Improving the communication of multifactorial cancer risk assessment results for different audiences: a co-design process.

BACKGROUND: Multifactorial cancer risk prediction tools, such as CanRisk, are increasingly being incorporated into routine healthcare. Understanding risk information and communicating risk is challenging and healthcare professionals rely substantially on the outputs of risk prediction tools to communicate results. This work aimed to produce a new CanRisk report so users can directly access key information and communicate risk estimates effectively. METHODS: Over a 13-month period, we led an 8-step co-design process with patients, the public, and healthcare professionals. Steps comprised 1) think aloud testing of the original CanRisk report; 2) structured feedback on the original report; 3) literature review; 4) development of a new report prototype; 5) first round of structured feedback; 6) updating the new report prototype; 7) second round of structured feedback; and 8) finalising and publishing the new CanRisk report. RESULTS: We received 56 sets of feedback from 34 stakeholders. Overall, the original CanRisk report was not suitable for patients and the public. Building on the feedback, the new report has an overview of the information presented: section one summarises key information for individuals; sections two and three present information for healthcare professionals in different settings. New features also include explanatory text, definitions, graphs, keys and tables to support the interpretation of the information. DISCUSSION: This co-design experience shows the value of collaboration for the successful communication of complex health information. As a result, the new CanRisk report has the potential to better support shared decision-making processes about cancer risk management across clinical settings

Analysis of protein-coding genetic variation in 60,706 humans

Large-scale reference data sets of human genetic variation are critical for the medical and functional interpretation of DNA sequence changes. Here we describe the aggregation and analysis of high-quality exome (protein-coding region) DNA sequence data for 60,706 individuals of diverse ancestries generated as part of the Exome Aggregation Consortium (ExAC). This catalogue of human genetic diversity contains an average of one variant every eight bases of the exome, and provides direct evidence for the presence of widespread mutational recurrence. We have used this catalogue to calculate objective metrics of pathogenicity for sequence variants, and to identify genes subject to strong selection against various classes of mutation; identifying 3,230 genes with near-complete depletion of predicted protein-truncating variants, with 72% of these genes having no currently established human disease phenotype. Finally, we demonstrate that these data can be used for the efficient filtering of candidate disease-causing variants, and for the discovery of human 'knockout' variants in protein-coding genes.Peer reviewe

Experimental Proof of a Magnetic Coulomb Phase

Spin ice materials are magnetic substances in which the spin directions map onto hydrogen positions in water ice. Recently this analogy has been elevated to an electromagnetic equivalence, indicating that the spin ice state is a Coulomb phase, with magnetic monopole excitations analogous to ice's mobile ionic defects. No Coulomb phase has yet been proved in a real magnetic material, as the key experimental signature is difficult to resolve in most systems. Here we measure the scattering of polarised neutrons from the prototypical spin ice Ho2Ti2O7. This enables us to separate different contributions to the magnetic correlations to clearly demonstrate the existence of an almost perfect Coulomb phase in this material. The temperature dependence of the scattering is consistent with the existence of deconfined magnetic monopoles connected by Dirac strings of divergent length

Magnetic Coulomb phase in the spin ice Ho2Ti2O7.

Spin-ice materials are magnetic substances in which the spin directions map onto hydrogen positions in water ice. Their low-temperature magnetic state has been predicted to be a phase that obeys a Gauss' law and supports magnetic monopole excitations: in short, a Coulomb phase. We used polarized neutron scattering to show that the spin-ice material Ho2Ti2O7 exhibits an almost perfect Coulomb phase. Our result proves the existence of such phases in magnetic materials and strongly supports the magnetic monopole theory of spin ice