nonuniform fluence profiles were introduced to compensate for potential areas of reduced dose. RESULTS: Results based on 100 simulated full course treatments indicate that a 10 mm CTV to PTV margin, combined with an additional 5 mm dosimetric margin, provides adequate CTV coverage in the presence of known treatment uncertainties. Nonuniform margins can be employed to reduce dose delivered to normal tissues while preserving CTV coverage. Nonuniform fluence profiles can also be used to further reduce dose delivered to normal tissues, though this strategy does result in higher dose levels delivered to a small volume of the CTV and normal tissues. CONCLUSIONS: Monte Carlo-based treatment simulation is an effective means of assessing the impact of organ motion and daily setup error on dose delivery via external beam radiation therapy. Probability of Prescription Dose (PoPD) isosurfaces are a useful tool for the determination of nonuniform beam margins that reduce dose delivered to critical organs while preserving CTV dose coverage. Nonuniform fluence profiles can further alter critical organ dose with potential therapeutic benefits. Clinical consequences of this latter approach can only be assessed via clinical trials.

Algorithms↗

Assessment of the uncertainties in dose delivery of a commercial system for linac-based stereotactic radiosurgery.

PURPOSE: Linac-based stereotactic radiosurgery (SRS) was introduced in our department in 1992, and since then, more than 200 patients have been treated with this method. An in-house-developed algorithm for target localization and dose calculation has recently been replaced with a commercially available system. In this study, both systems have been compared, and positional accuracy, as well as dose calculation, have been verified experimentally. METHODS AND MATERIALS: The in-house-developed software for target localization and dose calculation is an extension to George Sherouse's GRATIS(R) software for radiotherapy treatment planning, and has been replaced by a commercial (BrainSCAN version 3.1; BrainLAB, Germany) treatment planning system (TPS) for SRS. The positional accuracy for the entire SRS procedure (from image acquisition to treatment) has been investigated by treatment of simulated targets in the form of 0.2-cm lead beads inserted into an anthropomorphic phantom. Both dose calculation algorithms have been verified against manual calculations (based on basic beam data and CT data from phantom and patients), and measurements with the anthropomorphic phantom applying ionization chamber, thermoluminescent detectors, and radiographic film. This analysis has been performed on a variety of experimental situations, starting with static beams and simple one-arc treatments, to more complex and clinical relevant applications. Finally, 11 patients have been evaluated with both TPS in parallel for comparison and continuity of clinical experience. RESULTS: Phantom studies evaluating the entire SRS procedure have shown that a target, localized by CT, can be irradiated with a positional accuracy of 0.08 cm in any direction with 95% confidence. Neglecting the influence of dose perturbation when the beam passes through bone tissue or air cavities, the calculated dose values obtained from both TPSs agreed within 1% (SD 1%) for phantom and patient studies. The application of a one-dimensional path length correction for tissue heterogeneity influences the treatment prescription 4% on average (SD 1%), which is in compliance with theoretical predictions. The phantom measurements confirmed the predicted dose at isocenter within uncertainty for the different treatment schedules in this study. CONCLUSION: The full SRS procedure applied to an anthropomorphic phantom has been used as a comprehensive method to assess the uncertainties involved in dose delivery and target positioning. The results obtained with both TPSs are in agreement with AAPM Report 54, TG 42 and clinical continuity is assured. However, the use of a one-dimensional path length correction will result in an increase of 4% in dose prescription, which is slightly more than that predicted in the literature.

Algorithms↗

Estimation of uncertainty in kinetic-colorimetric assay of bacterial endotoxins.

The relative standard deviation (R.S.D.) of measurements is estimated in the kinetic-colorimetric assay of bacterial endotoxins without recourse to the usual repeated experiments. The measurements are the slopes of kinetic curves and two major factors are considered to cause the uncertainty of the measurements: (1) the pipetting of the sample and color development reagent; and (2) noise in the detection unit. The measurement R.S.D. is formulated as a function of endotoxin concentration. Two parameters (S.D. of the pipetted volumes and S.D. of the detector noise) are also required in the uncertainty equation, but no arbitrary coefficients are included. Since the S.D. values for pipettes and detector noise can be determined independently of the endotoxin assays, the measurement R.S.D. can be estimated by the above equation without repeating the assays. However, the calibration curve is necessary. The theoretical estimation is shown to be in good agreement with the experimental R.S.D. (n = 12) over a wide concentration range.

Algorithms↗

Uncertainty in the information provided during genetic counseling.

Clients seek genetic counseling in order to become informed, to make better decisions, and, if possible, to be reassured. Genetic knowledge, however, is fragmentary and incomplete and therefore it may involve more uncertainty than is desirable. In a cohort of 30 counseling sessions we studied the genetic information that was actually conveyed in terms of its predictability, controllability and novelty. With regard to predictability it emerged to be rather the rule than the exception that clients of genetic counseling were confronted with (1) an inconclusive diagnosis, (2) the chance or an estimate of the chance of the occurrence or recurrence of a genetic disorder, and (3) ambiguity about the severity of the disease. In case of bad news, possibilities for control (therapeutic or preventive measures) were minimal. In a few cases, clients were confronted with completely unexpected findings, i.e., information of high novelty. It is concluded that the high degree of uncertainty in the information provided during genetic counseling--reflecting the true state of the art--is in direct contrast to the needs of clients.

Adult↗

The diagnostic dilemma of incidentalomas. Working through uncertainty.

The clinical evaluation of incidentally found nodules in the adrenal, thyroid, and pituitary glands is a challenge for physicians, regardless of their level of expertise. Choosing the most direct and cost-effective diagnostic approach and deciding when to treat or not to treat are common dilemmas in clinical practice. This article outlines one diagnostic approach using medical decision-making techniques such as heuristic thinking, critical appraisal of the literature, treatment threshold probability assessment, Bayes' theorem, and discriminant properties of diagnostic tests. These skills are usually discussed in postgraduate training curricula. Nevertheless, they often seem foreign to many clinicians. Evidence suggests that training in these techniques can improve clinical decision making. Use of the skills outlined herein provides a framework to work through the diagnostic uncertainty common in the evaluation of incidentalomas. This approach does not provide perfect answers, as noted in examplar 3 in which two experts argued about the actual pretest probability and treatment thresholds for pituitary incidentalomas. Even if there were no such disagreement, each patient presents unique issues, and there will always be some uncertainty. Nevertheless, this approach provides a starting point from which critical decisions can be made for individual patients.

Adenoma↗

Managing uncertainty in diagnosis of acute coronaric ischemia.

The paper presents the reasoning mechanism of COR, a knowledge-based system (KBS) able to provide support for the diagnosis of coronaric ischemia by integrating the interpretation of chest pain, 12-lead ECG, and bio-marker concentrations. Chest pain features are collected interactively through a questionnaire. The ECG signal is acquired in SCP format. Any set of bio-markers can be considered. Data input is incremental and possibly incomplete. Reasoning is based on revised uncertainty calculus, which allows a formal treatment of verbally expressed uncertainty concerning both input data and diagnostic rules. Each diagnosis is supplemented by a linguistic label, expressing the plausibility of the disease identified, given the symptoms observed.

Artificial Intelligence↗