Investigating the presentation of uncertainty in an icon array: A randomized trial.

Background: Clinicians are often advised to use pictographs to communicate risk, but whether they offer benefits when communicating risk imprecision (e.g., 65%-79%) is unknown. Purpose: To test whether any of three approaches to visualizing imprecision would more effectively communicate breast and ovarian cancer risk for BRCA1 pathogenic variant carriers. Methods: 1,300 UK residents were presented with a genetic report with information about BRCA1-related risks, with random assignment to one of four formats: no visualization (text alone), or a pictograph using shaded icons, a gradient, or arrows marking range endpoints. We also tested pictographs in two layouts. Analysis of variance (ANOVA) and regression was employed. Results: There was no effect of format. Participants shown pictographs vs. text alone had better uptake of breast cancer risk messages (p < .05, η 2 = 0.003). Pictographs facilitated memory for the specific amount of risk (p < 0.001, η 2 = 0.019), as did the tabular layout. Individuals not having completed upper secondary education may benefit most. Conclusions: We found weak evidence in favor of using simple pictographs with ranges to communicate BRCA risk (versus text alone), and of the tabular layout. Innovation: Testing different ways of communicating imprecision within pictographs is a novel and promising line of research.

Making BRCA1 genetic test reports easier to understand through user-centered design: A randomized trial.

PURPOSE: Our objective was to apply a user-centered design process to identify phrases, graphics, and ways of communicating numerical risks that could be used to help patients understand their cancer risk and next steps on receiving BRCA1 genetic test results (positive, negative, and variants of uncertain significance). METHODS: The first phase of the study, a user-centered design process, consisted of 4 rounds of interviews (N = 42, including 13 health care professionals and 16 patients having undergone BRCA testing). The second was a randomized, between-participants experimental study of 456 United Kingdom residents that compared the resulting reports to reports used in a United Kingdom national genomic laboratory hub. Outcomes were subjective and objective comprehension, communication efficacy, actionability, and perceived risk. RESULTS: Subjective comprehension, communication efficacy, and actionability were all higher for the user-centered reports, with no difference in perceived risk. Comprehension of participants viewing user-centered reports was significantly better on 2 items, directionally (but not significantly) better on 6 items, and directionally (but not significantly) worse on 2 items. CONCLUSION: Our results imply that user-centered design is a promising approach for developing materials about complex genetic risks. We suggest wordings that are likely to lead to improved comprehension when communicating BRCA-associated risks.

Communicating personalized risks from COVID-19: guidelines from an empirical study.

As increasing amounts of data accumulate on the effects of the novel coronavirus SARS-CoV-2 and the risk factors that lead to poor outcomes, it is possible to produce personalized estimates of the risks faced by groups of people with different characteristics. The challenge of how to communicate these then becomes apparent. Based on empirical work (total n = 5520, UK) supported by in-person interviews with the public and physicians, we make recommendations on the presentation of such information. These include: using predominantly percentages when communicating the absolute risk, but also providing, for balance, a format which conveys a contrasting (higher) perception of risk (expected frequency out of 10 000); using a visual linear scale cut at an appropriate point to illustrate the maximum risk, explained through an illustrative 'persona' who might face that highest level of risk; and providing context to the absolute risk through presenting a range of other 'personas' illustrating people who would face risks of a wide range of different levels. These 'personas' should have their major risk factors (age, existing health conditions) described. By contrast, giving people absolute likelihoods of other risks they face in an attempt to add context was considered less helpful. We note that observed effect sizes generally were small. However, even small effects are meaningful and relevant when scaled up to population levels.

A new record for a massive Porites colony at Ta'u Island, American Samoa.

An exceptionally large, hermatypic colony of Porites sp. has been identified and measured at Ta'u, American Samoa. This coral was measured in November 2019 as part of an effort to catalogue all large (≥ 2 m diameter) Porites colonies around Ta'u. Colonies exceeding 10 m in diameter were recorded on three different sides of the island with seasonally different wave exposures. The largest colony measured 8 m tall, 69 m in circumference and had a diameter of 22.4 m. To date, this is the biggest colony recorded in American Samoa, and one of the largest documented worldwide. It is currently unknown why such large corals exist around this particular island. Possible explanations include mild wave or atmospheric climates and minimal anthropogenic impacts. Physiologically, these colonies may be resistant and/or resilient to disturbances. Large, intact corals can help build past (century-scale) climatic profiles, and better understand coral persistence, particularly as coral communities worldwide are declining at rapid rates.

Conus-level combined dorsal and ventral lumbar rhizotomy for treatment of mixed hypertonia: technical note and complications.

Combined dorsal and ventral rhizotomy is an effective treatment for patients with concurrent spasticity and dystonia, with the preponderance of complaints relating to their lower extremities. This operative approach provides definitive relief of hypertonia and should be considered after less-invasive techniques have been exhausted. Previously, the surgery has been described through an L1-S1 laminoplasty. In this series, 7 patients underwent a conus-level laminectomy for performing a lumbar dorsal and ventral rhizotomy. Technical challenges included identifying the appropriate-level ventral roots and performing the procedure in children with significant scoliosis. Techniques are described to overcome these obstacles. The technique was found to be safe, with no infections, CSF leaks, or neurogenic bladders.

Nutrient thresholds to protect water quality and coral reefs.

Establishing nutrient thresholds to protect coral reefs is difficult because water quality is dynamic and shifts with many environmental factors. We examined the contribution of natural and human factors in predicting water quality at the base of 34 streams on a high tropical Pacific island. Mixed regression models revealed that rainfall, sea-surface temperature, and windspeed were fixed factors predicting dissolved inorganic nitrogen (DIN) concentrations at the base of all watersheds. In contrast, human influences were captured as random components of variation associated with site-based differences. The novel modeling approach using temporal and spatial data provided daily-loading simulations that were used to evaluate exceedance criteria, defined as the percent of time each watershed exceeded a suite of DIN thresholds. Exceedance criteria were considered alongside biological data to recommend a 0.1 to 0.15 mg l-1 benchmark to protect coastal water quality and coral reefs surrounding Tutuila, American Samoa.

Early clinical indicators of developmental outcome in abusive head trauma.

PURPOSE: The purpose of the study was to determine the developmental prognostic significance of early clinical indicators in abusive head trauma. METHODS: Seventy-one children were diagnosed with abusive head trauma and followed in a post-injury growth and development clinic. A retrospective chart review was completed to gather clinical features at the time of injury, including presence or absence of early post-traumatic seizures, presence or absence of intubation, and presence or absence of pediatric intensive care unit admission. Children then underwent developmental testing with use of the Capute Scales of the Cognitive Adaptive Test (CAT) and the Clinical Linguistic and Auditory Milestone Scale (CLAMS) during follow-up clinic visits. Clinical features at initial injury were compared to developmental outcome. RESULTS: Thirty-four of 71 patients with seizures during their admission hospitalization scored significantly lower on follow-up developmental testing than patients who did not have seizures. Twenty-one of 71 patients who required intubation scored lower on developmental testing than patients who did not require intubation. Thirty-five of 71 patients who required pediatric intensive care unit admission scored lower on developmental testing than patients who did not require pediatric intensive care unit admission. CONCLUSIONS: This study demonstrates that clinical factors at the time of injury, such as early post-traumatic seizures and intubation requirement, are associated with poorer developmental outcome. This study also suggests that close developmental follow-up should be obtained for all children with abusive head trauma, regardless of whether or not the child was admitted to the PICU.