Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review

Background: Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh‐related complications. Objective: To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline ‘Urinary incontinence (update) and pelvic organ prolapse in women: management’. Search strategy: Search strategies were developed for each indication for referral. Selection criteria: Relevant interventions included complete or partial mesh removal, mesh division, and non‐surgical treatments such as vaginal estrogen. Data collection and analysis: Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted. Main results: Twenty‐four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely. Conclusions: The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh‐related complications. Robust data are needed so that mesh complications can be managed effectively in the future

Learning to trust: trust and attachment in early psychosis

Background Distrust and social dysfunction are characteristic in psychosis and may arise from attachment insecurity, which is elevated in the disorder. The relationship between trust and attachment in the early stages of psychosis is unknown, yet could help to understand interpersonal difficulties and disease progression. This study aimed to investigate whether trust is reduced in patients with early psychosis and whether this is accounted for by attachment avoidance and attachment anxiety. Method We used two trust games with a cooperative and unfair partner in a sample of 39 adolescents with early psychosis and 100 healthy controls. Results Patients had higher levels of attachment anxiety, but the groups did not differ in attachment avoidance. Basic trust was lower in patients than controls, as indicated by lower initial investments. During cooperation patients increased their trust towards levels of controls, i.e. they were able to learn and to override initial suspiciousness. Patients decreased their trust less than controls during unfair interactions. Anxious attachment was associated with higher basic trust and higher trust during unfair interactions and predicted trust independent of group status. Discussion Patients showed decreased basic trust but were able to learn from the trustworthy behaviour of their counterpart. Worries about the acceptance by others and low self-esteem are associated with psychosis and attachment anxiety and may explain behaviour that is focused on conciliation, rather than self-protection

Establishing and Prioritising Research Questions for the Treatment of Alopecia Areata: The Alopecia Areata Priority Setting Partnership

BACKGROUND: Alopecia areata is a common hair loss disorder that results in patchy to complete hair loss. Many uncertainties exist around the most effective treatments for this condition. OBJECTIVES: To identify uncertainties in alopecia areata management and treatment that are important to both service users (people with hair loss, carers and relatives) and healthcare professionals. METHODS: An alopecia areata priority setting partnership was established between patients, their carers and relatives, and healthcare professionals to identify the most important uncertainties in alopecia areata. The methodology of the James Lind Alliance was followed to ensure a balanced, inclusive and transparent process. RESULTS: In total 2747 treatment uncertainties were submitted by 912 participants, of which 1012 uncertainties relating to alopecia areata (and variants) were analyzed. Questions were combined into "indicative uncertainties" following a structured format. A series of ranking exercises further reduced this list to a top 25 that were taken to a final prioritization workshop where the top 10 priorities were agreed. CONCLUSIONS: We present the top 10 research priorities for alopecia areata to guide researchers and funding bodies to support studies important to both patients and clinicians. This article is protected by copyright. All rights reserved

Policy, Performativity and Partnership: an Ethical Leadership Perspective

This article identifies the need to think differently about educational partnerships in a changing and turbulent post compulsory policy environment in England. The policy and institutional contexts in which universities and colleges currently operate seem to be fuelling performativity at the expense of educational values. There appears to be a sharp interruption in the steady increase in educational partnerships as a vehicle for increasing and widening participation in higher education. We are witnessing a marked change in university / college relationships that appears to be a consequence of government calling a halt to increased participation in higher education, creating an increasingly competitive market for a more limited pool of student places. The implication that educational policy at the national level determines a particular pattern or mode of leadership decision making throughout an institution should however be resisted. Policy developments that challenge the moral precepts of education should not be allowed to determine how a leader acts, rather they should prompt actions that are truly educational, rooted in morality, and atached to identifiable educational values. Educational leaders have agency to resist restricted discourses in favour of ethical and principled change strategies that are a precondition for sustainable transformative partnerships in post compulsory education. University leaders in particular are called upon to use their considerable influence to resist narrow policy or managerial instrumentalism or performativity and embrace alternatives that are both educationally worthwhile and can enhance institutional resilience

Reports of the AAAI 2019 spring symposium series

Applications of machine learning combined with AI algorithms have propelled unprecedented economic disruptions across diverse fields in industry, military, medicine, finance, and others. With the forecast for even larger impacts, the present economic impact of machine learning is estimated in the trillions of dollars. But as autonomous machines become ubiquitous, recent problems have surfaced. Early on, and again in 2018, Judea Pearl warned AI scientists they must "build machines that make sense of what goes on in their environment," a warning still unheeded that may impede future development. For example, self-driving vehicles often rely on sparse data; self-driving cars have already been involved in fatalities, including a pedestrian; and yet machine learning is unable to explain the contexts within which it operates

A randomized controlled trial of an online, compassion-based intervention for maternal psychological well-being in the first year postpartum

Objectives New self-help interventions have been called for to promote psychological well-being amongst mothers in the first year postpartum, with compassion-based interventions having potential in this regard. The present study developed and evaluated a low-intensity, online, compassion-based intervention for this population called Kindness for Mums Online (KFMO). Methods UK mothers of infants under one year (N = 206) participated in a pragmatic randomized controlled trial, comparing KFMO with a waitlist control. Results The effect of the intervention on well-being (the primary outcome) was small and was sensitive to the way missing data were treated. However, KFMO robustly increased self-compassion relative to control, from baseline (week 0) to post-intervention (week 6), and from baseline to follow-up (week 12). No effects were observed on other secondary outcomes. Conclusions The findings suggest that self-compassion can be increased in postpartum mothers via an accessible, low-intensity, web-based, self-help program. However, this did not translate into robust improvements in well-being. Study limitations include relatively high attrition rates and limited generalizability to more diverse samples

Theorizing compassion and empathy in educational contexts: what are compassion and empathy and why are they important?

The world is in constant change with growing inequality and access. When you watch the news, you are confronted with national disasters, wars/conflicts, waves of refugees and other crimes against humanity. At a national level, many countries have a changing political landscape that has seen a rise in fundamentalist nationalist parties leading to a discourse of 'problematic immigrants'. We also witness the decline of democratic ideals and the ethos of supporting people in society as politicians are influenced by capitalist ideals and individual gain. In essence, the world appears to be becoming meaner, with little understanding shown to others. When did values change