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Introduction: Previous research has suggested that complications stemming from vaginal mesh can lead to life-changing negative physical consequences including erosion and chronic pain. However, there has been little research on the experiences of women who have had complications. This study was aimed at exploring the individual experiences of women who have had vaginal mesh complications and how this has impacted them. Methods: An explorative qualitative design was followed. Eighteen semi-structured interviews were conducted with women who had experienced complications with vaginal mesh due to stress urinary incontinence and pelvic organ prolapse. The mean age was 52 and the mean time since the mesh was fitted was 8 years (6 had since had it removed and a further 6 had had partial removal), and the mean time since first mesh-related symptom was 10 months. Data were analysed using thematic analysis. Results: Four main themes were identified: perceived impact of mesh complications, attitudes of medical professionals, social support and positive growth. Results showed that participant experiences of their mesh complication were psychologically traumatic, including feelings of increased anxiety and fears relating to suicidal thoughts. Intimate relationships were also affected, with reduced sexual functioning and intimacy stemming from mesh complications. Negative experiences with medical professionals included feeling dismissed, a lack of recognition of their symptoms, and anger towards the profession. Conclusions: The impacts of vaginal mesh complications were found to be wide-reaching and life-changing, affecting numerous aspects of participants' lives. Greater awareness in this area is needed to provide further support for women experiencing vaginal mesh complications. [ABSTRACT FROM AUTHOR]

Computational modeling, machine learning, and statistical data analysis are increasingly utilized to mitigate chemistry, manufacturing, and control failures related to particle properties in solid dosage form manufacture. Advances in particle characterization techniques and computational approaches provide unprecedented opportunities to explore relationships between particle morphology and drug product manufacturability. Achieving this, however, has numerous challenges such as producing and appropriately curating robust particle size and shape data. Addressing these challenges requires a harmonized strategy from material sampling practices, characterization technique selection, and data curation to provide data sets which are informative on material properties. Herein, common sources of error in particle characterization and data compression are reviewed, and a proposal for providing robust particle morphology (size and shape) data to support modeling efforts, approaches for data curation, and the outlook for modeling particle properties are discussed. [ABSTRACT FROM AUTHOR]

Identifying factors that influence risk of dietary lapses (i.e., instances of dietary non-adherence) is important because lapses contribute to suboptimal weight loss outcomes. Existing research examining lapse risk factors has had methodological limitations, including retrospective recall biases, subjective operationalizations of lapse, and has investigated lapses among participants in gold-standard behavioral weight loss programs (which are not accessible to most Americans). The current study will address these limitations by being the first to prospectively assess several risk factors of lapse (objectively operationalized) in the context of a commercial mobile health (mHealth) intervention, a highly popular and accessible method of weight loss. N = 159 adults with overweight or obesity enrolled in an mHealth commercial weight loss program completed ecological momentary assessments (EMAs) of 15 risk factors and lapses (defined as exceeding a point target for a meal/snack) over a 2-week period. N = 9 participants were excluded due to low EMA compliance, resulting in a sample of N = 150. Dietary lapses were predicted by momentary increases in urges to deviate from one's eating plan (b =.55, p <.001), cravings (b =.55, p <.001), alcohol consumption (b =.51, p <.001), and tiredness (b =.19, p <.001), and decreases in confidence related to meeting dietary goals (b = −.21, p <.001) and planning food intake (b = −.15, p <.001). This study was among the first to identify prospective predictors of lapse in the context of a commercial mHealth weight loss program. Findings can inform mHealth weight loss programs, including just-in-time interventions that measure these risk factors, calculate when risk of lapse is high, and deliver momentary interventions to prevent lapses. [ABSTRACT FROM AUTHOR]

The diagnostic experiences of autistic adults in New Zealand have not been investigated and little is known globally about autistic adults' satisfaction with the autism diagnostic process. This study describes the diagnostic experiences of 70 autistic adults living in New Zealand and explores how these experiences are related to satisfaction during three stages of the diagnostic process. The results show that autistic adults were reasonably satisfied with the early query and diagnostic assessment stages, but were dissatisfied with the post-diagnostic support stage, with significant unmet needs. Dissatisfaction during the post-diagnostic support stage was also related to satisfaction during previous stages and poor coordination of supports. Suggestions are made on how to improve the autism diagnostic pathway for autistic adults in New Zealand. [ABSTRACT FROM AUTHOR]

A wealth of parent-report research shows adaptive functioning difficulties in autistic children, with parent-report influenced by a number of child factors. Adaptive functioning in autistic children is known to vary across settings; however, no research has yet explored factors influencing education professional-report. This study investigated the rate and profile of impairment, and child factors influencing education professional-reported adaptive skills in 248 autistic children. Twelve children were < 3 years (min age for available normative data on the adaptive function measure), so were removed from the analyses. Results replicated parent-literature; adaptive skills were negatively associated with age and informant-reported autism severity, and positively associated with nonverbal ability and expressive language. Adaptive functioning is important for real-world outcomes, e.g. educational attainment, independence, and support needs. Improving our understanding of adaptive functioning in the education context may support opportunities for shared learning and enhance personalised support. [ABSTRACT FROM AUTHOR]

Low-dimensional materials have recently attracted much interest as thermoelectric materials because of their charge carrier confinement leading to thermoelectric performance enhancement. Carbon nanotubes are promising candidates because of their one-dimensionality in addition to their unique advantages such as flexibility and light weight. However, preserving the large power factor of individual carbon nanotubes in macroscopic assemblies has been challenging, primarily due to poor sample morphology and a lack of proper Fermi energy tuning. Here, we report an ultrahigh value of power factor (14 ± 5 mW m−1 K−2) for macroscopic weavable fibers of aligned carbon nanotubes with ultrahigh electrical and thermal conductivity. The observed giant power factor originates from the ultrahigh electrical conductivity achieved through excellent sample morphology, combined with an enhanced Seebeck coefficient through Fermi energy tuning. We fabricate a textile thermoelectric generator based on these carbon nanotube fibers, which demonstrates high thermoelectric performance, weavability, and scalability. The giant power factor we observe make these fibers strong candidates for the emerging field of thermoelectric active cooling, which requires a large thermoelectric power factor and a large thermal conductivity at the same time. Preserving the large power factor of carbon nanotubes is challenging, due to poor sample morphology and a lack of proper Fermi energy tuning. Here, the authors achieve a value of power factor of 14 ± 5 mW m−1 K−2 originating from the preserved conductivity and the ability to tune Fermi energy. [ABSTRACT FROM AUTHOR]

Purpose: Randomized controlled trials demonstrate that omission of radiation therapy (RT) in older women with early-stage cancer undergoing breast conserving surgery (BCS) is an "acceptable choice." Despite this, high RT rates have been reported. The objective was to evaluate the impact of patient- and system-level factors on RT rates in a contemporary cohort. Methods: Through the National Cancer Data Base, we identified women with clinical stage I estrogen receptor-positive breast cancer who underwent BCS (n = 84,214). Multivariable logistic regression identified patient, tumor, and system-level factors associated with RT. Joinpoint regression analysis calculated trends in RT use over time stratified by age and facility-type, reporting annual percent change (APC). Results: RT rates decreased from 2004 (77.2%) to 2015 (64.3%). The decline occurred earliest and was most pronounced in older women treated at academic facilities. At academic facilities, the APC was − 5.6 (95% CI − 8.6, − 2.4) after 2009 for women aged > 85 years, − 6.4 (95% CI − 9.0, − 3.8) after 2010 for women aged 80 − < 85 years, − 3.7 (95% CI − 5.6, − 1.9) after 2009 for women aged 75 − < 80, and − 2.4 (95% CI, − 3.1, − 1.6) after 2009 for women aged 70 − < 75. In contrast, at community facilities rates of RT declined later (2011, 2012, and 2013 for age groups 70–74, 75–79, and 80–84 years). Conclusions: RT rates for older women with early-stage breast cancer are declining with patient-level variation based on factors related to life expectancy and locoregional recurrence. Facility-level variation suggests opportunities to improve care delivery by focusing on barriers to de-implementation of routine use of RT. [ABSTRACT FROM AUTHOR]

We investigated the early sociocognitive battery (ESB), a novel measure of preverbal social communication skills, in children with autism participating in the Paediatric Autism Communication Trial-Generalised (PACT-G). The associations between ESB scores, language and autism symptoms were assessed in 249 children aged 2–11 years. The results show that ESB subscale scores (social responsiveness, joint attention and symbolic comprehension) were significantly associated with concurrent autism symptoms and receptive and expressive language levels. The pattern of association between the ESB subscale scores differed between the ADOS-2 symptom domains and expressive and receptive language. These findings indicate the potential utility of the ESB as a measure of preverbal social communication in children with autism. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend counseling on risk-reduction strategies, including lifestyle modification, endocrine therapy, and bilateral mastectomy, for patients with classic-type lobular carcinoma in situ (LCIS) detected on core biopsy or surgical excision. Importantly, current diagnosis and treatment guidelines for classic-type LCIS do not include unilateral mastectomy for primary treatment or risk reduction. Prior studies reporting national practice patterns suggest increasing use of mastectomy for management of LCIS, with considerable variation by geographic region. However, these studies did not distinguish between uni- and bilateral mastectomies. This study aimed to investigate national practice patterns and factors associated with unilateral mastectomy.Methods: The study used the National Cancer Database to identify women with a diagnosis of LCIS from 2004 to 2013. Descriptive statistics were used to describe surgical treatment, and multinomial logistic regression was used to identify temporal, patient, and facility-level factors associated with receipt of uni- and bilateral mastectomy.Results: The study identified 30,105 women with LCIS. Of these woman, 5.4% received no surgery, 84.8% had surgical excision, 4% underwent unilateral mastectomy, and 5.1% underwent bilateral mastectomy. Adjusted analysis showed that young age, white race, insurance coverage, greater comorbidity, and geographic region (p < 0.001) were associated with receipt of both uni- and bilateral mastectomy. Additionally, more recent year of diagnosis was associated with receipt of bilateral mastectomy. Unilateral mastectomy rates within geographic regions ranged from 2.7% in New England to 8% in the South.Conclusions: Nearly as many patients underwent unilateral (4%) as bilateral mastectomy (5.1%), representing inappropriate care. These findings highlight an opportunity to reduce unnecessary care through improved provider and patient education regarding optimal management of LCIS. [ABSTRACT FROM AUTHOR]

Background: Post-mastectomy reconstruction is a critical component of high-quality breast cancer care. Prior studies demonstrate socioeconomic disparity in receipt of reconstruction. Our objective was to evaluate trends in receipt of immediate reconstruction and examine socioeconomic factors associated with reconstruction in a contemporary cohort. Methods: Using the National Cancer Database, we identified women <75 years of age with stage 0-1 breast cancer treated with mastectomy ( n = 297,121). Trends in immediate reconstruction rates (2004-2013) for the overall cohort and stratified by socioeconomic factors were examined using Join-point regression analysis, and annual percentage change (APC) was calculated. We then restricted our sample to a contemporary cohort (2010-2013, n = 145,577). Multivariable logistic regression identified socioeconomic factors associated with immediate reconstruction. Average adjusted predicted probabilities of receiving reconstruction were calculated. Results: Immediate reconstruction rates increased from 27 to 48%. Although absolute rates of reconstruction for each stratification group increased, similar APCs across strata led to persistent gaps in receipt of reconstruction. On multivariable logistic regression using our contemporary cohort, race, income, education, and insurance type were all strongly associated with immediate reconstruction. Patients with the lowest predicted probability of receiving reconstruction were patients with Medicaid who lived in areas with the lowest rates of high-school graduation (Black 42.4% [95% CI 40.5-44.3], White 45.7% [95% CI 43.9-47.4]). Conclusions: Although reconstruction rates have increased dramatically over the past decade, lower rates persist for disadvantaged patients. Understanding how socioeconomic factors influence receipt of reconstruction, and identifying modifiable factors, are critical next steps towards identifying interventions to reduce disparities in breast cancer surgical care. [ABSTRACT FROM AUTHOR]

Previous research shows inconsistency in clinician-assigned diagnoses of Autism Spectrum Disorder (ASD). We conducted an exploratory study that examined the concordance of diagnoses between a multidisciplinary assessment team and a range of independent clinicians throughout Australia. Nine video-taped Autism Diagnostic Observation Schedule (ADOS) assessments were collected from two Australian sites. Twenty-seven Australian health professionals each observed two video-recordings and rated the degree to which the individual met the DSM-5 criteria for ASD. There was 100% agreement on the diagnostic classification for only 3 of the 9 video clips (33%), with the remaining 6 clips (66%) reaching poor reliability. In addition, only 24% of the participating clinicians achieved 'good' or 'excellent' levels of agreement (Cohen's kappa > 0.6) with the original ASD assessment. These findings have implications for clinical guidelines for ASD assessments. [ABSTRACT FROM AUTHOR]

The preparation of collector- and binder-free, high-energy density cathodes made from carbon-coated LiFePO (C-LFP) and single-walled carbon nanotubes (SWNT) is reported here. These electrodes were developed using a simple to execute, two-step, eco-friendly process. The C-LFP and the SWNT were dispersed in IPA and water, respectively, and then filtered. Electrodes with active material loading as high as 95 wt% were achieved. These electrodes exhibit high specific capacities of 144 mAh/g of electrode at C/10 rate. Additionally, the specific gravimetric power and energy of the C-LFP/SWNT self-standing electrodes surpassed that of the supported electrodes at high C-rate. Finally, the successful preparation of such high-energy density electrodes may provide a step toward the US DOE targets of batteries for electric vehicles for the year 2022. [ABSTRACT FROM AUTHOR]

After more than a decade of war, the US military continues to place significant emphasis on psychological health and resilience. While research and programs that focus on the broader military community's resilience continue to emerge, less is known about and until recently little focus has been placed on military medical provider resilience. In this article, we review the literature on military medical provider resilience, provide an overview of the programmatic and technological advances designed to sustain and develop military medical provider resilience, and finally offer recommendations for future research. [ABSTRACT FROM AUTHOR]

As coral reefs are home to dense aggregations of a variety of species, aggressive territoriality is often a critical component of individual behavior. Identification and assessment of the risk posed by intruders is crucial to defending a territory, and fishes on coral reefs have been found to attend to body shape, body size, and coloration when responding to intruders. We examined the extent to which dusky damselfish ( Stegastes adustus) discriminate among distinct categories of intruders by measuring the distance at which a fish attacks an intruder and the relative intensity and frequency of those attacks. We found that S. adustus discriminated among perceived threats, attacking conspecifics more intensely and more often than egg-predators and herbivores, and showing a trend of attacking those groups more often than invertebrate-feeders, which do not compete with damselfish for resources. Furthermore, territory holders attacked initial-phase wrasses from a farther distance than terminal-phase wrasses, suggesting that they can discriminate among classes of individuals within a species other than their own. Dusky damselfish thus exhibit the ability to make fine distinctions among intruders in a diverse ecosystem. [ABSTRACT FROM AUTHOR]

Findings that a subgroup of children with an autism spectrum disorder (ASD) have linguistic capabilities that resemble specific language impairment (SLI) have led some authors to hypothesise that ASD and SLI have a shared aetiology. While considerable research has explored overlap in the language phenotypes of the two conditions, little research has examined possible overlap in cognitive characteristics. In this study, we explored nonword and sentence repetition performance, as well as performance on the Children's Embedded Figures Test (CEFT) for children with ASD or SLI. As expected, 'language impaired' children with ASD (ALI) and children with SLI performed worse than both 'language normal' ASD (ALN) and typically developing (TD) children on the nonword and sentence repetition tests. Further, the SLI children performed worse than all other groups on the CEFT. This finding supports distinct cognitive profiles in ASD and SLI and may provide further evidence for distinct aetiological mechanisms in the two conditions. [ABSTRACT FROM AUTHOR]

Extensive empirical evidence indicates that the lesser variant of Autism Spectrum Disorders (ASD) involves a communication impairment that is similar to, but milder than, the deficit in clinical ASD. This research explored the relationship between the broader autism phenotype (BAP) among parents, an index of genetic liability for ASD, and proband communication difficulties. ASD probands with at least one BAP parent (identified using the Autism Spectrum Quotient) had greater structural and pragmatic language difficulties (assessed using the Children’s Communication Checklist-2) than ASD probands with no BAP parent. This finding provides support for the position that genetic liability for ASD is associated with increased communication difficulties across structural and pragmatic domains. [ABSTRACT FROM AUTHOR]

There is debate regarding the relationship between autism and specific language impairment (SLI), with some researchers proposing aetiological overlap between the conditions and others maintaining their aetiological distinction. Although considerable research has investigated the language phenotypes of these disorders, the relationship between the cognitive phenotypes has been left relatively unexplored. This paper reviews relevant literature on whether individuals with SLI exhibit cognitive characteristics reminiscent of autism. Overall, findings are inconsistent and there is a lack of substantive evidence supporting overlapping cognitive phenotypes in autism and SLI. Better powered and more rigorous experimental designs, as well as studies directly comparing the cognitive phenotype of children with SLI and those with autism will further elucidate the aetiological relationship between these two conditions. [ABSTRACT FROM AUTHOR]