What do we know about communicating risk? A brief review and suggestion for contextualising serious, but rare, risk, and the example of cox-2 selective and non-selective NSAIDs

BACKGROUND: Communicating risk is difficult. Although different methods have been proposed - using numbers, words, pictures or combinations - none has been extensively tested. We used electronic and bibliographic searches to review evidence concerning risk perception and presentation. People tend to underestimate common risk and overestimate rare risk; they respond to risks primarily on the basis of emotion rather than facts, seem to be risk averse when faced with medical interventions, and want information on even the rarest of adverse events. METHODS: We identified observational studies (primarily in the form of meta-analyses) with information on individual non-steroidal anti-inflammatory drug (NSAID) or selective cyclooxygenase-2 inhibitor (coxib) use and relative risk of gastrointestinal bleed or cardiovascular event, the background rate of events in the absence of NSAID or coxib, and the likelihood of death from an event. Using this information we present the outcome of additional risk of death from gastrointestinal bleed and cardiovascular event for individual NSAIDs and coxibs alongside information about death from other causes in a series of perspective scales. RESULTS: The literature on communicating risk to patients is limited. There are problems with literacy, numeracy and the human tendency to overestimate rare risk and underestimate common risk. There is inconsistency in how people translate between numbers and words. We present a method of communicating information about serious risks using the common outcome of death, using pictures, numbers and words, and contextualising the information. The use of this method for gastrointestinal and cardiovascular harm with NSAIDs and coxibs shows differences between individual NSAIDs and coxibs. CONCLUSION: Although contextualised risk information can be provided on two possible adverse events, many other possible adverse events with potential serious consequences were omitted. Patients and professionals want much information about risks of medical interventions but we do not know how best to meet expectations. The impact of contextualised information remains to be tested

First measurement of low intensity fast neutron background from rock at the Boulby Underground Laboratory

A technique to measure low intensity fast neutron flux has been developed. The design, calibrations, procedure for data analysis and interpretation of the results are discussed in detail. The technique has been applied to measure the neutron background from rock at the Boulby Underground Laboratory, a site used for dark matter and other experiments, requiring shielding from cosmic ray muons. The experiment was performed using a liquid scintillation detector. A 6.1 litre volume stainless steel cell was filled with an in-house made liquid scintillator loaded with Gd to enhance neutron capture. A two-pulse signature (proton recoils followed by gammas from neutron capture) was used to identify the neutron events from much larger gamma background from PMTs. Suppression of gammas from the rock was achieved by surrounding the detector with high-purity lead and copper. Calibrations of the detector were performed with various gamma and neutron sources. Special care was taken to eliminate PMT afterpulses and correlated background events from the delayed coincidences of two pulses in the Bi-Po decay chain. A four month run revealed a neutron-induced event rate of 1.84 +- 0.65 (stat.) events/day. Monte Carlo simulations based on the GEANT4 toolkit were carried out to estimate the efficiency of the detector and the energy spectra of the expected proton recoils. From comparison of the measured rate with Monte Carlo simulations the flux of fast neutrons from rock was estimated as (1.72 +- 0.61 (stat.) +- 0.38 (syst.))*10^(-6) cm^(-2) s^(-1) above 0.5 MeV.Comment: 37 pages, 24 figures, to be published in Astroparticle Physic

The DRIFT Dark Matter Experiments

The current status of the DRIFT (Directional Recoil Identification From Tracks) experiment at Boulby Mine is presented, including the latest limits on the WIMP spin-dependent cross-section from 1.5 kg days of running with a mixture of CS2 and CF4. Planned upgrades to DRIFT IId are detailed, along with ongoing work towards DRIFT III, which aims to be the world's first 10 m3-scale directional Dark Matter detector.Comment: Proceedings of the 3rd International conference on Directional Detection of Dark Matter (CYGNUS 2011), Aussois, France, 8-10 June 201

Effect of remote ischaemic preconditioning on walking in people with multiple sclerosis: double-blind randomised controlled trial

Background Remote ischaemic preconditioning (RIPC) is the exposure of body parts to brief periods of circulatory occlusion and reperfusion. Recent studies have also shown that RIPC can improve exercise performance in healthy individuals. Objective This study aimed to assess the effect of RIPC on walking in people with multiple sclerosis (MS). Methods This was a double-blind randomised controlled clinical trial. We used three cycles of RIPC delivered by occluding the upper arm with a blood pressure (BP) cuff inflated to a pressure of 30 mm Hg above the systolic BP. In patients in the sham intervention group, the BP cuff was inflated only to 30 mm Hg below diastolic BP. Outcome measures included the Six-Minute Walk Test (6MWT), gait speed, the Borg rate of perceived exertion (RPE) scale, the tolerability of the RIPC using a Numerical Rating Scale for discomfort from 0 to 10, and adverse events. We identified responders meeting the minimal clinically important difference (MCID) established in the literature in each group. Results Seventy-five participants completed the study (RIPC: 38 and Sham: 37). The distance walked during the 6MWT improved by 1.9% in the sham group and 5.7% in the RIPC group (p=0.012). The number of responders meeting MCID criteria in the RIPC group was significantly greater compared with the sham intervention group. No serious adverse events occurred. Conclusion Single cycle of RIPC resulted in immediate improvement in walking distances during 6MWT in people with MS. Trial registration numbers NCT0315355

Quenching Factor for Low Energy Nuclear Recoils in a Plastic Scintillator

Plastic scintillators are widely used in industry, medicine and scientific research, including nuclear and particle physics. Although one of their most common applications is in neutron detection, experimental data on their response to low-energy nuclear recoils are scarce. Here, the relative scintillation efficiency for neutron-induced nuclear recoils in a polystyrene-based plastic scintillator (UPS-923A) is presented, exploring recoil energies between 125 keV and 850 keV. Monte Carlo simulations, incorporating light collection efficiency and energy resolution effects, are used to generate neutron scattering spectra which are matched to observed distributions of scintillation signals to parameterise the energy-dependent quenching factor. At energies above 300 keV the dependence is reasonably described using the semi-empirical formulation of Birks and a kB factor of (0.014+/-0.002) g/MeVcm^2 has been determined. Below that energy the measured quenching factor falls more steeply than predicted by the Birks formalism.Comment: 8 pages, 9 figure

WIMP-nucleon cross-section results from the second science run of ZEPLIN-III

We report experimental upper limits on WIMP-nucleon elastic scattering cross sections from the second science run of ZEPLIN-III at the Boulby Underground Laboratory. A raw fiducial exposure of 1,344 kg.days was accrued over 319 days of continuous operation between June 2010 and May 2011. A total of eight events was observed in the signal acceptance region in the nuclear recoil energy range 7-29 keV, which is compatible with background expectations. This allows the exclusion of the scalar cross-section above 4.8E-8 pb near 50 GeV/c^2 WIMP mass with 90% confidence. Combined with data from the first run, this result improves to 3.9E-8 pb. The corresponding WIMP-neutron spin-dependent cross-section limit is 8.0E-3 pb. The ZEPLIN programme reaches thus its conclusion at Boulby, having deployed and exploited successfully three liquid xenon experiments of increasing reach