Increased attention has focused on shared decision-making (SDM) and use of decision aids for treatment decisions in cardiology. In this issue of JAMA Cardiology, Coylewright et al report the results of a rigorously performed pilot study on the use of a decision aid to facilitate SDM for patients with symptomatic severe aortic stenosis (AS) at high or prohibitive risk for surgery considered for transcatheter aortic valve replacement vs medical therapy. Comparisons were made between encounters before clinicians were trained to use a decision aid and the first and fifth encounters after a decision aid was used. The patient-clinician interactions were audio recorded and later coded by independent reviewers using a validated measure to assess SDM. This mixed-methods study found that SDM significantly improved in a stepwise manner from the initial usual care encounter (before use of a decision aid) to the first and then fifth encounters after implementation of the decision aid. Along with this improvement in SDM, patients (n = 35) demonstrated increased knowledge about their treatment choices and reported increased satisfaction in their care with no increase in decisional conflict. In contrast, clinicians (n = 6) reported that they believed they already engaged in SDM prior to use of the decision aid and, after multiple uses of the decision aid, believed patients did not understand or benefit from this tool. The disconnect between clinician and patient perspectives was sobering and has implications for the adoption of decision aids or other tools to facilitate SDM in the clinical setting. Notable limitations of the study, which are acknowledged by the authors, include (1) small sample size (of clinicians and patients); (2) the decision aid is most useful for the relatively smaller number of patients at high or prohibitive risk for surgery for whom transcatheter aortic valve replacement and medical therapy may both be reasonable options; and (3) the lack of diversity in the clinicians (all male), which reflects the current demographics of interventional cardiology and cardiac surgery.

This mixed-methods pilot study examines whether the repeated use of a decision aid by heart teams was associated with greater shared decision-making, along with improved patient-centered outcomes and clinicians’ attitudes about decision aids.

De Villiers, Marq, 1940- author

Murray-Darling Basin Authority (Australia)

Hart, Barry T., author

Australia. Parliament. House of Representatives. Standing Committee on Agriculture and Water Resources, author

Archer, John, 1941-

A collection of tried-and-true recipes for the warm summer months. Contains dishes that work great for outdoor gatherings at home as well as for picnics, festivals, or the beach.

Booth, Vernon

Booth, Vernon

Edwards, Steven A. (Steven Alan), 1951-

Cisco Press, in support of the Network Professional Association (NPA), announced today the winners of the 2008 Awards for Professionalism program.

Hayden Library - TP352.N49 2019

Online Resource

Online Resource

Horrell, David G., author

Shinall, Myrick C., author

Lee-Barnewall, Michelle, 1966- author

Horrell, David G., author

King, Karen L., author

Hollier, Joel, author

Holland, Tom, author

Wright, Arthur M., author

For the first time since coming back to San Francisco in January, I had everything I needed for a saunter across the city in the sun: a means of taking photos / videos, a pair of sunglasses, no work, no plans, and no excuse.

On the morning of July 4th, I decided to spend the next couple of days offline. I read a book, and decided to go for a walk the rest of the day. I didn’t have any expectations or intended destination. I left my apartment at 2pm and decided to walk west, as I haven’t spent any proper time on that side of the city.

I passed through a couple of small parks and quiet neighbourhoods before hitting the edge of The Presidio.

At this point, I realised how long it had been since I’d seen a large expanse of something approximating nature. The Presidio was beautifully tranquil, with just a handful of people strolling or running through the trees. Walking off the trails, I saw a lizard for the first time in years; probably a San Francisco Alligator Lizard.

I exited The Presidio somewhere near the golf course and picked a long road to keep walking west.

On the way, I hit a main road and stood at the traffic lights. While I waited a young woman walking her dog struck up the first of several impromptu conversations I had with strangers that day. She must have seen me looking around for the street name, as she asked, “Are you lost? Are you a tourist? Where are you going?”

“I’m not sure. That way”, I said pointing down the long road before us.

She laughed. “See, you are lost!”

We chatted for a few blocks before our paths diverged. She told me that I would find some nice trails, and a good view of the Golden Gate Bridge, in the woodland near Lands End. It was dead ahead for another 30 minutes. So that’s where I went.

I hit the trails at about 4:30pm. It must have been close to perfect weather. Really sunny, warm, only a mild breeze, and the bay was completely clear. I wandered around for over an hour; perching near the edge of cliffs, taking in the sight of the Golden Gate Bridge on my right and a vast expanse of ocean to my left. Such a relaxing place.

I made time for a Dorsey-like Vine (my first Vine)…

On the way back, I crossed a road to take a photo. A post-middle-age man crossed my path, struck up a conversation, and began to tell me about his life in San Francisco “back in the day”. As if he could peer into my soul, he assured me that there was nothing wrong with being a software engineer (although he did initially think I was an estate agent; that was one of the first things he said to me).

My spirits further lifted by a stranger’s validation, I continued home. For last 30 minutes all I could think about was lying down, resting my feet, and eating. I’d been walking for nearly 6 hours. I’ll definitely do it again, but a skateboard would be helpful next time.

Using SVG is currently the best way to create icon libraries for apps. Icons built with SVG are scalable and adjustable, but also discrete, which allows them to be incrementally loaded and updated. In contrast, icons built as fonts cannot be incrementally loaded or updated. This alone makes SVG icons the better choice for high-performance apps that rely on code-splitting and incremental deploys.

This post describes how to make a package of React components from a library of SVG icons. Although I’m focusing on React, making any other type of package is also possible. At Twitter I used the approach described here to publish the company’s SVG icon library in several different formats: optimized SVGs, plain JavaScript modules, React DOM components, and React Native components.

Using the icons

The end result is a JavaScript package that can be installed and used like any other JavaScript package.

yarnpkg add @acme/react-icons

Each icon is available as an individually exported React component.

import IconCamera from '@acme/react-icons/camera';

This allows your module bundler to package only the icons that are needed, and icons can be efficiently split across chunks when using code-splitting. This is a significant advantage over icon libraries that require fonts and bundle all icons into a single component.

// entire icon library is bundled with your app
import Icon from '@acme/react-icons';
const IconCamera = <Icon name='camera' />;

Each icon is straightforward to customize (e.g., color and dimensions) on a per-use basis.

import IconCamera from '@twitter/react-icons/camera';
const Icon = (
  <IconCamera
    style={{ color: 'white', height: '2em' }}
  />
);

Although the icons render to SVG, this is an implementation detail that isn’t exposed to users of the components.

Creating components

Each React component renders an inline SVG, using path and dimensions data extracted from the SVG source files. A helper function called createIconComponent means that only a few lines of boilerplate are needed to create a component from SVG data.

import createIconComponent from './utils/createIconComponent';
import React from 'react';
const IconCamera = createIconComponent({
  content: <g><path d='...'></g>,
  height: 24,
  width: 24
});
IconCamera.displayName = 'IconCamera';
export default IconCamera;

This is an example of what the createIconComponent function looks like when building components for a web app like Twitter Lite, which is built with React Native for Web.

// createIconComponent.js
import { createElement, StyleSheet } from 'react-native-web';
import React from 'react';

const createIconComponent = ({ content, height, width }) =>
  (initialProps) => {
    const props = {
      ...initialProps,
      style: StyleSheet.compose(styles.root, initialProps.style),
      viewBox: `0 0 ${width} ${height}`
    };

    return createElement('svg', props, content);
  };

const styles = StyleSheet.create({
  root: {
    display: 'inline-block',
    fill: 'currentcolor',
    height: '1.25em',
    maxWidth: '100%',
    position: 'relative',
    userSelect: 'none',
    textAlignVertical: 'text-bottom'
  }
});

Setting the fill style to currentcolor allows you to control the color of the SVG using the color style property instead.

All that’s left is to use scripts to process the SVGs and generate each React component.

Creating icon packages

A complete example of one way to do this can be found in the icon-builder-example repository on GitHub.

The project structure of the example tool looks like this.

.
├── README.md
├── package.json
├── scripts/
    ├── build.js
    ├── createReactPackage.js
    └── svgOptimize.js
└── src/
    ├── alerts.svg
    ├── camera.svg
    ├── circle.svg
    └── ...

The build script uses SVGO to optimize the SVGs, extract SVG path data, and extract metadata. The example packager for React then uses templates to create a package.json and the React icon components shown earlier.

import createIconComponent from './utils/createIconComponent';
import React from 'react';
const ${componentName} = createIconComponent({
  height: ${height},
  width: ${width},
  content: <g>${paths}</g>
});
${componentName}.displayName = '${componentName}';
export default ${componentName};

Additional packagers can be included to build other package types from the same SVG source. When the underlying icon library changes, it only takes a couple of commands to rebuild hundreds of icons and publish new versions of each package.

Goulston, Mark

Duening, Thomas N

Crainer, Stuart

Crainer, Stuart

Crainer, Stuart

Kahane, Adam

Gunther, Robert E., 1960- author

Banfield, Richard, author

Davies, Joseph, 1962-

Zhu, Wei-Dong, author

Bush, Mirabai, 1939- author

Bush, Mirabai, 1939- author

Interview with Daniel Scott. Reuland, MD MPH, author of Evaluating Shared Decision Making for Lung Cancer Screening, and Bruno Heleno, MD, PhD, author of Estimation of Overdiagnosis of Lung Cancer in Low-Dose Computed Tomography Screening

Interview with Jaclyn M. Hall, PhD, author of Association of Rates of Smoking During Pregnancy With Corporate Tobacco Sales Policies

Interview with Ian A. Maher, author of Association of Smoking and Other Factors With the Outcome of Mohs Reconstruction Using Flaps or Grafts