Differences in views of experts about their role in particulate matter policy advice: Empirical evidence from an international expert consultation

There is ample scientific evidence of adverse health effects of air pollution at exposure levels that are common among the general population. Some points of uncertainty remain, however. Several theories exist regarding the various roles that experts may play when they offer policy advice on uncertain issues such as particulate matter (PM). Roles may vary according to e.g. the views of the expert on the science-policy interface or the extent to which she/he involves stakeholders. Empirical underpinning of these theories, however, does not exist. We therefore conducted a consultation with experts on the following research question: What are PM experts’ views on their roles when providing policy advice? Q methodology was used to empirically test theoretical notions concerning the existence of differences in views on expert roles. Experts were selected based on a structured nominee process. In total, 31 international PM experts participated. Responses were examined via Principal Component Analysis, and for the open-ended questions, we used Atlas.ti software. Four different expert roles were identified among the participating experts. Main differences were found with respect to views on the need for precautionary measures and on the experts positioning within the science-policy interface. There was consensus on certain issues such as the need for transparency, general disagreement with current policies and general agreement on key scientific issues. This empirical study shows that while most PM experts consider their views on the risks of PM to be in line with those of their colleagues, four distinct expert roles were observed. This provides support for thus far largely theoretical debates on the existence of different roles of experts when they provide policy advice

Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences

<p>Abstract</p> <p>Background</p> <p>Long waiting times for elective surgical treatment threaten timely care provision in several countries. The purpose of this study was to assess the impact of waiting for elective general surgery on the quality of life and psychosocial health of patients.</p> <p>Methods</p> <p>A cross-sectional questionnaire study with postoperative follow-up was performed among patients on waiting lists for surgical treatment of varicose veins (n = 176), inguinal hernia (n = 201), and gallstones (n = 128) in 27 hospitals.</p> <p>Results</p> <p>In each group the waiting period involved worse general health perceptions (GHPQ), more problems in quality of life (EuroQoL), and raised levels of anxiety (STAI) as compared to after surgery (all differences: p < 0.05). Quality of life was not affected in 19–36% of patients.</p> <p>Emotional reactions to waiting were most negative among patients with gallstones. Prior information about the duration of the wait reduced the negativity of these reactions (p < 0.05).</p> <p>Social activities were affected in 39% to 48% of the patients and 18%-23% of employed patients reported problems with work during the wait.</p> <p>Having waited a longer time was associated with worse quality of life among patients with inguinal hernia. Longer waited times also engendered more negative reactions to waiting among patients with inguinal hernia and gallstones (multilevel regression analysis, p < 0.01).</p> <p>Conclusion</p> <p>Waiting for general surgery mainly involves a prolonged period of decreased health and an affected psychological and social life of the patient in waiting. Variation in the severity of these consequences across patients indicates that the prioritisation of patients could reduce the overall burden of waiting. Early information about the duration of the delay could further promote a patient's acceptance of waiting.</p

Expert Views on Their Role as Policy Advisor: Pilot Study for the Cases of Electromagnetic Fields, Particulate Matter, and Antimicrobial Resistance

This perspective presents empirical data to demonstrate the existence of different expert views on scientific policy advice on complex environmental health issues. These views are partly research-field specific. According to scientific literature, experts differ in the way they provide policy advice on complex issues such as electromagnetic fields (EMF), particulate matter (PM), and antimicrobial resistance (AMR). Where some experts feel their primary task is to carry out fundamental research, others actively engage in the policy dialogue. Although the literature provides ideas about expert roles, there exists little empirical underpinning. Our aim is to gather empirical evidence about expert roles. The results of an international study indicated that experts on EMF, PM, and AMR differ in the way they view their role in the policy dialogue. For example, experts differed in their views on the need for precaution and their motivation to initiate stakeholder cooperation. Besides, most experts thought that their views on the risks of EMF/PM/AMR did not differ from those of colleagues. Great dissensus was found in views on the best ways of managing risks and uncertainties. In conclusion, the theoretical ideal-typical roles from the literature can be identified to a certain extent

Black carbon as an additional indicator of the adverse health effects of airborne particles compared with PM10 and PM2.5.

Current air quality standards for particulate matter (PM) use the PM mass concentration [PM with aerodynamic diameters ≤ 10 μm (PM(10)) or ≤ 2.5 μm (PM(2.5))] as a metric. It has been suggested that particles from combustion sources are more relevant to human health than are particles from other sources, but the impact of policies directed at reducing PM from combustion processes is usually relatively small when effects are estimated for a reduction in the total mass concentration

Roles of scientists as policy advisers on complex issues: A literature review

Background and Aims: Policymakers frequently encounter complex issues, and the role of scientists as policy advisers on these issues is not always clearly defined. We present an overview of the interdisciplinary literature on the roles of scientific experts when advising policymakers on complex issues, and in particular on the factors that influence these roles. / Methods: A structured literature search was combined with literature found in reference lists of peer reviewed papers (the snowball method). In total, 267 publications were analyzed using scientometrics analyses (discipline clustering analysis and co-citation analysis) followed by a qualitative analysis and interpretation. / Results: The scientometrics analysis shows an amalgam of disciplines that publish on our research topic. Five clusters of authors were identified based on similarities in the references used: post-normal science, science and technology studies, science policy studies, politics of expertise and risk governance. The content of the clusters demonstrates that authors in different clusters agree that the role of experts is influenced by the type of problem (simple or complex) and by other parties (the public and stakeholders). However, opinions vary on the extent to which roles can vary and the necessity to explicate different viewpoints. / Discussion and conclusions: Publications on scientific experts who provide policy advice affirm that such experts should and do hold different roles, depending on the type of problem and factors such as values held by the expert and the type of knowledge. We conclude that research on expert roles has remained mostly theoretical. Existing theories about science systems can be used to study real policy advice processes. Most theories are well elaborated, but empirical proof for the described changes, roles and processes is limited

EXPLICIT: a feasibility study of remote expert elicitation in health technology assessment

This is the final version of the article. Available from BioMed Central via the DOI in this recordBACKGROUND: Expert opinion is often sought to complement available information needed to inform model-based economic evaluations in health technology assessments. In this context, we define expert elicitation as the process of encoding expert opinion on a quantity of interest, together with associated uncertainty, as a probability distribution. When availability for face-to-face expert elicitation with a facilitator is limited, elicitation can be conducted remotely, overcoming challenges of finding an appropriate time to meet the expert and allowing access to experts situated too far away for practical face-to-face sessions. However, distance elicitation is associated with reduced response rates and limited assistance for the expert during the elicitation session. The aim of this study was to inform the development of a remote elicitation tool by exploring the influence of mode of elicitation on elicited beliefs. METHODS: An Excel-based tool (EXPLICIT) was developed to assist the elicitation session, including the preparation of the expert and recording of their responses. General practitioners (GPs) were invited to provide expert opinion about population alcohol consumption behaviours. They were randomised to complete the elicitation by either a face-to-face meeting or email. EXPLICIT was used in the elicitation sessions for both arms. RESULTS: Fifteen GPs completed the elicitation session. Those conducted by email were longer than the face-to-face sessions (13 min 30 s vs 10 min 26 s, p = 0.1) and the email-elicited estimates contained less uncertainty. However, the resulting aggregated distributions were comparable. CONCLUSIONS: EXPLICIT was useful in both facilitating the elicitation task and in obtaining expert opinion from experts via email. The findings support the opinion that remote, self-administered elicitation is a viable approach within the constraints of HTA to inform policy making, although poor response rates may be observed and additional time for individual sessions may be required.This paper presents independent research funded by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula

Health impact assessment of waste management facilities in three European countries

<p>Abstract</p> <p>Background</p> <p>Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential health implications that are largely unknown. We conducted a health impact assessment of landfilling and incineration in three European countries: Italy, Slovakia and England.</p> <p>Methods</p> <p>A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfills the figures were 619, 121 and 232, respectively. The study population consisted of residents living within 3 km of an incinerator and 2 km of a landfill. Excess risk estimates from epidemiological studies were used, combined with air pollution dispersion modelling for particulate matter (PM₁₀) and nitrogen dioxide (NO₂). For incinerators, we estimated attributable cancer incidence and years of life lost (YoLL), while for landfills we estimated attributable cases of congenital anomalies and low birth weight infants.</p> <p>Results</p> <p>About 1,000,000, 16,000, and 1,200,000 subjects lived close to incinerators in Italy, Slovakia and England, respectively. The additional contribution to NO₂levels within a 3 km radius was 0.23, 0.15, and 0.14 μg/m³, respectively. Lower values were found for PM₁₀. Assuming that the incinerators continue to operate until 2020, we are moderately confident that the annual number of cancer cases due to exposure in 2001-2020 will reach 11, 0, and 7 in 2020 and then decline to 0 in the three countries in 2050. We are moderately confident that by 2050, the attributable impact on the 2001 cohort of residents will be 3,621 (Italy), 37 (Slovakia) and 3,966 (England) YoLL. The total exposed population to landfills was 1,350,000, 329,000, and 1,425,000 subjects, respectively. We are moderately confident that the annual additional cases of congenital anomalies up to 2030 will be approximately 2, 2, and 3 whereas there will be 42, 13, and 59 additional low-birth weight newborns, respectively.</p> <p>Conclusions</p> <p>The current health impacts of landfilling and incineration can be characterized as moderate when compared to other sources of environmental pollution, e.g. traffic or industrial emissions, that have an impact on public health. There are several uncertainties and critical assumptions in the assessment model, but it provides insight into the relative health impact attributable to waste management.</p

A comparison of two methods for expert elicitation in health technology assessments.

BACKGROUND: When data needed to inform parameters in decision models are lacking, formal elicitation of expert judgement can be used to characterise parameter uncertainty. Although numerous methods for eliciting expert opinion as probability distributions exist, there is little research to suggest whether one method is more useful than any other method. This study had three objectives: (i) to obtain subjective probability distributions characterising parameter uncertainty in the context of a health technology assessment; (ii) to compare two elicitation methods by eliciting the same parameters in different ways; (iii) to collect subjective preferences of the experts for the different elicitation methods used. METHODS: Twenty-seven clinical experts were invited to participate in an elicitation exercise to inform a published model-based cost-effectiveness analysis of alternative treatments for prostate cancer. Participants were individually asked to express their judgements as probability distributions using two different methods - the histogram and hybrid elicitation methods - presented in a random order. Individual distributions were mathematically aggregated across experts with and without weighting. The resulting combined distributions were used in the probabilistic analysis of the decision model and mean incremental cost-effectiveness ratios and the expected values of perfect information (EVPI) were calculated for each method, and compared with the original cost-effectiveness analysis. Scores on the ease of use of the two methods and the extent to which the probability distributions obtained from each method accurately reflected the expert's opinion were also recorded. RESULTS: Six experts completed the task. Mean ICERs from the probabilistic analysis ranged between £162,600-£175,500 per quality-adjusted life year (QALY) depending on the elicitation and weighting methods used. Compared to having no information, use of expert opinion decreased decision uncertainty: the EVPI value at the £30,000 per QALY threshold decreased by 74-86 % from the original cost-effectiveness analysis. Experts indicated that the histogram method was easier to use, but attributed a perception of more accuracy to the hybrid method. CONCLUSIONS: Inclusion of expert elicitation can decrease decision uncertainty. Here, choice of method did not affect the overall cost-effectiveness conclusions, but researchers intending to use expert elicitation need to be aware of the impact different methods could have.This paper presents independent research funded by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula