When evidence changes: Communicating uncertainty protects against a loss of trust.

Scientific findings can be overturned when new evidence arises. This study examines how communicating and explaining uncertainty around scientific findings affect trust in the communicator when findings change. In an online experiment (N = 800, convenience sample), participants read a fictitious statement from a public health authority announcing that there was no link between a new COVID-19 vaccine and heart muscle inflammation. The authority communicated (1) no uncertainty, (2) uncertainty without giving a reason, (3) uncertainty due to imprecision, or (4) uncertainty due to incomplete accounting of patients. Participants were then informed that the authority's statement was no longer correct as new data showed a link between the vaccine and heart muscle inflammation. Participants rated the authority's trustworthiness before and after the evidence update. Our findings indicate that communicating uncertainty buffers against a loss of trust when evidence changes. Moreover, explaining uncertainty does not appear to harm trust.

The Good Talk! A Serious Game to Boost People's Competence to Have Open Conversations About COVID-19: Protocol for a Randomized Controlled Trial.

BACKGROUND: Vaccine hesitancy is one of the many factors impeding efforts to control the COVID-19 pandemic. Exacerbated by the COVID-19 infodemic, misinformation has undermined public trust in vaccination, led to greater polarization, and resulted in a high social cost where close social relationships have experienced conflict or disagreements about the public health response. OBJECTIVE: The purpose of this paper is to describe the theory behind the development of a digital behavioral science intervention-The Good Talk!-designed to target vaccine-hesitant individuals through their close contacts (eg, family, friends, and colleagues) and to describe the methodology of a research study to evaluate its efficacy. METHODS: The Good Talk! uses an educational serious game approach to boost the skills and competences of vaccine advocates to have open conversations about COVID-19 with their close contacts who are vaccine hesitant. The game teaches vaccine advocates evidence-based open conversation skills to help them speak with individuals who have opposing points of view or who may ascribe to nonscientifically supported beliefs while retaining trust, identifying common ground, and fostering acceptance and respect of divergent views. The game is currently under development and will be available on the web, free to access for participants worldwide, and accompanied by a promotional campaign to recruit participants through social media channels. This protocol describes the methodology for a randomized controlled trial that will compare participants who play The Good Talk! game with a control group that plays the widely known noneducational game Tetris. The study will evaluate a participant's open conversation skills, self-efficacy, and behavioral intentions to have an open conversation with a vaccine-hesitant individual both before and after game play. RESULTS: Recruitment will commence in early 2023 and will cease once 450 participants complete the study (225 per group). The primary outcome is improvement in open conversation skills. Secondary outcomes are self-efficacy and behavioral intentions to have an open conversation with a vaccine-hesitant individual. Exploratory analyses will examine the effect of the game on implementation intentions as well as potential covariates or subgroup differences based on sociodemographic information or previous experiences with COVID-19 vaccination conversations. CONCLUSIONS: The outcome of the project is to promote more open conversations regarding COVID-19 vaccination. We hope that our approach will encourage more governments and public health experts to engage in their mission to reach their citizens directly with digital health solutions and to consider such interventions as an important tool in infodemic management. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40753.

Communicating Uncertainties About the Effects of Medical Interventions Using Different Display Formats.

Communicating uncertainties in scientific evidence is important to accurately reflect scientific knowledge , increase public understanding of uncertainty, and to signal transparency and honesty in reporting. While techniques have been developed to facilitate the communication of uncertainty, many have not been empirically tested, compared for communicating different types of uncertainty, or their effects on different cognitive, trust, and behavioral outcomes have not been evaluated. The present study examined how a point estimate, imprecise estimate, conflicting estimates, or a statement about the lack of evidence about treatment effects, influenced participant's responses to communications about medical evidence. For each type of uncertainty, we adapted three display formats to communicate the information: tables, bar graphs, and icon arrays. We compared participant's best estimates of treatment effects, as well as effects on recall, subjective evaluations (understandability and usefuleness), certainty perceptions, perceptions of trustworthiness of the information, and behavioral intentions. We did not find any detrimental effects from communicating imprecision or conflicting estimates relative to a point estimate across any outcome. Furthermore, there were more favorable responses to communicating imprecision or conflicting estimates relative to lack of evidence, where participants estimated the treatment would improve outcomes by 30-50% relative to a placebo. There were no differences across display formats, suggesting that, if well-designed, it may not matter which format is used. Future research on specific display formats or uncertainty types and with larger sample sizes would be needed to detect small effects. Implications for the communication of uncertainty are discussed.

Public knowledge of stroke and heart attack symptoms in China: a cross-sectional survey.

OBJECTIVE: Stroke and ischaemic heart disease have become the leading causes of death in China. We evaluated recognition of stroke and heart attack symptoms and stroke treatment-seeking behaviour in a large representative sample of the Chinese adult population and explored characteristics associated with recognition rates. DESIGN: Cross-sectional survey. SETTING: Household interviews. PARTICIPANT: 3051 Chinese adults aged between 18 and 69 (50.7% female) were interviewed between January and March 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary measures include recognitions of stroke and heart attack symptoms and stroke treatment-seeking behaviour. Secondary measures include numeracy level, sociodemographics and prior history of cardiovascular diseases and high blood pressure. RESULTS: Participants on average recognised 5.2 out of 14 stroke symptoms and 2.6 out of 6 heart attack symptoms. In the presence of stroke symptoms, three quarters of participants would take immediate action and call an ambulance, yet the second most common action was to advise the person to see a doctor (59%) rather than to consult a doctor immediately (34%). Recognition of atypical heartattack symptoms, such as nausea and feeling of anxiety, was poor. Symptom recognition rates were higher in females, people with a personal or family/friend history of cardiovascular events, those with higher numeracy scores, and for stroke symptoms, participants with high (versus low) education level. Furthermore, symptom recognition rate was negatively correlated with burden of cardiovascular diseases across the four economic regions of China. CONCLUSION: Recognition of stroke and heart-attack symptoms was moderate and there remains a gap between recognising symptoms and taking immediate action. Interventions focusing on simple symptom detection tools and on building numerical competencies may help reduce the burden of cardiovascular diseases in China.

Availability, Affect, and Decisions to Seek Information about Cancer Risks.

How do people decide which risks they want to get informed about? The present study examines the role of the availability and affect heuristics on these decisions. Participants (N = 100, aged 19-72 years) selected for which of 23 cancers they would like to receive an information brochure, reported the number of occurrences of each type of cancer in their social circle (availability), and rated their dread reaction to each type of cancer (affect); they also made relative judgments about which of 2 cancers was more common in Germany (judged risk). Participants tended to choose information brochures for those cancers for which they indicated a higher availability within their social networks as well as for cancers they dreaded. Mediation analyses suggested that the influence of availability and affect on information choice was only partly mediated by judged risk. The results demonstrate the operation of 2 key judgment heuristics (availability and affect), previously studied in risk perception, also in decisions about information choice. We discuss how our findings can be used to identify which risks are likely to fall from people's radar.

Risk communication in tables versus text: a registered report randomized trial on 'fact boxes'.

OBJECTIVES: identifying effective summary formats is fundamental to multiple fields including science communication, systematic reviews, evidence-based policy and medical decision-making. This study tested whether table or text-only formats lead to better comprehension of the potential harms and benefits of different options, here in a medical context. DESIGN: pre-registered, longitudinal experiment: between-subjects factorial 2 (message format) × 2 topic (therapeutic or preventative intervention) on comprehension and later recall (CONSORT-SPI 2018). SETTING: longitudinal online survey experiment. PARTICIPANTS: 2305 census-matched UK residents recruited through the survey panel firm YouGov. PRIMARY OUTCOME MEASURE: comprehension of harms and benefits and knowledge recall after six weeks. RESULTS: fact boxes-simple tabular messages-led to more comprehension (d = 0.39) and slightly more knowledge recall after six weeks (d = 0.12) compared to the same information in text. These patterns of results were consistent between the two medical topics and across all levels of objective numeracy and education. Fact boxes were rated as more engaging than text, and there were no differences between formats in treatment decisions, feeling informed or trust. CONCLUSIONS: the brief table format of the fact box improved the comprehension of harms and benefits relative to the text-only control. Effective communication supports informed consent and decision-making and brings ethical and practical advantages. Fact boxes and other summary formats may be effective in a wide range of communication contexts.

Effect of Tabular and Icon Fact Box Formats on Comprehension of Benefits and Harms of Prostate Cancer Screening: A Randomized Trial.

BACKGROUND: Fact boxes employ evidence-based guidelines on risk communication to present benefits and harms of health interventions in a balanced and transparent format. However, little is known about their short- and long-term efficacy and whether designing fact boxes to present multiple outcomes with icon arrays would increase their efficacy. METHOD: In study 1, 120 men (30-75 y) completed a lab study. Participants were randomly assigned to 1 of 3 fact box formats on prostate cancer screening: a tabular fact box with numbers, a fact box with numbers and icon array, and a fact box with numbers, separate icon arrays, and text to describe each benefit and harm. Comprehension of information (while materials were present) and short-term knowledge recall were assessed. Study 2 recruited an online sample of 244 German men (40-75 y). Participants were randomly assigned to 1 of the 3 fact box formats or widely distributed health information, and knowledge was assessed at baseline, shortly after presentation, and at 6-mo follow-up, along with comprehension while materials were present. RESULTS: In both studies, comprehension and knowledge-recall scores were similar when comparing tabular and icon fact boxes. In the 6-mo follow-up, this positive effect on knowledge recall disappeared. Fact boxes increased knowledge relative to baseline but did not affect decision intentions or perceptions of having complete information to make decisions. CONCLUSIONS: This study shows that fact boxes with and without icon arrays are equally effective at improving comprehension and knowledge recall over the short-term and are simple formats that can improve on current health information. Specifically, if fact boxes are used at the time or immediately before a decision is made, they promote informed decisions about prostate cancer screening.

Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail.

Background: fact Boxes are decision support tools that can inform about treatment effects. Objectives: to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design: randomized controlled trial. Setting: Swiss-German region of Switzerland. Subjects: two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118). Intervention: two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month). Methods: participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments. Results: participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = -8.35, 95% Confidence Interval (CI), -12.43, -4.28) and artificial hydration (b = -6.02, 95% CI, -9.84, -2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration. Conclusions: fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers. Trial registration: FORSbase (12091).

Natural Frequencies Do Foster Public Understanding of Medical Tests: Comment on Pighin, Gonzalez, Savadori, and Girotto (2016).

Patients and doctors often need to make decisions based on the results of medical tests. When these results are presented in the form of conditional probabilities, even doctors find it difficult to interpret them correctly. There is over 20 y of research supporting the finding that people are better able to calculate the correct positive predictive value of a test when given information in natural frequencies, as opposed to conditional probabilities. Natural frequencies are one of a few psychological tools that have made it into evidence-based medicine. Recently, Pighin and others (Med Decis Making 2016;36:686-91) argued that natural frequencies could hinder informed decision making, a critique based on a single task and a crude scoring criterion we refer to as the 50%-Split. Our commentary addresses these criticisms based on three analyses. First, we show how the 50%-Split scoring used by Pighin and others misclassifies known errors, such as solely attending to the hit rate (true-positive rate) of the test, as strategies that support understanding. Second, we reanalyze data from 21 additional problems completed by various participant groups to show that their scoring criterion does not support their results in 19 out of 21 cases. Third, we apply the mean deviation scoring method and show that, when given information in natural frequency formats, participants provide estimates that are closer to the correct Bayesian solution than for conditional probability formats. In each analysis, natural frequencies lead to more correct judgements and therefore promote informed decision making relative to conditional probabilities. We welcome further discussions of performance metrics that can provide insight into how the public and therefore patients understand the implications of medical test results.

Concepts for communication about risk in dementia care: A review of the literature.

Communication about risk is central to decisions in dementia care. This review synthesises research on risk concepts and communication in dementia. Twelve bibliographic databases and one online search engine were searched up to February 2016. Reference lists of two related literature reviews were used. Thirty-four articles were identified that focused on risk concepts; two articles related to risk communication. Concepts were often socially constructed, and perceptions may differ from actual adverse outcomes. Perceptions of risk and thresholds of risk-tolerance varied between individuals with dementia, carers and professionals. Individuals with dementia were found to behave differently from controls when making decisions involving risk information in experimental settings. Cognitive impairment was also associated with lower health numeracy. These findings highlight the importance of communication between stakeholders when making decisions and of presenting information in an appropriate way to support informed and positive risk taking. Research is required on risk communication in dementia.

Communicating risk in dementia care: Survey of health and social care professionals.

Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision-making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June-September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants' responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10-fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.

Meta-analysis of the effect of natural frequencies on Bayesian reasoning.

The natural frequency facilitation effect describes the finding that people are better able to solve descriptive Bayesian inference tasks when represented as joint frequencies obtained through natural sampling, known as natural frequencies, than as conditional probabilities. The present meta-analysis reviews 20 years of research seeking to address when, why, and for whom natural frequency formats are most effective. We review contributions from research associated with the 2 dominant theoretical perspectives, the ecological rationality framework and nested-sets theory, and test potential moderators of the effect. A systematic review of relevant literature yielded 35 articles representing 226 performance estimates. These estimates were statistically integrated using a bivariate mixed-effects model that yields summary estimates of average performances across the 2 formats and estimates of the effects of different study characteristics on performance. These study characteristics range from moderators representing individual characteristics (e.g., numeracy, expertise), to methodological differences (e.g., use of incentives, scoring criteria) and features of problem representation (e.g., short menu format, visual aid). Short menu formats (less computationally complex representations showing joint-events) and visual aids demonstrated some of the strongest moderation effects, improving performance for both conditional probability and natural frequency formats. A number of methodological factors (e.g., exposure to both problem formats) were also found to affect performance rates, emphasizing the importance of a systematic approach. We suggest how research on Bayesian reasoning can be strengthened by broadening the definition of successful Bayesian reasoning to incorporate choice and process and by applying different research methodologies. (PsycINFO Database Record

Bruton's Tyrosine Kinase Small Molecule Inhibitors Induce a Distinct Pancreatic Toxicity in Rats.

Bruton's tyrosine kinase (BTK) is a member of the Tec family of cytoplasmic tyrosine kinases involved in B-cell and myeloid cell signaling. Small molecule inhibitors of BTK are being investigated for treatment of several hematologic cancers and autoimmune diseases. GDC-0853 ((S)-2-(3'-(hydroxymethyl)-1-methyl-5-((5-(2-methyl-4-(oxetan-3-yl)piperazin-1-yl)pyridin-2-yl)amino)-6-oxo-1,6-dihydro-[3,4'-bipyridin]-2'-yl)-7,7-dimethyl-3,4,7,8-tetrahydro-2H-cyclopenta[4,5]pyrrolo[1,2-a]pyrazin-1(6H)-one) is a selective and reversible oral small-molecule BTK inhibitor in development for the treatment of rheumatoid arthritis and systemic lupus erythematosus. In Sprague-Dawley (SD) rats, administration of GDC-0853 and other structurally diverse BTK inhibitors for 7 days or longer caused pancreatic lesions consisting of multifocal islet-centered hemorrhage, inflammation, fibrosis, and pigment-laden macrophages with adjacent lobular exocrine acinar cell atrophy, degeneration, and inflammation. Similar findings were not observed in mice or dogs at much higher exposures. Hemorrhage in the peri-islet vasculature emerged between four and seven daily doses of GDC-0853 and was histologically similar to spontaneously occurring changes in aging SD rats. This suggests that GDC-0853 could exacerbate a background finding in younger animals. Glucose homeostasis was dysregulated following a glucose challenge; however, this occurred only after 28 days of administration and was not directly associated with onset or severity of pancreatic lesions. There were no changes in other common serum biomarkers assessing endocrine and exocrine pancreatic function. Additionally, these lesions were not readily detectable via Doppler ultrasound, computed tomography, or magnetic resonance imaging. Our results indicate that pancreatic lesions in rats are likely a class effect of BTK inhibitors, which may exacerbate an islet-centered pathology that is unlikely to be relevant to humans.

A Simple Tool for Communicating the Benefits and Harms of Health Interventions: A Guide for Creating a Fact Box.

One of the major hurdles to promoting informed decision making in health is the continued use of poor risk presentation formats. This article offers a guide to develop a Fact Box, a simple decision tool to present data about the benefits and harms of treatments that has been demonstrated to improve understanding of health risks, an important part of risk literacy. The article offers guidance about how to determine the evidence basis for a health topic, select outcomes to report, extract and present numbers or outcomes, and design the layout. The guide also addresses potential challenges for summarizing evidence and provides alternatives for addressing issues related to missing, insufficient, imprecise, or conflicting evidence and for dealing with issues related to statistical and clinical significance. The guide concludes with details on how to document the development of the Fact Box for the purpose of transparency and reproducibility. Fact Boxes are an efficient tool to promote risk literacy and should be available in every physician's office.

A randomized trial comparing two low-intensity psychological interventions for distressed patients with cancer and their caregivers.

PURPOSE/OBJECTIVES: To compare the effectiveness of two low-intensity approaches for distressed patients with cancer and caregivers who had called cancer helplines seeking support. Baseline distress was hypothesized as a moderator of intervention effect. DESIGN: Randomized trial. SETTING: Community-based cancer helplines in Queensland and New South Wales, Australia. SAMPLE: 354 patients with cancer and 336 caregivers. METHODS: Participants were randomized to either a single session of nurse-led self-management intervention or a five-session psychologist cognitive behavioral intervention delivered by telephone. Assessments were undertaken at baseline (preintervention) and at 3, 6, and 12 months. MAIN RESEARCH VARIABLES: Psychological and cancer-specific distress and post-traumatic growth. FINDINGS: No significant moderation by baseline cancer-specific distress was noted. For low-education patients, only the psychologist intervention was associated with a significant drop in distress. For all other participants, distress decreased over time in both arms with small to large effect sizes (Cohen's ds = 0.05-0.82). Post-traumatic growth increased over time for all participants (Cohen's ds = 0.6-0.64). CONCLUSIONS: Many distressed patients with cancer and their caregivers may benefit significantly from a single session of a nurse psychoeducation intervention that can be delivered remotely by telephone and supported by self-management materials. Research is needed to develop an algorithm that moves beyond the use of distress as the only indicator for referral to specialist psychological services. Survivors and caregivers with low education and low literacy may require more in-depth and targeted support. IMPLICATIONS FOR NURSING: Brief nurse psychoeducation and stress management for cancer survivors and caregivers should be considered as part of a tiered approach to psychosocial care.

Classifying the reasons men consider to be important in prostate-specific antigen (PSA) testing decisions: evaluating risks, lay beliefs, and informed decisions.

BACKGROUND: Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostate-specific antigen (PSA) test. PURPOSE: This study aims to identify classes of reasons guiding men's decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour. METHODS: First-degree relatives of men with prostate cancer (n = 207) and men from the general population (n = 239) of Australia listed reasons they considered when deciding whether to have a PSA test. RESULTS: Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9 %) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7 %). Informed decisions and health system class (26.5 %) included a lower proportion of men who had had a PSA test and greater proportions of highly educated and married men. CONCLUSION: Understanding the reasons underlying men's screening decisions may lead to a more effective information provision and decision support.

The influence of family history on cognitive heuristics, risk perceptions, and prostate cancer screening behavior.

OBJECTIVE: To examine how family history of prostate cancer, risk perceptions, and heuristic decision strategies influence prostate cancer screening behavior. METHODS: Men with a first-degree family history of prostate cancer (FDRs; n = 207) and men without a family history (PM; n = 239) completed a Computer Assisted Telephone Interview (CATI) examining prostate cancer risk perceptions, PSA testing behaviors, perceptions of similarity to the typical man who gets prostate cancer (representativeness heuristic), and availability of information about prostate cancer (availability heuristic). A path model explored family history as influencing the availability of information about prostate cancer (number of acquaintances with prostate cancer and number of recent discussions about prostate cancer) to mediate judgments of risk and to predict PSA testing behaviors and family history as a moderator of the relationship between representativeness (perceived similarity) and risk perceptions. RESULTS: FDRs reported greater risk perceptions and a greater number of PSA tests than did PM. Risk perceptions predicted increased PSA testing only in path models and was significant only for PM in multi-Group SEM analyses. Family history moderated the relationship between similarity perceptions and risk perceptions such that the relationship between these variables was significant only for FDRs. Recent discussions about prostate cancer mediated the relationships between family history and risk perceptions, and the number of acquaintances men knew with prostate cancer mediated the relationship between family history and PSA testing behavior. CONCLUSIONS: Family history interacts with the individuals' broader social environment to influence risk perceptions and screening behavior. Research into how risk perceptions develop and what primes behavior change is crucial to underpin psychological or public health intervention that seeks to influence health decision making.

Polar solvents decrease the viscosity of high concentration IgG1 solutions through hydrophobic solvation and interaction: formulation and biocompatibility considerations.

Low-volume protein dosage forms for subcutaneous injection pose unique challenges to the pharmaceutical scientist. Indeed, high protein concentrations are often required to achieve acceptable bioavailability and efficacy for many indications. Furthermore, high solution viscosities are often observed with formulations containing protein concentrations well above 150 mg/mL. In this work, we explored the use of polar solvents for reducing solution viscosity of high concentration protein formulations intended for subcutaneous injection. An immunoglobulin, IgG1, was used in this study. The thermodynamic preferential interaction parameter (Γ23 ) measured by differential scanning calorimetry, as well as Fourier transform infrared, Raman, and second-derivative UV spectroscopy, were used to characterize the effects of polar solvents on protein structure and to reveal important mechanistic insight regarding the nature of the protein-solvent interaction. Finally, the hemolytic potential and postdose toxicity in rats were determined to further investigate the feasibility of using these cosolvents for subcutaneous pharmaceutical formulations. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 102:1182-1193, 2013.

Patterns of prostate-specific antigen (PSA) testing in Australian men: the influence of family history.

OBJECTIVE: To describe how a family history of prostate cancer influences men's prostate cancer testing behaviours, information support preferences, and motives for testing. SUBJECTS AND METHODS: Men with a first-degree family history (239 men) and a comparison sample from the general population of Queensland, Australia (289) aged 40-65 years, and no prior history of cancer. Cross-sectional, retrospective survey assessing: prevalence of prostate-specific antigen (PSA) testing and digital rectal examination (DRE); discussion of prostate cancer risks and benefits with a physician; prostate cancer information needs and preferences; motivations for testing. RESULTS: Men with a family history were more likely to report: having ever had a PSA test (odds ratio [OR] 4.98; 95% confidence interval [CI] 3.16-7.85), more PSA tests in their lifetimes (b 1.04; se 0.40; 95% CI 0.26-1.82); to have had a DRE (OR 2.23; 95% CI 1.54-3.23); to have spoken to a doctor about prostate cancer (OR 3.72; 95% CI 2.30-6.02); and to have instigated these discussions (OR 1.74; 95%CI 1.13-2.70). Most men from both groups did not recall any discussion of the 'cons' of prostate cancer testing with a doctor. Men with a family history reported a greater desire for information about prostate cancer prevention than did men without a family history. CONCLUSIONS: Men with a family history are more concerned about getting prostate cancer and are tested more often; however, information needs, discussions about prostate cancer, and motivations for testing are similar to those of all men. There appears to be a disparity between public health approaches that promote informed decision-making and what is happening in practice.

An ecoregional context for forest management on National Wildlife Refuges of the Upper Midwest, USA.

To facilitate forest planning and management on National Wildlife Refuges, we synthesized multiple data sources to describe land ownership patterns, land cover, landscape pattern, and changes in forest composition for four ecoregions and their associated refuges of the Upper Midwest. We related observed patterns to ecological processes important for forest conservation and restoration, with specific attention to refuge patterns of importance for forest landbirds of conservation priority. The large amount of public land within the ecoregions (31-80%) suggests that opportunities exist for coarse and meso-scale approaches to conserving and restoring ecological processes affecting the refuges, particularly historical fire regimes. Forests dominate both ecoregions and refuges, but refuge forest patches are generally larger and more aggregated than in associated ecoregions. Broadleaf taxa have increased in dominance in the ecoregions and displaced fire-dependent taxa such as pine (Pinus spp.) and other coniferous species; these changes in forest composition have likely also affected refuge forests. Despite compositional changes, larger forest patches on refuges suggests that they may provide better habitat for area-sensitive forest landbirds of mature, compositionally diverse forests than surrounding lands if management continues to promote increased patch size. We reason that although fine-scale research and monitoring for species of conservation priority is important, broad scale (ecoregional) assessments provide crucial context for effective forest and wildlife management in protected areas.