Readability of patient and family education materials on pediatric surgical association websites.

PURPOSE: Globally, pediatric surgical association websites present patient/family education materials on an extensive list of conditions, including descriptions of the condition, signs and symptoms, diagnostic modalities, and treatment options. The purpose of this project was to assess the readability of pediatric surgical association websites' patient/family education materials. METHODS: With IRB approval, we accessed all patient/family education materials on pediatric surgical association websites from around the globe and used multiple grade-level assessments and readability assessments to determine the reading level at which the information is presented. RESULTS: The American Pediatric Surgical Association (APSA) website and the British Association of Paediatric Surgeons (BAPS) present publicly accessible patient/family education materials. Seventy-four (74) conditions on APSA's website were analyzed. Three grade-level assessments and the Flesch Reading Ease assessment indicated that the articles are written at high school reading levels. No articles were available in languages other than English. BAPS presented 6 conditions, most of which were more readable than their APSA counterparts. CONCLUSIONS: Our analysis indicates that the patient/family education materials available on pediatric surgical association websites may not be written at a level that is comprehensible by the general population. Potential solutions include re-writing the materials with an emphasis on readability and presenting materials in languages other than English. LEVEL OF EVIDENCE: V.

Macroinvertebrate sensitivity thresholds for sediment in Virginia streams.

Sediment is the most commonly identified pollutant associated with macroinvertebrate community impairments in freshwater streams nationwide. Management of this physical stressor is complicated by the multiple measures of sediment available (e.g., suspended, dissolved, bedded) and the variability in natural "healthy" sediment loadings across ecoregions. Here we examine the relative importance of 9 sediment parameters on macroinvertebrate community health as measured by the Virginia Stream Condition Index (VSCI) across 5 ecoregions. In combination, sediment parameters explained 27.4% of variance in the VSCI in a multiregion data set and from 20.2% to 76.4% of variance for individual ecoregions. Bedded sediment parameters had a stronger influence on VSCI than did dissolved or suspended parameters in the multiregion assessment. However, assessments of individual ecoregions revealed conductivity had a key influence on VSCI in the Central Appalachian, Northern Piedmont and Piedmont ecoregions. In no case was a single sediment parameter sufficient to predict VSCI scores or individual biological metrics. Given the identification of embeddedness and conductivity as key parameters for predicting biological condition, we developed family-level sensitivity thresholds for these parameters, based on extirpation. Resulting thresholds for embeddedness were 68% for combined ecoregions, 65% for the Mountain bioregion (composed of Central Appalachian, Ridge and Valley, and Blue Ridge ecoregions), and 88% for the Piedmont bioregion (composed of Northern Piedmont and Piedmont ecoregions). Thresholds for conductivity were 366 µS/cm for combined ecoregions, 391 µS/cm for the Mountain bioregion, and 136 µS/cm for the Piedmont bioregion. These thresholds may help water quality professionals identify impaired and at-risk waters designated to support aquatic life and develop regional strategies to manage sediment-impaired streams. Inclusion of embeddedness as a restoration endpoint may be warranted; this could be facilitated by application of more quantitative, less time-intensive measurement approaches. We encourage refinement of thresholds as additional data and genus-based metrics become available. Integr Environ Assess Manag 2019;15:77-92. Published 2018. This article has been contributed to by US Government employees and their work is in the public domain in the USA.