Theory of uncertainty in illness in patients with cancer of unknown primary origin: Structure providers as antecedents of uncertainty in a population of cancer patients with an unknown primary diagnosis

Uncertainty has been found to be a major component of the cancer experience and can dramatically affect psychosocial adaptation and outcomes of a patient's disease state (McCormick, 2002). Patients with a diagnosis of Carcinoma of Unknown Primary (CUP) may experience higher levels of uncertainty due to the unpredictability of current and future symptoms, limited treatment options and an undetermined life expectancy. To date, only one study has touched upon uncertainty and its' effects on those with CUP but no information exists concerning the effects of uncertainty regarding diagnosis and treatment on the distress level and psychosocial adjustment of this population (Parker & Lenzi, 2003). ^ Mishel's Uncertainty in Illness Theory (1984) proposes that uncertainty is preceded by three variables, one of which being Structure Providers. Structure Providers include credible authority, the degree of trust and confidence the patient has with their doctor, education and social support. It was the goal of this study to examine the relationship between uncertainty and Structure Providers to support the following hypotheses: (1) There will be a negative association between credible authority and uncertainty, (2) There will be a negative association between education level and uncertainty, and (3) There will be a negative association between social support and uncertainty. ^ This cross-sectional analysis utilized data from 219 patients following their initial consultation with their oncologist. Data included the Mishel Uncertainty in Illness Scale (MUIS) which was used to determine patients' uncertainty levels, the Medical Outcomes Study-Social Support Scale (MOSS-SSS) to assess patients, levels of social support, the Patient Satisfaction Questionnaire (PSQ-18) and the Cancer Diagnostic Interview Scale (CDIS) to measure credible authority and general demographic information to assess age, education, marital status and ethnicity. ^ In this study we found that uncertainty levels were generally higher in this sample as compared to other types of cancer populations. And while our results seemed to support most of our hypothesis, we were only able to show significant associations between two. The analyses indicated that credible authority measured by both the CDIS and the PSQ was a significant predictor of uncertainty as was social support measured by the MOSS-SS. Education has shown to have an inconsistent pattern of effect in relation to uncertainty and in the current study there was not enough data to significantly support our hypothesis. ^ The results of this study generally support Mishel's Theory of Uncertainty in Illness and highlight the importance of taking into consideration patients, psychosocial factors as well as employing proper communication practices between physicians and their patients.^

Using the Precede-Proceed Model of Health Program Planning in breast cancer nursing research

Aim: In this paper we discuss the use of the Precede-Proceed model when investigating health promotion options for breast cancer survivors. Background: Adherence to recommended health behaviors can optimize well-being after cancer treatment. Guided by the Precede-Proceed approach, we studied the behaviors of breast cancer survivors in our health service area. Data sources: The interview data from the cohort of breast cancer survivors are used in this paper to illustrate the use of Precede-Proceed in this nursing research context. Interview data were collected from June to December 2009. We also searched Medline, CINAHL, PsychInfo and PsychExtra up to 2010 for relevant literature in English to interrogate the data from other theoretical perspectives. Discussion: The Precede-Proceed model is theoretically-complex. The deductive analytic process guided by the model usefully explained some of the health behaviors of cancer survivors, although it could not explicate many other findings. A complementary inductive approach to the analysis and subsequent interpretation by way of Uncertainty in Illness Theory and other psychosocial perspectives provided a comprehensive account of the qualitative data that resulted in contextually-relevant recommendations for nursing practice. Implications for nursing: Nursing researchers using Precede-Proceed should maintain theoretical flexibility when interpreting qualitative data. Perspectives not embedded in the model might need to be considered to ensure that the data are analyzed in a contextually-relevant way. Conclusion: Precede-Proceed provides a robust framework for nursing researchers investigating health promotion in cancer survivors; however additional theoretical lenses to those embedded in the model can enhance data interpretation.

Prevalence and determinants of the health promotion and risk reduction practices of younger female survivors of breast cancer

This thesis describes a discrete component of a larger mixed-method (survey and interview) study that explored the health-promotion and risk-reduction practices of younger premenopausal survivors of ovarian, breast and haematological cancers. This thesis outlines my distinct contribution to the larger study, which was to: (1) Produce a literature review that thoroughly explored all longer-term breast cancer treatment outcomes, and which outlined the health risks to survivors associated with these; (2) Describe and analyse the health-promotion and risk-reduction behaviours of nine younger female survivors of breast cancer as articulated in the qualitative interview dataset; and (3) Test the explanatory power of the Precede-Proceed theoretical framework underpinning the study in relation to the qualitative data from the breast cancer cohort. The thesis reveals that breast cancer survivors experienced many adverse outcomes as a result of treatment. While they generally engaged in healthy lifestyle practices, a lack of knowledge about many recommended health behaviours emerged throughout the interviews. The participants also described significant internal and external pressures to behave in certain ways because of the social norms surrounding the disease. This thesis also reports that the Precede-Proceed model is a generally robust approach to data collection, analysis and interpretation in the context of breast cancer survivorship. It provided plausible explanations for much of the data in this study. However, profound sociological and psychological implications arose during the analysis that were not effectively captured or explained by the theories underpinning the model. A sociological filter—such as Turner’s explanation of the meaning of the body and embodiment in the social sphere (Turner, 2008)—and the psychological concerns teased out in Mishel’s (1990) Uncertainty in Illness Theory, provided a useful dimension to the findings generated through the Precede-Proceed model. The thesis concludes with several recommendations for future research, clinical practice and education in this context.

The probability archive : from essence to uncertainty in the growth of knowledge

From a ‘cultural science’ perspective, this paper traces one aspect of a more general shift, from the realist representational regime of modernity to the productive DIY systems of the internet era. It argues that collecting and archiving is transformed by this change. Modern museums – and also broadcast television – were based on determinist or ‘essence’ theory; while internet archives like YouTube (and the internet as an archive) are based on ‘probability’ theory. The paper goes through the differences between modernist ‘essence’ and postmodern ‘probability’; starting from the obvious difference that in a museum each object is selected by experts for its intrinsic properties, while on the internet you don’t know what you will find. The status of individual objects is uncertain, although the productivity of the overall archive is unlimited. The paper links these differences with changes in contemporary culture – from a Newtonian to a quantum universe, progress to risk, institutional structure to evolutionary change, objectivity to uncertainty, identity to performance. Borrowing some of its methodology from science fiction, the paper uses examples from museums and online archives, ranging from the oldest stone tool in the world to the latest tribute vid on the net.

A sequential Monte Carlo algorithm to incorporate model uncertainty in Bayesian sequential design

Here we present a sequential Monte Carlo (SMC) algorithm that can be used for any one-at-a-time Bayesian sequential design problem in the presence of model uncertainty where discrete data are encountered. Our focus is on adaptive design for model discrimination but the methodology is applicable if one has a different design objective such as parameter estimation or prediction. An SMC algorithm is run in parallel for each model and the algorithm relies on a convenient estimator of the evidence of each model which is essentially a function of importance sampling weights. Other methods for this task such as quadrature, often used in design, suffer from the curse of dimensionality. Approximating posterior model probabilities in this way allows us to use model discrimination utility functions derived from information theory that were previously difficult to compute except for conjugate models. A major benefit of the algorithm is that it requires very little problem specific tuning. We demonstrate the methodology on three applications, including discriminating between models for decline in motor neuron numbers in patients suffering from neurological diseases such as Motor Neuron disease.

The paradox of creative uncertainty in learning and teaching

In an ever-changing and globalised world there is a need for higher education to adapt and evolve its models of learning and teaching. The old industrial model has lost traction, and new patterns of creative engagement are required. These new models potentially increase relevancy and better equip students for the future. Although creativity is recognised as an attribute that can contribute much to the development of these pedagogies, and creativity is valued by universities as a graduate capability, some educators understandably struggle to translate this vision into practice. This paper reports on selected survey findings from a mixed methods research project which aimed to shed light on how creativity can be designed for in higher education learning and teaching settings. A social constructivist epistemology underpinned the research and data was gathered using survey and case study methods. Descriptive statistical methods and informed grounded theory were employed for the analysis reported here. The findings confirm that creativity is valued for its contribution to the development of students’ academic work, employment opportunities and life in general; however, tensions arise between individual educator’s creative pedagogical goals and the provision of institutional support for implementation of those objectives. Designing for creativity becomes, paradoxically, a matter of navigating and limiting complexity and uncertainty, while simultaneously designing for those same states or qualities.

Good Lives, Hidden Miseries : An Ethnography of Uncertainty in a Finnish Village

This is an ethnographic study, in the field of medical anthropology, of village life among farmers in southwest Finland. It is based on 12 months of field work conducted 2002-2003 in a coastal village. The study discusses how social and cultural change affects the life of farmers, how they experience it and how they act in order to deal with the it. Using social suffering as a methodological approach the study seeks to investigate how change is related to lived experiences, idioms of distress, and narratives. Its aim has been to draw a locally specific picture of what matters are at stake in the local moral world that these farmers inhabit, and how they emerge as creative actors within it. A central assumption made about change is that it is two-fold; both a constructive force which gives birth to something new, and also a process that brings about uncertainty regarding the future. Uncertainty is understood as an existential condition of human life that demands a response, both causing suffering and transforming it. The possibility for positive outcomes in the future enables one to understand this small suffering of everyday life both as a consequence of social change, which fragments and destroys, and as an answer to it - as something that is positively meaningful. Suffering is seen to engage individuals to ensure continuity, in spite of the odds, and to sustain hope regarding the future. When the fieldwork was initiated Finland had been a member of the European Union for seven years and farmers felt it had substantially impacted on their working conditions. They complained about the restrictions placed on their autonomy and that their knowledge was neither recognised, nor respected by the bureaucrats of the EU system. New regulations require them to work in a manner that is morally unacceptable to them and financial insecurity has become more prominent. All these changes indicate the potential loss of the home and of the ability to ensure continuity of the family farm. Although the study initially focused on getting a general picture of working conditions and the nature of farming life, during the course of the fieldwork there was repeated mention of a perceived high prevalence of cancer in the area. This cancer talk is replete with metaphors that reveal cultural meanings tied to the farming life and the core values of autonomy, endurance and permanence. It also forms the basis of a shared identity and a means of delivering a moral message about the fragmentation of the good life; the loss of control; and the invasion of the foreign. This thesis formed part of the research project Expressions of Suffering. Ethnographies of Illness Experiences in Contemporary Finnish Contexts funded by the Academy of Finland. It opens up a vital perspective on the multiplicity and variety of the experience of suffering and that it is particularly through the use of the ethnographic method that these experiences can be brought to light. Keywords: suffering, uncertainty, phenomenology, habitus, agency, cancer, farming

Constraining uncertainty in regional hydrologic impacts of climate change: Nonstationarity in downscaling

Regional impacts of climate change remain subject to large uncertainties accumulating from various sources, including those due to choice of general circulation models (GCMs), scenarios, and downscaling methods. Objective constraints to reduce the uncertainty in regional predictions have proven elusive. In most studies to date the nature of the downscaling relationship (DSR) used for such regional predictions has been assumed to remain unchanged in a future climate. However,studies have shown that climate change may manifest in terms of changes in frequencies of occurrence of the leading modes of variability, and hence, stationarity of DSRs is not really a valid assumption in regional climate impact assessment. This work presents an uncertainty modeling framework where, in addition to GCM and scenario uncertainty, uncertainty in the nature of the DSR is explored by linking downscaling with changes in frequencies of such modes of natural variability. Future projections of the regional hydrologic variable obtained by training a conditional random field (CRF) model on each natural cluster are combined using the weighted Dempster-Shafer (D-S) theory of evidence combination. Each projection is weighted with the future projected frequency of occurrence of that cluster (''cluster linking'') and scaled by the GCM performance with respect to the associated cluster for the present period (''frequency scaling''). The D-S theory was chosen for its ability to express beliefs in some hypotheses, describe uncertainty and ignorance in the system, and give a quantitative measurement of belief and plausibility in results. The methodology is tested for predicting monsoon streamflow of the Mahanadi River at Hirakud Reservoir in Orissa, India. The results show an increasing probability of extreme, severe, and moderate droughts due to limate change. Significantly improved agreement between GCM predictions owing to cluster linking and frequency scaling is seen, suggesting that by linking regional impacts to natural regime frequencies, uncertainty in regional predictions can be realistically quantified. Additionally, by using a measure of GCM performance in simulating natural regimes, this uncertainty can be effectively constrained.

Model and parameter uncertainty in IDF relationships under climate change

Quantifying distributional behavior of extreme events is crucial in hydrologic designs. Intensity Duration Frequency (IDF) relationships are used extensively in engineering especially in urban hydrology, to obtain return level of extreme rainfall event for a specified return period and duration. Major sources of uncertainty in the IDF relationships are due to insufficient quantity and quality of data leading to parameter uncertainty due to the distribution fitted to the data and uncertainty as a result of using multiple GCMs. It is important to study these uncertainties and propagate them to future for accurate assessment of return levels for future. The objective of this study is to quantify the uncertainties arising from parameters of the distribution fitted to data and the multiple GCM models using Bayesian approach. Posterior distribution of parameters is obtained from Bayes rule and the parameters are transformed to obtain return levels for a specified return period. Markov Chain Monte Carlo (MCMC) method using Metropolis Hastings algorithm is used to obtain the posterior distribution of parameters. Twenty six CMIP5 GCMs along with four RCP scenarios are considered for studying the effects of climate change and to obtain projected IDF relationships for the case study of Bangalore city in India. GCM uncertainty due to the use of multiple GCMs is treated using Reliability Ensemble Averaging (REA) technique along with the parameter uncertainty. Scale invariance theory is employed for obtaining short duration return levels from daily data. It is observed that the uncertainty in short duration rainfall return levels is high when compared to the longer durations. Further it is observed that parameter uncertainty is large compared to the model uncertainty. (C) 2015 Elsevier Ltd. All rights reserved.

Phase uncertainty in calibrating microwave test fixtures

The problem of phase uncertainty arising in calibration of the test fixtures is investigated in this paper, It is shown that the problem exists no matter what kinds of calibration standards are used. It is also found that there is no need to determine the individual S-parameters of the test fixtures. In order to eliminate the problem of phase uncertainty, three different precise (known) reflection standards or one known reflection standard plus one known transmission standard should be used to calibrate symmetrical test fixtures. For the asymmetrical cases, three known standards, including at least one transmission standard, should be used. The thru-open-match (TOM) and thru-short-match (TSM) techniques are the simplest methods, and they have no bandwidth limitation. When the standards are imprecise (unknown), it is recommended to use any suitable technique, such as the thru-reflect-line, line-reflect-line, thru-short-delay, thru-open-delay,line-reflect-match, line-reflect-reflect-match, or multiline methods, to accurately determine the values of the required calibration terms and, in addition, to use the TOM or TSM method with the same imprecise standards to resolve the phase uncertainty.

Modelling uncertainty in agricultural image analysis

C.M. Onyango, J.A. Marchant and R. Zwiggelaar, 'Modelling uncertainty in agricultural image analysis', Computers and Electronics in Agriculture 17 (3), 295-305 (1997)