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Micronutrient deficiencies can hurt the health of women of reproductive age (WRA), their pregnancy outcomes, and the growth and development of their offspring in sub-Saharan African countries. The present study aimed to estimate the dietary intake of non-pregnant and non-lactating (NPNL) WRA, residing in seven districts of the Mbeya region in Tanzania using a 24-hour dietary recall. A cross sectional study was conducted among 500 NPNL WRA. A two-stage sampling method was used, three enumeration areas (EAs) were chosen for each district using the probability proportional to size and, 24 eligible households were randomly selected from each chosen EA.The SAS macros (version 9.4) were used to analyse the quantities consumed and explore the usual intakes of three fortified food vehicles. The median intake of oil, wheat flour, and calories was 36.47g, 110.53g, and 2,169.9 kcal, respectively. The median protein intake was 63.5g, higher than the recommended value of 56.0g. Among the micronutrients, zinc had the highest prevalence of inadequate intake (91.2%), followed by iron (82.2%), and vitamin B12 (80.0%). Vitamin E had the highest nutrient gap (50.7%), while the nutrient gap in Q1 was relatively low (9.8%). There was a moderate prevalence of inadequate intake of vitamin C (46.5%) and riboflavin (54.8%), with a nutrient gap in Q1 (42%). Inadequate intake of vitamin A, thiamine, niacin, vitamin B6, and folate was moderate, ranging from 32.6% to 44.4%, with a nutrient gap at Q1 ranging from 16.2% to 34%. Our study has revealed a prevalent inadequate intake of micronutrients among NPNL WRA. Furthermore, our findings suggest that fortifying oil represents a promising intervention. However, fortified wheat flour had limited reach among NPNL WRA in the Mbeya region of Tanzania.

Osmotic demyelination syndrome (ODS) is a rare complication associated with rapid sodium changes, typically encountered in patients with severe hyponatremia. ODS in patients with normonatremia (ODSIN) is less recognized. We describe a patient with MRI-detected ODSIN following neurotrauma and reviewed the relevant literature. We present a 57-year-old female with subdural hematoma following ground-level fall. Her initial sodium was 140 mEq/L but over 2 days, rose 17 mEq/L, peaking at 157 mEq/L. On exam, unexplainable, unexpected left-sided hemiplegia with weakness sparing her face were noted; ODS was suspected. MRI revealed central pontine T2 hyperintensity, T1 hypointensity, and FLAIR hyperintensity. Treatment included gradual lowering of sodium with normal saline and free water. She was discharged to a skilled nursing facility (SNF) with sodium 138 mEq/L and upon 4-year follow-up had moderate disability and required some assistance to support activities of daily living. Our literature search yielded 23 cases (22 normonatremic; 1 where normonatremia progressed to hypernatremia). Common signs/symptoms were hyperreflexia, dysarthria, and gait disturbance. Common comorbidities were alcoholism, dialysis, and renal disease/failure. Cranial MRI confirmed all cases, frequently revealing central pontine T2 and FLAIR hyperintensity and T1 hypointensity. Our review further characterizes the diverse etiologies, clinical course, and radiographic features of ODSIN. Clinicians should consider this diagnosis when neurological symptoms occur even in the setting of normonatremia.

Maternal healthcare-seeking behaviour affects the health and well-being of under-five children. Drawing from the concepts of the health belief model, this study seeks to understand the determinants of health-seeking behaviours among mothers or caregivers of under-five-year-old children having severe wasting in Tanzania. A qualitative study employing the ethnography method conducted 32 semi-structured and narrative interviews with healthcare workers, community health workers, traditional healers, religious and village leaders, and mothers or caregivers of children who had acute malnutrition. The analysis of transcripts was done by qualitative content analysis. Further, the thematic analysis was carried out by assigning data into relevant codes to generate categories based on study objectives. Severe wasting among under-five-year-old children was not observed as a serious disease by the majority of mothers or caregivers. The study established that the health systems parameters such as the availability of the community health workers or healthcare providers and the availability of medicines and supplies to the health facility impact on mothers' or caregivers' healthcare-seeking behaviours. The findings also show that long distances to the health facility, behavioural parameters such as lack of awareness, negative perception of the management of severe wasting at the health facility, superstitious beliefs, women's workload, household food insecurity, and gender issues have a significant role in seeking healthcare. The results reaffirm how a programme on integrated management of severe wasting in Tanzania should encompass sociocultural factors that negatively influence mothers or caregivers of children with acute malnutrition. The programme should focus on engaging community structures including traditional healers, religious and village leaders to address prevailing local beliefs and sociocultural factors.

The components of each stage have similarities as well as differences, which make each unique in its own right. As the film-making and the movie industry may have much we can learn from, some of these will be covered under the different sections of the paper, for example, “Writing Powerful Narratives,” depiction of emotional elements, specific industry-driven developments as well as the “cultural considerations” in both. For medical simulation and simulation-based education, the corresponding stages are as follows: Development Preproduction Production Postproduction and Distribution. The art of sim-making has many similarities to that of film-making. In fact, there is potentially much to be learnt from the film-making process in cinematography and storytelling. Both film-making and sim-making can be seen from the artistic perspective as starting with a large piece of blank, white sheet of paper, which will need to be colored by the “artists” and personnel involved; in the former, to come up with the film and for the latter, to engage learners and ensure learning takes place, which is then translated into action for patients in the actual clinical care areas. Both entities have to go through a series of systematic stages. For film-making, the stages are as follows: Identification of problems and needs analysis Setting objectives, based on educational strategies Implementation of the simulation activity Debriefing and evaluation, as well as Fine-tuning for future use and archiving of scenarios/cases.

Iron deficiency anaemia remains a public health problem, particularly in children aged 6–59 months. This study assessed factors associated with iron deficiency anaemia among children aged 6–23 months, 24–59 months and 6–59 months in Tanzania. Data for this cross-sectional study were extracted from the 2015–16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015–16 TDHS-MIS). The study covered 8014 children aged 6–59 months and their mothers. Iron deficiency anaemia was defined (haemoglobin < 11g/dL). Univariable and multivariable logistic regression analyses that adjust for clustering and sampling weights were conducted to describe the associations between anaemia and potential confounding variables. The prevalence of iron deficiency anaemia among children aged 6–23 months, 24–59 months and 6–59 months were 76%, 49% and 59%, respectively. Factors associated with increased odds of iron deficiency anaemia among children aged 6–23 months included a mother being employed, being a male child, child perceived to small size at birth by mothers, a mother being anaemic and children belonging to the poorest socio-economic quintile. In addition, being a mother with no schooling, children not being dewormed, a mother being anaemic, delivering a baby at home, child fever and stunting, were factors associated with increased odds of iron deficiency anaemia among children aged 24–59 months. Factors associated with increased odds of iron deficiency anaemia among children aged 6–59 months were: a mother being employed, being a mother with no schooling, being a male child, belonging to the 6–59 months age bracket, a mother having a BMI of between 19 and 25 kg/m2, a mother being anaemic, having a baby at home, children belonging to bigger households, child fever and stunting. Interventions to minimise the burden of iron deficiency anaemia in children should target employed and/or anaemic mothers, poor and rich households, as well as male children.

Abstract Classifying images using supervised machine learning (ML) relies on labeled training data—classes or text descriptions, for example, associated with each image. Data‐driven models are only as good as the data used for training, and this points to the importance of high‐quality labeled data for developing a ML model that has predictive skill. Labeling data is typically a time‐consuming, manual process. Here, we investigate the process of labeling data, with a specific focus on coastal aerial imagery captured in the wake of hurricanes that affected the Atlantic and Gulf Coasts of the United States. The imagery data set is a rich observational record of storm impacts and coastal change, but the imagery requires labeling to render that information accessible. We created an online interface that served labelers a stream of images and a fixed set of questions. A total of 1,600 images were labeled by at least two or as many as seven coastal scientists. We used the resulting data set to investigate interrater agreement: the extent to which labelers labeled each image similarly. Interrater agreement scores, assessed with percent agreement and Krippendorff's alpha, are higher when the questions posed to labelers are relatively simple, when the labelers are provided with a user manual, and when images are smaller. Experiments in interrater agreement point toward the benefit of multiple labelers for understanding the uncertainty in labeling data for machine learning research.

Coronavirus disease 2019 (COVID-19) was an impetus for a multitude of transformations – from the ever-changing clinical practice frameworks, to changes in our execution of education and research. It called for our decisiveness, innovativeness, creativity, and adaptability in many circumstances. Even as care for our patients was always top priority, we tried to integrate, where possible, educational and research activities in order to ensure these areas continue to be harnessed and developed. COVID-19 provided a platform that stretched our ingenuity in all these domains. One of the mnemonics we use at SingHealth in responding to crisis is PACERS: P: Preparedness (in responding to any crisis, this is critical) A: Adaptability (needed especially with the ever-changing situation) C: Communications (the cornerstone in handling any crisis) E: Education (must continue, irrespective of what) R: Research (new opportunities to share and learn) S: Support (both physical and psychological). This article shares our experience integrating the concept of simulation-based training, quality improvement, and failure mode analysis.

Abstract Climate variability has increased demand for research on how management practices impact crop growth. Past research suggests increased root cortical aerenchyma tissue may increase corn's tolerance to abiotic stress, and it is possible seed treatments may affect its formation. In 2019, an open‐air pot study was conducted in central Ohio to assess how a commercial seed treatment (Poncho 1250 + VOTiVO) would impact early season above‐ and belowground growth of corn (Zea mays L.). Two recombinant inbred lines and two commercial hybrids were selected, with each corn accession treated with clothianidin + Bacillus firmus I‐1582 (Poncho 1250 + VOTiVO) or untreated prior to planting. Seed treatment had a positive effect on growth stage, plant height, and root surface area at termination. Root porosity was unaffected by seed treatment aside from one commercial hybrid where porosity decreased with seed treatment. Application of Poncho 1250 + VOTiVO improved early season growth of seedlings, but more research is needed to understand its impact on yield and improving crop tolerance to early season abiotic stresses.

OBJETIVOS: A proposta deste trabalho foi verificar a influência da ingestão de sardinha, alimento rico em ácidos graxos poliinsaturados da série ômega3, na composição do leite materno. MÉTODOS: Estudo prospectivo avaliou 31 nutrizes acompanhadas no Hospital Guilherme Álvaro, as quais receberam 2 kg de sardinha fresca por duas vezes, em intervalos de 15 dias. Nos tempos 0, 15 e 30 dias, realizou-se inquérito alimentar de 24 horas e coleta de leite. Determinaram-se os ácidos graxos do leite materno por cromatografia a gás. Para análise estatística dos resultados, utilizaram-se testes não paramétricos, com nível de significância p < 0,05. RESULTADOS: Os resultados mostraram que o consumo alimentar das nutrizes estava adequado e apresentou-se constante durante os três momentos do estudo. Quanto aos ácidos graxos da série ômega3 no leite, verificou-se que o consumo regular e os menores intervalos entre coleta de leite e ingestão de sardinha determinaram maiores proporções de ácido docosapentaenóico e ácido docosahexaenóico após 15 e 30 dias do início do estudo. Os ácidos graxos da série ômega6 e ômega3 apresentaram correlação significante, r² = 0,58 e 0,59, respectivamente, nos tempos 15 e 30 dias. CONCLUSÃO: Esses resultados sugerem que a ingestão de peixe incorporada ao hábito alimentar da nutriz durante a lactação, com o consumo de 100 g de sardinha, duas a três vezes por semana, contribui para o aumento dos ácidos graxos da série ômega3.OBJECTIVES: The purpose of this study was to investigate what effect the intake of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. METHODS: This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Álvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. RESULTS: The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between intake and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r² was 0.58 and 0.59 at 15 and 30 days, respectively. CONCLUSION: These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids.

The Cancer Research Network (CRN) is a consortium of 12 research groups, each affiliated with a nonprofit integrated health care delivery system, that was first funded in 1998. The overall goal of the CRN is to support and facilitate collaborative cancer research within its component delivery systems. This paper describes the CRN's 20-year experience and evolution. The network combined its members' scientific capabilities and data resources to create an infrastructure that has ultimately supported over 275 projects. Insights about the strengths and limitations of electronic health data for research, approaches to optimizing multidisciplinary collaboration, and the role of a health services research infrastructure to complement traditional clinical trials and large observational datasets are described, along with recommendations for other research consortia.

The purpose of this comparative analysis study is to compare how students' motivation, emotional stability, and positivity in life are affected by indoor technology-driven activities compared to outdoor play activities. Furthermore, the researchers conducted their study at the St. Michael Institute of Bacoor, using quantitative methods to collect data. They surveyed one hundred and fifty senior high school students aged 18-20. The study used self-made questionnaires with sixty questions divided into three variables: emotional stability, motivation, and positivity in life. The results show no significant difference between the levels of emotional stability, motivation, and positivity in life based on the respondents' preferred activities. This study aims to promote outdoor play activities and a balanced lifestyle with indoor technology-driven activities. It will serve as a basis for suggesting activities that will boost motivation, emotional stability, and positivity in life. [ABSTRACT FROM AUTHOR]

Osmotic demyelination syndrome (ODS) is a rare complication associated with rapid sodium changes, typically encountered in patients with severe hyponatremia. ODS in patients with normonatremia (ODSIN) is less recognized. We describe a patient with MRI‐detected ODSIN following neurotrauma and reviewed the relevant literature. We present a 57‐year‐old female with subdural hematoma following ground‐level fall. Her initial sodium was 140 mEq/L but over 2 days, rose 17 mEq/L, peaking at 157 mEq/L. On exam, unexplainable, unexpected left‐sided hemiplegia with weakness sparing her face were noted; ODS was suspected. MRI revealed central pontine T2 hyperintensity, T1 hypointensity, and FLAIR hyperintensity. Treatment included gradual lowering of sodium with normal saline and free water. She was discharged to a skilled nursing facility (SNF) with sodium 138 mEq/L and upon 4‐year follow‐up had moderate disability and required some assistance to support activities of daily living. Our literature search yielded 23 cases (22 normonatremic; 1 where normonatremia progressed to hypernatremia). Common signs/symptoms were hyperreflexia, dysarthria, and gait disturbance. Common comorbidities were alcoholism, dialysis, and renal disease/failure. Cranial MRI confirmed all cases, frequently revealing central pontine T2 and FLAIR hyperintensity and T1 hypointensity. Our review further characterizes the diverse etiologies, clinical course, and radiographic features of ODSIN. Clinicians should consider this diagnosis when neurological symptoms occur even in the setting of normonatremia. [ABSTRACT FROM AUTHOR]

The critical role of road transport in the economic growth of the Philippines underscores the importance of maintaining an efficient infrastructure. Traditional methods for detecting potholes, primarily manual methods, have demonstrated significant limitations, revealing a technological gap in road maintenance. This study proposes a novel solution with the development of the EyeWay system, an AIoT prototype specifically designed for real-time pothole detection within the Philippine context. The primary focus of this study is the design, development, and evaluation of the effectiveness of the EyeWay system in revolutionizing road maintenance practices. By employing advanced computer vision algorithms, AI-on-edge technology, and map visualization techniques, the EyeWay system achieves real-time pothole detection. The system demonstrated a mAP of 91.8%, a testing accuracy of 82.95%, and an inference time of 1.76 milliseconds using the YOLOv5m model, highlighting substantial improvements in detection accuracy and efficiency. Despite these successes, challenges, such as GPS data inaccuracies and system overheating, have been identified, indicating areas for further enhancement. The EyeWay system offers significant advancement in proactive pothole identification and repair, contributing to road safety and reducing maintenance costs. This study provides valuable insights into the potential of AI-based systems for sustainable transportation infrastructure. [ABSTRACT FROM AUTHOR]

We are still largely reliant on pesticides for the suppression of arthropod pests which threaten human health and food production, but the recent rise of evolved resistance among important pest species has reduced pesticide efficacy. Despite this, our understanding of strategies that effectively limit the evolution of resistance remains weak. Male‐killing sex ratio distorting microbes (SRDMs), such as Wolbachia and Spiroplasma, are common among arthropod species. Previous theoretical work has suggested that they could limit adaptive potential in two ways: first, because by distorting sex ratios they reduce the effective population size, and second, because infected females produce no male offspring which restricts gene flow. Here we present the results of a novel experiment in which we test the extent by which these two mechanisms limit the adaptive response of arthropods to pesticide. Using a fully factorial design, we manipulated the adult sex ratio of laboratory populations of Drosophila melanogaster, both in the presence and absence of SRDMs, and exposed these populations to six generations of pesticide poisoning. This design allows the effects of SRDMs on sex ratio and their effects on gene flow to be estimated separately. After six generations, individuals from populations with even sex ratios displayed a higher resistance to pesticide relative to individuals from female‐biased populations. By contrast, we found no effect of the presence of SRDMs in host populations on pesticide resistance independent of sex ratio. In addition, males were more susceptible to pesticide than females—this was true of flies from both naïve and previously exposed populations. These findings provide the first empirical proof of concept that sex ratio distortion arising from SRDMs can limit adaptation to pesticides, but cast doubt on the theoretical effect of male‐killers limiting adaptation by disrupting gene flow. [ABSTRACT FROM AUTHOR]

Screening may decrease cancer mortality and treatment costs, but the annual cost of cancer screening in the United States is unknown. This study used national health care survey and cost resources data to estimate the annual medical care cost of cancer screening in the United States in 2021. Visual Abstract. The Annual Cost of Cancer Screening in the United States: Screening may decrease cancer mortality and treatment costs, but the annual cost of cancer screening in the United States is unknown. This study used national health care survey and cost resources data to estimate the annual medical care cost of cancer screening in the United States in 2021. Background: Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. Objective: To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. Design: Model using national health care survey and cost resources data. Setting: U.S. health care systems and institutions. Participants: People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. Measurements: The number of people screened and associated health care system costs by insurance status in 2021 dollars. Results: Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. Limitations: All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. Conclusion: The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that individuals differ in foraging tactics and this variation is often linked to an individual's behavioural type (BT). Yet, while foraging typically comprises a series of search and handling steps, empirical investigations have rarely considered BT‐dependent effects across multiple stages of the foraging process, particularly in natural settings.In our long‐term sleepy lizard (Tiliqua rugosa) study system, individuals exhibit behavioural consistency in boldness (measured as an individual's willingness to approach a novel food item in the presence of a threat) and aggressiveness (measured as an individual's response to an 'attack' by a conspecific dummy). These BTs are only weakly correlated and have previously been shown to have interactive effects on lizard space use and movement, suggesting that they could also affect lizard foraging performance, particularly in their search behaviour for food.To investigate how lizards' BTs affect their foraging process in the wild, we supplemented food in 123 patches across a 120‐ha study site with three food abundance treatments (high, low and no‐food controls). Patches were replenished twice a week over the species' entire spring activity season and feeding behaviours were quantified with camera traps at these patches. We tracked lizards using GPS to determine their home range (HR) size and repeatedly assayed their aggressiveness and boldness in designated assays.We hypothesised that bolder lizards would be more efficient foragers while aggressive ones would be less attentive to the quality of foraging patches. We found an interactive BT effect on overall foraging performance. Individuals that were both bold and aggressive ate the highest number of food items from the foraging array. Further dissection of the foraging process showed that aggressive lizards in general ate the fewest food items in part because they visited foraging patches less regularly, and because they discriminated less between high and low‐quality patches when revisiting them. Bolder lizards, in contrast, ate more tomatoes because they visited foraging patches more regularly, and ate a higher proportion of the available tomatoes at patches during visits.Our study demonstrates that BTs can interact to affect different search and handling components of the foraging process, leading to within‐population variation in foraging success. Given that individual differences in foraging and movement will influence social and ecological interactions, our results highlight the potential role of BT's in shaping individual fitness strategies and population dynamics. [ABSTRACT FROM AUTHOR]

The shorelines of Titan's hydrocarbon seas trace flooded erosional landforms such as river valleys; however, it is unclear whether coastal erosion has subsequently altered these shorelines. Spacecraft observations and theoretical models suggest that wind may cause waves to form on Titan's seas, potentially driving coastal erosion, but the observational evidence of waves is indirect, and the processes affecting shoreline evolution on Titan remain unknown. No widely accepted framework exists for using shoreline morphology to quantitatively discern coastal erosion mechanisms, even on Earth, where the dominant mechanisms are known. We combine landscape evolution models with measurements of shoreline shape on Earth to characterize how different coastal erosion mechanisms affect shoreline morphology. Applying this framework to Titan, we find that the shorelines of Titan's seas are most consistent with flooded landscapes that subsequently have been eroded by waves, rather than a uniform erosional process or no coastal erosion, particularly if wave growth saturates at fetch lengths of tens of kilometers. [ABSTRACT FROM AUTHOR]

Models of rocky-coast erosion help us understand the physical phenomena that control coastal morphology and evolution, infer the processes shaping coasts in remote environments, and evaluate risk from natural hazards and future climate change. Existing models, however, are highly complex, are computationally expensive, and depend on many input parameters; this limits our ability to explore planform erosion of rocky coasts over long timescales (thousands to millions of years) and over a range of conditions. In this paper, we present a simplified cellular model of coastline evolution in closed basins through uniform erosion and wave-driven erosion. Uniform erosion is modeled as a constant rate of retreat. Wave erosion is modeled as a function of fetch, the distance over which the wind blows to generate waves, and the angle between the incident wave and the shoreline. This reduced-complexity model can be used to evaluate how a detachment-limited coastal landscape reflects climate, sea-level history, material properties, and the relative influence of different erosional processes. [ABSTRACT FROM AUTHOR]

The paper examines the application of adaptive antennas in wireless communication systems with particular attention to how well they can transmit and receive signals by dynamically adjusting radiation patterns. The review covers a range of artificial intelligence (AI) approaches that have been used to enhance adaptive antenna performance in beamforming, channel estimation, interference mitigation, and spectrum utilization. Besides adaptive antennas' potential to improve wireless communication systems, the paper also discusses their limitations, including computational complexity, interference sensitivity, and the significance of precise channel state information (CSI) estimates. [ABSTRACT FROM AUTHOR]

Background: Estimates of the proportion of children with autism spectrum disorder (ASD) who are minimally verbal vary from 25% to 35%. However, there is a lack of consensus in defining minimally verbal and few detailed reports of communication outcomes for these children following intervention. The aim of this study was to explore how minimally verbal children have been defined and to document the proportion of minimally verbal children in a group of children with ASD receiving a community based early intervention programme. Method: A longitudinal cohort design was used to examine the proportion of children who met criteria for minimally verbal in 246 children with ASD when they entered and exited an early intervention programme. Results: Overall, 26.3% of the children in this study exited the programme using "fewer than five spontaneous and functional words" and 36.4% exited not using "two word phrases" as indicated by direct assessment. However, our findings were mixed depending on measures and definitions used, with parent report indicating that as many as 29.4% of children were not "naming at least three objects" consistently, and 43.3% not using "phrases with a noun and verb" consistently at exit. More than half of the children who entered the programme with minimal speech exited the programme with a similar language profile. A small percentage of children (1.2%-4.7%) regressed in their language level over time. Conclusions: Despite advances in early intervention, and access to services at a younger age, around a quarter of individuals with ASD in this study exited early intervention with significant communication needs. Our findings are considered in relation to the literature and clinical implications, and future research directions are discussed.

Lung cancer screening with low-dose computed tomography has been shown to reduce lung cancer mortality. Nevertheless, it may also lead to potential harms, including complications arising from downstream invasive procedures. However, the magnitude of such potential harms in real-world practice remains unknown. The current study evaluated downstream use of invasive procedures and procedural complications after lung cancer screening in 5 diverse U.S. health care systems. Visual Abstract. Downstream Procedures and Complications Associated With Lung Cancer Screening.: Lung cancer screening with low-dose computed tomography has been shown to reduce lung cancer mortality. Nevertheless, it may also lead to potential harms, including complications arising from downstream invasive procedures. However, the magnitude of such potential harms in real-world practice remains unknown. The current study evaluated downstream use of invasive procedures and procedural complications after lung cancer screening in 5 diverse U.S. health care systems. Background: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces lung cancer mortality but can lead to downstream procedures, complications, and other potential harms. Estimates of these events outside NLST (National Lung Screening Trial) have been variable and lacked evaluation by screening result, which allows more direct comparison with trials. Objective: To identify rates of downstream procedures and complications associated with LCS. Design: Retrospective cohort study. Setting: 5 U.S. health care systems. Patients: Individuals who completed a baseline LDCT scan for LCS between 2014 and 2018. Measurements: Outcomes included downstream imaging, invasive diagnostic procedures, and procedural complications. For each, absolute rates were calculated overall and stratified by screening result and by lung cancer detection, and positive and negative predictive values were calculated. Results: Among the 9266 screened patients, 1472 (15.9%) had a baseline LDCT scan showing abnormalities, of whom 140 (9.5%) were diagnosed with lung cancer within 12 months (positive predictive value, 9.5% [95% CI, 8.0% to 11.0%]; negative predictive value, 99.8% [CI, 99.7% to 99.9%]; sensitivity, 92.7% [CI, 88.6% to 96.9%]; specificity, 84.4% [CI, 83.7% to 85.2%]). Absolute rates of downstream imaging and invasive procedures in screened patients were 31.9% and 2.8%, respectively. In patients undergoing invasive procedures after abnormal findings, complication rates were substantially higher than those in NLST (30.6% vs. 17.7% for any complication; 20.6% vs. 9.4% for major complications). Limitation: Assessment of outcomes was retrospective and was based on procedural coding. Conclusion: The results indicate substantially higher rates of downstream procedures and complications associated with LCS in practice than observed in NLST. Diagnostic management likely needs to be assessed and improved to ensure that screening benefits outweigh potential harms. Primary Funding Source: National Cancer Institute and Gordon and Betty Moore Foundation. [ABSTRACT FROM AUTHOR]

Models of rocky coast erosion help us understand the physical phenomena that control coastal morphology and evolution, infer the processes shaping coasts in remote environments, and evaluate risk from natural hazards and future climate change. Existing models, however, are highly complex, computationally expensive, and depend on many input parameters; this limits our ability to explore planform erosion of rocky coasts over long timescales (100s to 100,000s years) and a range of conditions. In this paper, we present a simplified cellular model of coastline evolution through uniform erosion and wave-driven erosion. Uniform erosion is modeled as a constant rate of retreat. Wave erosion is modeled as a function of fetch, the distance over which the wind blows to generate waves, and the angle between the incident wave and the shoreline. This reduced complexity model can be used to evaluate how a detachment-limited coastal landscape reflects climate, sea level history, material properties, and the relative influence of different erosional processes. [ABSTRACT FROM AUTHOR]