Despite the well-recognised health benefits of fresh fruit consumption, substantial uncertainties remain about its potential effects on incident diabetes and, among those with diabetes, on risks of death and major vascular complications.
Orthostatic hypotension (OH) is a common cause of transient cerebral hypoperfusion in the population. Cerebral hypoperfusion is widely implicated in cognitive impairment, but whether OH contributes to cognitive decline and dementia is uncertain. We aimed to determine the association between OH and the risk of developing dementia in the general population.
Background Formulation and evaluation of public health policy commonly employs science-based mathematical models. For instance, epidemiological dynamics of TB is dominated, in general, by flow between actively and latently infected populations. Thus modelling is central in planning public health intervention. However, models are highly uncertain because they are based on observations that are geographically and temporally distinct from the population to which they are applied.Aims We aim to demonstrate the advantages of info-gap theory, a non-probabilistic approach to severe uncertainty when worst cases cannot be reliably identified and probability distributions are unreliable or unavailable. Info-gap is applied here to mathematical modelling of epidemics and analysis of public health decision-making.Methods Applying info-gap robustness analysis to tuberculosis/HIV (TB/HIV) epidemics, we illustrate the critical role of incorporating uncertainty in formulating recommendations for interventions. Robustness is assessed as the magnitude of uncertainty that can be tolerated by a given intervention. We illustrate the methodology by exploring interventions that alter the rates of diagnosis, cure, relapse and HIV infection.Results We demonstrate several policy implications. Equivalence among alternative rates of diagnosis and relapse are identified. The impact of initial TB and HIV prevalence on the robustness to uncertainty is quantified. In some configurations, increased aggressiveness of intervention improves the predicted outcome but also reduces the robustness to uncertainty. Similarly, predicted outcomes may be better at larger target times, but may also be more vulnerable to model error.Conclusions The info-gap framework is useful for managing model uncertainty and is attractive when uncertainties on model parameters are extreme. When a public health model underlies guidelines, info-gap decision theory provides valuable insight into the confidence of achieving agreed-upon goals.
Recently published asthma guidelines by the European Respiratory Society and the American Thoracic Society (ERS-ATS) define severe disease based on medication use and control level. These guidelines also emphasize that asthma severity involves certain biomarker phenotypes, one of them being eosinophilic phenotype. The quantification of the influence of eosinophil level toward predicting disease severity can help decision makers manage therapy better earlier.
The differential warming of land and ocean leads to many continental regions in the Northern Hemisphere warming at rates higher than the global mean temperature. Adaptation and conservation efforts will, therefore, benefit from understanding regional consequences of limiting the global mean temperature increase to well below 2°C above pre-industrial levels, a limit agreed upon at the United Nations Climate Summit in Paris in December 2015. Here, we analyze climate model simulations from the Coupled Model Intercomparison Project Phase 5 (CMIP5) to determine the timing and magnitude of regional temperature and precipitation changes across the contiguous United States (US) for global warming of 1.5 and 2°C and highlight consensus and uncertainties in model projections and their implications for making decisions. The regional warming rates differ considerably across the contiguous US, but all regions are projected to reach 2°C about 10-20 years before the global mean temperature. Although there is uncertainty in the timing of exactly when the 1.5 and 2°C thresholds will be crossed regionally, over 80% of the models project at least 2°C warming by 2050 for all regions for the high emissions scenario. This threshold-based approach also highlights regional variations in the rate of warming across the US. The fastest warming region in the contiguous US is the Northeast, which is projected to warm by 3°C when global warming reaches 2°C. The signal-to-noise ratio calculations indicate that the regional warming estimates remain outside the envelope of uncertainty throughout the twenty-first century, making them potentially useful to planners. The regional precipitation projections for global warming of 1.5°C and 2°C are uncertain, but the eastern US is projected to experience wetter winters and the Great Plains and the Northwest US are projected to experience drier summers in the future. The impact of different scenarios on regional precipitation projections is negligible throughout the twenty-first century compared to uncertainties associated with internal variability and model diversity.
People who are physically active have at least a 30% lower risk of death during follow-up compared with those who are inactive. However, the ideal dose of exercise for improving longevity is uncertain.
Information about genetic and phenotypic risk of type 2 diabetes is now widely available and is being incorporated into disease prevention programs. Whether such information motivates behavior change or has adverse effects is uncertain. We examined the effect of communicating an estimate of genetic or phenotypic risk of type 2 diabetes in a parallel group, open, randomized controlled trial.
Our actions often do not match our intentions when there are external disturbances such as turbulence. We derived a novel modeling approach for determining this motor intent from targeted reaching motions that are disturbed by an unexpected force. First, we demonstrated how to mathematically invert both feedforward (predictive) and feedback controls to obtain an intended trajectory. We next examined the model’s sensitivity to a realistic range of parameter uncertainties, and found that the expected inaccuracy due to all possible parameter mis-estimations was less than typical movement-to-movement variations seen when humans reach to similar targets. The largest sensitivity arose mainly from uncertainty in joint stiffnesses. Humans cannot change their intent until they acquire sensory feedback, therefore we tested the hypothesis that a straight-line intent should be evident for at least the first 120 milliseconds following the onset of a disturbance. As expected, the intended trajectory showed no change from undisturbed reaching for more than 150 milliseconds after the disturbance onset. Beyond this point, however, we detected a change in intent in five out of eight subjects, surprisingly even when the hand is already near the target. Knowing such an intent signal is broadly applicable: enhanced human-machine interaction, the study of impaired intent in neural disorders, the real-time determination (and manipulation) of error in training, and complex systems that embody planning such as brain machine interfaces, team sports, crowds, or swarms. In addition, observing intent as it changes might act as a window into the mechanisms of planning, correction, and learning.
Although actuarial data indicate that risk-taking behavior peaks in adolescence, laboratory evidence for this developmental spike remains scarce. One possible explanation for this incongruity is that in the real world adolescents often have only vague information about the potential consequences of their behavior and the likelihoods of those consequences, whereas in the lab these are often clearly stated. How do adolescents behave under such more realistic conditions of ambiguity and uncertainty? We asked 105 participants aged from 8 to 22 years to make three types of choices: (1) choices between options whose possible outcomes and probabilities were fully described (choices under risk); (2) choices between options whose possible outcomes were described but whose probability information was incomplete (choices under ambiguity), and (3) choices between unknown options whose possible outcomes and probabilities could be explored (choices under uncertainty). Relative to children and adults, two adolescent-specific markers emerged. First, adolescents were more accepting of ambiguity; second, they were also more accepting of uncertainty (as indicated by shorter pre-decisional search). Furthermore, this tolerance of the unknown was associated with motivational, but not cognitive, factors. These findings offer novel insights into the psychology of adolescent risk taking.
Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual’s risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries.