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Sample records for pelvic floor descent

  1. MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position

    PubMed Central

    Renzi, Adolfo; Monaco, Luigi; Serra, Nicola; Feragalli, Beatrice; Iacomino, Aniello; Brunese, Luca; Cappabianca, Salvatore

    2016-01-01

    Introduction. Functional disorders of the pelvic floor represent have a significant impact on the quality of life. The advent of open-configuration systems allowed for the evaluation of defecation with MR imaging in sitting position. The purpose of the present study is to compare the results of static and dynamic pelvic MR performed in supine position versus sitting position, using a new MR prototype machine, in the diagnosis of pelvic floor descent. Materials and Methods. Thirty-one patients with pelvic floor disorders were enrolled, and underwent MR Defecography in supine position with 1.5 T closed magnet (MAGNETOM Symphony, Siemens, Germany) and in sitting position with a 0.25-Tesla open magnet system (G-Scan ESAOTE, Italy). Results. In rest and squeezing phases, positions of bladder, vagina, and ARJ were significantly different when the patient was imaged in supine versus sitting position. In the defecation phase, a significant difference for the bladder and vagina position was detected between the two exams whereas a significant difference for the ARJ was not found. A statistically significant difference exists when the pelvic floor descent is evaluated in sitting versus supine position. Conclusion. Our results show that MR Defecography in sitting position may represent a useful tool to correctly diagnose and grade the pelvic organ descent. PMID:26880893

  2. Pelvic floor muscle training exercises

    MedlinePlus

    Pelvic floor muscle training exercises are a series of exercises designed to strengthen the muscles of the pelvic floor. ... Pelvic floor muscle training exercises are recommended for: Women ... Men with urinary stress incontinence after prostate surgery ...

  3. Chronic pelvic floor dysfunction.

    PubMed

    Hartmann, Dee; Sarton, Julie

    2014-10-01

    The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vulvar pain and sexual dysfunction. Though the studies have yet to prove a specific protocol, physical therapists trained in pelvic dysfunction are reporting success with restoring tissue normalcy and reducing vulvar and sexual pain. A review of pelvic anatomy and common findings are presented along with suggested physical therapy management. PMID:25108498

  4. Pelvic Floor Disorders Network

    MedlinePlus

    ... to develop and perform research studies related to women with pelvic floor disorders. In this way, studies can be done more quickly than if the medical centers were working alone. Doctors, nurses, other health care workers, and support staff all play important roles.The ...

  5. [Pelvic floor muscle training and pelvic floor disorders in women].

    PubMed

    Thubert, T; Bakker, E; Fritel, X

    2015-05-01

    Our goal is to provide an update on the results of pelvic floor rehabilitation in the treatment of urinary incontinence and genital prolapse symptoms. Pelvic floor muscle training allows a reduction of urinary incontinence symptoms. Pelvic floor muscle contractions supervised by a healthcare professional allow cure in half cases of stress urinary incontinence. Viewing this contraction through biofeedback improves outcomes, but this effect could also be due by a more intensive and prolonged program with the physiotherapist. The place of electrostimulation remains unclear. The results obtained with vaginal cones are similar to pelvic floor muscle training with or without biofeedback or electrostimulation. It is not known whether pelvic floor muscle training has an effect after one year. In case of stress urinary incontinence, supervised pelvic floor muscle training avoids surgery in half of the cases at 1-year follow-up. Pelvic floor muscle training is the first-line treatment of post-partum urinary incontinence. Its preventive effect is uncertain. Pelvic floor muscle training may reduce the symptoms associated with genital prolapse. In conclusion, pelvic floor rehabilitation supervised by a physiotherapist is an effective short-term treatment to reduce the symptoms of urinary incontinence or pelvic organ prolapse. PMID:25921509

  6. Pelvic floor muscle training exercises

    MedlinePlus

    ... nlm.nih.gov/pubmed/22258946 . Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, ... nlm.nih.gov/pubmed/20091581 . Herderschee R, Hay-Smith EJC, Herbison GP, Roovers JP, Heineman MJ. Feedback ...

  7. Post partum pelvic floor changes.

    PubMed

    Fonti, Ylenia; Giordano, Rosalba; Cacciatore, Alessandra; Romano, Mattea; La Rosa, Beatrice

    2009-10-01

    Pelvic-perineal dysfunctions, are the most common diseases in women after pregnancy. Urinary incontinence and genital prolapsy, often associated, are the most important consequences of childbirth and are determined by specific alterations in the structure of neurological and musculo-fascial pelvic support.Causation is difficult to prove because symptom occur remote from delivery.Furthermore it is unclear whether changes are secondary to the method of childbirth or to the pregnancy itself.This controversy fuels the debate about whether or not women should be offered the choice of elective caesarean delivery to avoid the development of subsequent pelvic floor disfunction.But it has been demonstrated that pregnancy itself, by means of mechanical changes of pelvic statics and changes in hormones, can be a significant risk factor for these diseases. Especially is the first child to be decisive for the stability of the pelvic floor.During pregnancy, the progressive increase in volume of the uterus subject perineal structures to a major overload. During delivery, the parties present and passes through the urogenital hiatus leading to growing pressure on the tissues causing the stretching of the pelvic floor with possible muscle damage, connective tissue and / or nervous.In this article we aim to describe genitourinary post partum changes with particular attention to the impact of pregnancy or childbirth on these changes. PMID:22439048

  8. Pelvic floor ultrasonography: an update.

    PubMed

    Shek, K L; Dietz, H-P

    2013-02-01

    Female pelvic floor dysfunction encompasses a number of highly prevalent clinical conditions such as female pelvic organ prolapse, urinary and fecal incontinence, and sexual dysfunction. The etiology and pathophysiology of those conditions are, however, not well understood. Recent technological advances have seen a surge in the use of imaging, both in research and clinical practice. Among the techniques available such as sonography, X-ray, computed tomography and magnetic resonance imaging, ultrasound is superior for pelvic floor imaging, especially in the form of perineal or translabial imaging. The technique is safe with no radiation, simple, cheap, easily accessible and provides high spatial and temporal resolutions. Translabial or perineal ultrasound is useful in determining residual urinary volume, detrusor wall thickness, bladder neck mobility and in assessing pelvic organ prolapse as well as levator function and anatomy. It is at least equivalent to other imaging techniques in diagnosing, such diverse conditions as urethral diverticula, rectal intussusception and avulsion of the puborectalis muscle. Ultrasound is the only imaging method capable of visualizing modern slings and mesh implants and may help selecting patients for implant surgery. Delivery-related levator injury seems to be the most important etiological factor for pelvic organ prolapse and recurrence after prolapse surgery, and it is most conveniently diagnosed by pelvic floor ultrasound. This review gives an overview of the methodology. Its main current uses in clinical assessment and research will also be discussed. PMID:23412016

  9. Pelvic Organ Prolapse: New Concepts in Pelvic Floor Anatomy.

    PubMed

    Maldonado, Pedro A; Wai, Clifford Y

    2016-03-01

    As the field of reconstructive pelvic surgery continues to evolve, with descriptions of new procedures to repair pelvic organ prolapse, it remains imperative to maintain a functional understanding of pelvic floor anatomy and support. The goal of this review was to provide a focused, conceptual approach to differentiating anatomic defects contributing to prolapse in the various compartments of the vagina. Rather than provide exhaustive descriptions of pelvic floor anatomy, basic pelvic floor anatomy is reviewed, new and historical concepts of pelvic floor support are discussed, and relevance to the surgical management of specific anatomic defects is addressed. PMID:26880505

  10. [PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP].

    PubMed

    Pavlov, V N; Bakirov, A A; Kabirov, I R; Izmajlov, A A; Kutlijarov, L M; Safiullin, R L; Urmancev, M F; Sultanov, I M; Abdrahimov, R V

    2015-01-01

    Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall. PMID:26390558

  11. Pelvic floor ultrasound: a review.

    PubMed

    Dietz, Hans Peter

    2010-04-01

    Imaging currently plays a limited role in the investigation of pelvic floor disorders. It is obvious that magnetic resonance imaging has limitations in urogynecology and female urology at present due to cost and access limitations and due to the fact that it is generally a static, not a dynamic, method. However, none of those limitations apply to sonography, a diagnostic method that is very much part of general practice in obstetrics and gynecology. Translabial or transperineal ultrasound is helpful in determining residual urine; detrusor wall thickness; bladder neck mobility; urethral integrity; anterior, central, and posterior compartment prolapse; and levator anatomy and function. It is at least equivalent to other imaging methods in visualizing such diverse conditions as urethral diverticula, rectal intussusception, mesh dislodgment, and avulsion of the puborectalis muscle. Ultrasound is the only imaging method able to visualize modern mesh slings and implants and may predict who actually needs such implants. Delivery-related levator trauma is the most important known etiologic factor for pelvic organ prolapse and not difficult to diagnose on 3-/4-dimensional and even on 2-dimensional pelvic floor ultrasound. It is likely that this will be an important driver behind the universal use of this technology. This review gives an overview of the method and its main current uses in clinical assessment and research. PMID:20350640

  12. Pelvic floor muscle rehabilitation using biofeedback.

    PubMed

    Newman, Diane K

    2014-01-01

    Pelvic floor muscle exercises have been recommended for urinary incontinence since first described by obstetrician gynecologist Dr. Arnold Kegel more than six decades ago. These exercises are performed to strengthen pelvic floor muscles, provide urethral support to prevent urine leakage, and suppress urgency. In clinical urology practice, expert clinicians also teach patients how to relax the muscle to improve bladder emptying and relieve pelvic pain caused by muscle spasm. When treating lower urinary tract symptoms, an exercise training program combined with biofeedback therapy has been recommended as first-line treatment. This article provides clinical application of pelvic floor muscle rehabilitation using biofeedback as a technique to enhance pelvic floor muscle training. PMID:25233622

  13. Physical therapy for female pelvic floor disorders.

    PubMed

    Bourcier, A P

    1994-08-01

    Non-surgical, non-pharmacological treatment for female pelvic floor dysfunction is represented by rehabilitation in urogynecology. Since Kegel, in 1948, who proposed the concept of functional restoration of the perineal muscles, no specific term has actually been established. Owing to the number of specialists involved in the management of female pelvic floor disorders (such as gynecologists, urologists, coloproctologists, and neurologists) and the different types of health care providers concerned (such as physicians, physical therapists, nurses, and midwives), it is difficult to make the proper choice between 'physical therapy for pelvic floor', 'pelvic floor rehabilitation', 'pelvic muscle re-education', and 'pelvic floor training'. Because muscle re-education is under the control of physical therapists, we have chosen the term of physical therapy for female pelvic floor disorders. Muscle re-education has an important role in the primary treatment of lower urinary tract dysfunction. A multidisciplinary collaboration may be of particular interest, and a thorough evaluation is useful for a proper selection of patients. PMID:7742496

  14. Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review.

    PubMed

    Hainsworth, Alison J; Solanki, Deepa; Schizas, Alexis M P; Williams, Andrew B

    2015-01-01

    Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognized and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation MRI. Total pelvic floor ultrasound is a cheap, safe, imaging tool, which may be performed as a first-line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor, essential for treatment planning for females who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360° cross-sectional image to allow anatomical visualization of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in females presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex, but this is beyond the scope of this review. PMID:26388109

  15. Magnetic Resonance Imaging (MRI): Dynamic Pelvic Floor

    MedlinePlus

    ... a powerful magnetic field, radio waves and a computer to produce detailed pictures of the pelvic floor, ... powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, ...

  16. Pelvic floor hypertonic disorders: identification and management.

    PubMed

    Butrick, Charles W

    2009-09-01

    Patients with hypertonic pelvic floor disorders can present with pelvic pain or dysfunction. Each of the various syndromes will be discussed including elimination disorders, bladder pain syndrome/interstitial cystitis (BPS/IC), vulvodynia, vaginismus, and chronic pelvic pain. The symptoms and objective findings on physical examination and various diagnostic studies will be reviewed. Therapeutic options including physical therapy, pharmacologic management, and trigger point injections, as well as botulinum toxin injections will be reviewed in detail. PMID:19932423

  17. Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures, and Pelvic Organs

    PubMed Central

    Herschorn, Sender

    2004-01-01

    The development of novel, less invasive therapies for stress urinary incontinence in women requires a thorough knowledge of the relationship between the pathophysiology of incontinence and anatomy. This article provides a review of the anatomy of the pelvic floor and lower urinary tract. Also discussed is the hammock hypothesis, which describes urethral support within the pelvis and provides an explanation of the continence mechanism. PMID:16985905

  18. [Fibrosis of the pelvic floor].

    PubMed

    Beernaerts, A; Hirsch, F

    1984-01-01

    A pelvic pain is sometimes extremely difficult to define and to treat. The origin of this pain was said to be due to either neurological, psychosomatic, urological or orthopaedic factors. It was in fact an unilateral fibrosis of the perineal transverse muscle. A surgical section has definitively cured the patient. PMID:6539549

  19. Physical activity and the pelvic floor.

    PubMed

    Nygaard, Ingrid E; Shaw, Janet M

    2016-02-01

    Pelvic floor disorders are common, with 1 in 4 US women reporting moderate to severe symptoms of urinary incontinence, pelvic organ prolapse, or fecal incontinence. Given the high societal burden of these disorders, identifying potentially modifiable risk factors is crucial. Physical activity is one such potentially modifiable risk factor; the large number of girls and women participating in sport and strenuous training regimens increases the need to understand associated risks and benefits of these exposures. The aim of this review was to summarize studies reporting the association between physical activity and pelvic floor disorders. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include that urinary incontinence during exercise is common and is more prevalent in women during high-impact sports. Mild to moderate physical activity, such as brisk walking, decreases both the odds of having and the risk of developing urinary incontinence. In older women, mild to moderate activity also decreases the odds of having fecal incontinence; however, young women participating in high-intensity activity are more likely to report anal incontinence than less active women. Scant data suggest that in middle-aged women, lifetime physical activity increases the odds of stress urinary incontinence slightly and does not increase the odds of pelvic organ prolapse. Women undergoing surgery for pelvic organ prolapse are more likely to report a history of heavy work than controls; however, women recruited from the community with pelvic organ prolapse on examination report similar lifetime levels of strenuous activity as women without this examination finding. Data are insufficient to determine whether strenuous activity while young predisposes to pelvic floor disorders later in life. The existing literature suggests that most physical activity does not harm the pelvic floor and does provide numerous health benefits for

  20. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

    PubMed Central

    Faubion, Stephanie S.; Shuster, Lynne T.; Bharucha, Adil E.

    2012-01-01

    Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life. Focus on the global symptom complex, rather than the individual symptoms, may help the clinician identify the condition. The primary care provider is in a position to intervene early, efficiently, and effectively by (1) recognizing the range of symptoms that might suggest nonrelaxing pelvic floor dysfunction, (2) educating patients, (3) performing selective tests when needed to confirm the diagnosis, and (4) providing early referral for physical therapy. PMID:22305030

  1. Effect of pelvic floor muscle exercises on pulmonary function.

    PubMed

    Han, DongWook; Ha, Misook

    2015-10-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19-21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal voluntary ventilation. Pelvic floor muscle exercises consisted of Kegel exercises performed three times daily for 4 weeks. [Results] Kegel exercises performed in the experimental group significantly improved forced vital capacity, forced expiratory volume in 1 second, PER, FEF 25-75%, IC, and maximum voluntary ventilation compared to no improvement in the control group. [Conclusion] Kegel exercises significantly improved pulmonary function. When abdominal pressure increased, pelvic floor muscles performed contraction at the same time. Therefore, we recommend that the use of pelvic floor muscle exercises be considered for improving pulmonary function. PMID:26644681

  2. Effect of pelvic floor muscle exercises on pulmonary function

    PubMed Central

    Han, DongWook; Ha, Misook

    2015-01-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19–21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal voluntary ventilation. Pelvic floor muscle exercises consisted of Kegel exercises performed three times daily for 4 weeks. [Results] Kegel exercises performed in the experimental group significantly improved forced vital capacity, forced expiratory volume in 1 second, PER, FEF 25–75%, IC, and maximum voluntary ventilation compared to no improvement in the control group. [Conclusion] Kegel exercises significantly improved pulmonary function. When abdominal pressure increased, pelvic floor muscles performed contraction at the same time. Therefore, we recommend that the use of pelvic floor muscle exercises be considered for improving pulmonary function. PMID:26644681

  3. [Translabial ultrasonography in pelvic floor prolapse and urinary incontinence diagnostics].

    PubMed

    Pietrus, Miłosz; Pityński, Kazimierz; Bałajewicz-Nowak, Marta; Wiecheć, Marcin; Knafel, Anna; Ludwin, Artur; Dziechciowski, Marek; Nocuń, Agnieszka

    2012-09-01

    Technological advances in the construction of sonographic devices and increasingly universal access to such tests considerably widens the range of diagnostic application of the sonographic examination. This situation also refers to pelvic organs prolapse. At present, sonographic sets used in everyday obstetrical-gynecological practice allow for insight into the structures forming the female pelvic floor, and the obtained images constitute a valuable addition to the physical examination. Positioning the sonographic transducer on a the perineum enables to visualize the three compartments of the female pelvis minor. After freezing the image, it is possible to assess the position of anatomical structures in relation to bones and designated surfaces, establish mutual distances and measure appropriate angles. Most information can be obtained in this manner within the range of the frontal compartment, whose damage is often linked with urinary incontinence. The examination standards developed so far, including the analysis of the quantitative parameters, greatly minimize the potential subjectivity of the assessment of the existing disorders. Apart from its low costs, the main value of the sonographic examination of the pelvic floor is the possibility to dynamically assess the changes in statics which take place during functional testing. Not only does it have a cognitive significance, but also it allows to adjust the scope of the surgical correction to the existing damages. Thus, indirectly it can contribute to the reduction of a number of subsequent remedial surgeries. Three-dimensional sonography allows to thoroughly examine the construction and functioning of the anal levators and to detect their possible damage. It is the trauma to these muscles--occurring, among others, during childbirth--that is one of the major causes of pelvic organs descent and prolapse in women. Sonographic examination also enables to visualize the artificial material, the use of which is

  4. A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders

    PubMed Central

    Kanter, Gregg; Rogers, Rebecca G; Pauls, Rachel N; Kammerer-Doak, Dorothy; Thakar, Ranee

    2015-01-01

    Introduction and Hypothesis We evaluated the associations between pelvic floor muscle strength and tone with sexual activity and sexual function in women with pelvic floor disorders. Methods This was a secondary analysis of a multicenter study of women with pelvic floor disorders from the US and UK performed to validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Participants were surveyed about whether they were sexually active and completed the PISQ-IR and Female Sexual Function Index (FSFI) questionnaires to assess sexual function. Physical exams included assessment of pelvic floor strength by the Oxford Grading Scale, and assessment of pelvic floor tone per ICS guidelines. Results The cohort of 585 women was middle aged (mean age 54.9 +/−12.1) with 395 (67.5%) reporting sexual activity. Women with a strong pelvic floor (n=275) were more likely to report sexual activity than women with weak strength (n=280) (75.3 vs. 61.8%, p<0.001), but normal or hypoactive pelvic floor tone was not associated with sexual activity (68.8 vs. 60.2%, normal vs. hypoactive, p=0.08). After multivariable analysis, a strong pelvic floor remained predictive of sexual activity (OR 1.89, CI 1.18–3.03, p<0.01). Among sexually active women (n=370), a strong pelvic floor was associated with higher scores on the PISQ-IR domain of condition impact (Parameter Estimate 0.20+/−0.09, P=0.04), and FSFI orgasm domain (PE 0.51+/−0.17, P=0.004). Conclusion A strong pelvic floor is associated with higher rates of sexual activity as well as higher sexual function scores on the condition impact domain of the PISQ-IR and orgasm domain of the FSFI. PMID:25994625

  5. Knowledge of the pelvic floor in nulliparous women

    PubMed Central

    Neels, Hedwig; Wyndaele, Jean-Jacques; Tjalma, Wiebren A. A.; De Wachter, Stefan; Wyndaele, Michel; Vermandel, Alexandra

    2016-01-01

    [Purpose] Proper pelvic floor function is important to avoid serious dysfunctions including incontinence, prolapse, and sexual problems. The current study evaluated the knowledge of young nulliparous women about their pelvic floor and identified what additional information they wanted. [Subjects and Methods] In this cross-sectional survey, a validated, 36 item questionnaire was distributed to 212 nulliparous women. The questionnaire addressed demography, pelvic floor muscles, pelvic floor dysfunction, and possible information sources. Descriptive statistics were generated for all variables. Stability and validity testing were performed using Kappa statistics and intra class correlation coefficients to define agreement for each question. The study was approved by the ethics Committee (B300201318334). [Results] Using a VAS scale (0 to 10), the women rated their knowledge about the pelvic floor as a mean of 2.4 (SD 2.01). A total of 93% of the women were insufficiently informed and requested more information; 25% had concerns about developing urinary incontinence, and 14% about fecal incontinence. Many of the women were unaware what pelvic floor training meant. [Conclusion] There was a significant lack of knowledge about pelvic floor function among nulliparous women. The majority of nulliparous women expressed a need for education, which might offer a way to reduce dysfunction. PMID:27313364

  6. Three-dimensional ultrasound appearance of pelvic floor in nulliparous women and pelvic organ prolapse women.

    PubMed

    Ying, Tao; Li, Qin; Xu, Lian; Liu, Feifei; Hu, Bing

    2012-01-01

    The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor. PMID:23155363

  7. Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Pelvic Organ Prolapse Women

    PubMed Central

    Ying, Tao; Li, Qin; Xu, Lian; Liu, Feifei; Hu, Bing

    2012-01-01

    The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor. PMID:23155363

  8. Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence

    PubMed Central

    Scott, Kelly M.

    2014-01-01

    Fecal incontinence (FI) is a prevalent problem that can drastically affect quality of life. Pelvic floor rehabilitation is an important first-line treatment for patients with FI, and many published case reports and a small number of randomized controlled trials (RCTs) provide limited evidence for its efficacy. Pelvic floor rehabilitation approaches to the treatment of FI include pelvic floor muscle training, biofeedback, and volumetric training with rectal balloon catheters. Various forms of external electrical stimulation have also been described and may be of added benefit. Behavioral bowel retraining is an important part of a good rehabilitative approach as well. Pelvic floor rehabilitation treatment for FI is thought to be effective and safe, with reported success rates in a majority of studies at 50 to 80%. Many more high-quality RCTs are needed to define optimal treatment protocols. PMID:25320568

  9. Tactile Imaging Markers to Characterize Female Pelvic Floor Conditions

    PubMed Central

    van Raalte, Heather; Egorov, Vladimir

    2015-01-01

    The Vaginal Tactile Imager (VTI) records pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. The objective of this study is to validate tactile imaging and muscle contraction parameters (markers) sensitive to the female pelvic floor conditions. Twenty-two women with normal and prolapse conditions were examined by a vaginal tactile imaging probe. We identified 9 parameters which were sensitive to prolapse conditions (p < 0.05 for one-way ANOVA and/or p < 0.05 for t-test with correlation factor r from −0.73 to −0.56). The list of parameters includes pressure, pressure gradient and dynamic pressure response during muscle contraction at identified locations. These parameters may be used for biomechanical characterization of female pelvic floor conditions to support an effective management of pelvic floor prolapse. PMID:26389014

  10. Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles

    PubMed Central

    de Groat, William C.

    2010-01-01

    The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided. PMID:20484700

  11. Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat?

    PubMed

    Westesson, Karin E; Shoskes, Daniel A

    2010-07-01

    National Institutes of Health category III prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome, is a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several approaches to therapy including biofeedback, acupuncture, and myofascial release physical therapy. However, the only multicenter study of pelvic floor physical therapy for pelvic floor spasm in men failed to show an advantage over conventional Western massage. We have proposed a clinical phenotyping system called UPOINT to classify patients with urologic chronic pelvic pain and subsequently direct appropriate therapy. Here, we review the current approach to category III prostatitis and describe how clinical phenotyping with UPOINT may improve therapy outcomes. PMID:20490725

  12. The Effect of Body Mass Index on Pelvic Floor Support 1 Year Postpartum.

    PubMed

    Chen, Yi; Johnson, Benjamin; Li, Fangyong; King, William C; Connell, Kathleen A; Guess, Marsha K

    2016-02-01

    Elevated body mass index (BMI) is associated with the incidence, prevalence, and progression of pelvic organ prolapse (POP). This study investigated the effect of peripartum BMI on pelvic floor support 1 year postpartum (PP1y). One hundred eight nulliparous women had their BMI recorded and underwent POP assessments using the Pelvic Organ Prolapse Quantification System at baseline, third trimester (36th to 38th week of pregnancy [G36-38w]), and PP1y. Pelvic organ prolapse was defined as ≥stage II. Women gained on average 1.9 kg between baseline and PP1y. After adjustment, increasing BMI PP1y was associated with increasing anterior wall descent (P < .0001) and higher odds of having POP PP1y (odds ratio: 1.41, 95% confidence interval: 1.01-1.97, P = .045). Trial of labor compared to unlabored cesarean delivery, POP G36-38w, and decreased fetal weight were independently associated with anterior vaginal wall laxity PP1y. Our finding suggests that postpartum BMI influences pelvic floor laxity 1 year after delivery. Postpartum weight reduction may serve as a strategy for POP prevention in some women. PMID:26494698

  13. Do obstetrical providers counsel women about postpartum pelvic floor dysfunction?

    PubMed Central

    Dessie, Sybil G.; Hacker, Michele R.; Dodge, Laura E.; Elkadry, Eman A.

    2016-01-01

    Objective To assess prenatal counseling practices of obstetrical providers related to postpartum pelvic floor dysfunction at centers with integrated urogynecology services. Study Design A cross-sectional survey was distributed to obstetrical providers through urogynecology colleagues. The survey included questions about level of training as well as counseling practices related to common postpartum pelvic floor symptoms. All statistical tests were two sided, and P values <0.05 were considered statistically significant. Results One hundred ninety-two surveys were received; 19 respondents did not perform their own prenatal counseling and were excluded. Among the remaining 173 respondents, 94 (56.3%) of those who answered the question reported never discussing postpartum urinary incontinence, and 73.7% reported never discussing postpartum fecal incontinence during prenatal counseling. Obstetrics and gynecology residents were significantly less likely than attending physicians to report discussing various pelvic floor dysfunction topics in prenatal counseling. Among those who reported not counseling women regarding pelvic floor dysfunction, the most common reason cited was lack of time (39.9%) followed by lack of sufficient information (30.1%). Conclusion Prenatal counseling of pelvic floor dysfunction risk is lacking at all levels of obstetrical training. Limitations of time and information are the obstacles most often cited by providers. PMID:26126305

  14. Pelvic floor muscle training for urinary incontinence postpartum.

    PubMed

    Hall, Bethany; Woodward, Sue

    The offering of pelvic floor muscle exercises to all women during their first pregnancy is recommended by National Institute for Health and Care Excellence (NICE) guidelines. Pelvic floor muscles suffer significant trauma throughout pregnancy and childbirth, which may sometimes lead to urinary incontinence postpartum. However, it is uncertain how effective pelvic floor muscle exercises are in treating this incontinence. Several trials have been analysed to try to understand this question. Issues such as when the exercises were undertaken, how often they were performed and in what circumstances they were carried out, have all been considered. While it is still uncertain whether they are effective in reducing urinary incontinence postpartum, as they are non-invasive and fairly simple to carry out, they are still the first-line management for urinary incontinence postpartum with other treatments being considered if this is ineffective. PMID:26067791

  15. Stress incontinence and pelvic floor exercises in pregnancy.

    PubMed

    Sahakian, Josine

    This literature review is a critique of the research looking at the impact of pelvic floor exercises during pregnancy on urinary stress incontinence in postnatal women. Seven studies were selected for review following a database search on the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline and the British Nursing Index (BNI). The research produced mixed findings. Four of the seven studies demonstrated a significant improvement in urinary stress incontinence in postnatal women following pelvic floor muscle exercise during pregnancy. However, the studies that spanned a longer time period found no long-term effectiveness. More research is needed for a more conclusive picture as to whether antenatal pelvic floor exercises can improve stress incontinence in the postpartum period. PMID:23123811

  16. Modelling the pelvic floor for investigating difficulties during childbirth

    NASA Astrophysics Data System (ADS)

    Li, Xinshan; Kruger, Jennifer A.; Chung, Jae-Hoon; Nash, Martyn P.; Nielsen, Poul M. F.

    2008-03-01

    Research has suggested that athletes involved in high-intensity sports for sustained periods have a higher probability of experiencing prolonged second stage of labour compared to non-athletes. The mechanism responsible for this complication is unknown but may depend on the relative size or tone of the pelvic floor muscles. Prolonged training can result in enlargement and stiffening of these muscles, providing increased resistance as the fetal head descends through the birth canal during a vaginal birth. On the other hand, recent studies have suggested an association between increased muscle bulk in athletes and higher distensibility. This project aims to use mathematical modelling to study the relationship between the size and tone of the pelvic floor muscles and the level of difficulty during childbirth. We obtained sets of magnetic resonance (MR) images of the pelvic floor region for a female athlete and a female non-athlete. Thirteen components of the pelvic floor were segmented and used to generate finite element (FE) models. The fetal head data was obtained by laser scanning a skull replica and a FE model was fitted to these data. We used contact mechanics to simulate the motion of the fetal head moving through the pelvic floor, constructed from the non-athlete data. A maximum stretch ratio of 3.2 was induced in the muscle at the left lateral attachment point to the pubis. We plan to further improve our modelling framework to include active muscle contraction and fetal head rotations in order to address the hypotheses that there is a correlation between the level of difficulty and the size or tone of the pelvic floor muscles.

  17. Robotic Female Pelvic Floor Reconstruction: A Review.

    PubMed

    Clifton, Marisa M; Pizarro-Berdichevsky, Javier; Goldman, Howard B

    2016-05-01

    As the surgical correction of pelvic organ prolapse has continued to evolve, robotic-assisted abdominal sacrocolpopexy (RASC) has gained increasing popularity. Studies have shown equivalent subjective and objective outcomes compared with the "gold standard" abdominal sacrocolpopexy. Additionally, this approach is associated with a shorter hospital stay and less cost than the traditional open procedure. Although there is a learning curve associated with RASC, the basic principles of the procedure are the same. Herein, we discuss the robotic techniques for repair of pelvic organ prolapse as well as discuss the currently available literature regarding RASC. PMID:26723179

  18. The “Pelvic Harness”: a skeletonized mesh implant for safe pelvic floor reconstruction

    PubMed Central

    Natalia, Sumerova; Menahem, Neuman; Haim, Krissi; Dmitri, Pushkar

    2016-01-01

    ABSTRACT Objectives To evaluate the feasibility, safety and surgical results of skeletonized mesh implants to form a pelvic harness for pelvic floor reconstruction surgery. Study design Patients with advanced pelvic floor prolapse were enrolled to this study. Study model was a kit mesh, reduced to 75% of the original surface area by cutting out mesh material from the central mesh body. Patients were evaluated at the end of the 1st and 6th post-operative months and interviewed at the study conclusion. Results Ninety-five women with advanced pelvic floor prolapse had this implant. Mean follow-up duration was 9 months (6-12 months). The POP-Q point’s measurements showed marked and statistically significant improvements. Bladder over-activity symptoms, fecal incontinence, pelvic pain and constipation rates were all reduced as well. No adverse effects related to the dissection or mesh implantation were marked. The first and sixth post-operative month follow-up records as well as the study conclusion interview findings were satisfactory in terms of subjective and objective cure and adverse effects occurrence. Conclusion This study data proposes that skeletonizing meshes might be safely and successfully implanted for potentially improved pelvic floor reconstruction. PMID:27286114

  19. Pelvic Floor Muscle Training: Underutilization in the USA.

    PubMed

    Lamin, Eliza; Parrillo, Lisa M; Newman, Diane K; Smith, Ariana L

    2016-02-01

    Pelvic floor disorders are highly prevalent in women of all ages and can greatly impair quality of life. Pelvic floor muscle training (PFMT) is a viable treatment option for several pelvic floor conditions including urinary incontinence and pelvic organ prolapse. PFMT is a program of therapy initiated by an experienced clinician (e.g., women's health or urology nurse practitioner (NP), physical therapist (PT)) that involves exercises for women with stress urinary incontinence (UI) and exercises combined with behavioral or conservative treatments (lifestyle changes, bladder training with urge suppression) for women with urgency or mixed UI. These exercise programs are more comprehensive than simple Kegel exercises. Despite evidence-based research indicating the efficacy and cost-effectiveness for treatment of urinary incontinence, PFMT is not commonly used as a first-line treatment in clinical practice in the USA (Abrams et al., 2012). This article will review PFMT for the treatment of UI and pelvic organ prolapse (POP) and theorize how this conservative therapy can be utilized more effectively in the USA. PMID:26757904

  20. Fecal Incontinence and Pelvic Floor Dysfunction in Women: A Review.

    PubMed

    Freeman, Alison; Menees, Stacy

    2016-06-01

    Pelvic floor dysfunction and fecal incontinence is a common and debilitating condition in women, particularly as women age, and often goes under-reported to health care providers. It is important for providers to ask patients about possible symptoms. An algorithm for evaluation and treatment is presented. Current and future therapies are described and discussed. PMID:27261895

  1. [Treatment of the dysfunction of the pelvic floor].

    PubMed

    Pena Outeiriño, J M; Rodríguez Pérez, A J; Villodres Duarte, A; Mármol Navarro, S; Lozano Blasco, J M

    2007-01-01

    The perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies. The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation). The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality. PMID:17902464

  2. Personalizing pelvic floor reconstructive surgery in aging women.

    PubMed

    Mannella, Paolo; Giannini, Andrea; Russo, Eleonora; Naldini, Gabriele; Simoncini, Tommaso

    2015-09-01

    Pelvic floor dysfunction is a growingly frequent condition in aging individuals. Urinary or rectal incontinence, constipation, pelvic organ prolapse, pelvic pain or sexual dysfunction are common problems in this age range. Such conditions carry a severe impact on quality of life, but also limit individual independence in daily activities, favor social isolation and carry health risks. Diagnosis and treatment of pelvic floor dysfunction in aging women is tricky, since multiple interfering conditions affecting muscle tone and nerve function are common in these individuals. Diabetes mellitus, sarcopenia, use of drugs that affect cognition or impact bowel or urinary function are just a few examples. These conditions need to be thoroughly taken into account during pre-operative work up for their potential impact on the success of surgery and vice versa. Functional reconstruction aimed at treating symptoms rather than anatomic defects is key to success. The recent advancements in surgical treatment of urinary incontinence and pelvic organ prolapse allow for more options to achieve the best surgery in each patient. PMID:26142653

  3. Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction.

    PubMed

    Jung, Halim; Jung, Sangwoo; Joo, Sunghee; Song, Changho

    2016-01-01

    [Purpose] The purpose of this study was to compare changes in the mobility of the pelvic floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this study (15 men and 15 women). [Methods] All participants performed a bridge exercise and abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. Pelvic floor mobility was evaluated as the distance from the bladder base using ultrasound. [Results] According to exercise method, bridge exercise and abdominal curl-ups led to significantly different pelvic floor mobility. The pelvic floor muscle was elevated during the abdominal drawing-in maneuver and descended during maximal expiration. Finally, pelvic floor muscle mobility was greater during abdominal curl-up than during the bridge exercise. [Conclusion] According to these results, the abdominal drawing-in maneuver induced pelvic floor muscle contraction, and pelvic floor muscle contraction was greater during the abdominal curl-up than during the bridge exercise. PMID:27065532

  4. Assessment of the effect of pelvic floor exercises on pelvic floor muscle strength using ultrasonography in patients with urinary incontinence: a prospective randomized controlled trial.

    PubMed

    Tosun, Ozge Celiker; Solmaz, Ulas; Ekin, Atalay; Tosun, Gokhan; Gezer, Cenk; Ergenoglu, Ahmet Mete; Yeniel, Ahmet Ozgur; Mat, Emre; Malkoc, Mehtap; Askar, Niyazi

    2016-01-01

    [Purpose] The aim of this study was to evaluate whether the effect of pelvic floor exercises on pelvic floor muscle strength could be detected via ultrasonography in patients with urinary incontinence. [Subjects and Methods] Of 282 incontinent patients, 116 participated in the study and were randomly divided into a pelvic floor muscle training (n=65) group or control group (n=51). The pelvic floor muscle training group was given pelvic floor exercise training for 12 weeks. Both groups were evaluated at the beginning of the study and after 12 weeks. Abdominal ultrasonography measurements in transverse and longitudinal planes, the PERFECT scheme, perineometric evaluation, the stop test, the stress test, and the pad test were used to assess pelvic floor muscle strength in all cases. [Results] After training, the PERFECT, perineometry and transabdominal ultrasonography measurements were found to be significantly improved, and the stop test and pad test results were significantly decreased in the pelvic floor muscle training group, whereas no difference was observed in the control group. There was a positive correlation between the PERFECT force measurement scale and ultrasonography force measurement scale before and after the intervention in the control and pelvic floor muscle training groups (r=0.632 and r=0.642, respectively). [Conclusion] Ultrasonography can be used as a noninvasive method to identify the change in pelvic floor muscle strength with exercise training. PMID:27065519

  5. Assessment of the effect of pelvic floor exercises on pelvic floor muscle strength using ultrasonography in patients with urinary incontinence: a prospective randomized controlled trial

    PubMed Central

    Tosun, Ozge Celiker; Solmaz, Ulas; Ekin, Atalay; Tosun, Gokhan; Gezer, Cenk; Ergenoglu, Ahmet Mete; Yeniel, Ahmet Ozgur; Mat, Emre; Malkoc, Mehtap; Askar, Niyazi

    2016-01-01

    [Purpose] The aim of this study was to evaluate whether the effect of pelvic floor exercises on pelvic floor muscle strength could be detected via ultrasonography in patients with urinary incontinence. [Subjects and Methods] Of 282 incontinent patients, 116 participated in the study and were randomly divided into a pelvic floor muscle training (n=65) group or control group (n=51). The pelvic floor muscle training group was given pelvic floor exercise training for 12 weeks. Both groups were evaluated at the beginning of the study and after 12 weeks. Abdominal ultrasonography measurements in transverse and longitudinal planes, the PERFECT scheme, perineometric evaluation, the stop test, the stress test, and the pad test were used to assess pelvic floor muscle strength in all cases. [Results] After training, the PERFECT, perineometry and transabdominal ultrasonography measurements were found to be significantly improved, and the stop test and pad test results were significantly decreased in the pelvic floor muscle training group, whereas no difference was observed in the control group. There was a positive correlation between the PERFECT force measurement scale and ultrasonography force measurement scale before and after the intervention in the control and pelvic floor muscle training groups (r=0.632 and r=0.642, respectively). [Conclusion] Ultrasonography can be used as a noninvasive method to identify the change in pelvic floor muscle strength with exercise training. PMID:27065519

  6. Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction

    PubMed Central

    Jung, Halim; Jung, Sangwoo; Joo, Sunghee; Song, Changho

    2016-01-01

    [Purpose] The purpose of this study was to compare changes in the mobility of the pelvic floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this study (15 men and 15 women). [Methods] All participants performed a bridge exercise and abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. Pelvic floor mobility was evaluated as the distance from the bladder base using ultrasound. [Results] According to exercise method, bridge exercise and abdominal curl-ups led to significantly different pelvic floor mobility. The pelvic floor muscle was elevated during the abdominal drawing-in maneuver and descended during maximal expiration. Finally, pelvic floor muscle mobility was greater during abdominal curl-up than during the bridge exercise. [Conclusion] According to these results, the abdominal drawing-in maneuver induced pelvic floor muscle contraction, and pelvic floor muscle contraction was greater during the abdominal curl-up than during the bridge exercise. PMID:27065532

  7. Urinary incontinence, pelvic floor dysfunction, exercise and sport.

    PubMed

    Bø, Kari

    2004-01-01

    Urinary incontinence is defined as "the complaint of any involuntary leakage of urine" and is a common problem in the female population with prevalence rates varying between 10% and 55% in 15- to 64-year-old women. The most frequent form of urinary incontinence in women is stress urinary incontinence, defined as "involuntary leakage on effort or exertion, or on sneezing or coughing". The aim of this article is to systematically review the literature on urinary incontinence and participation in sport and fitness activities with a special emphasis on prevalence and treatment in female elite athletes. Stress urinary incontinence is a barrier to women's participation in sport and fitness activities and, therefore, it may be a threat to women's health, self-esteem and well-being. The prevalence during sports among young, nulliparous elite athletes varies between 0% (golf) and 80% (trampolinists). The highest prevalence is found in sports involving high impact activities such as gymnastics, track and field, and some ball games. A 'stiff' and strong pelvic floor positioned at an optimal level inside the pelvis may be a crucial factor in counteracting the increases in abdominal pressure occurring during high-impact activities. There are no randomised controlled trials or reports on the effect of any treatment for stress urinary incontinence in female elite athletes. However, strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as <2g of leakage on pad tests, varied between 44% and 69%. Pelvic floor muscle training has no serious adverse effects and has been recommended as first-line treatment in the general population. Use of preventive devices such as vaginal tampons or pessaries can prevent leakage during high impact physical activity. The pelvic floor muscles need to be much stronger in elite athletes

  8. Ultrasound Evaluation of Dynamic Responses of Female Pelvic Floor Muscles

    PubMed Central

    Peng, Qiyu; Jones, Ruth; Shishido, Keiichi; Constantinou, Christos E.

    2007-01-01

    Ultrasound imaging of the pelvic floor carrys diagnostically important information about the dynamic response of the Pelvic Floor Muscles (PFM) to potentially incontinence-producing stress, which can not be readily captured and assimilated by the observer during the scanning process. We presented an approach based on motion tracking to quantatively analyze the dynamic parameters of PFM on the Ano-Rectal Angle (ARA). Perineal ultrasonography was performed on 22 asymptomatic females and 9 Stress Urinary Incontinent (SUI) patients with a broad age distribution and parity. The ventral-dorsal and cephalad-caudad movements of the ARA were resolved and kinematic parameters, in terms of displacement, trajectory, velocity and acceleration were analyzed. The results revealed the possible mechanisms of PFM responses to prevent the urine from incontinence in fast and stress events. The statistical analyses showed the PFM responses of the healthy subjects and the SUI patients are significantly different in both the supine and standing experiments. PMID:17210220

  9. A shell finite element model of the pelvic floor muscles.

    PubMed

    d'Aulignac, D; Martins, J A C; Pires, E B; Mascarenhas, T; Jorge, R M Natal

    2005-10-01

    The pelvic floor gives support to the organs in the abdominal cavity. Using the dataset made public in (Janda et al. J. Biomech. (2003) 36(6), pp. 749-757), we have reconstructed the geometry of one of the most important parts of the pelvic floor, the levator ani, using NURB surfaces. Once the surface is triangulated, the corresponding mesh is used in a finite element analysis with shell elements. Based on the 3D behavior of the muscle we have constructed a shell that takes into account the direction of the muscle fibers and the incompressibility of the tissue. The constitutive model for the isotropic strain energy and the passive strain energy stored in the fibers is adapted from Humphrey's model for cardiac muscles. To this the active behavior of the skeletal muscle is added. We present preliminary results of a simulation of the levator ani muscle under pressure and with active contraction. This research aims at helping simulate the damages to the pelvic floor that can occur after childbirth. PMID:16298856

  10. Alterations in pelvic floor muscles and pelvic organ support by pregnancy and vaginal delivery in squirrel monkeys

    PubMed Central

    Reyes, Michelle; Gendron, Jilene M.; Pierce, Lisa M.; Runge, Val M.; Kuehl, Thomas J.

    2014-01-01

    Introduction and hypothesis The objective of this study was to measure the effects of pregnancy and parturition on pelvic floor muscles and pelvic organ support. Methods Levator ani, obturator internus, and coccygeus (COC) muscle volumes and contrast uptake were assessed by MRI of seven females prior to pregnancy, 3 days, and 4 months postpartum. Bladder neck and cervix position were measured dynamically with abdominal squeezing. Results The sides of three paired muscles were similar (p>0.66). COC volumes were greater (p<0.004) after parturition than before pregnancy or after recovery. COC contrast uptake increased (p<0.02) immediately after delivery. Bladder neck position both in the relaxed state and abdominal pressure descended (p<0.04) after delivery and descended further (p<0.001) after recovery. Cervical position in the relaxed state before delivery was higher (p<0.001) than postpartum but was unchanged (p=0.50) with abdominal pressure relative to delivery. Conclusion In squirrel monkeys, coccygeus muscles demonstrate the greatest change related to parturition, and parturition-related bladder neck descent seems permanent. PMID:21567260

  11. [Nursing care in the initial phases of pelvic floor prolapse].

    PubMed

    Hernández-González, Ana Maria

    2008-01-01

    Uterine prolapse consists of a falling or sliding of the uterus from its normal position in the pelvic cavity inside the vagina and is one of the most frequent alterations secondary to pelvic floor dysfunction in gynecology consultations. Although patients are reluctant to talk about this sensitive issue, they complain of feeling a lump in their genitals, urinary incontinence, and problems in their sexual relations. In fact, uterine prolapse is not a disease but an alteration of the elements suspending and containing the uterus, which are almost always injured by pregnancy and childbirth. Other causes in addition to trauma of the endopelvic fascia (mainly cardinal and uterosacral ligaments) are injuries or relaxations of the pelvic floor (the muscles lifting the anus and the fascia that covers the bladder, vagina and rectum). Causes of uterine prolapse without obstetric antecedents are usually those that involve an increase in abdominal pressure and respiratory diseases causing severe coughing. The incidence of uterine prolapse is highest in multiparous women, with prolonged deliveries, a long second stage involving marked straining, in forceps deliveries and in women with perineal tears. Nursing care is essential, both in the prevention and the detection of prolapse, so that women can express their needs without fear and are aware of the need for appropriate treatment in the incipient stages of prolapse. PMID:19080886

  12. MR defecography: a diagnostic test for the evaluation of pelvic floor motion in patients with dyssynergic defecation after biofeedback therapy

    PubMed Central

    Nikjooy, Afsaneh; Maroufi, Nader; Ebrahimi Takamjani, Ismaeil; Hadizdeh Kharazi, Homayoun; Mahjoubi, Bahar; Azizi, Rasoul; Haghani, Hamid

    2015-01-01

    Background: Dyssynergic defecation is a major cause of chronic functional constipation as a common digestive complaint. We clinically evaluated the effects of biofeedback therapy on the pelvic floor motion indices through magnetic resonance (MR) defecography, quality of life and depression in patients with dyssynergic defecation. Methods: In this clinical trial study, among patients referring to the Colorectal Clinic of Hazrat Rasoul Hospital, 22 subjects were randomly assigned into two equal groups (n= 11) to receive either standard only or biofeedback and standard therapy. Dynamic changes of the pelvic floor were measured by MR defecography. During the simulated defecation, two MR defecography dynamic indices including abnormal anorectal angle change and perineal descent were measured before and after treatment. The effects of biofeedback therapy on patients’ symptoms, quality of life and severity of depression were assessed and compared with the standard therapy. Statistical analysis was carried out using independent _t-test and Mann-Whitney test. Results: Paradox index (p< 0.001), perineal descent index (p< 0.001), depression (p< 0.1), physical function (p< 0.001), vitality (p< 0.001) and role emotion (p< 0.001) significantly improved in the biofeedback therapy group in contrast to the standard therapy SDT group. Conclusion: Biofeedback therapy appears to be effective in improving symptoms of functional constipation and dysfunction of pelvic floor motion as well as patient’s quality of life and depression state. MR defecography is able to show the changes in dynamic indices of the pelvic floor through biofeedback therapy. PMID:26034741

  13. Pelvic floor muscle exercises in genuine urinary stress incontinence.

    PubMed

    Cammu, H; Van Nylen, M

    1997-01-01

    Pelvic floor muscle exercises, in the treatment of genuine stress incontinence, have been used successfully since 1948. One may expect a significant improvement (warranting no further therapy), or cure rate of about 50%. These exercises have a long-lasting effect. Poorly motivated women should be discouraged to follow exercise sessions. An active co-operation between urogynecologist, physiotherapist and the patient is important in order to avoid undertreated and dissatisfied women. The option to be operated upon must be easily available. PMID:9557995

  14. Cortical Activation Associated with Muscle Synergies of the Human Male Pelvic Floor

    PubMed Central

    Asavasopon, Skulpan; Rana, Manku; Kirages, Daniel J.; Yani, Moheb S.; Fisher, Beth E.; Hwang, Darryl H.; Lohman, Everett B.; Berk, Lee S.

    2014-01-01

    Human pelvic floor muscles have been shown to operate synergistically with a wide variety of muscles, which has been suggested to be an important contributor to continence and pelvic stability during functional tasks. However, the neural mechanism of pelvic floor muscle synergies remains unknown. Here, we test the hypothesis that activation in motor cortical regions associated with pelvic floor activation are part of the neural substrate for such synergies. We first use electromyographic recordings to extend previous findings and demonstrate that pelvic floor muscles activate synergistically during voluntary activation of gluteal muscles, but not during voluntary activation of finger muscles. We then show, using functional magnetic resonance imaging (fMRI), that a region of the medial wall of the precentral gyrus consistently activates during both voluntary pelvic floor muscle activation and voluntary gluteal activation, but not during voluntary finger activation. We finally confirm, using transcranial magnetic stimulation, that the fMRI-identified medial wall region is likely to generate pelvic floor muscle activation. Thus, muscle synergies of the human male pelvic floor appear to involve activation of motor cortical areas associated with pelvic floor control. PMID:25297107

  15. Laparoscopic surgery for rectal prolapse and pelvic floor disorders

    PubMed Central

    Rickert, Alexander; Kienle, Peter

    2015-01-01

    Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders. PMID:26380050

  16. Medical & Surgical Management of Pelvic Floor Disorders Affecting Defecation

    PubMed Central

    Schey, Ron; Cromwell, John; Rao, Satish S.C.

    2014-01-01

    Pelvic floor disorders that affect stool evacuation include structural (example: rectocele) and functional disorders (example: dyssynergic defecation). Meticulous history, digital rectal examination, and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion and imaging studies such as anal ultrasound, defecography, and static and dynamic MRI can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and lastly surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating dyssynergic defecation. Because dyssynergic defecation may co-exist with conditions such as solitary rectal ulcer syndrome (SRUS), and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic and trans-abdominal approach, stapled transanal rectal resection (STARR), and robotic colon and rectal resections. However, there is lack of well controlled randomized studies and efficacy of these surgical procedures remains to be established. PMID:22907620

  17. Local Oestrogen for Pelvic Floor Disorders: A Systematic Review

    PubMed Central

    Weber, M. A.; Kleijn, M. H.; Langendam, M.; Limpens, J.; Heineman, M. J.; Roovers, J. P.

    2015-01-01

    Objective The decline in available oestrogen after menopause is a possible etiological factor in pelvic floor disorders like vaginal atrophy (VA), urinary incontinence (UI), overactive bladder (OAB) and pelvic organ prolapse (POP). This systematic review will examine the evidence for local oestrogen therapy in the treatment of these pelvic floor disorders. Evidence Acquisition We performed a systematic search in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the non-MEDLINE subset of PubMed from inception to May 2014. We searched for local oestrogens and VA (I), UI/OAB (II) and POP (III). Part I was combined with broad methodological filters for randomized controlled trials (RCTs) and secondary evidence. For part I and II two reviewers independently selected RCTs evaluating the effect of topical oestrogens on symptoms and signs of VA and UI/OAB. In part III all studies of topical oestrogen therapy in the treatment of POP were selected. Data extraction and the assessment of risk of bias using the Cochrane Risk of Bias Tool was undertaken independently by two reviewers. Evidence Synthesis The included studies varied in ways of topical application, types of oestrogen, dosage and treatment durations. Objective and subjective outcomes were assessed by a variety of measures. Overall, subjective and urodynamic outcomes, vaginal maturation and vaginal pH changed in favor of vaginal oestrogens compared to placebo. No obvious differences between different application methods were revealed. Low doses already seemed to have a beneficial effect. Studies evaluating the effect of topical oestrogen in women with POP are scarce and mainly assessed symptoms and signs associated with VA instead of POP symptoms. Conclusion Topical oestrogen administration is effective for the treatment of VA and seems to decrease complaints of OAB and UI. The potential for local oestrogens in the prevention as well as treatment of POP needs further research. PMID:26383760

  18. Pelvic Floor Biofeedback via a Smart Phone App for Treatment Of Stress Urinary Incontinence.

    PubMed

    Starr, Julie A; Drobnis, Erma Z; Cornelius, Chelsea

    2016-01-01

    Biofeedback can be useful for treatment of stress urinary incontinence. Many women have difficulty isolating their pelvic floor muscles and adhering to a daily exercise regimen. This case study highlights a woman's experience using PeriCoach, a home biofeedback device that assists women in strengthening their pelvic floor muscles through Bluetooth technology using a smartphone. PMID:27281866

  19. Production of ascorbic acid releasing biomaterials for pelvic floor repair

    PubMed Central

    Mangır, Naşide; Bullock, Anthony J.; Roman, Sabiniano; Osman, Nadir; Chapple, Christopher; MacNeil, Sheila

    2016-01-01

    Objective An underlying abnormality in collagen turnover is implied in the occurrence of complications and recurrences after mesh augmented pelvic floor repair surgeries. Ascorbic acid is a potent stimulant of collagen synthesis. The aim of this study is to produce ascorbic acid releasing poly-lactic acid (PLA) scaffolds and evaluate them for their effects on extracellular matrix production and the strength of the materials. Materials and methods Scaffolds which contained either l-ascorbic acid (AA) and Ascorbate-2-Phosphate (A2P) were produced with emulsion electrospinning. The release of both drugs was measured by UV spectrophotometry. Human dermal fibroblasts were seeded on scaffolds and cultured for 2 weeks. Cell attachment, viability and total collagen production were evaluated as well as mechanical properties. Results No significant differences were observed between AA, A2P, Vehicle and PLA scaffolds in terms of fibre diameter and pore size. The encapsulation efficiency and successful release of both AA and A2P were demonstrated. Both AA and A2P containing scaffolds were significantly more hydrophilic and stronger in both dry and wet states compared to PLA scaffolds. Fibroblasts produced more collagen on scaffolds containing either AA or A2P compared to cells grown on control scaffolds. Conclusion This study is the first to directly compare the two ascorbic acid derivatives in a tissue engineered scaffold and shows that both AA and A2P releasing electrospun PLA scaffolds increased collagen production of fibroblasts to similar extents but AA scaffolds seemed to be more hydrophilic and stronger compared to A2P scaffolds. Statement of significance Mesh augmented surgical repair of the pelvic floor currently relies on non-degradable materials which results in severe complications in some patients. There is an unmet and urgent need for better pelvic floor repair materials. Our current understanding suggests that the ideal material should be able to better

  20. Voiding trial outcome following pelvic floor repair without incontinence procedures

    PubMed Central

    Wang, Rui; Won, Sara; Haviland, Miriam J.; Bargen, Emily Von; Hacker, Michele R.; Li, Janet

    2016-01-01

    Introduction and hypothesis Our aim was to identify predictors of postoperative voiding trial failure among patients who had a pelvic floor repair without a concurrent incontinence procedure in order to identify low-risk patients in whom postoperative voiding trials may be modified. Methods We conducted a retrospective cohort study of women who underwent pelvic floor repair without concurrent incontinence procedures at two institutions from 1 November 2011 through 13 October 2013 after abstracting demographic and clinical data from medical records. The primary outcome was postoperative retrograde voiding trial failure. We used modified Poisson regression to calculate the risk ratio (RR) and 95 % confidence interval (CI). Results Of the 371 women who met eligibility criteria, 294 (79.2 %) had complete data on the variables of interest. Forty nine (16.7%) failed the trial, and those women were less likely to be white (p = 0.04), more likely to have had an anterior colporrhaphy (p = 0.001), and more likely to have had a preoperative postvoid residual (PVR) ≥150 ml (p = 0.001). After adjusting for race, women were more likely to fail their voiding trial if they had a preoperative PVR of ≥150 ml (RR: 1.9; 95 % CI: 1.1–3.2); institution also was associated with voiding trial failure (RR: 3.0; 95 % CI: 1.6–5.4). Conclusions Among our cohort, postoperative voiding trial failure was associated with a PVR of ≥150 ml and institution at which the surgery was performed. PMID:26886553

  1. Obesity and Pelvic Floor Disorders: A Review of the Literature

    PubMed Central

    Pomian, Andrzej; Lisik, Wojciech; Kosieradzki, Maciej; Barcz, Ewa

    2016-01-01

    Overweight and obesity are becoming a worldwide health problem associated with numerous co-morbidities. National costs of obesity and pelvic flor disorders have been rising since the 1950s across the world. Obesity is thought to have a very strong effect on pelvic floor disorders, and, considering the high prevalence of both problems worldwide, it is of utmost importance to evaluate the association between these pathologies as well as the impact of obesity on treatment efficacy. This review is based on a selection of reports in the literature (PubMed search), including guidelines and Cochrane reviews. Obesity seems to be a well-documented risk factor for lower urinary tract symptoms (LUTS) and is a predictor of exacerbation of stress urinary incontinence (SUI) and overactive bladder (OAB). Weight loss is also associated with improvement or resolution of SUI and OAB. In the case of pelvic organ prolapse (POP), weight loss is associated with improvement in quality of life. Although obesity is associated with POP in general, the exact role of obesity in symptomatic POP remains uncertain. While outcomes of anti-incontinence surgery among obese women are similar to those in non-obese women, postoperative urge incontinence is more likely to occur. It seems that obesity is not a risk factor for postoperative complications or short-term efficacy of POP surgical treatment. Long-term effects are still uncertain. Obesity is a strong risk factor for LUTS, but in most cases it does not affect efficacy of operative treatment. It may be associated with some post-operative complications. Weight loss in many cases allows avoiding surgical intervention. PMID:27255341

  2. Obesity and Pelvic Floor Disorders: A Review of the Literature.

    PubMed

    Pomian, Andrzej; Lisik, Wojciech; Kosieradzki, Maciej; Barcz, Ewa

    2016-01-01

    Overweight and obesity are becoming a worldwide health problem associated with numerous co-morbidities. National costs of obesity and pelvic flor disorders have been rising since the 1950s across the world. Obesity is thought to have a very strong effect on pelvic floor disorders, and, considering the high prevalence of both problems worldwide, it is of utmost importance to evaluate the association between these pathologies as well as the impact of obesity on treatment efficacy. This review is based on a selection of reports in the literature (PubMed search), including guidelines and Cochrane reviews. Obesity seems to be a well-documented risk factor for lower urinary tract symptoms (LUTS) and is a predictor of exacerbation of stress urinary incontinence (SUI) and overactive bladder (OAB). Weight loss is also associated with improvement or resolution of SUI and OAB. In the case of pelvic organ prolapse (POP), weight loss is associated with improvement in quality of life. Although obesity is associated with POP in general, the exact role of obesity in symptomatic POP remains uncertain. While outcomes of anti-incontinence surgery among obese women are similar to those in non-obese women, postoperative urge incontinence is more likely to occur. It seems that obesity is not a risk factor for postoperative complications or short-term efficacy of POP surgical treatment. Long-term effects are still uncertain. Obesity is a strong risk factor for LUTS, but in most cases it does not affect efficacy of operative treatment. It may be associated with some post-operative complications. Weight loss in many cases allows avoiding surgical intervention. PMID:27255341

  3. The role of local estrogen therapy in the management of pelvic floor disorders.

    PubMed

    Tzur, T; Yohai, D; Weintraub, A Y

    2016-04-01

    Pelvic floor disorders are common and bothersome problems that include a variety of conditions. These conditions greatly affect the performance of daily activities and social function such as work, traveling, physical exercise, sleep and sexual function. Aging is a well-known factor affecting the pelvic floor and lower urinary tract anatomy and function. It is clear that the pelvic organs and their surrounding muscular and connective tissue support are estrogen-responsive. Treatment of pelvic floor disorders requires significant health-care resources and their impact is likely to increase in the near future. This literature review aims to provide an overview of both research and clinical aspects of the pathophysiology of urogenital estrogen deficiency and the role of local estrogen therapy as part of the management strategy of different pelvic floor disorders. The safety and risk concerns regarding the use of local estrogen therapy are addressed as well. PMID:26830033

  4. The Pelvic Floor Disorders Registry: Purpose and Development.

    PubMed

    Bradley, Catherine S; Visco, Anthony G; Weber LeBrun, Emily E; Barber, Matthew D

    2016-01-01

    Pelvic organ prolapse (POP) is a common problem that negatively impacts women's quality of life. A variety of surgeries exist for POP treatment, including procedures performed with and without mesh augmentation. The growing use of mesh in prolapse surgeries in the 2000s was associated with increasing reports of complications, resulting in Food and Drug Administration (FDA) Safety Notifications, and in 2012, the FDA ordered transvaginal mesh manufacturers to conduct prospective studies to evaluate longer-term outcomes. These requirements provided incentives and an environment conducive to collaboration. American Urogynecologic Society leaders collaborated with device manufacturers, the FDA, and other professional organizations to establish the Pelvic Floor Disorders Registry (PFDR), a collection of interrelated registries, which could meet manufacturers' needs but also allow surgeons to track individual and aggregate outcomes for quality improvement. The PFDR was developed and launched by American Urogynecologic Society with objectives of (1) collecting, storing, and analyzing clinical data related to POP treatment; (2) establishing common data elements and quality metrics; and (3) providing a framework for external stakeholders to conduct POP research. The PFDR includes industry-sponsored studies, as well as 2 options for volunteer registry participation, the PFDR-Quality Improvement and PFDR-Research. The PFDR promotes quality improvement and national benchmarking and will provide real-world comparative safety and effectiveness data for prolapse surgeries. The PFDR can serve as a model for collaboration between medical practitioners, researchers, industry, and federal agencies and may allow progress toward our similar goal of high-quality surgical care of women with prolapse. PMID:26829344

  5. Numerical simulation of the damage evolution in the pelvic floor muscles during childbirth.

    PubMed

    Oliveira, Dulce A; Parente, Marco P L; Calvo, Begoña; Mascarenhas, Teresa; Natal Jorge, Renato M

    2016-02-29

    Several studies have shown that pelvic floor injuries during a vaginal delivery can be considered a significant factor in the development of pelvic floor dysfunction. Such disorders include a group of conditions affecting women like urinary incontinence, pelvic organ prolapse and fecal incontinence. Numerical simulations are valuable tools that are contributing to the clarification of the mechanisms behind pelvic floor disorders. The aim of this work is to propose a mechanical model implemented in the finite element method context to estimate the damage in the pelvic floor muscles by mechanical effects during a vaginal delivery of a fetus in vertex presentation and occipitoanterior position. The constitutive model adopted has already been successfully used in the simulation of childbirth and the structural damage model added has previously been applied to characterize the damage process in biological soft tissues undergoing finite deformations. The constitutive parameters were fit to experimental data available in the literature and the final proposed material model is suitable to estimate the mechanical damage in the pelvic floor muscle during a vaginal delivery. The computational model predicts that even an apparently uneventful vaginal delivery inflicts injuries to the pelvic floor muscles, particularly during the extension of the fetus head, having been obtained more than 10% of damaged fibers. As a clinical evidence, the present work allows to conclude that the puborectalis component of the levator ani muscle is the most prone to damage. PMID:26895779

  6. Postpartum pelvic floor function performance after two different modes of delivery.

    PubMed

    Li, H; Wu, R F; Qi, F; Xiao, A M; Ma, Z; Hu, Y; Zhang, W Y; Li, W; Wang, Z C

    2015-01-01

    This study investigated the incidences of urinary incontinence and pelvic organ prolapse as well as pelvic floor muscle strength after cesarean section and vaginal delivery. From June 2010 to July 2011, 149 puerpera in Shenzhen Hospital, Peking University, were divided into the cesarean section group (N = 66) and the vaginal delivery group (N = 83). Postpartum urinary incontinence analysis, pelvic examination, and pelvic muscle contraction analysis using the PHENIX neuromuscular therapy instrument were performed to compare urinary incontinence, pelvic organ prolapse, and pelvic floor muscle condition between the 2 groups. The incidences of urinary incontinence in the cesarean and vaginal delivery groups were 9.09% (6/66) and 16.87% (14/83), respectively (P > 0.05); the incidences of pelvic organ prolapse were 53.03% (35/66) and 86.75% (72/83), respectively (P < 0.05). There was no significant difference in pelvic muscle pressure or electrophysiological examination results between the 2 groups (P > 0.05). Hence, cesarean section has a protective effect on early postpartum pelvic organ prolapse, but the delivery modes do not differ significantly with respect to the incidence of postpartum urinary incontinence or pelvic muscle floor muscle strength. PMID:25966063

  7. [Importance of sonography in the diagnostics of functional disorders of the female pelvic floor].

    PubMed

    Albrich, S; Bauer, R M; Haberer, E; Skala, C; Naumann, G

    2013-04-01

    Ultrasound now plays an indispensible role in urogynecological diagnostics. Sonographic imaging of the female pelvic floor allows depiction of the urethra, bladder neck, bladder, anorectum and the levator ani muscle and is currently an important clinical component for the diagnostics of functional disorders in the region of the female pelvic floor. Essential aspects in sonography of the female pelvic floor are the dynamic depiction and direct imaging of alloplastic implants. For these reasons sonographic imaging is of great clinical importance especially for the diagnostics of recurrent or postoperative complications. A further important factor which supports the success of ultrasound in the diagnostics of functional disorders of the female pelvic floor is the wide availability of ultrasound devices in patient care. Furthermore, the method is noninvasive, comparatively inexpensive and does not involve radiation. PMID:23483273

  8. Prevention of Labour-Associated Pelvic Floor Injuries – What is Known for Sure

    PubMed Central

    Franz, H. B.G.; Erxleben, C.; Franz, A.; Hofmann, R.

    2012-01-01

    In order to avoid pelvic floor injuries a caesarean section is on the one hand often requested by the pregnant women and, on the other hand, offered by obstetric staff. For both forms of delivery, comprehensive risk-benefit analyses should be carried out before deciding in favour of the surgical procedure. The present brief review summarizes the current evidence on the avoidance of pelvic floor injuries. PMID:26640288

  9. PELVIC FLOOR SYMPTOMS AND QUALITY OF LIFE ANALYSES IN WOMEN UNDERGOING SURGERY FOR RECTAL PROLPASE

    PubMed Central

    ELLINGTON, DR; MANN, M; BOWLING, CB; DRELICHMAN, ER; GREER, WJ; SZYCHOWSKI, JM; RICHTER, HE

    2014-01-01

    Objective Characterize pelvic floor symptom distress and impact, sexual function and quality of life in women who underwent rectal prolapse surgery. Methods Subjects undergoing rectal prolapse surgery from 2004–2009 completed questionnaires including the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and the Prolapse/Urinary Incontinence Sexual Questionnaire. Baseline demographic, medical, and surgical characteristics were extracted by chart review. Demographic and clinic outcomes of women undergoing transperineal and abdominal approaches were compared. Wilcoxon rank-sum test was used for continuous variables and Fisher’s exact test for categorical measures. Results 45 were identified; two deceased at follow-up. 28/43 subjects (65.1%) responded to the questionnaires. Mean time from original procedure was 3.9 ± 3.1 years. No differences in median total Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and subscale scores, and Prolapse/Urinary Incontinence Sexual Questionnaire scores in women undergoing open rectopexy versus transperineal proctectomy were seen (all p>0.05). 26 (60%) participants answered the Prolapse/Urinary Incontinence Sexual Questionnaire, nine reported sexual activity within the last month. All underwent abdominal procedures. Conclusion There are few colorectal or other pelvic floor symptoms after rectal prolapse repair. Robust prospective studies are needed to more fully characterize and understand issues associated with rectal prolapse surgery in women. PMID:25379122

  10. Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction.

    PubMed

    Khatri, Gaurav; Carmel, Maude E; Bailey, April A; Foreman, Melissa R; Brewington, Cecelia C; Zimmern, Philippe E; Pedrosa, Ivan

    2016-01-01

    Pelvic floor dysfunction encompasses an extremely common set of conditions, with various surgical and nonsurgical treatment options. Surgical options include injection of urethral bulking agents, native tissue repair with or without bioabsorbable or synthetic graft material, placement of synthetic midurethral slings or use of vaginal mesh kits, and mesh sacrocolpopexy procedures. Numerous different synthetic products with varied imaging appearances exist, and some of these products may be difficult to identify at imaging. Patients often present with recurrent or new symptoms after surgery; and depending on the presenting complaint and the nature of the initial intervention, imaging with ultrasonography (US), magnetic resonance (MR) imaging, voiding cystourethrography, or computed tomography (CT) may be indicated. US and MR imaging can both be used to image urethral bulking agents; US is often used to follow potential changes in bulking agent volume with time. Compared with MR imaging, US depicts midurethral slings better in the urethrovaginal space, and MR imaging is better than US for depiction of the arms in the retropubic space and obturator foramen. Mesh along the vaginal wall may be depicted with both US and MR imaging; however, the distal arms of the mesh traversing the sacrospinous ligaments or within the ischiorectal fossae (ischioanal fossae) are better depicted with MR imaging. Scarring can mimic slings and mesh at both US and MR imaging. MR imaging is superior to US for depiction of sacrocolpopexy mesh and associated complications. Voiding cystourethrography and CT are used less commonly because they rarely allow direct depiction of implanted material. Online supplemental material is available for this article. (©)RSNA, 2016. PMID:27399245

  11. Reliability of measuring pelvic floor elevation with a diagnostic ultrasonic imaging device

    PubMed Central

    Ubukata, Hitomi; Maruyama, Hitoshi; Huo, Ming

    2015-01-01

    [Purpose] The purpose of this study was to investigate the reliability of measuring the amount of pelvic floor elevation during pelvic and abdominal muscle contraction with a diagnostic ultrasonic imaging device. [Subjects] The study group comprised 11 healthy women without urinary incontinence or previous birth experience. [Methods] We measured the displacement elevation of the bladder base during contraction of the abdominal and pelvic floor muscles was measured using a diagnostic ultrasonic imaging device. The exercise was a four-part operation undertaken with the subjects in the lateral position. The reliability analysis included use of the interclass correlation coefficient (ICC) was used to assess the reliability. [Results] ICC (1.1) values for the pelvic floor elevation measurement with a diagnostic ultrasonic imaging device were 0.98 [contraction of the transversus abdominis (TrA) muscle], 0.99 [contraction of pelvic floor muscles (PFMs)], 0.98 (co-contraction of the TrA and PFMs), and 0.98 (resistance of the TrA and PFMs). This study proved the reliability of the method because the coefficient of reliability was 0.97 or more for all of the measurements, even for those during exercise. [Conclusion] The diagnostic ultrasonic imaging device measures pelvic floor elevation with high reliability. PMID:26355420

  12. Health Literacy and Disease Understanding among Aging Women with Pelvic Floor Disorders

    PubMed Central

    Anger, Jennifer T.; Lee, Una; Mittal, Brita M.; Pollard, Matthew; Tarnay, Christopher; Maliski, Sally; Rogers, Rebecca G

    2013-01-01

    OBJECTIVES Few studies on health literacy and disease understanding among women with pelvic floor disorders have been published. We conducted a pilot study to explore the relationship between disease understanding and health literacy, age, and diagnosis type among women with urinary incontinence and pelvic organ prolapse. METHODS Study subjects were recruited from urology and urogynecology specialty clinics based on a chief complaint suggestive of urinary incontinence or pelvic prolapse. Subjects completed questionnaires to assess symptom severity and health literacy was measured using the Test of Functional Health Literacy in Adults. Patient-physician interactions were audiotaped during the office visit. Immediately afterwards, patients were asked to describe diagnoses and treatments discussed by the physician and record them on a checklist, with follow-up phone call where the same checklist was administered 2–3 days later. RESULTS A total of 36 women with pelvic floor disorders, aged 42–94, were enrolled. We found that health literacy scores decreased with increasing age; however, all patients had low percentage recall of their pelvic floor diagnoses and poor understanding of their pelvic floor condition despite high health literacy scores. Patients with pelvic prolapse appeared to have worse recall and disease understanding than patients with urinary incontinence. CONCLUSIONS High health literacy as assessed by the TOFHLA may not correlate with patients' ability to comprehend complex functional conditions such as pelvic floor disorders. Lack of understanding may lead to unrealistic treatment expectations, inability to give informed consent for treatment, and dissatisfaction with care. Better methods to improve disease understanding are needed. PMID:23143427

  13. Reduced Pelvic Floor Muscle Tone Predisposes to Persistence of Lower Urinary Tract Symptoms after Puerperium.

    PubMed

    Bhat, Chandana; Khan, Mahjabeen; Ballala, Kirthinath; Kamath, Asha; Pandey, Deeksha

    2016-01-01

    Pregnant primiparous women at term were enrolled in the study. ICIQ-FLUTS questionnaire was used to find out prevalence of LUTS. MOS was used to assess pelvic floor muscle strength. Women were followed up after 8-10 weeks of delivery to find out remission or persistence of these symptoms. We found that increased frequency of micturition was the most common (82%) LUTS seen in primiparous women at term. More than half (51%) of these women who complained of LUTS had a poor pelvic floor muscle tone (MOS grade 3). Out of those who had symptoms during pregnancy 11% remained symptomatic even after puerperium. Interestingly 61% of those with persistence of symptoms demonstrated a very poor pelvic floor muscle tone at term (MOS grade 2), while the remaining 39% also had a tone of only MOS grade 3. Thus women with LUTS during pregnancy should be screened for their pelvic floor muscle tone with simple MOS system which will help to predict the persistence of these symptoms later on. Women with a low score (three or less) should be triaged for regular pelvic floor muscle exercises. PMID:27119044

  14. Reduced Pelvic Floor Muscle Tone Predisposes to Persistence of Lower Urinary Tract Symptoms after Puerperium

    PubMed Central

    Bhat, Chandana; Khan, Mahjabeen; Ballala, Kirthinath; Kamath, Asha

    2016-01-01

    Pregnant primiparous women at term were enrolled in the study. ICIQ-FLUTS questionnaire was used to find out prevalence of LUTS. MOS was used to assess pelvic floor muscle strength. Women were followed up after 8–10 weeks of delivery to find out remission or persistence of these symptoms. We found that increased frequency of micturition was the most common (82%) LUTS seen in primiparous women at term. More than half (51%) of these women who complained of LUTS had a poor pelvic floor muscle tone (MOS grade 3). Out of those who had symptoms during pregnancy 11% remained symptomatic even after puerperium. Interestingly 61% of those with persistence of symptoms demonstrated a very poor pelvic floor muscle tone at term (MOS grade 2), while the remaining 39% also had a tone of only MOS grade 3. Thus women with LUTS during pregnancy should be screened for their pelvic floor muscle tone with simple MOS system which will help to predict the persistence of these symptoms later on. Women with a low score (three or less) should be triaged for regular pelvic floor muscle exercises. PMID:27119044

  15. Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

    PubMed Central

    Gameiro, Mônica Orsi; Sousa, Vanessa Oliveira; Gameiro, Luiz Felipe; Muchailh, Rosana Carneiro; Padovani, Carlos Roberto; Amaro, João Luiz

    2011-01-01

    OBJECTIVE: This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women. METHODS: A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20th and 36th weeks of pregnancy and 45 days after delivery. RESULTS: In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m2 in G1 and 25.0 kg/m2 in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients. CONCLUSION: Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles. PMID:21915489

  16. [Possibilities of 4D ultrasonography in imaging of the pelvic floor structures].

    PubMed

    Dlouhá, K; Krofta, L

    2011-12-01

    Technological boom of the last decades brought urogynaecologists and other specialists new possibilities in imaging of the pelvic floor structures which may substantially add to search for etiology of pelvic floor dysfunction. Magnetic resonance imaging (MRI) is an expensive, less accessible method and may pose certain dyscomphort to the patient. 3D/4D ultrasonography overcomes these disadvantages and brings new possibilities especially in dynamic, real time imaging and consequently enables focus on functional anatomy of complex of muscles and fascial structures of the pelvic floor. With 3D/4D ultrasound we can visualise urethra and surrounding structures, levator ani and urogenital hiatus, its changes during muscle contraction and Valsalva manévre. This method has great potential in diagnostics of pelvic organ prolapse, it may bring new knowledge of factors contributing to loss of integrity of pelvic floor structures resulting in prolapse and incontinence. Studies exist which describe changes in urogenital hiatus after vaginal delivery, further studies of large numbers of patients during longer period of time are though necessary so that conclusions can be drawn for clinical praxis. PMID:22312840

  17. Duplicated Pelvic Floor Musculature and Diastematomyelia in a Cloacal Exstrophy Patient

    PubMed Central

    Inouye, Brian M; Tourchi, Ali; Massanyi, Eric Z; Gearhart, John P; Tekes, Aylin

    2014-01-01

    Cloacal exstrophy is the most severe and rare form of the exstrophy-epispadias complex, presenting with exposed bladder halves extruding through an abdominal wall defect and variable genitourinary, gastrointestinal, musculoskeletal, and neurological defects. The authors report magnetic resonance imaging findings of a neurologically-intact, 24-month-old female with cloacal exstrophy who presented with anterior spinal dysraphism and diastematomyelia and duplicate pelvic floor musculature. The constellation of defects suggests a common genetic, biochemical, and embryological origin for duplication of the bladder, spinal cord, and pelvic floor muscles occurring in the fourth week of gestation. PMID:25426220

  18. Noxious electrical stimulation of the pelvic floor and vagina induces transient voiding dysfunction in a rabbit survival model of pelvic floor dystonia

    PubMed Central

    Spettel, Sara; Schuler, Catherine; Levin, Robert M.; Dubin, Andrew H.; De, Elise J.B.

    2015-01-01

    Purpose Existing data supports a relationship between pelvic floor dysfunction and lower urinary tract symptoms. We developed a survival model of pelvic floor dysfunction in the rabbit and evaluated cystometric (CMG), electromyographic (EMG) and ambulatory voiding behavior. Materials and Methods Twelve female adult virgin rabbits were housed in metabolic cages to record voiding and defecation. Anesthetized CMG/EMG was performed before and after treatment animals (n=9) received bilateral tetanizing needle stimulation to the pubococcygeous (PC) muscle and controls (n=3) sham needle placement. After 7 days all animals were subjected to tetanizing transvaginal stimulation and CMG/EMG. After 5 days a final CMG/EMG was performed. Results Of rabbits that underwent needle stimulation 7 of 9 (78%) demonstrated dysfunctional CMG micturition contractions versus 6 of 12 (50%) after transvaginal stimulation. Needle stimulation of the PC musculature resulted in significant changes in: basal CMG pressure, precontraction pressure change, contraction pressure, interval between contractions and postvoid residual; with time to 3rd contraction increased from 38 to 53 minutes (p=0.008 vs. prestimulation). Vaginal noxious stimulation resulted in significant changes in: basal CMG pressure and interval between contractions; with time to 3rd contraction increased from 37 to 46 minutes (p=0.008 vs. prestimulation). Changes in cage parameters were primarily seen after direct needle stimulation. Conclusions In a majority of animals, tetanizing electrical stimulation of the rabbit pelvic floor resulted in voiding changes suggestive of pelvic floor dysfunction as characterized by a larger bladder capacity, longer interval between contractions and prolonged contraction duration. PMID:26682025

  19. Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs

    PubMed Central

    Stafford, Ryan E.; Mazzone, Stuart; Ashton-Miller, James A.; Constantinou, Christos

    2014-01-01

    Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28–42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism. PMID:24526580

  20. Pelvic floor complaints in gastroenterology practice: results of a survey in the netherlands

    PubMed Central

    Nicolai, Melianthe P J; Fidder, Herma H; Bekker, Milou D; Putter, Hein; Pelger, Rob C M; Elzevier, Henk W

    2012-01-01

    Objective The pelvic floor is an integrated structure; dysfunctions may lead to a wide range of symptoms, involving voiding, defecation and sexual functioning (SF). Functional symptoms such as constipation and lower abdominal pain are often caused by pelvic floor dysfunction (PFD), and they highly impact the quality of life. Multiple specialists are responsible for a specific part of the pelvic floor, but its treatment asks for a holistic approach. The authors are still unaware of gastroenterologists' knowledge on PFD or whether they are addressing pelvic floor complaints in their daily practice. Design A 42-itemed anonymous questionnaire was mailed to all 402 members of the Dutch Society of Gastroenterology (gastroenterologists and residents-in-training). Results 169 (42%) questionnaires were analysed. Most gastroenterologists address lower urinary tract symptoms in their history-taking, 92% in female patients and 84% in male patients. When patients indicate irritable bowel syndrome-like complaints, more than 60% of the physicians inquire about SF to their female patients, compared with 38% inquiries to male patients (p<0.001). A reason not to inquire about SF is a lack of knowledge about female and male sexuality (19% and 23%, respectively). Forty-six per cent of the respondents regard it rather important to receive more training on PFD in male patients versus 61% in female patients. Conclusion Awareness of PFD is not yet routinely integrated into the history taken by gastroenterologists. PMID:24124626

  1. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach

    PubMed Central

    Palleschi, Giovanni; Fuschi, Andrea; Maggioni, Cristina; Rago, Rocco; Zucchi, Alessandro; Costantini, Elisabetta; Carbone, Antonio

    2014-01-01

    Objectives: Premature ejaculation is the most common male sexual disorder. The aim of the study was to evaluate the possible therapeutic role of pelvic floor muscle rehabilitation in patients affected by lifelong premature ejaculation. Methods: We treated 40 men with lifelong premature ejaculation, reporting, a baseline intravaginal ejaculatory latency time (IELT) ≤ 1 min, with 12-week pelvic floor muscle rehabilitation. Results: At the end of the rehabilitation, mean IELTs were calculated to evaluate the effectiveness of the therapy. At the end of the treatment, 33 (82.5%) of the 40 patients gained control of their ejaculatory reflex, with a mean IELT of 146.2 s (range: 123.6–152.4 s). A total of 13 out of 33 (39%) patients were evaluated at 6 months follow up, and they maintained a significant IELT (112.6 s) compared with their initial IELT (mean 39.8 s). Conclusions: The results obtained in our subjects treated with pelvic floor rehabilitation are promising. This therapy represents an important cost reduction compared with the standard treatment (selective serotonin reuptake inhibitors). Based on the present data, we propose pelvic floor muscle rehabilitation as a new, viable therapeutic option for the treatment of premature ejaculation. PMID:24883105

  2. Dose-Effect Relationships for Individual Pelvic Floor Muscles and Anorectal Complaints After Prostate Radiotherapy

    SciTech Connect

    Smeenk, Robert Jan; Hoffmann, Aswin L.; Hopman, Wim P.M.; Lin, Emile N.J. Th. van; Kaanders, Johannes H.A.M.

    2012-06-01

    Purpose: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). Methods and Materials: In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed. Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. Results: The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: {<=}30 Gy to the IAS; {<=}10 Gy to the EAS; {<=}50 Gy to the PRM; and {<=}40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Conclusions: Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus are

  3. Defecography: a still needful exam for evaluation of pelvic floor diseases.

    PubMed

    Gazzani, Silvia Eleonora; Marcantoni, Emanuela Angela; Capretti, Giovanni; Trunfio, Vincenzo; Bacchini, Emanuele; Artioli, Giulia; Paladini, Ilaria; Seletti, Valeria; Milanese, Gianluca; Barbalace, Sandro; Borgia, Daniele; Bresciani, Paolo

    2016-01-01

    The aim of this discussion is to describe what is a defecography, how we have to perform it, what can we see and to present the main physio-pathological illnesses of pelvic floor and anorectal region that can be studied with this method and its advantages over other screening techniques. Defecography is a contrastographic radiological examination that highlights structural and functional pelvic floor diseases. Upon preliminary ileum-colic opacification giving to patient radiopaque contrast, are first acquired static images (at rest, in maximum voluntary contraction of the pelvic muscles, while straining) and secondarily dynamic sequences (during evacuation), allowing a complete evaluation of the functionality of the anorectal region and the pelvic floor. Defecography is an easy procedure to perform widely available, and economic, carried out in conditions where the patient experiences symptoms, the most realistic possible. It can be still considered reliable technology and first choice in many patients in whom the clinic alone is not sufficient and it is not possible or necessary to perform a study with MRI. PMID:27467865

  4. Dynamic Magnetic Resonance Imaging and pelvic floor disorders: how and when?

    PubMed

    Pizzoferrato, Anne-Cécile; Nyangoh Timoh, Krystel; Fritel, Xavier; Zareski, Elise; Bader, Georges; Fauconnier, Arnaud

    2014-10-01

    Pelvic Floor Disorders (PFD) are a major public health problem in the world and decrease seriously the patient's quality of life. In case of recurrence after surgery or complex prolapse, imaging techniques can be used. Dynamic MRI, introduced in the early 1990s, offers information of the four compartments of the pelvis with a high resolution and a direct visualization of muscles and fascias in multiple planes. But for a practical use, such an expensive exam should be well correlated to symptoms and clinical examination or change surgical approach. The aim of our review was to precise the evidence regarding techniques, and indication of dynamic MRI in the assessment of pelvic floor disorders in daily practice. The first part is a review of available studies on methods of carrying out the dynamic MRI. The second part consists on the comparison of dynamic MRI to other assessment methods in case of pelvic floor disorders. Results emphasize the lack of strong level studies about the interest of dynamic MRI in the diagnosis and surgical management of pelvic organ prolapse. Although dynamic MRI appears highly reproducible between examiners, especially for the anterior compartment, its correlation with the degree of prolapse or the symptoms appears low. The most interesting field of application seems the detection of levator ani (LA) avulsion with a higher risk of prolapse and recidive in case of LA defects. More prospective, randomized, comparative studies have to be done. PMID:25212114

  5. [Magnetic stimulation of the pelvic floor in older patients. Results of a prospective analysis].

    PubMed

    Kirschner-Hermanns, R; Jakse, G

    2007-04-01

    Since 2001 magnetic stimulation therapy has been available in Germany for treating urinary incontinence as an alternative to traditional electrical stimulation therapy. The results of 83 patients who underwent magnetic stimulation therapy for stress incontinence, OAB, and pelvic pain syndrome were evaluated. The results differed depending on the underlying disease. Patients with stress incontinence who could not properly contract pelvic floor muscles before could do so in 74% when clinically evaluated and patients with OAB symptoms improved in 54% as assessed by objective and subjective criteria, whereas patients with pelvic pain syndrome only benefited in 23%. Comparison of the results according to age revealed no significant difference between patients >65 years and younger patients. PMID:17356834

  6. Effective use of the Bakri postpartum balloon for posthysterectomy pelvic floor hemorrhage.

    PubMed

    Charoenkwan, Kittipat

    2014-06-01

    After hysterectomy, massive pelvic floor hemorrhage sometimes occurs, especially in those who underwent complicated procedures. Conventional methods frequently fail to control this type of life-threatening bleeding. This report demonstrates the successful application of the large-volume Bakri balloon as a pelvic pressure pack for the control of intractable pelvic floor hemorrhage after hysterectomy in 3 consecutive cases. The Bakri balloon was introduced through the laparotomy incision and was passed inflation port first through a small posterior culdotomy to the vagina. The shaft of the balloon then was pulled through the vaginal canal. When proper tamponade position was achieved, the balloon was inflated gradually with sterile normal saline solution up to the minimal volume that effectively compressed against the pelvic floor and successfully controlled the hemorrhage. Continuous traction was used by the connection of the balloon shaft to a 1-L intravenous fluid bag that was hanging from the end of the bed. In all cases, the bleeding was controlled promptly when the balloons were filled up to 400-550 mL. The balloons were removed at bedside 24-30 hours after the operation. On follow-up examination, all patients recovered well without complication. From the author's experience, pelvic pressure packing with the Bakri balloon can be an immediate lifesaver. It is safe and readily applicable and provides a period of temporary hemostasis during which time volume replacement and coagulation defect correction can be obtained. The balloon pack can be removed vaginally without the need for reexploration. It is easy and fast to assemble, apply, and remove. In addition, the size of the balloon pack is adjustable easily to match the size of hemorrhagic areas by merely inflating or deflating the balloon. Furthermore, it is convenient to monitor continuing intraabdominal blood loss through the balloon's drainage port without the need for an additional drain. Further

  7. Pelvic floor physical therapy for lifelong vaginismus: a retrospective chart review and interview study.

    PubMed

    Reissing, Elke D; Armstrong, Heather L; Allen, Caroline

    2013-01-01

    Pelvic floor physical therapy is used in the treatment of sexual pain disorders; however, women with lifelong vaginismus have not yet been included in treatment studies or have not been differentiated from women with acquired vaginismus and/or dyspareunia. This retrospective chart review and interview study was intended to obtain initial information on physical therapy interventions, course, and outcome in women who have never been able to experience vaginal intercourse. The files of 53 women, consecutively treated at one physical therapy clinic, were included in the chart review; 13 of these women volunteered to be interviewed. The chart review revealed significant pelvic floor pathology and an average treatment course of 29 sessions. Internal manual techniques were found to be most effective, followed by patient education, dilatation exercises, and home exercises. Although participants were very satisfied with the physical therapy, some symptoms, such as pain, anxiety/fear, and pelvic floor tension remained and scores on the Female Sexual Distress Scale and Female Sexual Function Index indicated clinical levels of sexual distress and impaired sexual function after treatment. Although there appears to be no linear relation between symptom reduction and healthy sexual function, this initial information suggests that physical therapy may be a promising treatment option for some women with lifelong vaginismus and merits further evaluation. PMID:23470141

  8. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    PubMed

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03). PMID:25708131

  9. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction.

    PubMed

    Rogalski, Matthew J; Kellogg-Spadt, Susan; Hoffmann, Amy R; Fariello, Jennifer Y; Whitmore, Kristene E

    2010-07-01

    To study intravaginal diazepam suppositories as adjunctive treatment for high-tone pelvic floor dysfunction (HTPFD) and sexual pain. A retrospective chart review was conducted on 26 patients who received diazepam suppositories as adjuvant therapy to pelvic physical therapy and intramuscular trigger point injections for bladder pain, sexual pain, and levator hypertonus. Pelvic floor muscular tone and pain were assessed by palpation and perineometry; sexual pain was objectively rated by Female Sexual Function Index (FSFI) and the Visual Analog Scale for Pain (VAS-P). Twenty-five out of 26 patients reported subjective improvement with suppository use; six out of seven sexually active patients resumed intercourse. Sexual pain as assessed on FSFI and serial VAS-P improved with diazepam (by 1.44 on 10-point scale, p = 0.14). PFM tone improved during resting (p < 0.001), squeezing (p = 0.014), and relaxation (p = 0.003) phases. Vaginal diazepam suppositories gave a clinically significant improvement in the treatment of HTPFD compared with the usual treatment regimen alone. PMID:20066399

  10. [MANAGEMENT OF VAGINAL CONES IN THE TREATMENT OF PELVIC FLOOR REHABILITATION].

    PubMed

    Onandia Garate, Maialen; Luces Lago, Ana María; Mosquera Pan, Lucía; Tizón Bouza, Eva

    2015-01-01

    The pelvic floor (PF) is a sheet of muscles and other tissues that support the pelvic organs in their physiological positions. Throughout women's lives, these structures can become weak or be injured by events such as pregnancy, childbirth, surgery, overweight or constipation. PF dysfunction includes a group of disorders causing urinary incontinence, as well as genital prolapse or pelvic pain, and can significantly deteriorate women's quality of life. Vaginal cones (VC) represent a non-pharmacological, economical, safe and non-invasive method for the treatment of PF dysfunction; they allow the patient to increase the physiological consciousness of the musculature of the PF while promoting an increase in the muscle tone. The midwife, as a professional intimately connected with women's health care, works with the multidisciplinary team which treats pelvic dysfunctions; therefore, they need to provide updated information about the different methods for improving perineal function, including VC, and providing advice on their use and management, and establishing individualized exercise programs and tracking information for each case. The available scientific evidence on the effectiveness of the VC is limited and there may be other methods to treat PF dysfunctions. PMID:26448995

  11. Pelvic floor muscle training for urgency urinary incontinence in women: a systematic review.

    PubMed

    Greer, Joy A; Smith, Ariana L; Arya, Lily A

    2012-06-01

    The objective of this study is to evaluate the effectiveness of existing physiotherapy modalities for the treatment of urge urinary incontinence (UUI). A systematic review was performed for primary studies of physiotherapy techniques for UUI published in English between 1996 and August 2010 in major electronic databases. Only randomized clinical trials that reported outcomes separately for women with UUI were included. Outcomes assessed were reduction in UUI, urinary frequency, and nocturia. Data from 13 full-text trials including the modalities of pelvic floor muscles exercises with or without biofeedback, vaginal electrical stimulation, magnetic stimulation, and vaginal cones were analyzed. The methodologic quality of these trials was fair. Significant improvement in UUI was reported for all physiotherapy techniques except vaginal cone therapy. There are insufficient data to determine if pelvic physiotherapy improves urinary frequency or nocturia. Evidence suggests that physiotherapy techniques may be beneficial for the treatment of UUI. PMID:22246576

  12. Prevalence and degree of bother from pelvic floor disorders in obese women

    PubMed Central

    Whitcomb, Emily L.; Lawrence, Jean M.; Nager, Charles W.; Luber, Karl M.

    2016-01-01

    We aimed to determine the prevalence and bother from pelvic floor disorders (PFD) by obesity severity, hypothesizing that both would increase with higher degrees of obesity. We performed a secondary analysis of 1,155 females enrolled in an epidemiologic study that used a validated questionnaire to identify PFD. Prevalence and degree of bother were compared across three obesity groups. Logistic regression assessed the contribution of degree of obesity to the odds of having PFD. Prevalence of any PFD was highest in morbidly (57%) and severely (53%) obese compared to obese women (44%). Regression models demonstrated higher prevalence of pelvic organ prolapse, overactive bladder, stress urinary incontinence, and any PFD in morbidly compared to obese women and higher prevalence of stress urinary incontinence in severely obese compared to obese women. Degree of bother did not vary by degree of obesity. Prevalence of PFD increases with higher degrees of obesity. PMID:19002365

  13. Can women correctly contract their pelvic floor muscles without formal instruction?

    PubMed Central

    Henderson, J. Welles; Wang, Siqing; Egger, Marlene J; Masters, Maria; Nygaard, Ingrid

    2012-01-01

    Objectives It is unknown how many women presenting for primary care can appropriately contract their pelvic floor muscle (PFM) or whether this ability differs between women with or without pelvic floor disorders. We sought to describe the proportion of women who initially incorrectly contract the PFM, and how many can learn after basic instruction. Methods This cross-sectional study enrolled 779 women presenting to community based primary care practices. During PFM assessment, research nurses recorded whether women could correctly contract their PFM after a brief verbal cue. We defined POP as prolapse to or beyond the hymen and SUI as a score of > 3 on the Incontinence Severity Index. Results PFM contraction was done correctly on first attempt in 85.5%, 83.4%, 68.6%, and 85.8% of women with POP, SUI, both POP and SUI and neither POP nor SUI, respectively (p=0.01 for difference between POP and SUI versus neither POP nor SUI). Of 120 women who initially incorrectly contracted the PFM, 94 (78%) learned after brief instruction. Women with POP were less likely to learn than women with neither POP nor SUI (54.3% vs. 85.7%, p=0.001). Increasing vaginal delivery and decreasing caffeine intake (but not age or other demographic factors) were associated with incorrect PFM contraction; only decreased caffeine intake remained significant on multivariable analysis. Conclusions Most women with no or mild pelvic floor disorders can correctly contract their PFM after a simple verbal cue, suggesting that population-based prevention interventions can be initiated without clinical confirmation of correct PFM technique. PMID:23321652

  14. Functional disorders of the ano-rectal compartment of the pelvic floor: clinical and diagnostic value of dynamic MRI.

    PubMed

    Maccioni, Francesca

    2013-10-01

    The obstructed defecation syndrome is the main functional disorder of the posterior or ano-rectal pelvic floor compartment. Different mechanical and functional rectal disorders may cause this syndrome, including rectocele, rectal invagination, rectal prolapse, and pubo-rectalis muscle dyskinesia. Since pelvic floor muscles and fasciae act as a unique functional entity, dysfunctions of the posterior compartment are usually associated to variable dysfunctions of the anterior and middle urogenital compartments as well. Over 50% of postmenopause women are affected by severe symptoms due to pelvic floor disorders, with frequent need of surgical invasive treatments. Both diagnosis of the specific ano-rectal dysfunction and identification of all possible associated disorders are mandatory for an effective surgical or conservative treatment. Currently, dynamic MRI provides an excellent morphological and functional display of the pelvic floor like no other imaging modality. Pros and cons of posterior pelvic floor MRI, different evaluation techniques, reference lines and grading systems together with the main imaging findings will be discussed and illustrated. PMID:23090206

  15. [Biometry and assessment of the levator hiatus by three-dimensional pelvic floor ultrasound].

    PubMed

    Dimitrov, R

    2013-01-01

    Images of the levator hiatus in 40 nulliparous, 40 asymptomatic parous women and 40 women with pelvic organ prolapse were obtained by transperineal/translabial three-dimentional ultrasonography of the pelvic floor. Volumes were taken at rest and during squeezing. Recontructed images of the levator hiatus at the plane of minimal dimentions were obtained by off-line processing of the stored volumes. The transverse, the longitudinal diameter and the area of the levator hiatus were measured at rest and during squeezing in the three groups. Qualitative assessment of the shape and the symmetry of the levator hiatus at rest was made, too. The average hiatal dimentions (transverse, longitudinal diameter and hiatal area) measured at rest in the three groups were: 35.8 mm, 43.1 mm and 11.84 cm2 in the nulliparous; 43.6 mm, 47.1 mm and 15.1 cm2 in the asymptomatic parous women and 50.5 mm, 57.2 mm and 25.8 cm2 in women with pelvic organ prolapse. Nulliparous women achieved the greatest reduction of hiatal area during squeezing (by 21% average). In asymptomatic parous women the hiatal area reduction averaged 12% while in women with pelvic organ prolapse the average reduction was by 4% only. Levator injury was detected in 7.5% of the asymptomatic parous women and in 22.5% of the women with pelvic organ prolapse. Left-sided injuries predominated. Three-dimentional ultrasound provides easy and high-quality imaging of the pubovisceral miscles for the objective assessment of the levator hiatus in static and dynamic conditions. PMID:23807973

  16. Anatomic variations of the pelvic floor nerves adjacent to the sacrospinous ligament: a female cadaver study.

    PubMed

    Lazarou, George; Grigorescu, Bogdan A; Olson, Todd R; Downie, Sherry A; Powers, Kenneth; Mikhail, Magdy S

    2008-05-01

    Our objective was to document variations in the topography of pelvic floor nerves (PFN) and describe a nerve-free zone adjacent to the sacrospinous ligament (SSL). Pelvic floor dissections were performed on 15 female cadavers. The course of the PFN was described in relation to the ischial spine (IS) and the SSL. The pudendal nerve (PN) passed medial to the IS and posterior to the SSL at a mean distance of 0.6 cm (SD = +/-0.4) in 80% of cadavers. In 40% of cadavers, an inferior rectal nerve (IRN) variant pierced the SSL at a distance of 1.9 cm (SD = +/-0.7) medial to the IS. The levator ani nerve (LAN), coursed over the superior surface of the SSL-coccygeus muscle complex at a mean distance of 2.5 cm (SD = +/-0.7) medial to the IS. Anatomic variations were found which challenge the classic description of PFN. A nerve-free zone is situated in the medial third of the SSL. PMID:18038107

  17. Phased surgical treatment of barium enema-induced rectal injury and retention of barium in the pelvic floor space

    PubMed Central

    Yang, Xuefei; Xia, Ligang; Huang, Jun; Wang, Jianping

    2014-01-01

    Iatrogenic injuries caused by barium enema are rarely reported. Following a phased surgical protocol for up to one year, we have successfully treated a patient with rectal injury and severe infection of the pelvic floor space complicated with retention of large amounts of barium and vaginal fistula. In this article, the phased surgery planning for the treatment of rectal injury complicated with vaginal fistula is discussed in terms of the pros and cons, and the observed effect and evolution of barium retained in the pelvic floor space are described. PMID:25405155

  18. Elder American Indian Women's Knowledge of Pelvic Floor Disorders and Barriers to Seeking Care

    PubMed Central

    Dunivan, Gena C; Komesu, Yuko M; Cichowski, Sara B; Lowery, Christine; Anger, Jennifer T; Rogers, Rebecca G

    2014-01-01

    Objectives To evaluate urinary incontinence and pelvic organ prolapse knowledge among elder Southwestern American Indian women and to assess barriers to care for pelvic floor disorders through Community Engaged Research. Methods Our group was invited to provide an educational talk on urinary incontinence and pelvic organ prolapse at an annual meeting of American Indian Elders. Female attendees ≥55 years anonymously completed demographic information and two validated questionnaires; the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Questionnaire results were compared to historical controls from the original PIKQ and BICS-Q validation study. Results 144 women completed questionnaires. The mean age was 77.7 ± 9.1 years. The mean PIKQ UI score was 6.6 ± 3.0 (similar to historic gynecology controls 6.8 ± 3.3, p=0.49) and the mean PIKQ POP score was 5.4 ± 2.9 (better than historic gynecology controls 3.6 ± 3.2, p<0.01). Barriers to care seeking reported by the elder women were highest on the BICS-Q subscales of “Cost” and “Inconvenience”. Conclusions Urinary incontinence knowledge is similar to historic gynecology controls and pelvic organ prolapse knowledge is higher than historic gynecology controls among elder Southwestern American Indian women. American Indian elder women report high levels of barriers to care. The greatest barriers to care seeking for this population were related to cost and inconvenience, reflecting the importance of assessing socioeconomic status when investigating barriers to care. Addressing these barriers may enhance care seeking Southwestern American Indian women. PMID:25185612

  19. Food, fibre, bile acids and the pelvic floor: An integrated low risk low cost approach to managing irritable bowel syndrome

    PubMed Central

    Philpott, Hamish; Nandurkar, Sanjay; Lubel, John; Gibson, Peter R

    2015-01-01

    Patients presenting with abdominal pain and diarrhea are often labelled as suffering from irritable bowel syndrome, and medications may be used often without success. Advances in the understanding of the causes of the symptoms (including pelvic floor weakness and incontinence, bile salt malabsorption and food intolerance) mean that effective, safe and well tolerated treatments are now available. PMID:26525925

  20. Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery-Presentation and Management.

    PubMed

    Cohen, Seth A; Goldman, Howard B

    2016-09-01

    Perforation of a viscus with a mesh product either during or subsequent to pelvic floor reconstruction can be associated with devastating outcomes. If surgeons are going to place mesh, they also need to be familiar with symptoms concerning for perforation. The index of suspicion should always be present, as these patients can present years after initial mesh placement. The best opportunity for intervention in these serious complications is the first intervention. As bits of mesh are chipped away during attempted interventions, residual mesh fragments become disjointed, frayed, and scarred further, making their removal even more challenging, in addition to traumatizing likely already weakened tissues. This review presents strategies for patient evaluation in the setting of possible mesh perforation, in addition to treatment strategies for urethral, bladder, ureteral, and colonic/rectal injury. Ultimately, the decision as to how much mesh is removed should be based on each patient's unique presentation. PMID:27438809

  1. Complementary and alternative medicine (CAM) use in women with pelvic floor disorders: a cohort study

    PubMed Central

    Slavin, Shannon L.; Komesu, Yuko; Omotosho, Tola; Hammil, Sarah; Lewis, Cindi; Sapien, Robert

    2013-01-01

    Introduction and hypothesis The objective of this study was to compare complementary and alternative medicine (CAM) use in women with and without pelvic floor disorders (PFD). Methods We conducted a survey of women presenting to a specialty urogynecology (Urogyn) and gynecology (Gyn) clinic that examined demographic data, CAM use, and the presence of PFD (validated questionnaires). T tests, Fisher’s exact tests, and logistic regression were used for analysis. To detect a 20% difference between groups, 234 Urogyn and 103 Gyn patients were needed. Results Participants included 234 Urogyn and 103 Gyn patients. Urogyn patients reported more CAM use than Gyn patients, even when controlled for differences between groups (51% vs. 32%, adjusted p=0.006). Previous treatment (61% vs. 39%, adjusted p<0.001) and increased number of PFD was associated with increased CAM use (adjusted p=0.02). Conclusions Women with PFD use CAM more frequently than women without PFD. PMID:19967336

  2. Reliability of Superficial Male Pelvic Floor Structural Measurements Using Linear-Array Transperineal Sonography

    PubMed Central

    Roll, Shawn C.; Rana, Manku; Sigward, Susan M.; Yani, Moheb S.; Kirages, Daniel J.; Kutch, Jason J.

    2014-01-01

    This study evaluated reliability of measures for superficial structures of the male pelvic floor (PF) obtained via transperineal sonography. Two embalmed cadavers were dissected to identify positioning of muscles on and around the bulb of the penis and to confirm the PF protocol. Cross-sectional area (CSA) and linear thickness of the bulb of the penis, urethra, bulbospongiosus (BS) muscles, and ischiocavernosus (IC) muscles were measured on 38 transverse images from 20 male subjects by three raters with varied study knowledge and sonographic experience. Intra- and interrater reliability were calculated with Two-way, mixed effects intra-class correlation coefficients. Measures of the bulb of the penis had the best reliability. CSA of all muscles and sagittal thickness of the BS near the central tendon had good reliability. Reliability varied for rater identified thickest muscle region and measures of the urethra. Our study suggests that structures of the male PF can be reliably evaluated using a transperineal sonographic approach. PMID:25444690

  3. Translabial ultrasound in the assessment of pelvic floor and anorectal function in women with defecatory disorders.

    PubMed

    Dietz, H P

    2014-05-01

    This article shows how modern ultrasound imaging can contribute to the investigation of patients with posterior vaginal wall prolapse, obstructed defecation, fecal incontinence and rectal intussusception/prolapse, conditions that should be similarly relevant and of interest to colorectal surgeons, gastroenterologists and gynecologists. Translabial/perineal ultrasound, a simple, universally available technique, may serve as a first-line diagnostic tool in women with posterior compartment prolapse and/or symptoms of obstructed defecation, largely replacing defecation proctography and magnetic resonance proctography. This has advantages for healthcare systems, since sonographic imaging is less expensive, non-invasive, less time-consuming and does not involve radiation exposure. However, there is a substantial need for teaching that remains unmet to date. This article illustrates in details the technique of translabial ultrasonography adopted by our unit and reviews the literature supporting this method of assessing pelvic floor and anorectal function in women with defecatory disorders. PMID:24515287

  4. The impact of the pelvic floor muscles on dynamic ventilation maneuvers

    PubMed Central

    Park, Hankyu; Hwang, Byoungha; Kim, Yeoungsung

    2015-01-01

    [Purpose] The aim of the present study was to examine the impact of the pelvic floor muscles (PFM) on dynamic ventilation maneuvers. [Subjects and Methods] The subjects were 19 healthy female adults in their 20s who consented to participate in the present study. Electromyography (EMG) was used to examine respiratory muscle activity, and a spirometer was used to examine vital capacity before and during contraction of the PFM. [Results] There were statistically significant differences in the sternocleidomastoid (SCM), rectus abdominis (RA), external oblique (EO), transverse abdominis/internal oblique (TrA/IO), and maximal voluntary ventilation (MVV) when the PFM was contracted. [Conclusion] Contraction of the PFM can be effective in promoting activation of the respiratory muscles and vital capacity. Therefore, the PFM should be considered to improve the effects of respiratory activity. PMID:26644664

  5. Posterior pelvic floor disorders and obstructed defecation syndrome: clinical and therapeutic approach.

    PubMed

    Zbar, Andrew P

    2013-10-01

    There are no clear recommended imaging guidelines for the assessment of patients presenting primarily with obstructed defecation syndrome and defecation difficulty. The gold standard has always been the defecating proctogram which may require a rather poorly tolerated extended technique involving high-radiation exposure in young women which includes cystography, vaginography, small bowel opacification, and occasional peritoneography. The development of dynamic magnetic resonance imaging has obviated many of these extended techniques and may be supplemented by novel ultrasonographic methods including dynamic transperineal sonography, real-time 3D translabial ultrasound and 3D dynamic echodefecography. Patients potentially suitable for surgical treatment display a multiplicity of pelvic floor and perineal soft-tissue anomalies where one pathology (such as rectocele or enterocele) are considered dominant. Despite the introduction of recent stapled and robotic technologies, there is a dual dialog concerning the functional outcome of these procedures. Imaging and surgical algorithms for these patients are provided. PMID:22415627

  6. Association between the Functionality of Pelvic Floor Muscles and Sexual Satisfaction in Young Women.

    PubMed

    Darski, Caroline; Barbosa, Lia Janaina Ferla; Paiva, Luciana Laureano; Vieira, Adriane

    2016-04-01

    Objective The objective of this study is to associate the results obtained while assessing the pelvic floor muscles (PFM) functionality with the score of sexual satisfaction of young adult women. Methods This is an observational and cross-sectional study. The inclusion criteria were women aged between 20 and 40 years who have had sexual intercourse, nulliparous, BMI lower than 25 kg/m(2), and absence of pelvic floor dysfunction. The evaluation consisted of both the medical history and assessment of the PFM functionality using the Perina pressure biofeedback and Oxford Scale. We measured sexual satisfaction using the Female Sexual Quotient questionnaire and used the Kolmogorov-Smirnov test to verify the normality of the data. We analyzed non-parametric variables using the Spearman correlation test. The significance level was 5%. Results A total of 80 women with a median age of 26 years and median BMI of 21.64 kg/m(2) participated in this study. We divided the subjects into two groups, best and worse PFM functionality, according to median Perina pressure biofeedback and Oxford scale. We found no difference between the groups when comparing the sexual satisfaction scores. There was only a slight significant correlation between the Contraction Voluntary Average obtained using the pressure biofeedback and the primary domain (r = 0.27; p = 0.01). Conclusion This study found a slight correlation between PFM functionality and the functionality of the primary domain of the Female Sexual Quotient questionnaire. Therefore, it is not possible to state whether there is an association between the PFM functionality and female sexual satisfaction in young adults. PMID:27088707

  7. Intra and inter-rater reliability study of pelvic floor muscle dynamometric measurements

    PubMed Central

    Martinho, Natalia M.; Marques, Joseane; Silva, Valéria R.; Silva, Silvia L. A.; Carvalho, Leonardo C.; Botelho, Simone

    2015-01-01

    OBJECTIVE: The aim of this study was to evaluate the intra and inter-rater reliability of pelvic floor muscle (PFM) dynamometric measurements for maximum and average strengths, as well as endurance. METHOD: A convenience sample of 18 nulliparous women, without any urogynecological complaints, aged between 19 and 31 (mean age of 25.4±3.9) participated in this study. They were evaluated using a pelvic floor dynamometer based on load cell technology. The dynamometric evaluations were repeated in three successive sessions: two on the same day with a rest period of 30 minutes between them, and the third on the following day. All participants were evaluated twice in each session; first by examiner 1 followed by examiner 2. The vaginal dynamometry data were analyzed using three parameters: maximum strength, average strength, and endurance. The Intraclass Correlation Coefficient (ICC) was applied to estimate the PFM dynamometric measurement reliability, considering a good level as being above 0.75. RESULTS: The intra and inter-raters' analyses showed good reliability for maximum strength (ICCintra-rater1=0.96, ICCintra-rater2=0.95, and ICCinter-rater=0.96), average strength (ICCintra-rater1=0.96, ICCintra-rater2=0.94, and ICCinter-rater=0.97), and endurance (ICCintra-rater1=0.88, ICCintra-rater2=0.86, and ICCinter-rater=0.92) dynamometric measurements. CONCLUSIONS: The PFM dynamometric measurements showed good intra- and inter-rater reliability for maximum strength, average strength and endurance, which demonstrates that this is a reliable device that can be used in clinical practice. PMID:25993624

  8. The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study

    PubMed Central

    Lone, F; Stankiewicz, A; Thakar, R

    2014-01-01

    Objective: Comprehensive assessment of the pelvic floor (PF) provides information and diagnoses of coexisting abnormalities that may affect operative decisions. Our aim was to establish if pre-operative PF ultrasonography (PFUS) in patients complaining of PF dysfunction can complement clinical findings and contribute to additional management strategies. Methods: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent pelvic organ prolapse quantification (POPQ) by an independent examiner. PFUS was performed using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. The clinician performing PFUS was blinded to POPQ results. POPQ and PFUS were repeated at 1 year. Two clinicians analysed the scans independently. Results: 158 of 160 females had a POPQ and PFUS. 105 females had pelvic organ prolapse and/or incontinence and 53 asymptomatic females were controls. 26 additional ultrasound diagnoses were noted at baseline and 46 at 1 year using 2D-TPUS and EVUS. Only one female with additional diagnoses on PFUS needed surgical intervention for this condition. Conclusion: Multicompartment PFUS identifies additional conditions to that diagnosed on clinical assessment. However, it neither changes the initial surgical management nor the management at 1-year follow-up and therefore clinical assessment should not be substituted by PFUS. Advances in knowledge: PFUS can be helpful in providing additional information; however, it does not change the initial management of the patient and therefore should not replace clinical assessment. PMID:24959953

  9. Randomized Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-type Constipation

    PubMed Central

    Heymen, Steve; Scarlett, Yolanda; Jones, Kenneth; Ringel, Yehuda; Drossman, Douglas; Whitehead, William E.

    2013-01-01

    Purpose To determine whether biofeedback is more effective than diazepam or placebo in a randomized controlled trial for patients with pelvic floor dyssynergia-type constipation, and whether instrumented biofeedback is necessary for successful training. Methods One hundred seventeen patients participated in a 4-week run-in (education and medical management). The 84 who remained constipated were randomized to Biofeedback (n=30); Diazepam (n=30); or Placebo (n=24). All patients were trained to do pelvic floor muscle exercises to correct pelvic floor dyssynergia during 6 biweekly 1-hour sessions, but only Biofeedback patients received electromyography feedback. All other patients received pills 1-2 hours before attempting defecation. Diary data on cathartic use, straining, incomplete bowel movements, Bristol stool scores, and compliance with homework were reviewed biweekly. Results Before treatment, the groups did not differ on demographic (average age 50, 85 percent females), physiologic or psychologic characteristics, severity of constipation, or expectation of benefit. Biofeedback was superior to diazepam by intention to treat analysis (70 percent vs. 23 percent reported adequate relief of constipation 3 months after treatment, χ2 = 13.1, p < 0.001), and also superior to placebo (38 percent successful, χ2 = 5.7, p = 0.017). Biofeedback patients had significantly more unassisted bowel movements at follow-up compared to Placebo (p = .005), with a trend favoring biofeedback over diazepam (p = .067). Biofeedback patients reduced pelvic floor electromyography during straining significantly more than diazepam patients (p < 0.001). Conclusions This investigation provides definitive support for the efficacy of biofeedback for pelvic floor dyssynergia and shows that instrumented biofeedback is essential to successful treatment. PMID:19966605

  10. SEXUAL FUNCTION AND PESSARY MANAGEMENT AMONG WOMEN USING A PESSARY FOR PELVIC FLOOR DISORDERS

    PubMed Central

    MERIWETHER, Kate V.; KOMESU, Yuko; CRAIG, Ellen; QUALLS, Clifford; DAVIS, Herbert; ROGERS, Rebecca G.

    2016-01-01

    Introduction Pessaries are commonly used to treat pelvic floor disorders, but little is known about the sexual function of pessary users. Aim We aimed to describe sexual function among pessary users and pessary management with regard to sexual activity. Methods This is a secondary analysis of a randomized trial of new pessary users, where study patients completed validated questionnaires on sexual function and body image at pessary fitting and 3 months later. Main outcome measures Women completed the Pelvic Organ Prolapse - Urinary Incontinence Sexual Function Questionnaire, IUGA Revised (PISQ-IR), a validated measure that evaluates the impact of pelvic floor disorders on sexual function, a modified female body image scale (mBIS), and questions regarding pessary management surrounding sexual activity. Results Of 127 women, 54% (68/127) were sexually active at baseline and 42% (64/114) were sexually active at 3 months. Sexual function scores were not different between baseline and 3 months on all domains except for a drop of 0.15 points (p=0.04) for sexually active women and a drop of 0.34 points for non-sexually active women (p=0.02) in the score related to the sexual partner. Total mBIS score did not change (p=0.07), but scores improved by 0.2 points (p=0.03) in the question related to self-consciousness. Pessary satisfaction was associated with improved sexual function scores in multiple domains and improved mBIS scores. The majority (45/64, 70%) of sexually active women removed their pessary for sex, with over half stating their partner preferred removal for sex (24/45, 53%). Conclusion Many women remove their pessary during sex for partner considerations, and increased partner concerns are the only change seen in sexual function in the first 3 months of pessary use. Pessary use may improve self-consciousness and pessary satisfaction is associated with improvements in sexual function and body image. PMID:26632106

  11. Concentration of Non-Steroidal Anti-Inflammatory Drugs in the Pelvic Floor Muscles: An Experimental Comparative Rat Model

    PubMed Central

    Chin, Hung-Yen; Changchien, Eileen; Lin, Mei-Fung; Chiang, Chi-Hsin

    2014-01-01

    Purpose The aim of this study is to explore non-steroid anti-inflammation drugs (NSAIDs) potency for pelvic floor muscle pain by measuring local concentration in a rat model. Materials and Methods We used nine NSAIDs, including nabumetone, naproxen, ibuprofen, meloxicam, piroxicam, diclofenac potassium, etodolac, indomethacin, and sulindac, and 9 groups of female Wister rats. Each group of rats was fed with one kind of NSAID (2 mg/mL) for three consecutive days. Thereafter, one mL of blood and one gram of pelvic floor muscle were taken to measure drug pharmacokinetics, including partition coefficient, lipophilicity, elimination of half-life (T1/2) and muscle/plasma converting ratio (Css, muscle/Css, plasma). Results Diclofenac potassium had the lowest T1/2 and the highest mean Css, muscle/Css, plasma (1.9 hours and 0.85±0.53, respectively). The mean Css, muscle/Css, plasma of sulindac, naproxen and ibuprofen were lower than other experimental NSAIDs. Conclusion Diclofenac potassium had the highest disposition in pelvic floor muscle in a rat model. The finding implies that diclofenac potassium might be the choice for pain relief in pelvic muscle. PMID:24954342

  12. Physical Therapy in the Management of Pelvic Floor Muscles Hypertonia in a Woman with Hereditary Spastic Paraplegia

    PubMed Central

    Ribeiro, Aline Moreira; Ferreira, Cristine Homsi Jorge; Cristine Lemes Mateus-Vasconcelos, Elaine; Moroni, Rafael Mendes; Brito, Luciane Maria Oliveira; Brito, Luiz Gustavo Oliveira

    2014-01-01

    Background. Pelvic floor (PF) hypertonic disorders are a group of conditions that present with muscular hypertonia or spasticity, resulting in a diminished capacity to isolate, contract, and relax the PF. Their presentation includes voiding and sexual dysfunctions, pelvic pain, and constipation. Various factors are associated, such as complicated vaginal birth, muscular injury, scar tissue formation, and neuropathies. Study Design. The case of a single patient will be presented, together with the management strategies employed. Case Description. A woman with hereditary spastic paraparesis and a history of muscle spasticity and urinary and fecal complaints since childhood. She presented to this institution seeking treatment for pelvic pain, pain during intercourse, constipation, and micturition problems. A physical therapy protocol was developed, with the trial of several treatment modalities. Outcome. After some failed attempts, perineal and pelvic floor stretching proved to be very efficacious therapies for this patient's complaint, leading to improved pain during intercourse, constipation, pelvic pain, and urinary stream. Discussion. PF spasticity can lead to severe disability and interfere with daily basic functions, such as micturition and evacuation. Physical therapy plays an essential role in the management of these patients and can lead to significant improvement in quality of life. PMID:25478261

  13. Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study.

    PubMed

    Almeida, M B A; Barra, A A; Saltiel, F; Silva-Filho, A L; Fonseca, A M R M; Figueiredo, E M

    2016-09-01

    The pelvic floor (PF) provides support to all pelvic organs, as well as appropriately closure/opening mechanism of the urethra, vagina, and anus. Therefore, it is likely that female athletes involved in high-impact and in strong-effort activities are at risk for the occurrence of urinary incontinence (UI). This study aimed to investigate the occurrence of UI and other PF dysfunctions (PFD) [anal incontinence (AI), symptoms of constipation, dyspareunia, vaginal laxity, and pelvic organ prolapse] in 67 amateur athletes (AT) compared with a group 96 of nonathletes (NAT). An ad hoc survey based on questions from reliable and valid instruments was developed to investigate the occurrence of PFD symptoms. The risk of UI was higher in AT group (odds ratio: 2.90; 95% CI: 1.50-5.61), mostly among artistic gymnastics and trampoline, followed by swimming and judo athletes. Whereas, AT group reported less straining to evacuate (OR: 0.46; 95% CI: 0.22-0.96), manual assistance to defecate (OR: 0.24; 95% CI: 0.05-1.12), and a higher stool frequency (OR: 0.29; 95% CI: 0.13-0.64) than NAT group. The occurrence of loss of gas and sexual symptoms was high for both groups when compared with literature, although with no statistical difference between them. Pelvic organ prolapse was only reported by nonathletes. Athletes are at higher risk to develop UI, loss of gas, and sexual dysfunctions, either practicing high-impact or strong-effort activities. Thus, pelvic floor must be considered as an entity and addressed as well. Also, women involved in long-term high-impact and strengthening sports should be advised of the impact of such activities on pelvic floor function and offered preventive PFD strategies as well. PMID:26369504

  14. Architectural design of the pelvic floor is consistent with muscle functional subspecialization

    PubMed Central

    Tuttle, Lori J.; Nguyen, Olivia T.; Cook, Mark S.; Alperin, Marianna; Shah, Sameer B.; Ward, Samuel R.

    2014-01-01

    Introduction and hypothesis Skeletal muscle architecture is the strongest predictor of a muscle’s functional capacity. The purpose of this study was to define the architectural properties of the deep muscles of the female pelvic floor (PFMs) to elucidate their structure–function relationships. Methods PFMs coccygeus (C), iliococcygeus (IC), and pubovisceral (PV) were harvested en bloc from ten fixed human cadavers (mean age 85 years, range 55–102). Fundamental architectural parameters of skeletal muscles [physiological cross-sectional area (PCSA), normalized fiber length, and sarcomere length (Ls)] were determined using validated methods. PCSA predicts muscle-force production, and normalized fiber length is related to muscle excursion. These parameters were compared using repeated measures analysis of variance (ANOVA) with post hoc t tests, as appropriate. Significance was set to α=0.05. Results PFMs were thinner than expected based on data reported from imaging studies and in vivo palpation. Significant differences in fiber length were observed across PFMs: C=5.29±0.32 cm, IC=7.55±0.46 cm, PV=10.45±0.67 cm (p<0.001). Average Ls of all PFMs was short relative to the optimal Ls of 2.7 µm of other human skeletal muscles: C=2.05±0.02 µm, IC=2.02±0.02 µm, PC/PR=2.07±0.01 µm (p=<0.001 compared with 2.7 µm; p=0.15 between PFMs, power=0.46). Average PCSA was very small compared with other human muscles, with no significant difference between individual PFMs: C=0.71±0.06 cm2, IC=0.63±0.04 cm2, PV=0.59±0.05 cm2 (p=0.21, power=0.27). Overall, C had shortest fibers, making it a good stabilizer. PV demonstrated the longest fibers, suggesting that it functions to produce large excursions. Conclusions PFM design shows individual muscles demonstrating differential architecture, corresponding to specialized function in the pelvic floor. PMID:23903821

  15. Pregnancy-induced adaptations in the intrinsic structure of rat pelvic floor muscles

    PubMed Central

    Alperin, Marianna; Lawley, Danielle M.; Esparza, Mary C.; Lieber, Richard L.

    2016-01-01

    OBJECTIVE Maternal birth trauma to the pelvic floor muscles (PFMs) is a major risk factor for pelvic floor disorders. Modeling and imaging studies suggest that demands placed on PFMs during childbirth exceed their physiologic limits; however many parous women do not sustain PFM injury. Here we determine whether pregnancy induces adaptations in PFM architecture, the strongest predictor of muscle function, and/or intramuscular extracellular matrix (ECM), responsible for load bearing. To establish if parallel changes occur in muscles outside of the PFM, we also examined a hind limb muscle. STUDY DESIGN Coccygeus, iliocaudalis, pubocaudalis, and tibialis anterior of 3-month-old Sprague-Dawley virgin, mid-pregnant, and late-pregnant; 6-month-old virgin; and 4- and 12-week postpartum rats (N = 10/group) were fixed in situ and harvested. Major architectural parameters determining muscle’s excursion and force-generating capacity were quantified, namely, normalized fiber length (Lfn), physiologic cross-sectional area, and sarcomere length. Hydroxyproline content was used as a surrogate for intramuscular ECM quantity. Analyses were performed by 2-way analysis of variance with Tukey post hoc testing at a significance level of .05. RESULTS Pregnancy induced a significant increase in Lfn in all PFMs by the end of gestation relative to virgin controls. Fibers were elongated by 37% in coccygeus (P < .0001), and by 21% in iliocaudalis and pubocaudalis (P < .0001). Importantly, no Lfn change was observed in the tibialis anterior. Physiologic cross-sectional area and sarcomere length were not affected by pregnancy. By 12 weeks’ postpartum, Lfn of all PFMs returned to the prepregnancy values. Relative to virgin controls, ECM increased by 140% in coccygeus, 52% in iliocaudalis, and 75% in pubocaudalis in late-pregnant group, but remained unchanged across time in the tibialis anterior. Postpartum, ECM collagen content returned to prepregnancy levels in iliocaudalis and pubocaudalis

  16. Treatment decision-making and information-seeking preferences in women with pelvic floor disorders

    PubMed Central

    Raker, Christina A.; Myers, Deborah L.; Clark, Melissa A.

    2010-01-01

    Introduction and hypothesis The Autonomy Preference Index (API) and Control Preferences Scale (CPS) measure information-seeking and decision-making preferences. Our objective was to validate these scales in women with pelvic floor disorders (PFDs) and identify variables associated with decision-making preferences. Methods Women seeking care for PFDs completed the API and the CPS. Psychometric properties were determined. Multivariable analyses were used to identify correlates of information-seeking and decision-making preferences. Results One hundred ten women were recruited. Both scales demonstrated good psychometric properties (intraclass correlation coefficient=0.5 to 0.7; Cronbach’s alpha = 0.8 for the API, and r=−0.3 between the API and CPS). Based on scores, women had strong preferences to be well informed, but were more neutral in their decision-making preferences. In multivariable analyses, higher education levels were associated with a stronger desire for seeking medical information. Conclusions Women seeking care for PFDs vary in their preferences for participating in treatment decisions. PMID:20424822

  17. Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence.

    PubMed Central

    Rogers, J; Levy, D M; Henry, M M; Misiewicz, J J

    1988-01-01

    Twenty one patients with diabetic peripheral neuropathy, 18 with idiopathic faecal incontinence and 11 normal controls were studied with techniques of mucosal electrosensitivity, rectal distension for the quantitative assessment of anorectal sensation, and manometric and electromyographic tests for the assessment of anorectal motor function. An asymptomatic sensorimotor deficit was found in the anal canal of patients with diabetic peripheral neuropathy. Mucosal electrosensitivity thresholds in the anal canal were significantly higher (p less than 0.01 v controls) and fibre density of the external anal sphincter significantly raised (p less than 0.0001 v controls). Anal manometry and pudendal nerve terminal motor latencies were similar to controls. In patients with idiopathic faecal incontinence the tests of sensory and motor function also showed a sensorimotor neuropathy; compared with controls, mucosal electrosensitivity thresholds were significantly higher (p less than 0.002), anal canal resting and maximum squeeze pressures were significantly lower (p less than 0.05 and p less than 0.002 respectively), and pudendal nerve terminal motor latencies and fibre density of the external anal sphincter were significantly raised (both p less than 0.05). Sensory thresholds to rectal distension were similar in all groups. Pelvic floor sensorimotor neuropathy in diabetic patients has several features in common with that of patients with idiopathic faecal incontinence but its functional significance remains uncertain. PMID:3384360

  18. Pelvic Floor Ultrasound Imaging: Are Physiotherapists Interchangeable in the Assessment of Levator Hiatal Biometry?

    PubMed Central

    Gentilcore-Saulnier, Evelyne; Auchincloss, Cindy; McLean, Linda

    2014-01-01

    ABSTRACT Purpose: To evaluate inter-examiner reliability in the ultrasound (US) assessment of levator hiatal dimensions when different physiotherapists perform independent data acquisition and analysis. Methods: In this cross-sectional observational study, 14 asymptomatic nulliparous women were imaged at rest, during pelvic floor muscle contraction, and during Valsalva manoeuvre by two physiotherapists using three-dimensional (3D) and four-dimensional (4D) transperineal US. Examiners each measured the dimensions of the levator hiatus (area and antero-posterior and transverse diameters) from the US volumes they respectively acquired. Inter-examiner reliability was determined using intra-class correlation coefficients (ICCs), and inter-examiner agreement was determined using Bland–Altman analyses. Results: The ICC results demonstrated very good inter-examiner reliability (ICC=0.84–0.98); Bland–Altman results showed high inter-examiner agreement across all measurements. Conclusions: Trained examiners may be considered interchangeable in the US assessment of levator hiatal biometry. Overall, trained physiotherapists using transperineal US imaging to assess levator hiatal biometry can be confident when comparing their own clinical findings to those of their colleagues and to findings published in the literature. PMID:25922555

  19. Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Postpartum Women One Week after Their First Delivery

    PubMed Central

    Liu, Feifei; Xu, Lian; Ying, Tao; Tao, Junjia; Hu, Bing

    2014-01-01

    This study investigated the morphology and structure of pelvic floor in 50 nulliparous and 95 postpartum women (47 vaginal delivery, 48 Cesarean section) using translabial three-dimensional (3D) ultrasound. All the primiparae underwent ultrasound examination within one week after their first delivery. Volume datasets were acquired and analyzed to determine the alterations of levator hiatus after childbirth. Significant differences were observed in the levator hiatus of postpartum women compared with that of nullipara women. In postpartum women, the levator hiatus, with their dimensions increased, expanded into a circular shape. Puborectalis was avulsed in eight cases (accounting for 8.42% of all) and pelvic organ prolapse was found in 12 cases (accounting for 12.63%). The hiatal dimensions were larger and the incidence of pubrectalis muscle avulsion (17.02% vs. 0%) and pelvic organ prolapse (21.28% vs. 4.17%) was significantly higher in Vaginal delivery group than Cesarean section group. In summary, 3D ultrasound is an effective tool to detect the pelvic floor of postpartum women who present with morphological abnormalities, and such abnormalities are more likely to show in vaginal delivery women compared to Cesarean section. PMID:24522119

  20. Training through gametherapy promotes coactivation of the pelvic floor and abdominal muscles in young women, nulliparous and continents

    PubMed Central

    Silva, Valeria Regina; Riccetto, Cássio; Martinho, Natalia Miguel; Marques, Joseane; Carvalho, Leonardo Cesar; Botelho, Simone

    2016-01-01

    ABSTRACT Introduction and objectives: Several studies have been investigated co-activation can enhance the effectveness of PFM training protocols allowing preventive and therapeutic goals in pelvic floor dysfunctions. The objective of the present study was to investigate if an abdominal-pelvic protocol of training (APT) using gametherapy would allow co-activation of PFM and transversus abdominis/oblique internal (TrA/OI) muscles. Patients and methods: Twenty-five nulliparous, continent, young females, with median age 24.76 (±3.76) years were evaluated using digital palpation (DP) of PFM and surface electromyography of PFM and TrA/OI simultaneously, during maximal voluntary contraction (MVC), alternating PFM and TrA/OI contraction requests. All women participated on a supervised program of APT using gametherapy, that included exercises of pelvic mobilization associated to contraction of TrA/OI muscles oriented by virtual games, for 30 minutes, three times a week, in a total of 10 sessions. Electromyographic data were processed and analyzed by ANOVA - analysis of variance. Results: When MVC of TrA/OI was solicited, it was observed simultaneous increase of electromyographic activity of PFM (p=0.001) following ATP. However, EMG activity did not change significantly during MVC of PFM. Conclusion: Training using gametherapy allowed better co-activation of pelvic floor muscles in response to contraction of TrA, in young nulliparous and continent women. PMID:27564290

  1. Three-dimensional ultrasound appearance of pelvic floor in nulliparous women and postpartum women one week after their first delivery.

    PubMed

    Liu, Feifei; Xu, Lian; Ying, Tao; Tao, Junjia; Hu, Bing

    2014-01-01

    This study investigated the morphology and structure of pelvic floor in 50 nulliparous and 95 postpartum women (47 vaginal delivery, 48 Cesarean section) using translabial three-dimensional (3D) ultrasound. All the primiparae underwent ultrasound examination within one week after their first delivery. Volume datasets were acquired and analyzed to determine the alterations of levator hiatus after childbirth. Significant differences were observed in the levator hiatus of postpartum women compared with that of nullipara women. In postpartum women, the levator hiatus, with their dimensions increased, expanded into a circular shape. Puborectalis was avulsed in eight cases (accounting for 8.42% of all) and pelvic organ prolapse was found in 12 cases (accounting for 12.63%). The hiatal dimensions were larger and the incidence of pubrectalis muscle avulsion (17.02% vs. 0%) and pelvic organ prolapse (21.28% vs. 4.17%) was significantly higher in Vaginal delivery group than Cesarean section group. In summary, 3D ultrasound is an effective tool to detect the pelvic floor of postpartum women who present with morphological abnormalities, and such abnormalities are more likely to show in vaginal delivery women compared to Cesarean section. PMID:24522119

  2. Influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women.

    PubMed

    Varella, Larissa Ramalho Dantas; Torres, Vanessa Braga; Angelo, Priscylla Helouyse Melo; Eugênia de Oliveira, Maria Clara; Matias de Barros, Alef Cavalcanti; Viana, Elizabel de Souza Ramalho; Micussi, Maria Thereza de Albuquerque Barbosa Cabral

    2016-03-01

    [Purpose] The aim of the present study was to assess the influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women. [Subjects and Methods] This was an observational analytic cross-sectional study with a sample of 100 postmenopausal women, aged between 45 and 65 years, divided into three groups according to menopausal stage: hysterectomized and early and late postmenopause. Patients were assessed for sociodemographic and gyneco-obstetric factors and subjected to a muscle strength test and perineometry. Descriptive statistics, ANOVA, Kruskal-Wallis and multiple regression were applied. [Results] The results showed homogeneity in sociodemographic and anthropometric characteristics. There was no difference in pelvic floor muscle function among the three groups. Type of delivery, parity and physical activity level showed no influence on muscle function. [Conclusion] The findings demonstrate that parity, type of delivery, and physical activity level had no influence on pelvic floor muscle pressure in postmenopausal women. One hypothesis to explain these results is the fact that the decline in muscle function in postmenopausal women is related to the female aging process. PMID:27134366

  3. Influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women

    PubMed Central

    Varella, Larissa Ramalho Dantas; Torres, Vanessa Braga; Angelo, Priscylla Helouyse Melo; Eugênia de Oliveira, Maria Clara; Matias de Barros, Alef Cavalcanti; Viana, Elizabel de Souza Ramalho; Micussi, Maria Thereza de Albuquerque Barbosa Cabral

    2016-01-01

    [Purpose] The aim of the present study was to assess the influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women. [Subjects and Methods] This was an observational analytic cross-sectional study with a sample of 100 postmenopausal women, aged between 45 and 65 years, divided into three groups according to menopausal stage: hysterectomized and early and late postmenopause. Patients were assessed for sociodemographic and gyneco-obstetric factors and subjected to a muscle strength test and perineometry. Descriptive statistics, ANOVA, Kruskal-Wallis and multiple regression were applied. [Results] The results showed homogeneity in sociodemographic and anthropometric characteristics. There was no difference in pelvic floor muscle function among the three groups. Type of delivery, parity and physical activity level showed no influence on muscle function. [Conclusion] The findings demonstrate that parity, type of delivery, and physical activity level had no influence on pelvic floor muscle pressure in postmenopausal women. One hypothesis to explain these results is the fact that the decline in muscle function in postmenopausal women is related to the female aging process. PMID:27134366

  4. Impact of Different Body Positions on Bioelectrical Activity of the Pelvic Floor Muscles in Nulliparous Continent Women

    PubMed Central

    Chmielewska, Daria; Stania, Magdalena; Sobota, Grzegorz; Kwaśna, Krystyna; Błaszczak, Edward; Taradaj, Jakub; Juras, Grzegorz

    2015-01-01

    We examined pelvic floor muscles (PFM) activity (%MVC) in twenty nulliparous women by body position during exercise as well as the activation of abdominal muscles and the gluteus maximus during voluntary contractions of the PFMs. Pelvic floor muscle activity was recorded using a vaginal probe during five experimental trials. Activation of transversus abdominis, rectus abdominis, and gluteus maximus during voluntary PFM contractions was also assessed. Significant differences in mean normalized amplitudes of baseline PFM activity were revealed between standing and lying (P < 0.00024) and lying and ball-sitting positions (P < 0.0053). Average peak, average time before peak, and average time after peak did not differ significantly during the voluntary contractions of the PFMs. Baseline PFM activity seemed to depend on the body position and was the highest in standing. Pelvic floor muscles activity during voluntary contractions did not differ by position in continent women. Statistically significant differences between the supine lying and sitting positions were only observed during a sustained 60-second contraction of the PFMs. PMID:25793212

  5. Is there a difference in the electromyographic activity of the pelvic floor muscles across the phases of the menstrual cycle?

    PubMed Central

    Micussi, Maria Thereza; Freitas, Rodrigo Pegado; Angelo, Priscylla Helouyse; Soares, Elvira Maria; Lemos, Telma Maria; Maranhão, Técia Maria

    2015-01-01

    [Purpose] To evaluate the electrical activity of the pelvic floor muscle in women during the follicular, ovulatory, and luteal phases of the menstrual cycle and its correlation with estradiol and total testosterone levels. [Subjects and Methods] This cross-sectional study involved 30 women with ovulatory menstrual cycles. Total testosterone and estradiol levels were measured and the muscle tone and maximum voluntary contraction of the pelvic floor muscles were evaluated using surface electromyography. [Results] Muscle tone was significantly lower during the follicular (21.1±3.3 μV) and ovulatory (27.1±5.9 μV) phases than the luteal phase (30.4±4.1 μV). The maximum voluntary contraction was not different across phases. The estradiol level on the 7th day of the menstrual cycle showed a strong positive correlation with muscle tone and maximum voluntary contraction, and the testosterone level was positively correlated with muscle tone on the 21st day. [Conclusion] Women have better muscle tone during the luteal phase. The muscle tone and maximum voluntary contraction were strongly correlated with the estradiol level on the 7th day, and the muscle tone was correlated with the testosterone level on the 21st day of the menstrual cycle. These findings suggest that hormonal fluctuations during the menstrual cycle alter pelvic floor muscle activity. PMID:26311960

  6. THE CONTRIBUTION OF THE SECOND STAGE OF LABOR TO PELVIC FLOOR DYSFUNCTION: A PROSPECTIVE COHORT COMPARISON OF NULLIPAROUS WOMEN

    PubMed Central

    Rogers, RG; Leeman, LM; Borders, Noelle; Qualls, Clifford; Fullilove, Anne M; Teaf, Dusty; Hall, Rebecca J; Bedrick, Edward; Albers, Leah L

    2015-01-01

    Objective Maternal expulsive efforts are thought to damage the pelvic floor. We aimed to compare pelvic floor function and anatomy between women who delivered vaginally (VB) versus cesarean (CD) without entering the second stage of labor. Design Prospective cohort Setting University Hospital Midwifery practice Population Nulliparas Methods Pregnant nulliparas were recruited during pregnancy and women who underwent CD prior to the 2nd stage of labor at birth were recruited immediately postpartum. Both groups were prospectively followed to 6 months postpartum. Main Outcome Measures POPQ, perineal ultrasound(U/S) and Paper Towel Test(PTT), an objective measure of stress incontinence; Incontinence Severity Index(ISI), Pelvic Floor Impact Questionnaire(PFIQ-7), Wexner Fecal Incontinence Scale(W) and Female Sexual Function Index(FSFI) Results 336/448(75%)VB and 138/224(62%)CD followed up. The VB group was younger (23.9+/−4.9 vs 26.6+/−6.1 years, P<.001) and less overweight/obese (38 vs 56%, P<.001); baseline functional measures were similar(all P>.05). At followup, urinary incontinence (UI)(55 vs 46% ISI>0, P=.10), fecal incontinence(FI) (8 vs 13% FI on W, P = .12), sexual activity rates(88 vs 92%, P=.18) and PFIQ-7 scores were similar. Positive PTT tests(17 vs 6%, P=.002) and ≥Stage 2 prolapse (22 vs 15%, P=.03) were higher with VB; differences were limited to points Aa and Ba. U/S findings were not different between groups. Stepwise multivariate analyses controlling for age, BMI, and non-Hispanic White race for prolapse of points Aa and Ba did not alter conclusions (all P <.004). Conclusions VB resulted in prolapse changes and objective UI, but did not result in increased self-report pelvic floor dysfunction at 6 months postpartum compared to women who delivered by CD without the second stage of labor. The second stage of labor has a modest effect on postpartum pelvic floor function. PMID:24548705

  7. Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction

    PubMed Central

    Erekson, Elisabeth A.; Fried, Terri R.; Martin, Deanna K.; Rutherford, Thomas J.; Strohbehn, Kris; Bynum, Julie P.W.

    2015-01-01

    Introduction There is a growing body of evidence demonstrating frailty as an important predictor of surgical outcomes in older adults undergoing major surgeries. The age-related onset of many symptoms of female pelvic floor dysfunction (PFD) in women suggests that many women seeking treatment for PFD may also have a high prevalence of frailty, which could potentially impact the risks and benefits of surgical treatment options. Our primary objective was to determine the prevalence of frailty, cognitive impairment, and functional disability in older women seeking treatment for PFD. Methods We conducted a cross-sectional study with prospective recruitment between 9/2011 and 9/2012. Women, age 65 years and older, were recruited at the conclusion of their new patient consultation for PFD at a tertiary center. A comprehensive geriatric screening including frailty measurements (Fried Frailty Index), cognitive screening (Saint Louis University Mental Status Score), and functional status evaluation for activities of daily living (Katz ADL score) was conducted. Results Sixteen percent (n/N = 25/150) of women were categorized as frail according to the Fried Frailty Index Score. After adjusting for education level, 21.3% of women (n/N =32/150) screened positive for dementia and 46 (30.7%) reported functional difficulty or dependence in performing at least one Katz ADL. Sixty-nine women (46.0%) chose surgical options for treatment of their PFD at the conclusion of their new patient visit with their physician. Conclusion Frailty, cognitive impairment, and functional disability are common in older women seeking treatment for PFD. PMID:25516232

  8. Communication Between Physicians And Spanish-Speaking Latin American Women With Pelvic Floor Disorders: A Cycle Of Misunderstanding?

    PubMed Central

    Sevilla, Claudia; Wieslander, Cecilia K.; Alas, Alexandriah N.; Dunivan, Gena C.; Khan, Aqsa A.; Maliski RN, Sally L.; Rogers, Rebecca G.; Anger, Jennifer T.

    2013-01-01

    Objectives To assess the effect of the initial visit with a specialist on disease understanding among Spanish-speaking women with pelvic floor disorders. Methods Spanish-speaking women with referrals suggestive of urinary incontinence (UI) and/or pelvic organ prolapse (POP) were recruited from public urogynecology clinics. Patients participated in a health literacy assessment and interview before and after their physician encounter. All interviews were analyzed using Grounded Theory qualitative methods. Results Twenty-seven women with POP (N=6), UI (N=11), and POP/UI (N=10) were enrolled in this study. The mean age was 55.5 years and the majority of women had marginal levels of health literacy. From our qualitative analysis, three concepts emerged. First, was that patients had poor understanding of their diagnosis before and after the encounter regardless of how extensive the physician’s explanation or level of Spanish-proficiency. Secondly, patients were overwhelmed with the amount of information given to them. Lastly, patients ultimately put their trust in the physician, relying on them for treatment recommendations. Conclusions Our findings emphasize the difficulty Spanish-speaking women with low health literacy have in understanding information regarding pelvic floor disorders. In this specific population, the physician has a major role in influencing patients’ treatment decisions and helping them overcome fears they may have about their condition. PMID:23442506

  9. Comparison effect of physiotherapy with surgery on sexual function in patients with pelvic floor disorder: A randomized clinical trial

    PubMed Central

    Eftekhar, Tahereh; Sohrabi, Maryam; Haghollahi, Fedyeh; Shariat, Mamak; Miri, Elahe

    2014-01-01

    Background: Female sexual dysfunction is a common problem among general population, especially in urogynecological patient, and can lead to a decrease in quality of life and affect martial relationship. Objective: This study was compared the effect of surgical methods versus physiotherapy on sexual function in pelvic floor disorder. Materials and Methods: This randomized controlled trial was performed in Urogynecology clinic since August 2007 to December 2009 on 90 patients aged from 25-55 years with previous delivery, positive history of sexual dysfunction with stage <3 of pelvic organ prolapsed and divided in two groups. Group A (n=45) received standard rectocele repair and prineorrhaphy, group B (n=45) received physiotherapy for eight weeks twice a week (electrical stimulation, Kegel exercises). The female sexual function index (FSFI) used to evaluate the sexual function in cases before and after intervention. Frequency of variable scores (libido, orgasm, dysparunia) included without disorder, frequently good, sometimes good, very much and extreme were compared between two groups. Results: Libido and arousal were improved in both groups (p=0.007, p=0.001 respectively). Orgasm and dyspareunia were improved in group B (p=0.001). Dysparunia was more painful in group A. There was significant difference between two groups (improvement of orgasm and dysparunia in group B) (p=0.001). Conclusion: It seems that physiotherapy is an appropriate method for treatment of sexual disorder in pelvic floor disorder. Registration ID in IRCT: IRCT2013031112790N1. PMID:24799856

  10. The Association Between Distances Traveled for Care and Treatment Choices for Pelvic Floor Disorders in a Rural Southwestern Population

    PubMed Central

    Dunivan, Gena C.; Fairchild, Pamela S.; Cichowski, Sara B.; Rogers, Rebecca G.

    2015-01-01

    Objectives To determine if distance traveled for care influenced patient choice for conservative vs. surgical treatment for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI). Methods Retrospective chart review of all new patients seen in the Urogynecology clinic at the University of New Mexico Hospital (UNMH) from January 2007 through September 2011. Data collected included medical history, Pelvic Organ Prolapse Quantification (POPQ) examination, and validated quality of life questionnaires. Results 1384 women were identified with POP and/or SUI. Women traveled an average of 50 miles to receive care at UNMH. After multivariable analysis, greater distance traveled was associated with increased likelihood of choosing surgery, OR 1.45 [1.18-1.76]. More advanced disease as measured by higher stage of prolapse, OR 3.43 [2.30-5.11], and positive leak with empty supine cough test, OR 1.94 [1.45-2.59] were also associated with choosing surgical management. Conclusions Women who travel further for care and women with more advanced pelvic organ prolapse and/or stress urinary incontinence are more likely to choose surgical management for pelvic floor disorders. PMID:26925308

  11. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study 1

    PubMed Central

    Mendes, Edilaine de Paula Batista; de Oliveira, Sonia Maria Junqueira Vasconcellos; Caroci, Adriana de Souza; Francisco, Adriana Amorim; Oliveira, Sheyla Guimaraes; da Silva, Renata Luana

    2016-01-01

    ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength. PMID:27533267

  12. Evaluation of the relationship between the pelvic floor muscles and insulin resistance

    PubMed Central

    Micussi, Maria Thereza; Freitas, Rodrigo Pegado; Angelo, Priscylla Helouyse; Soares, Elvira Maria; Lemos, Telma Maria; Maranhão, Técia Maria

    2015-01-01

    Purpose The aim of this study was to evaluate the pelvic floor muscles (PFMs) in women with insulin resistance (IR) using surface electromyography and to associate the results with insulin levels. Patients and methods Through an analytical, cross-sectional study, 86 women were evaluated and divided into two groups: a control group (n=35) and an IR group (n=51). Data were collected through detailed history-taking, physical examination, and biochemical analysis. Fasting insulin levels were used for diagnosing IR. Electromyography of the PFMs was used for analyzing the tone and maximal voluntary contraction (MVC). The measures of central tendency and linear regression models were used. Results The average age was 25.3±4.5 years in the IR group and 27.2±4.4 years in the control group. The mean weight was 75.6±17.6 kg and 51.8±4.9 kg in the IR and control groups, respectively. Fasting insulin levels were 19.7±6.6 µIU/mL in the IR group and 5.4±1.8 µIU/mL in the control group (P<0.010). There were significant differences between the groups with regard to PFM tone (IR: 13.4±3.4 µV; control: 25.1±3.3 µV; P<0.001) and MVC (IR: 47.6±4.5 µV; control: 64.3±5.0 µV; P<0.001). Multiple linear regression analysis using the insulin levels as dependent variable showed a significant association for MVC (P=0.047), weight (P=0.017), and waist circumference (P=0.000). Conclusion Compared with the control group, the IR group showed lower electromyographic activity of the PFMs, and there was an association between insulin levels and electromyographic activity. PMID:26357485

  13. A Comparative Study of Whole Body Vibration Training and Pelvic Floor Muscle Training on Women's Stress Urinary Incontinence: Three- Month Follow- Up

    PubMed Central

    Farzinmehr, Azizeh; Moezy, Azar; Koohpayehzadeh, Jalil; Kashanian, Maryam

    2015-01-01

    Objective: To determine whether Whole Body Vibration Training (WBVT) is effective at improving pelvic floor muscles strength in women with Stress Urinary Incontinence (SUI). Materials and methods: The study was designed as a randomized clinical trial. 43 women with SUI were randomly assigned in two groups; WBVT and Pelvic Floor Muscle Training (PFMT) and received interventions for four weeks. Pelvic floor muscle (PFM) strength, quality of life and incontinence intensity were evaluated. All measurements were conducted pre and post intervention and also after 3 months in all participants. The ANOVA and the independent sample t test were applied respectively to determine the differences in each group and between the groups. Results: This study showed the WBVT protocol in this study was effective in pelvic floor muscles strength similar to PFMT, and also in reducing the severity of incontinence and increasing I-QOL questionnaire score. We found significant differences in each group pre and post intervention (p = 0.0001); but no significant difference in comparison of two groups' outcomes. Also after three-month follow up, there was no significant difference between groups. Conclusion: The findings of this study showed the beneficial effects of WBVT in improving pelvic floor muscles strength and quality of life in patients with urinary incontinence in four-week treatment period and after three months follow up. PMID:27047560

  14. Single-Blind, Randomized, Controlled Trial of Pelvic Floor Muscle Training, Electrical Stimulation, Vaginal Cones, and No Active Treatment in the Management of Stress Urinary Incontinence

    PubMed Central

    Castro, Rodrigo A.; Arruda, Raquel M.; Zanetti, Miriam R. D.; Santos, Patricia D.; Sartori, Marair G. F.; Girão, Manoel J. B. C.

    2008-01-01

    PURPOSE To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS One hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence. PMID:18719756

  15. The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor-Implications for Future Research.

    PubMed

    Kavvadias, Tilemachos; Hoesli, Irene

    2016-01-01

    Aims. The aim of this review is to provide a comprehensive overview of the available literature on preventing perineal trauma with the EpiNo. Methods. We perfomed a literature research in the MedLine and EMBASE databases for studies referring to EpiNo published between 1990 and 2014, without restrictions for language and study type. Results. Five published studies were identified, regarding the effect of EpiNo on the rate of episiotomy and perineal tears, pelvic floor muscle function, and fetal outcome. The device seems to reduce episiotomy and perineal tears' rate, as well as the risk for levator ani microtrauma and avulsion, though not always statistically significant. It does not seem to have an effect on duration of second stage of labour and fetal outcome. The device is well tolerated and the adverse events are rare and mild. However, design and reporting bias in the reviewed articles do not allow evidence based conclusions. Conclusions. The EpiNo device seems to be promising, with potential positive effects on natural birth, while being uncomplicated to use and without major complications. Well designed, randomized trials are needed in order to understand the effects of EpiNo on pelvic floor and make evidence based recommendations on its use. PMID:26981126

  16. Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle: A Randomized Controlled Trial

    PubMed Central

    Xiong, Xiao-Ming; Huang, Li; Lao, Cheng-Yi; Yang, Mei; Gao, Shan; Huang, Qiong-Yan; Yang, Wei; Zhu, Yun-Feng; Zhang, Di-Hua

    2015-01-01

    Objective Combined spinal-epidural analgesia (CSEA) is sometimes used for difficult births, but whether it contributes to postpartum pelvic muscle disorder is unclear. This randomized controlled trial examined whether CSEA given during labor affects the electrophysiological index of postpartum pelvic floor muscle function. Methods A consecutive sample of primiparous women who delivered vaginally at term were randomly assigned to a CSEA group (n = 143) and control group (n = 142) between June 2013 and June 2014. All were assessed 6–8 weeks later for electrophysiological function of pelvic floor muscle. Results The two groups were similar in the degree of muscle strength, muscle fatigue, and pelvic dynamic pressure of pelvic floor muscle. The CSEA and control groups showed similar proportions of women with normal muscle strength (score ≥4) in type I pelvic fibers (23.1% vs. 14.1%, P = 0.051) and type II pelvic fibers (28.0% vs. 24.6%, P = 0.524). The groups also contained similar proportions of women who showed no fatigue in type I fibers (54.5% vs. 48.6%, P = 0.315) or type II fibers (88.8% vs. 87.3%, P = 0.699). Similarly low proportions of women in the CSEA group and control group showed normal pelvic dynamic pressure (11.2% vs. 7.7%, P = 0.321). However, women in the CSEA group spent significantly less time in labor than those in the control group (7.25 vs. 9.52 h, P <0.001). Conclusions CSEA did not affect the risk of postpartum pelvic muscle disorder in this cohort of primiparous women who gave birth vaginally. A significant shorter duration of labour was observed in the CSEA-group. Trial Registration ClinicalTrials.gov NCT02334150 PMID:26340002

  17. The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery

    PubMed Central

    Golmakani, Nahid; Zare, Zahra; Khadem, Nayereh; Shareh, Hossein; Shakeri, Mohammad Taghi

    2015-01-01

    Background: Selection and acceptance of appropriate sexual behavior and sexual function are made difficult by low sexual self-efficacy in the postpartum period. The general purpose of this research is to define the effects of an 8-week pelvic floor muscle exercise program on sexual self-efficacy in primiparous women after childbirth. Materials and Methods: This clinical trial was performed on 79 primiparous women who referred to health care centers, Mashhad, Iran in 2013, 8 weeks after delivery, to receive health care services. They were selected by easy sampling. The samples were randomly assigned to either intervention or control group. The intervention group was trained in Kegel exercises for 8 weeks. Both groups were evaluated at 4 and 8 weeks. Data collection tools included: Demographic information, sexual self-efficacy, and Brink scale. Data were analyzed using repeated measures, Friedman test, t-test, and Mann–Whitney test. Results: The results showed significant increase in pelvic floor muscle strength in the intervention group at 4 and 8 weeks after exercises (P < 0.0001), but no significant difference was observed in the control group (P = 0.368). There was a significant increase in sexual self-efficacy in the intervention (P < 0.0001) and control groups (P = 0.001) at 4 and 8 weeks after the start of the study. Comparison of the two groups showed a significant difference in sexual self-efficacy after they performed these exercises (P = 0.001). Conclusions: The findings showed that 8-week pelvic muscle exercises increase the sexual self-efficacy in women after delivery. PMID:26120335

  18. Weakness of the Pelvic Floor Muscle and Bladder Neck Is Predicted by a Slight Rise in Abdominal Pressure During Bladder Filling: A Video Urodynamic Study in Children

    PubMed Central

    2016-01-01

    Purpose: To investigate the significance of slowly rising abdominal pressure (SRAP), which is often observed in nonneurogenic children during bladder filling in video urodynamic studies (VUDSs). Methods: The records of patients who underwent VUDS from July 2011 to June 2013 were reviewed. SRAP was defined as a rising curve over 5 cm H2O from the baseline abdominal pressure during the filling phase in VUDS. Bladder descent was defined when the base of the bladder was below the upper line of the pubic symphysis. An open bladder neck was defined as the opening of the bladder neck during the filling phase. Results: Of the 488 patients, 285 were male patients. The mean age at VUDS was 3.7 years (range, 0.2–17.6 years). The VUDS findings were as follows: SRAP, 20.7% (101 of 488); descending bladder, 14.8% (72 of 488); and bladder neck opening, 4.3% (21 of 488). Of the 72 patients with a descending bladder, 84.7% had SRAP. A significant difference in the presence of SRAP was found between the descending bladder and the normal bladder (P<0.001). Of the 101 patients with SRAP, 40 (39.6%) did not have a descending bladder. Of the 40 patients, 14 (35.0%) had a bladder neck opening, which was a high incidence compared with the 4.3% in all subjects (P<0.001). Conclusions: SRAP was associated with a descending bladder or a bladder neck opening, suggesting that SRAP is a compensatory response to urinary incontinence. SRAP may also predict decreased function of the bladder neck or pelvic floor muscle. PMID:27032558

  19. Two-Year Outcomes After Vaginal Prolapse Reconstruction With Mesh Pelvic Floor Repair System

    PubMed Central

    Alperin, Marianna; Ellison, Rennique; Meyn, Leslie; Frankman, Elizabeth; Zyczynski, Halina M.

    2014-01-01

    Objective The aim of this study was to assess anatomical and functional outcomes 2 years after prolapse repair using vaginal mesh repair system. Methods Women enrolled in a 12-month observational study of outcomes after transvaginal mesh-augmented prolapse repair were invited to participate in an extended follow-up. Subjects completed questionnaires assessing pelvic symptoms, quality of life, global satisfaction, and a pelvic examination for anatomical support and mesh complications. Results Of 118 eligible women, 85 enrolled, 82 provided subjective data at 24 months, and pelvic examination/Pelvic Organ Prolapse Quantification data are available from 79 women. Total, anterior, and posterior Prolift kits were used in 47 (55%), 25 (29%), and 13 (15%), respectively. At baseline, most of the women had stage III prolapse (75%), with the anterior compartment constituting the leading edge in 71% of subjects. At 24 months, Pelvic Organ Prolapse Quantification measures were significantly improved from baseline in all compartments, with 51 (65%) stage 0/I, 25 (31%) stage II, 3 (4%) and stage III (P < 0.001), as were quality of life scores (P < 0.001), with the exception of sexual function. Symptomatic prolapse was reported by 7 (8.5%) women, of which 4 demonstrated prolapse in the nonoperated compartment. Three subjects (4%) reported persistent pelvic pain. The 2-year mesh exposure incidence was at least 13% (11/85). The proportion reporting dyspareunia was 28.9% (13/45) and was unchanged from baseline. The median global satisfaction was 9.3 (range 2.0–10.0). Conclusions Anatomical support, symptom relief, and satisfaction are high 24 months after mesh-augmented vaginal prolapse repair, although mesh exposure and new onset prolapse of the nonoperated compartment are not uncommon. PMID:23442503

  20. The pathophysiology of pelvic floor disorders: evidence from a histomorphologic study of the perineum and a mouse model of rectal prolapse

    PubMed Central

    YIOU, RENÉ; DELMAS, VINCENT; CARMELIET, PETER; GHERARDI, ROMAIN K.; BARLOVATZ-MEIMON, GEORGIA; CHOPIN, DOMINIQUE K.; ABBOU, CLÉMENT-CLAUDE; LEFAUCHEUR, JEAN-PASCAL

    2001-01-01

    The muscle changes related to pelvic floor disorders are poorly understood. We conducted an anatomical and histological study of the perineum of the normal mouse and of a transgenic mouse strain deficient in urokinase-type plasminogen activator (uPA−/−) that was previously reported to develop a high incidence of rectal prolapse. We could clearly identify the iliococcygeus (ILC) and pubococcygeus (PC) muscles and anal (SPA) and urethral (SPU) sphincters in male and female mice. The bulbocavernosus (BC), ischiocavernosus (ISC) and levator ani (LA) muscles could be found only in male mice. Histochemical analysis of the pelvic floor muscles revealed a majority of type IIA fibres. Rectal prolapses were observed only in male uPA−/− mice. The most obvious finding was an irreducible evagination of the rectal mucosa and a swelling of the entire perineal region corresponding to an irreducible hernia of the seminal vesicles through the pelvic outlet. The hernia caused stretching and thinning of the ISC, BC and LA. Myopathic damage, with degenerated and centronucleated myofibres, were observed in these muscles. The PC, ILC, SPA and SPU were not affected. This study provides an original description of a model of pelvic floor disorder and illustrates the differences existing between the perineum of humans and that of a quadruped species. In spite of these differences, the histopathologic changes observed in the pelvic floor muscles of uPA−/− mice with rectal prolapse suggest that prolonged muscular stretching causes a primary myopathic injury. This should be taken into account in the evaluation of pelvic floor disorders. PMID:11760891

  1. [An updated overview on the anatomy and function of the female pelvic floor, with emphasis on the effect of vaginal delivery].

    PubMed

    Jóźwik, Maciej; Jóźwik, Marcin; Adamkiewicz, Maciej; Szymanowski, Paweł; Jóźwik, Michał

    2013-01-01

    Phylogenetically, the pelvic floor is a relatively old group of skeletal muscles which, along the acquisition of the erect posture by the human, gained a number of new important roles or were subjected to adaptation of some other roles performed earlier. The functional tasks of the pelvic floor in women (mostly of its prominent representatives - the levator ani muscles) include: supporting the contents of the abdominal cavity at the upright position, participation in the volitional and reflex compression of the urethra, narrowing the transverse dimension of the vagina and urogenital hiatus, involvement in sexual functions, and securing the terminal portion of the alimentary tract. The aim of this overview was to briefly review the information on the latest understanding of the anatomy of the pelvic floor, delineate its nomenclature recommended by the Federative Committee on Anatomical Terminology, and emphasize an array of physiological findings related to the contractility of these important muscles. The functional specialization of striated muscle fiber types and the anatomical basis of the relationship between vaginal delivery at term and postpartum urinary incontinence have been underlined. Nowadays, some intrapartum injuries to the pelvic floor can be successfully detected with ultrasound in the immediate postpartum period. This updated information should be part of a basic professional knowledge for obstetrician-gynecologist. PMID:23749692

  2. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing

    PubMed Central

    Park, Hankyu; Han, Dongwook

    2015-01-01

    [Purpose] This study was conducted to investigate the effect of the correlation between the pelvic floor muscles (PFM) and diaphragmatic motion during breathing. [Subjects] The subjects of this study were 20 healthy female students who listened to an explanation of the study methods, purpose and agreed to participate in the experiment. [Methods] Radiograph equipment was used to examine diaphragmatic motion with contraction of the PFM during breathing, and a spirometer was used to examine lung vital capacity. [Results] The results revealed a significant change in the diaphragmatic motion and pulmonary function (FEV1, MVV). FEV1 and MVV showed significant differences when the PFM was contracted. Diaphragmatic motion showed a significant difference when the PFM was contracted. [Conclusion] Diaphragmatic motion and contraction of the PFM correlate with breathing. In addition, breathing is much more effective during contraction of the PFM. Therefore, PFM strengthening exercises should be included in respiratory rehabilitation programs. PMID:26311935

  3. Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women.

    PubMed

    Arruda, Raquel M; Castro, Rodrigo A; Sousa, Gabriela C; Sartori, Marair G F; Baracat, Edmund C; Girão, Manoel J B C

    2008-08-01

    The purpose of this study is to compare the effectiveness of oxybutynin, functional electrostimulation (FES), and pelvic floor training (PFT) for treatment of women with detrusor overactivity. Sixty-four subjects were randomized to oxybutynin (n=22), FES (n=21), or PFT (n=21). Women were evaluated before and after completion of 12 weeks of treatment by subjective response, voiding diary, and urodynamic test. There was subjective symptomatic improvement in 77% of the women treated with oxybutynin, 52% with FES, and 76% with PFT. Urgency resolved in 64% of women treated with oxybutynin, 52% with FES, and in 57% with PFT. Urodynamic evaluation was normal in 36% treated with oxybutynin, 57% with FES, and 52% with PFT. Maximum detrusor involuntary contraction pressure decreased in all groups (p<0.05). All treatments were equally effective. Subjective reduction of urge-incontinence episodes was associated with symptomatic improvement. PMID:18330483

  4. Technique and complications of reconstruction of the pelvic floor with polyglactin mesh

    SciTech Connect

    Sener, S.F.; Imperato, J.P.; Blum, M.D.; Ignatoff, J.M.; Soper, T.G.; Winchester, D.P.; Meiselman, M.

    1989-06-01

    A polyglactin mesh sling was used to reconstruct the pelvis in eight patients after colorectal or urologic resections in preparation for postoperative radiation therapy. There were three perioperative complications--a pelvic abscess requiring percutaneous drainage, a wound dehiscence and a herniation of the small intestine between the pelvic sidewall and mesh requiring small intestinal resection. There were two delayed complications, both partial small intestinal obstructions. One occurred just after the conclusion of radiation treatment and the other occurred five months after the conclusion of radiation therapy. Both obstructions responded to conservative management. None of the common acute radiation effects occurred during radiotherapy. One patient with delayed partial small intestinal obstruction had possible late radiation effects. The median follow-up period after radiation therapy was 12.5 months. Despite the complications described in this report, the use of a polyglactin mesh sling as an adjunct to resection of carcinoma of the pelvis has merit and should be studied further.

  5. [The role of ultrasound in the exploration of pelvic floor disorders].

    PubMed

    Lapray, J-F; Costa, P; Delmas, V; Haab, F

    2009-12-01

    Dynamic ultrasound, especially perineal and introital, allows the appreciation of the prolapses (cystoptosis, bladder neck and urethral mobility,enterocele, rectocele). It remains, however, clearly more limited in the precise study of posterior colpoceles, and especially in anorectal disorders, than colpocystodefecography or dynamic MRI. Endoanal ultrasound is the first line morphological examination of the anal sphincter. Perineal and introital ultrasound examinations are useful to appreciate certain complications with suburethral tape and pelvic mesh. For an appreciaton of the morphology of the pelvis and post-mictional residual, the ultrasound remains the first line examination. Pelvic and endovaginal ultrasounds should be systematic, in the absence of MRI, in the presurgical assessment of a prolapse: checks for an ovarian lesion or endrometrial cancer (obesity being a risk factor in the menopaused woman), evaluation of uterine volume in the younger woman. PMID:19969264

  6. A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation.

    PubMed

    Pastore, A L; Palleschi, G; Leto, A; Pacini, L; Iori, F; Leonardo, C; Carbone, A

    2012-08-01

    Premature ejaculation (PE) is the most common male sexual disorder. We compared pelvic floor muscle rehabilitation to on-demand treatment with the selective serotonin reuptake inhibitor dapoxetine in 40 men with lifelong PE (baseline intra-vaginal ejaculatory latency time (IELT) ≤1 min). Subjects were randomized into the following two treatment groups: (1) PFM rehabilitation or (2) 30 or 60 mg of on-demand dapoxetine. Total treatment time for both groups was 12 weeks, at the end of which, IELT mean values were calculated to compare the effectiveness of the two different therapeutic approaches. At the end of treatment, 11 of the 19 patients (57%) treated with rehabilitation were able to control the ejaculation reflex, with a mean IELT of 126.6 sec (range: 123.6-152.4 sec). In the dapoxetine group, after 12 weeks of therapy, 5 of 8 (62.5%) patients in the 30 mg subgroup and five of seven (72%) in the 60 mg subgroup had an IELT >180 sec (mean: 178.2 and 202.8 sec, respectively). The results obtained in the group treated with pelvic floor rehabilitation are promising, and this treatment represents an important cost reduction if compared to dapoxetine on-demand treatment. The present study confirms the data that are previously available in the literature on the efficacy and safety of the new inhibitor of serotonin reuptake, dapoxetine, as well as proposes and evaluates a new type of physical treatment that may be a viable therapeutic option for treatment of PE. PMID:22320846

  7. Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: A Cost-effectiveness Analysis

    PubMed Central

    Ivy, Julie S.; Patel, Divya A.; Patel, Sejal N.; Smith, Dean G.; Ransom, Scott B.; Fenner, Dee; DeLancey, John O.L.

    2010-01-01

    Abstract Background The potential benefit in preventing pelvic floor disorders (PFDs) is a frequently cited reason for requesting or performing cesarean delivery on maternal request (CDMR). However, for primigravid women without medical/obstetric indications, the lifetime cost-effectiveness of CDMR remains unknown, particularly with regard to lifelong pelvic floor consequences. Our objective was to assess the cost-effectiveness of CDMR in comparison to trial of labor (TOL) for primigravid women without medical/obstetric indications with a single childbirth over their lifetime, while explicitly accounting for the management of PFD throughout the lifetime. Methods We used Monte Carlo simulation of a decision model containing 249 chance events and 101 parameters depicting lifelong maternal and neonatal outcomes in the following domains: actual mode of delivery, emergency hysterectomy, transient maternal morbidity and mortality, perinatal morbidity and mortality, and the lifelong management of PFDs. Parameter estimates were obtained from published literature. The analysis was conducted from a societal perspective. All costs and quality-adjusted life-years (QALYs) were discounted to the present value at childbirth. Results The estimated mean cost and QALYs were $14,259 (95% confidence interval [CI] $8,964-$24,002) and 58.21 (95% CI 57.43-58.67) for CDMR and $13,283 (95% CI $7,861-$23,829) and 57.87 (95% CI 56.97-58.46) for TOL over the combined lifetime of the mother and the child. Parameters related to PFDs play an important role in determining cost and quality of life. Conclusions When a woman without medical/obstetric indications has only one childbirth in her lifetime, cost-effectiveness analysis does not reveal a clearly preferable mode of delivery. PMID:20088671

  8. Prolonged androgen deprivation may influence the autoregulation of estrogen receptors in the brain and pelvic floor muscles of male rats.

    PubMed

    Wibowo, Erik; Calich, Hannah J; Currie, R William; Wassersug, Richard J

    2015-06-01

    Androgen deprivation in males has detrimental effects on various tissues and bodily functions, some of which can be restored by estradiol (E2) administration. We investigated how the duration of androgen deprivation affects the autoregulation of estrogen receptors (ERs) levels in core brain areas associated with sexual behavior and cognition, as well as in pelvic floor muscles (PFM). We also measured c-Fos levels in brain areas associated with sexual behavior shortly after the rats mated. Prolonged castration increases ERα levels in the preoptic area (POA) and E2 treatment reverses these effects. In the POA, c-Fos levels after mating are not affected by the duration of androgen deprivation and/or E2 treatment. ERβ levels in the POA as well as c-Fos levels in the POA and the core area of nucleus accumbens correlate with the mounting frequency for E2-treated Short-Term castrates. Additionally, ERβ levels in the medial amygdala are positively correlated with the mounting frequency of Long-Term castrates that received E2 treatment. In the hippocampus, ERs are downregulated only when E2 is administered early after castration, whereas downregulation of ERα in the prefrontal cortex only occurs with delayed E2 treatment. Early, but not delayed, E2 treatment after castration increases ERβ levels in the bulbocavernosus and ERα levels in the levator ani of male rats. Our data suggest that the duration of androgen deprivation may influence the autoregulation of ERs by E2 treatment in select brain areas and pelvic floor muscles of male rats. PMID:25746452

  9. Surgical vs. non-surgical treatment in women with pelvic floor dysfunction: Patient-centered goals at one year

    PubMed Central

    Hullfish, Kathie L.; Bovbjerg, Viktor E.; Gurka, Matthew J.; Steers, William D.

    2009-01-01

    Objective In women with pelvic floor dysfunction (PFD), we assessed the degree to which treatment (surgical vs. non-surgical) was associated with achievement of patient-centered goals, satisfaction with care, and quality of life. Study design Prospective cohort. Between September 2003 and December 2004 we recruited women during their first referral visit for PFD treatment at our outpatient Urogynecology Clinic. At the first visit, women enumerated up to five personal treatment goals, and “anchored” each goal by anticipating best and worst possible outcomes. At 12 month follow-up, women were asked to indicate their level of goal attainment (−2, worst outcome; +2, best outcome). At baseline and follow-up, women completed short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) (range 0–100, high scores indicating greater impact or distress). Patients indicated level of treatment satisfaction on a 4 level ordinal scale. Results Of the 127 study participants with complete data, 46 (36.2 %) were managed surgically and 81 (63.8%) non surgically. There were no major demographic differences between the two groups in terms of age, race, weight, prior PFD surgery, and vaginal parity. The surgical group was more likely to have received baseline diagnosis of pelvic organ prolapse (80 % vs 60 %, p = 0.0259), and be post-menopausal (89 % vs 72 %, p = 0.0261). There were no significant differences in the distribution of goal type (symptom relief, activity, self image, general health) by treatment status (p = 0.1074). Using logistic regression to adjust for age and baseline diagnosis, surgically managed patients at one year were significantly more likely to report complete primary goal attainment (odds ratio (OR) = 4.42; p = 0.0154) and complete treatment satisfaction (OR = 6.12; p = 0.0109). For all participants, one-year IIQ-7 and UDI-6 scores were significantly correlated with primary goal attainment scores. Conclusions In

  10. Pelvic Pain

    MedlinePlus

    ... Reviewed: 04/12/2013 Related A-Z Topics Endometriosis Menstruation and Menstrual Problems Pelvic Floor Disorders All related topics NICHD News and Spotlights Endometriosis linked to increased risk for heart disease, NIH- ...

  11. Biomaterials for Pelvic Floor Reconstructive Surgery: How Can We Do Better?

    PubMed Central

    Osman, Nadir I.; Bissoli, Julio; Bullock, Anthony J.; Chapple, Chris R.

    2015-01-01

    Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are major health issues that detrimentally impact the quality of life of millions of women worldwide. Surgical repair is an effective and durable treatment for both conditions. Over the past two decades there has been a trend to enforce or reinforce repairs with synthetic and biological materials. The determinants of surgical outcome are many, encompassing the physical and mechanical properties of the material used, and individual immune responses, as well surgical and constitutional factors. Of the current biomaterials in use none represents an ideal. Biomaterials that induce limited inflammatory response followed by constructive remodelling appear to have more long term success than biomaterials that induce chronic inflammation, fibrosis and encapsulation. In this review we draw upon published animal and human studies to characterize the changes biomaterials undergo after implantation and the typical host responses, placing these in the context of clinical outcomes. PMID:25977927

  12. Validity and Reliability of an Instrumented Speculum Designed to Minimize the Effect of Intra-abdominal Pressure on the Measurement of Pelvic Floor Muscle Strength

    PubMed Central

    Ashton-Miller, James A.; Zielinski, Ruth; Miller, Janis M.; DeLancey, John O.L.

    2015-01-01

    Background Existing clinical measurements of pelvic floor muscle strength are contaminated by crosstalk from intra-abdominal pressure. We tested an improved instrumented speculum designed to minimize this crosstalk. The hypotheses were that the speculum yields: 1) maximum vaginal closure forces unrelated to intra-abdominal pressure, 2) discriminatory validity between women who have strong vs. weak pelvic floor muscles, and 3) acceptable test-retest reliability. Methods Maximum voluntary vaginal closure force was measured in 40 incontinent women (20–77 years) using the improved instrumented speculum on two visits spaced one month apart. At the baseline visit, intra-abdominal pressure was also estimated via intra-vesical catheterization during the vaginal closure force measurement. Subjective estimate of pelvic floor muscle strength was also assessed using digital palpation by a skilled examiner to determine group placement as “strong” (n=31) or “weak” (n=9). Findings Vaginal closure force was not significantly correlated with intra-abdominal pressure (r = −.26, p = .109). The groups with subjectively scored strong and weak pelvic floor muscles differed significantly by mean [SD] maximum vaginal closure force (3.8 [1.7] vs. 1.9 [0.8] N respectively, p < .01.) Across both time points the mean vaginal closure force was 3.42 [1.67] N with a range of .68 to 9.05 N. Mean Visit 1 and Visit 2 vaginal closure force scores did not differ (3.41 [1.8] and 3.42 [1.6] N, respectively). The vaginal closure force repeatability coefficient was 3.1 N. Interpretation The improved speculum measured maximum vaginal closure force without evidence of crosstalk from intra-abdominal pressure, while retaining acceptable discriminant validity and repeatability. PMID:25307868

  13. Preclinical animal study and human clinical trial data of co-electrospun poly(l-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction

    PubMed Central

    Wu, Xujun; Wang, Yuru; Zhu, Cancan; Tong, Xiaowen; Yang, Ming; Yang, Li; Liu, Zhang; Huang, Weihong; Wu, Feng; Zong, Honghai; Li, Huaifang; He, Hongbing

    2016-01-01

    Synthetic and biological materials are commonly used for pelvic floor reconstruction. In this study, host tissue response and biomechanical properties of mesh fabricated from co-electrospun poly(l-lactide-co-caprolactone) (PLCL) and fibrinogen (Fg) were compared with those of polypropylene mesh (PPM) in a canine abdominal defect model. Macroscopic, microscopic, histological, and biomechanical evaluations were performed over a 24-week period. The results showed that PLCL/Fg mesh had similar host tissue responses but better initial vascularization and graft site tissue organization than PPM. The efficacy of the PLCL/Fg mesh was further examined in human pelvic floor reconstruction. Operation time, intraoperative blood loss, and pelvic organ prolapse quantification during 6-month follow-up were compared for patients receiving PLCL/Fg mesh versus PPM. According to the pelvic organ prolapse quantification scores, the anterior vaginal wall 3 cm proximal to the hymen point (Aa point), most distal edge of the cervix or vaginal cuff scar point (C point), and posterior fornix point (D point) showed significant improvement (P<0.01) at 1, 3, and 6 months for both groups compared with preoperatively. At 6 months, improvements at the Aa point in the PLCL/Fg group were significantly more (P<0.005) than the PPM group, indicating that, while both materials improve the patient symptoms, PLCL/Fg mesh resulted in more obvious improvement. PMID:26893556

  14. Preclinical animal study and human clinical trial data of co-electrospun poly(L-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction.

    PubMed

    Wu, Xujun; Wang, Yuru; Zhu, Cancan; Tong, Xiaowen; Yang, Ming; Yang, Li; Liu, Zhang; Huang, Weihong; Wu, Feng; Zong, Honghai; Li, Huaifang; He, Hongbing

    2016-01-01

    Synthetic and biological materials are commonly used for pelvic floor reconstruction. In this study, host tissue response and biomechanical properties of mesh fabricated from co-electrospun poly(L-lactide-co-caprolactone) (PLCL) and fibrinogen (Fg) were compared with those of polypropylene mesh (PPM) in a canine abdominal defect model. Macroscopic, microscopic, histological, and biomechanical evaluations were performed over a 24-week period. The results showed that PLCL/Fg mesh had similar host tissue responses but better initial vascularization and graft site tissue organization than PPM. The efficacy of the PLCL/Fg mesh was further examined in human pelvic floor reconstruction. Operation time, intraoperative blood loss, and pelvic organ prolapse quantification during 6-month follow-up were compared for patients receiving PLCL/Fg mesh versus PPM. According to the pelvic organ prolapse quantification scores, the anterior vaginal wall 3 cm proximal to the hymen point (Aa point), most distal edge of the cervix or vaginal cuff scar point (C point), and posterior fornix point (D point) showed significant improvement (P<0.01) at 1, 3, and 6 months for both groups compared with preoperatively. At 6 months, improvements at the Aa point in the PLCL/Fg group were significantly more (P<0.005) than the PPM group, indicating that, while both materials improve the patient symptoms, PLCL/Fg mesh resulted in more obvious improvement. PMID:26893556

  15. Pelvic Organ Prolapse

    MedlinePlus

    ... and layers of connective tissue, which are called fascia, become weakened, stretched, or are torn the pelvic ... delivery) can cause injury to the muscles or fascia of the pelvic floor. The increased pressure of ...

  16. Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training

    PubMed Central

    Sjöström, Malin; Umefjord, Göran; Stenlund, Hans; Carlbring, Per; Andersson, Gerhard; Samuelsson, Eva

    2013-01-01

    What’s known on the subject? and What does the study add? Stress urinary incontinence (SUI) affects 10–35% of women, and it is sometimes very distressful. Pelvic floor exercises are the first line of treatment, but access barriers or embarrassment may prevent women from seeking help. There is a need for new, simple, and effective ways to deliver treatment. Management of SUI without face-to-face contact is possible, and Internet-based treatment is a new, promising treatment alternative. Objective To compare two treatment programmes for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post. Patients and Methods Randomised, controlled trial conducted in Sweden 2009–2011. Computer-generated block-randomisation, allocation by independent administrator. No ‘blinding’. The study included 250 community-dwelling women aged 18–70 years, with SUI ≥1 time/week. Consecutive online recruitment. The women had 3 months of either; (i) An Internet-based treatment programme (124 women), including e-mail support and cognitive behavioural therapy assignments or (ii) A treatment programme sent by post (126). Both programmes focused mainly on pelvic floor muscle training. Primary outcomes: symptom-score (International Consultation on Incontinence Questionnaire Short Form, ICIQ-UI SF) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life, ICIQ-LUTSQoL). Secondary outcomes: (i) Patient Global Impression of Improvement, (ii) Incontinence aids, (iii) Patient satisfaction, (iv) Health-specific QoL (EQ5D-Visual Analogue Scale), and (v) Incontinence episode frequency. Follow-up after 4 months via self-assessed postal questionnaires. Results In all, 12% (30 women) were lost to follow-up. Intention-to-treat analysis showed highly significant improvements (P < 0.001) with large effect sizes (>0.8) with both interventions, but there were no significant differences between groups in primary outcomes

  17. A pilot study on the use of acupuncture or pelvic floor muscle training for mixed urinary incontinence

    PubMed Central

    Solberg, Mona; Alræk, Terje; Mdala, Ibrahimu; Klovning, Atle

    2016-01-01

    Objectives To determine the feasibility and acceptability of traditional Chinese medicine (TCM) acupuncture and pelvic floor muscle training (PFMT) in reducing symptoms and bothersomeness in women with mixed urinary incontinence (MUI); and to estimate the sample size for a full scale trial. Methods Thirty-four women with MUI were randomly assigned to either 12 sessions of TCM acupuncture, 12 sessions of PFMT, or to a waiting list control group. Outcome measures included an assessment of interest to participate in the trial, identification of successful recruitment strategies, the appropriateness of eligibility criteria, and compliance with treatment. Clinical outcomes were assessed at baseline and 12 weeks, and included the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI SF), expectations of treatment effect, and adverse events. Results Recruitment was feasible and randomisation worked adequately by means of SurveyMonkey. SurveyMonkey does not permit stratification by ICIQ-UI SF baseline score. Fourteen of 22 women found the treatment options acceptable. The dropout rate was high, especially in the control group (6/12). Outcome forms were completed by 20 of 34 women. The median (IQR) changes of the ICIQ-UI SF scores in the acupuncture, physiotherapy, and waiting list group were 5.5 (2.3 to 6.8), 1.0 (−3.0 to 4.5), and 1.5 (−1.5 to 3.0), respectively, suggesting the need for a full scale trial. Conclusions Women with MUI were willing to participate in this study. There is a need for adjusting eligibility criteria. A sample size of 129 women, 43 in three arms, is required. No major adverse events occurred. PMID:26362793

  18. Length Tension Function of Puborectalis Muscle: Implications for the Treatment of Fecal Incontinence and Pelvic Floor Disorders

    PubMed Central

    Mittal, Ravinder K; Sheean, Geoff; Padda, Bikram S; Rajasekaran, Mahadevan R

    2014-01-01

    Background/Aims External anal sphincter (EAS) and puborectalis muscle (PRM) play important role in anal continence function. Based on length-tension measurement, we recently reported that the human EAS muscle operates at short sarcomere length under physiological conditions. Goal of our study was to determine if PRM also operates at the short sarcomere length. Methods Length-tension relationship of the PRM muscle was studied in vivo in 10 healthy nullipara women. Length was altered by vaginal distension using custom-designed probes of 5, 10, 15, 20, 25 and 30 mm diameters as well as by distending a polyethylene bag with different volumes of water. Probes were equipped with a reverse perfuse sleeve sensor to measure vaginal pressure (surrogate of PRM tension). PRM electromyogram (EMG) was recorded using wire electrodes. Three-dimensional ultra-sound images were obtained to determine effect of vaginal distension on PRM length. Results Ultrasound images demonstrate distension volume dependent increase in PRM length. Rest and squeeze pressures of vaginal bag increased with the increase in bag volume. Similarly, the change in vaginal pressure, which represents the PRM contraction increased with the increase in the probe size. Increase in probe size was not associated with an increase in EMG activity (a marker of neural drive) of the PRM. Conclusions Probe size dependent increase in PRM contraction pressure, in the presence of constant EMG (neural input) proves that the human PRM operates at short sarcomere length. Surgically adjusting the PRM length may represent a novel strategy to improve treat anal continence and possibly other pelvic floor disorders. PMID:25273124

  19. Pelvic Floor Support Defect in Apical Anterior Vaginal Prolapse with Cervical Hypertrophy. Review with Case Report in a 20-year-old Cadaver.

    PubMed

    Chhetri, Kalpana

    2015-10-01

    Apical anterior vaginal wall prolapse (AVWP) with central defect is uncommon in young non hysterectomized patients causing considerable mortality after the fourth decade of life. Its high propensity to recurrence poses the greatest challenge to pelvic reconstructive surgeons. Approximately 40% of women with prolapse have hypertrophic cervical elongation and the extent of elongation increases with greater degrees of prolapse. Women with prolapse either have inherent hypertrophic elongation of the cervix which predisposes them to prolapse or the downward traction in prolapse leads to cervical elongation. The Pelvic Organ Prolapse Quantification (POP-Q) examination includes measurement of the location of the posterior fornix (point D) with the assumption that this measurement is associated with cervical elongation. Multifocal site involvement with apical and perineal descent primarily afflicts elderly, postmenopausal women after the fourth decade while cervical hypertrophic elongation with prolapse is observed in younger women less than 40 years of age. A review of the anatomical implication of the association of cervical hypertrophy in prolapse is carried out in this article. We observed a combination of distension type anterior vaginal prolapse with apical descent and cervical hypertrophy in a 20-year-old cadaver during routine dissection for undergraduate medical students at Sikkim Manipal Institute of Medical Sciences in 2013. Distension type anterior vaginal prolapse with central defect is rarer as most reported cases are of the displacement type, paravaginal defect. Hypertrophic cervical elongation is either the cause or consequence of prolapse and its identification before reconstructive surgery is paramount as uterine suspension in the face of cervical elongation is contraindicated. Inappropriate identification of all support defects and breaking of tissues is the primary cause of failure of laparoscopic pelvic reconstructive surgery. PMID:26557506

  20. Fabrication of electrospun thermoplastic polyurethane blended poly (l-lactide-co-e-caprolactone) microyarn scaffolds for engineering of female pelvic-floor tissue.

    PubMed

    Hou, Min; Wu, Qingkai; Dai, Miao; Xu, Peirong; Gu, Chaochen; Jia, Xiang; Feng, Jie; Mo, Xiumei

    2015-02-01

    Potential scaffolds for repair of the female pelvic floor require new materials and fabrication by novel methods to improve cellular infiltration. An 'ideal' engineered scaffold for pelvic-floor tissue should mimic the three-dimensional (3D) network of the extracellular matrix (ECM), which possesses intricate macro- and nano-architecture. In this study, a series of blended poly(l-lactide-co-ecaprolactone) P(LLA-CL)/thermoplastic polyurethane (TPU) microyarn/microfibrous scaffolds were produced with different weight ratios via dynamic liquid electrospinning and electrospinning. Both biopolymers were dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol (HFIP). Our data showed the mean diameter of microyarn scaffolds to be significantly larger than that of microfibers. Microyarn scaffolds possessed large pore sizes and high porosity. There was no significant difference between the mechanical properties of microyarn and microfibrous scaffolds. Fourier-transform infrared spectroscopy suggested that intermolecular bonds were not present between the molecules of TPU and P(LLA-CL). Morphologic observations using scanning electron microscopy and inverted fluorescence microscopy showed that adipose-derived stem cells labeled with enhanced green fluorescent protein could grow well along or within blend microyarns and migrate within the novel 3D scaffolds. Hematoxylin and eosin staining demonstrated that cell infiltration on microyarn scaffolds was significantly enhanced. The CCK-8 assay showed that microyarns could significantly facilitate cell proliferation compared with microfibrous scaffolds. These results suggested that blend microyarns of P(LLA-CL)/TPU designed to mimic the ECM for female pelvic-floor tissue may be excellent macroporous scaffolds for tissue repair. PMID:25546879

  1. Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review

    PubMed Central

    Neumann, Patricia B; Grimmer, Karen A; Deenadayalan, Yamini

    2006-01-01

    Background Stress urinary incontinence (SUI) is a prevalent and costly condition which may be treated surgically or by physical therapy. The aim of this review was to systematically assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training (PFMT) performed alone and together with adjunctive therapies (eg biofeedback, electrical stimulation, vaginal cones) for the treatment of female SUI. Methods All major electronic sources of relevant information were systematically searched to identify peer-reviewed English language abstracts or papers published between 1995 and 2005. Randomised controlled trials (RCTs) and other study designs eg non-randomised trials, cohort studies, case series, were considered for this review in order to source all the available evidence relevant to clinical practice. Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion. Excluded were studies of women who were pregnant, immediately post-partum or with a diagnosis of mixed or urge incontinence. Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. Due to the heterogeneity of study designs, the results are presented in narrative format. Results Twenty four studies, including 17 RCTs and seven non-RCTs, met the inclusion criteria. The methodological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence. This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for women with SUI with rates of 'cure' and 'cure/improvement' up to 73% and 97% respectively. The contribution of adjunctive therapies is unclear and there is limited evidence about treatment

  2. Pelvic Floor Dyssynergia

    MedlinePlus

    ... we receive information (feedback) on how our bodies work. The therapist helps us to use this displayed information to modify or change abnormal responses to more normal patterns. ... Cyclic Vomiting Syndrome CVS ...

  3. Pelvic Floor Dysfunction

    MedlinePlus

    Skip to main content ASCRS Patients Educational Resources Diseases and Conditions Patient Education Library Patient Success Stories Treatments and Screening Resources Find a Surgeon Hereditary Colorectal Cancer Registries Helpful Links Physicians ...

  4. Pelvic Floor Disorders

    MedlinePlus

    ... with questions about grants, contracts & research areas Training, Education & Career Development Support for Training at Universities & Other Institutions Extramural training, fellowships & career development opportunities Training at ...

  5. The effects of training by virtual reality or gym ball on pelvic floor muscle strength in postmenopausal women: a randomized controlled trial

    PubMed Central

    Martinho, Natalia M.; Silva, Valéria R.; Marques, Joseane; Carvalho, Leonardo C.; Iunes, Denise H.; Botelho, Simone

    2016-01-01

    ABSTRACT Objective To evaluate the effectiveness of abdominopelvic training by virtual reality compared to pelvic floor muscle training (PFMT) using a gym ball (a previously tested and efficient protocol) on postmenopausal women’s pelvic floor muscle (PFM) strength. Method A randomized controlled trial was conducted with 60 postmenopausal women, randomly allocated into two groups: Abdominopelvic training by virtual reality – APT_VR (n=30) and PFMT using a gym ball – PFMT_GB (n=30). Both types of training were supervised by the same physical therapist, during 10 sessions each, for 30 minutes. The participants’ PFM strength was evaluated by digital palpation and vaginal dynamometry, considering three different parameters: maximum strength, average strength and endurance. An intention-to-treat approach was used to analyze the participants according to original groups. Results No significant between-group differences were observed in most analyzed parameters. The outcome endurance was higher in the APT_VR group (p=0.003; effect size=0.89; mean difference=1.37; 95% CI=0.46 to 2.28). Conclusion Both protocols have improved the overall PFM strength, suggesting that both are equally beneficial and can be used in clinical practice. Muscle endurance was higher in patients who trained using virtual reality. PMID:27437716

  6. Impact of episiotomy on pelvic floor disorders and their influence on women's wellness after the sixth month postpartum: a retrospective study

    PubMed Central

    2011-01-01

    Background The role of episiotomy as a protective factor against pelvic floor disorders postpartum has been debated for many years, but its routine use has been hitherto discouraged in the literature. Comparisons between restrictive and routine use of episiotomy in existent literature, however, fail to include any consideration relating to quality of life. The aim of this study, therefore, is to state the role of episiotomy in preserving the perineum from damage, in order to prevent the influence of pelvic floor disorders on women's psycho-physical wellness after the sixth month postpartum. Methods A follow-up telephone interview was performed among 377 primiparous and secondiparous Caucasian women who had a child by spontaneous or operative vaginal delivery in 2006 using a self-created questionnaire and King's Health Questionnaire (KHQ). Results The mean age at delivery was 35.26 (±4.68) years and episiotomy was performed in 59.2% of women. Multivariate linear regression shows episiotomy associated to higher quality of life after the sixth month postpartum by correlating with inferior values of King's Health Questionnaire (p < 0.05). Conclusions Episiotomy appears to be a protective factor for women's wellness. Women who had episiotomy and who experienced perineal symptoms have a better psycho-physical health status in the 12.79 months (±3.3) follow-up. PMID:21501462

  7. Pelvic Floor Muscle Training in Women With Stress Urinary Incontinence Causes Hypertrophy of the Urethral Sphincters and Reduces Bladder Neck Mobility During Coughing

    PubMed Central

    McLean, Linda; Varette, Kevin; Gentilcore-Saulnier, Evelyne; Harvey, Marie-Andree; Baker, Kevin; Sauerbrei, Eric

    2016-01-01

    Aims The purpose of this study was to determine the effect of a 12-week pelvic floor muscle (PFM) training program on urethral morphology and mobility in women with stress urinary incontinence (SUI). Methods Forty women with SUI were randomly assigned to one of two groups: the treatment group received 12 weekly physiotherapy sessions during which they learned how to properly contract their pelvic floor muscles (PFMs) and a home exercise program was prescribed, reviewed, and progressed; the control group received no treatment. Before and after the 12-week study period, ultrasound imaging was used to evaluate bladder neck position and mobility during coughing and Valsalva maneuver in supine and in standing, as well as urethral morphology. Secondary outcome measures included a 3-day bladder diary, 30-min pad test, the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6). Results The women in the treatment group demonstrated reduced bladder neck mobility during coughing and increased cross-sectional area of their urethra after as compared to before the training. These changes were not evident in the control group. No differences in the resting position of the bladder neck or in bladder neck excursion during Valsalva maneuver were noted in either group. Concomitantly the women in the treatment group demonstrated significant improvements in the 3-day bladder diary and IIQ-7 after the PFM training and improved significantly more than the control group. Conclusion Physiotherapist-supervised PFM training reduces bladder neck motion during coughing, and results in hypertrophy of the urethral sphincter in women who present with SUI. PMID:23861324

  8. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence.

    PubMed

    Miller, Janis M; Sampselle, Carolyn; Ashton-Miller, James; Hong, Gwi-Ryung Son; DeLancey, John O L

    2008-06-01

    The aim of the study was to determine the immediate effect of timing a pelvic muscle contraction with the moment of expected leakage (the Knack maneuver) to preempt cough-related stress incontinence. Women performed a standing stress test using three hard coughs without and then with the Knack maneuver. Volume of urine loss under both conditions was quantified with paper-towel test. Two groups of women were tested: nonpregnant women (n = 64) and pregnant women (n = 29). In nonpregnant women, wetted area decreased from a median (range) of 43.2 (0.2-183.7) cm2 without the Knack maneuver to 6.9 (range of 0 to 183.7 cm2) with it (p < 0.0001); while in pregnant women it decreased from 14.8 (0-169.7) cm2 to 0 (0-96.5) cm2, respectively (p = 0.001). This study confirms the effect from the Knack maneuver as immediate and provides a partial explanation for early response to widely applied pelvic muscle training regimens in women with stress incontinence. PMID:18204797

  9. Evaluation of Bioelectrical Activity of Pelvic Floor Muscles and Synergistic Muscles Depending on Orientation of Pelvis in Menopausal Women with Symptoms of Stress Urinary Incontinence: A Preliminary Observational Study

    PubMed Central

    Halski, Tomasz; Słupska, Lucyna; Dymarek, Robert; Bartnicki, Janusz; Halska, Urszula; Król, Agata; Paprocka-Borowicz, Małgorzata; Dembowski, Janusz; Zdrojowy, Romuald

    2014-01-01

    Objectives. Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt. Design. Preliminary, prospective observational study. Setting. Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Participants. Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study. Primary Outcome Measures. Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe. Secondary Outcome Measures. Evaluation of activity of the synergistic muscles by sEMG and surface electrodes. Results. No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles. Conclusions. This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM. PMID:24701567

  10. The effect of parity on pelvic floor muscle strength and quality of life in women with urinary incontinence: a cross sectional study

    PubMed Central

    Özdemır, Özlem Çınar; Bakar, Yesim; Özengın, Nuriye; Duran, Bülent

    2015-01-01

    [Purpose] The purpose of this study was to analyze the pelvic floor muscle (PFM) activity after vaginal birth, and the effect of parity on PFM strength and quality of life (QoL) in women with urinary incontinence. [Subjects and Methods] Patients (n=241) who gave birth vaginally and experienced urinary incontinence were divided into three groups: group 1 consisted of women having 1–3 children, group 2 consisted of women having 4–6 children, and group 3 consisted of women having more than 6 children. All patients underwent detailed examination of the PFM. The Turkish version of the self-administered Incontinence Quality of Life Instrument (I-QoL) questionnaire was used to evaluate the effects of stress urinary incontinence on participants’ QoL. [Results] Comparison of PFM strengths showed a significant intergroup difference. Group 1 showed significantly higher PFM strength scores than those of groups 2 and 3. I-QoL scores related to stress incontinence showed a significant intergroup difference. As number of deliveries increased, quality of life decreased. Comparison of PFM strengths and I-QoL scores related to stress incontinence showed a significant intergroup difference. [Conclusion] Increasing the awareness of PFM training in women will reduce potential postpartum incontinence due to a weak PFM strength; and will increase quality of life. PMID:26311939

  11. Developing evidence-based standards for diagnosis and management of lower urinary tract or pelvic floor dysfunction.

    PubMed

    Rosier, Peter F W M; de Ridder, Dirk; Meijlink, Jane; Webb, Ralph; Whitmore, Kristene; Drake, Marcus J

    2012-06-01

    The International Continence Society (ICS) has a key role in standardizing terminology related to lower urinary tract and pelvic organ dysfunction. The ICS Standardization Steering Committee (SSC) presents the new structure and process by which future ICS Standards will be developed. The new processes aim to meet present-day evidence-based practice requirements, and to foster unbiased, inclusive, and transparent development. For each new ICS Standard, the SSC will oversee a dedicated ad hoc Working Group (WG). Applications to chair or contribute to a WG will be invited from the ICS membership. The SSC will select the Chairperson, and work with him or her to select the WG composition, balanced to represent key disciplines, stakeholders, and regions. Consultants can be invited to contribute to the WG where specific need arises. Every WG will review current knowledge, adhering to evidence-based medicine requirements. Progress reports will be reviewed by the SSC, and amendments recommended, culminating in a first draft. The draft will be offered to the ICS membership and additional relevant experts for comment. Further revision, if needed, will result in a document, which the SSC will submit to the ICS Trustees, as arbiters of whether the document should be adopted as an ICS Standard. The SCC will then coordinate with the WG to ensure that the new ICS Standard is published and disseminated. Implementation strategies, such as education, audit, accreditation, and research initiatives will be linked to the Standards where appropriate. Revisions of ICS Standards will be undertaken to maintain contemporaneous relevance. PMID:22396134

  12. Descent vehicles

    NASA Technical Reports Server (NTRS)

    Popov, Y. I.

    1985-01-01

    The creation of descent vehicles marked a new stage in the development of cosmonautics, involving the beginning of manned space flight and substantial progress in space research on the distant bodies of the Solar System. This booklet describes these vehicles and their structures, systems, and purposes. It is intended for the general public interested in modern problems of space technology.

  13. Pelvic Muscle Exercises Using A Home Trainer for Pelvic Muscle Dysfunction: A Case Report.

    PubMed

    Shelly, Beth

    2016-01-01

    Pelvic muscle exercises can help improve symptoms of pelvic floor muscle dysfunction. This article describes the case of a 66-year-old woman with moderate pelvic organ prolapse (POP) and mild urinary incontinence (UI) who initiated pelvic muscle exercises with the assistance of a novel, at-home trainer equipped with a vaginal sensor and accompanying smartphone app software, the PeriCoach system (Analytica, 2015). After 8 weeks of training with the device, she showed improvements in strength, endurance, and disability, as measured by manual muscle test, electromyography, and Pelvic Floor Disability Index scores. Older women can use biofeedback technology to improve pelvic floor muscle function successfully at home. PMID:27281865

  14. Biological findings from the PheWAS catalog: focus on connective tissue-related disorders (pelvic floor dysfunction, abdominal hernia, varicose veins and hemorrhoids).

    PubMed

    Salnikova, Lyubov E; Khadzhieva, Maryam B; Kolobkov, Dmitry S

    2016-07-01

    Pelvic floor dysfunction, specifically genital prolapse (GP) and stress urinary inconsistency (SUI) presumably co-occur with other connective tissue disorders such as hernia, hemorrhoids, and varicose veins. Observations on non-random coexistence of these disorders have never been summarized in a meta-analysis. The performed meta-analysis demonstrated that varicose veins and hernia are associated with GP. Disease connections on the molecular level may be partially based on shared genetic susceptibility. A unique opportunity to estimate shared genetic susceptibility to disorders is provided by a PheWAS (phenome-wide association study) designed to utilize GWAS data concurrently to many phenotypes. We searched the PheWAS Catalog, which includes the results of the PheWAS study with P value < 0.05, for genes associated with GP, SUI, abdominal hernia, varicose veins and hemorrhoids. We found pronounced signals for the associations of the SLC2A9 gene with SUI (P = 6.0e-05) and the MYH9 gene with varicose veins of lower extremity (P = 0.0001) and hemorrhoids (P = 0.0007). The comparison of the PheWAS Catalog and the NHGRI Catalog data revealed enrichment of genes associated with bone mineral density in GP and with activated partial thromboplastin time in varicose veins of lower extremity. In cross-phenotype associations, genes responsible for peripheral nerve functions seem to predominate. This study not only established novel biologically plausible associations that may warrant further studies but also exemplified an effective use of the PheWAS Catalog data. PMID:27126235

  15. Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinence: a preliminary observational study

    PubMed Central

    Ptaszkowski, Kuba; Paprocka-Borowicz, Małgorzata; Słupska, Lucyna; Bartnicki, Janusz; Dymarek, Robert; Rosińczuk, Joanna; Heimrath, Jerzy; Dembowski, Janusz; Zdrojowy, Romuald

    2015-01-01

    Objective Muscles such as adductor magnus (AM), gluteus maximus (GM), rectus abdominis (RA), and abdominal external and internal oblique muscles are considered to play an important role in the treatment of stress urinary incontinence (SUI), and the relationship between contraction of these muscles and pelvic floor muscles (PFM) has been established in previous studies. Synergistic muscle activation intensifies a woman’s ability to contract the PFM. In some cases, even for continent women, it is not possible to fully contract their PFM without involving the synergistic muscles. The primary aim of this study was to assess the surface electromyographic activity of synergistic muscles to PFM (SPFM) during resting and functional PFM activation in postmenopausal women with and without SUI. Materials and methods This study was a preliminary, prospective, cross-sectional observational study and included volunteers and patients who visited the Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Forty-two patients participated in the study and were screened for eligibility criteria. Thirty participants satisfied the criteria and were categorized into two groups: women with SUI (n=16) and continent women (n=14). The bioelectrical activity of PFM and SPFM (AM, RA, GM) was recorded with a surface electromyographic instrument in a standing position during resting and functional PFM activity. Results Bioelectrical activity of RA was significantly higher in the incontinent group than in the continent group. These results concern the RA activity during resting and functional PFM activity. The results for other muscles showed no significant difference in bioelectrical activity between groups. Conclusion In women with SUI, during the isolated activation of PFM, an increased synergistic activity of RA muscle was observed; however, this activity was not observed in asymptomatic women. This may indicate the important accessory contribution of these muscles in the

  16. Pelvic Exam

    MedlinePlus

    ... hyphen, e.g. -historical Searches are case-insensitive Exam, Pelvic Add to My Pictures View /Download : Small: ... 1500x1230 View Download Large: 3000x2460 View Download Title: Exam, Pelvic Description: Pelvic exam; drawing shows a side ...

  17. Protocol for Translabial 3D-Ultrasonography for diagnosing levator defects (TRUDIL): a multicentre cohort study for estimating the diagnostic accuracy of translabial 3D-ultrasonography of the pelvic floor as compared to MR imaging

    PubMed Central

    2011-01-01

    Background Pelvic organ prolapse (POP) is a condition affecting more than half of the women above age 40. The estimated lifetime risk of needing surgical management for POP is 11%. In patients undergoing POP surgery of the anterior vaginal wall, the re-operation rate is 30%. The recurrence risk is especially high in women with a levator ani defect. Such defect is present if there is a partially or completely detachment of the levator ani from the inferior ramus of the symphysis. Detecting levator ani defects is relevant for counseling, and probably also for treatment. Levator ani defects can be imaged with MRI and also with Translabial 3D ultrasonography of the pelvic floor. The primary aim of this study is to assess the diagnostic accuracy of translabial 3D ultrasonography for diagnosing levator defects in women with POP with Magnetic Resonance Imaging as the reference standard. Secondary goals of this study include quantification of the inter-observer agreement about levator ani defects and determining the association between levator defects and recurrent POP after anterior repair. In addition, the cost-effectiveness of adding translabial ultrasonography to the diagnostic work-up in patients with POP will be estimated in a decision analytic model. Methods/Design A multicentre cohort study will be performed in nine Dutch hospitals. 140 consecutive women with a POPQ stage 2 or more anterior vaginal wall prolapse, who are indicated for anterior colporapphy will be included. Patients undergoing additional prolapse procedures will also be included. Prior to surgery, patients will undergo MR imaging and translabial 3D ultrasound examination of the pelvic floor. Patients will be asked to complete validated disease specific quality of life questionnaires before surgery and at six and twelve months after surgery. Pelvic examination will be performed at the same time points. Assuming a sensitivity and specificity of 90% of 3D ultrasound for diagnosing levator defects in a

  18. Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain

    PubMed Central

    Pastore, Elizabeth Anne; Katzman, Wendy B.

    2012-01-01

    Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by healthcare providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, PMID:22862153

  19. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training

    PubMed Central

    Sjöström, Malin; Umefjord, Göran; Stenlund, Hans; Carlbring, Per; Andersson, Gerhard; Samuelsson, Eva

    2015-01-01

    Objectives To evaluate the long-term effects of two non-face-to-face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT). Subjects and Methods The present study was a randomized controlled trial with online recruitment of 250 community-dwelling women aged 18–70 years with SUI ≥ one time/week. Diagnosis was based on validated self-assessed questionnaires, 2-day bladder diary and telephone interview with a urotherapist. Consecutive computer-generated block randomization was carried out with allocation by an independent administrator to 3 months of treatment with either an internet-based treatment programme (n = 124) or a programme sent by post (n = 126). Both interventions focused mainly on PFMT. The internet group received continuous e-mail support from a urotherapist, whereas the postal group trained on their own. Follow-up was performed after 1 and 2 years via self-assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form [ICIQ-UI SF]) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]). Secondary outcomes were the Patient Global Impression of Improvement, health-specific quality of life (EQ-visual analogue scale [EQ-VAS]), use of incontinence aids, and satisfaction with treatment. There was no face-to-face contact with the participants at any time. Analysis was based on intention-to-treat. Results We lost 32.4% (81/250) of participants to follow-up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (P < 0.001) improvements with large effect sizes (>0.8) for symptoms and condition-specific quality of life (QoL) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean (sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group (P = 0

  20. Pelvic radiation - discharge

    MedlinePlus

    Radiation of the pelvis - discharge; Cancer treatment - pelvic radiation; Prostate cancer - pelvic radiation; Ovarian cancer - pelvic radiation; Cervical cancer - pelvic radiation; Uterine cancer - pelvic radiation; Rectal cancer - ...

  1. Pelvic Support Problems

    MedlinePlus

    ... correct pelvic support problems? • Glossary What are pelvic support problems? The pelvic organs include the vagina , cervix , uterus , bladder , urethra , small intestines, and rectum . The pelvic ...

  2. Pelvic Organ Prolapse--Surgery

    MedlinePlus

    ... on PFDs Videos Bookmark These Websites Helpful Organizations Patient Privacy Concerns Community Find a Provider Break Free Upcoming ... Download Preparing for Surgery (PDF) Mesh Information for Patients with Pelvic Floor Disorders ... Us | Privacy Policy Accredited © 2016 American Urogynecologic Society. All rights ...

  3. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

    PubMed

    Pastore, Elizabeth A; Katzman, Wendy B

    2012-01-01

    Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP. PMID:22862153

  4. Ascent/Descent Software

    NASA Technical Reports Server (NTRS)

    Brown, Charles; Andrew, Robert; Roe, Scott; Frye, Ronald; Harvey, Michael; Vu, Tuan; Balachandran, Krishnaiyer; Bly, Ben

    2012-01-01

    The Ascent/Descent Software Suite has been used to support a variety of NASA Shuttle Program mission planning and analysis activities, such as range safety, on the Integrated Planning System (IPS) platform. The Ascent/Descent Software Suite, containing Ascent Flight Design (ASC)/Descent Flight Design (DESC) Configuration items (Cis), lifecycle documents, and data files used for shuttle ascent and entry modeling analysis and mission design, resides on IPS/Linux workstations. A list of tools in Navigation (NAV)/Prop Software Suite represents tool versions established during or after the IPS Equipment Rehost-3 project.

  5. Continence and Quality-of-Life Outcomes 6 Months Following an Intensive Pelvic-Floor Muscle Exercise Program for Female Stress Urinary Incontinence: A Randomized Trial Comparing Low- and High-Frequency Maintenance Exercise

    PubMed Central

    Borello-France, Diane F; Downey, Patricia A; Zyczynski, Halina M; Rause, Christine R

    2008-01-01

    Background and Objectives: Few studies have examined the effectiveness of pelvic-floor muscle (PFM) exercises to reduce female stress urinary incontinence (SUI) over the long term. This study: (1) evaluated continence and quality-of-life outcomes of women 6 months following formalized therapy and (2) determined whether low- and high-frequency maintenance exercise programs were equivalent in sustaining outcomes. Subjects and Methods: Thirty-six women with SUI who completed an intensive PFM exercise intervention trial were randomly assigned to perform a maintenance exercise program either 1 or 4 times per week. Urine leaks per week, volume of urine loss, quality of life (Incontinence Impact Questionnaire [IIQ] score), PFM strength (Brink score), and prevalence of urodynamic stress incontinence (USI) were measured at a 6-month follow-up for comparison with postintervention status. Parametric and nonparametric statistics were used to determine differences in outcome status over time and between exercise frequency groups. Results: Twenty-eight women provided follow-up data. Postintervention status was sustained at 6 months for all outcomes (mean [SD] urine leaks per week=1.2±2.1 versus 1.4±3.1; mean [SD] urine loss=0.2±0.5 g versus 0.2±0.8 g; mean [SD] IIQ score=17±20 versus 22±30; mean [SD] Brink score=11±1 versus 11±1; and prevalence of USI=48% versus 35%). Women assigned to perform exercises once or 4 times per week similarly sustained their postintervention status. Discussion and Conclusions: Benefits of an initial intensive intervention program for SUI were sustained over 6 months. However, only 15 of the 28 women provided documentation of their exercise adherence, limiting conclusions regarding the need for continued PFM exercise during follow-up intervals of ≤6 months. PMID:18820095

  6. How Are Pelvic Floor Disorders Diagnosed?

    MedlinePlus

    ... NICHD Research Information Research Goals Activities and Advances Scientific Articles Staff Contacts Clinical Trials Resources and Publications For Patients and Consumers For Researchers and Health ...

  7. How Are Pelvic Floor Disorders Commonly Treated?

    MedlinePlus

    ... articles, clinical trials, resources Clinical Trials & Clinical Research Find clinical trials, guidance for clinical researchers Health Education Campaigns & Programs Safe to Sleep, Media-Smart Youth, Maternal/Child Health Education Program NICHD Publications ...

  8. Informed Consent for Reconstructive Pelvic Surgery.

    PubMed

    Alam, Pakeeza; Iglesia, Cheryl B

    2016-03-01

    Informed consent is the process in which a patient makes a decision about a surgical procedure or medical intervention after adequate information is relayed by the physician and understood by the patient. This process is critical for reconstructive pelvic surgeries, particularly with the advent of vaginal mesh procedures. In this article, we review the principles of informed consent, the pros and cons of different approaches in reconstructive pelvic surgery, the current legal issues surrounding mesh use for vaginal surgery, and tips on how to incorporate this information when consenting patients for pelvic floor surgery. PMID:26880513

  9. Pelvic Pain

    MedlinePlus

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  10. Prevention and management of pelvic organ prolapse

    PubMed Central

    Giarenis, Ilias

    2014-01-01

    Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery. PMID:25343034

  11. Pelvic Organ Prolapse

    MedlinePlus

    ... Prosthetics Urogynecologic Surgical Mesh Implants Pelvic Organ Prolapse (POP) Share Tweet Linkedin Pin it More sharing options ... What is Pelvic Organ Prolapse? Pelvic organ prolapse (POP) occurs when the tissue and muscles of the ...

  12. Chronic Pelvic Pain in Women.

    PubMed

    Speer, Linda M; Mushkbar, Saudia; Erbele, Tara

    2016-03-01

    Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medroxyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuromodulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach. PMID:26926975

  13. Third Floor Plan, Second Floor Plan, First Floor Plan, Ground ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Third Floor Plan, Second Floor Plan, First Floor Plan, Ground Floor Plan, West Bunkhouse - Kennecott Copper Corporation, On Copper River & Northwestern Railroad, Kennicott, Valdez-Cordova Census Area, AK

  14. Terminal Descent Sensor Simulation

    NASA Technical Reports Server (NTRS)

    Chen, Curtis W.

    2009-01-01

    Sulcata software simulates the operation of the Mars Science Laboratory (MSL) radar terminal descent sensor (TDS). The program models TDS radar antennas, RF hardware, and digital processing, as well as the physics of scattering from a coherent ground surface. This application is specific to this sensor and is flexible enough to handle end-to-end design validation. Sulcata is a high-fidelity simulation and is used for performance evaluation, anomaly resolution, and design validation. Within the trajectory frame, almost all internal vectors are represented in whatever coordinate system is used to represent platform position. The trajectory frame must be planet-fixed. The platform body frame is specified relative to arbitrary reference points relative to the platform (spacecraft or test vehicle). Its rotation is a function of time from the trajectory coordinate system specified via dynamics input (file for open loop, callback for closed loop). Orientation of the frame relative to the body is arbitrary, but constant over time. The TDS frame must have a constant rotation and translation from the platform body frame specified at run time. The DEM frame has an arbitrary, but time-constant, rotation and translation with respect to the simulation frame specified at run time. It has the same orientation as sigma0 frame, but is possibly translated. Surface sigma0 has the same arbitrary rotation and translation as DEM frame.

  15. Chronic Pelvic Pain

    MedlinePlus

    ... found. How is chronic pelvic pain diagnosed? Your health care provider will ask about your medical history. You will have a physical exam, including a pelvic exam . Tests also may be done to find the cause. ...

  16. Pelvic inflammatory disease (PID)

    MedlinePlus

    ... see what else may be causing your symptoms. Appendicitis or pockets of infection around your tubes and ... pelvic organs. This can lead to: Chronic pelvic pain Ectopic pregnancy Infertility Tuboovarian abscess If you have ...

  17. Pelvic laparoscopy - slideshow

    MedlinePlus

    ... Hysterectomy Ovarian Cysts Pelvic Inflammatory Disease Pelvic Pain Uterine Fibroids A.D.A.M., Inc. is accredited by ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

  18. [Pelvic injury from the urogyneacology point of view. Overview].

    PubMed

    Hron, F; Dzupa, V; Otcenásek, M; Feyereisl, J; Grill, R

    2010-11-01

    The authors completed all available information of the national and foreign literature concerning problems of urogynecological injuries associated with a pelvic injury in women with regard to possible consequences to the quality of life. The authors also aimed their attention on potentional risks associated with pelvic injury in pregnant women. Urological and sexual disorders following pelvic injuries in women in the fertile age represent a separate chapter of traumatology. Increase in these injuries noticed in last years requires particular attention to diagnostics and treatment of these conditions: urinary incontinence, sexual disorders and pregnancy in women who suffered a pelvic injury. The problem of diagnostics and sequelae of injury of the pelvic floor still remains unresolved. PMID:21409806

  19. Simulation Test Of Descent Advisor

    NASA Technical Reports Server (NTRS)

    Davis, Thomas J.; Green, Steven M.

    1991-01-01

    Report describes piloted-simulation test of Descent Advisor (DA), subsystem of larger automation system being developed to assist human air-traffic controllers and pilots. Focuses on results of piloted simulation, in which airline crews executed controller-issued descent advisories along standard curved-path arrival routes. Crews able to achieve arrival-time precision of plus or minus 20 seconds at metering fix. Analysis of errors generated in turns resulted in further enhancements of algorithm to increase accuracies of its predicted trajectories. Evaluations by pilots indicate general support for DA concept and provide specific recommendations for improvement.

  20. Floors: Selection and Maintenance.

    ERIC Educational Resources Information Center

    Berkeley, Bernard

    Flooring for institutional, commercial, and industrial use is described with regard to its selection, care, and maintenance. The following flooring and subflooring material categories are discussed--(1) resilient floor coverings, (2) carpeting, (3) masonry floors, (4) wood floors, and (5) "formed-in-place floors". The properties, problems,…

  1. EXOMARS Descent Module GNC Performance

    NASA Astrophysics Data System (ADS)

    Portigliotti, S.; Capuano, M.; Montagna, M.; Martella, P.; Venditto, P.

    2007-08-01

    The ExoMars mission is the first ESA led robotic mission of the Aurora Programme and combines technology development with investigations of major scientific interest. Italy is by far the major contributor to the mission through the strong support of the Italian Space Agency (ASI). ExoMars will search for traces of past and present life, characterize the Mars geochemistry and water distribution, improve the knowledge of the Mars environment and geophysics, and identify possible surface hazards to future human exploration missions. ExoMars will also validate the technology for safe Entry, Descent and Landing (EDL) of a large size Descent Module (DM) carrying a Rover with medium range surface mobility and the access to subsurface. The ExoMars project is presently undergoing its Phase B1 with Thales Alenia Space-Italia as Industrial Prime Contractor. Additionally, as Descent Module responsible, a dedicated simulation tool is under development in Thales Alenia Space-Italia, Turin site, for the end-to-end design and validation / verification of the DM Entry Descent and Landing.

  2. Pelvic and acetabular fractures

    SciTech Connect

    Mears, D.C.; Rubash, H.E.

    1986-01-01

    This treatise focuses primarily on the clinical aspects of diagnosis and treatments of pelvic and acetabular fractures. However, considerable attention is also paid to the radiographic diagnosis of trauma and postoperative effects. The book begins with a succinct review of pelvic and acetabular anatomy and pelvic biomechanics. It continues with a radiographic classification of pelvic injury, which will represent the major source of the book's interest for radiologists. The remainder of the book is concerned with clinical management of pelvic and acetabular trauma, including preoperative planning, surgical approaches, techniques of reduction, internal fixation, eternal fixation, post-operative care, and late problems. Even throughout this later portion of the book there are extensive illustrations, including plain radiographs, computed tomographic (CT) scans, reconstructed three-dimensional CT scans, and schematic diagrams of diverse pelvic and acetabular fractures and the elementary surgical techniques for their repair.

  3. Pelvic Congestion Syndrome

    PubMed Central

    Durham, Janette D.; Machan, Lindsay

    2013-01-01

    Patients with pelvic congestion syndrome present with otherwise unexplained chronic pelvic pain that has been present for greater than 6 months, and anatomic findings that include pelvic venous insufficiency and pelvic varicosities. It remains an underdiagnosed explanation for pelvic pain in young, premenopausal, usually multiparous females. Symptoms include noncyclical, positional lower back, pelvic and upper thigh pain, dyspareunia, and prolonged postcoital discomfort. Symptoms worsen throughout the day and are exacerbated by activity or prolonged standing. Examination may reveal ovarian tenderness and unusual varicosities—vulvoperineal, posterior thigh, and gluteal. Diagnosis is suspected by clinical history and imaging that demonstrates pelvic varicosities. Venography is usually necessary to confirm ovarian vein reflux, although transvaginal ultrasound may be useful in documenting this finding. Endovascular therapy has been validated by several large patient series with long-term follow-up using standardized pain assessment surveys. Embolization has been shown to be significantly more effective than surgical therapy in improving symptoms in patients who fail hormonal therapy. Although there has been variation in approaches between investigators, the goal is elimination of ovarian vein reflux with or without direct sclerosis of enlarged pelvic varicosities. Symptom reduction is seen in 70 to 90% of the treated females despite technical variation. PMID:24436564

  4. Pelvic Organ Prolapse-Associated Cystitis.

    PubMed

    Hamid, Rizwan; Losco, Giovanni

    2014-01-01

    Pelvic organ prolapse (POP) and urinary tract infection (UTI) are important problems, estimated to affect around 14 and 40 % of women, respectively, at some point in their lives. Positive urine culture in the presence of symptoms is the cornerstone of diagnosis of UTI and should be performed along with ultrasound assessment of postvoid residual (PVR) in all women presenting with POP and UTI. PVR over 30 mL is an independent risk factor for UTI, although no specific association with POP and UTI has been demonstrated. The use of prophylactic antibiotics remains controversial. The major risk factors for postoperative UTI are postoperative catheterisation, prolonged catheterisation, previous recurrent UTI and an increased urethro-anal distance-suggesting that global pelvic floor dysfunction may play a role. PMID:25170365

  5. Consert during the Philae Descent

    NASA Astrophysics Data System (ADS)

    Herique, Alain; Berquin, Yann; Blazquez, Alejandro; Antoine Foulon, Marc; Hahnel, Ronny; Hegler, Sebastian; Jurado, Eric; Kofman, Wlodek; Plettemeier, Dirk; Rogez, Yves; Statz, Christoph; Zine, Sonia

    2014-05-01

    The CONSERT experiment on board Rosetta and Philae is to perform the tomography of the 67P/CG comet nucleus measuring radio waves transmission from the Rosetta S/C to the Philae Lander and using the 67P nucleus rotation to cover different geometries. CONSERT will operate during the Philae descent. This geometry strongly differs from the "nominal" bistatic tomography where the orbiter is on the opposite side of the nucleus by regard to the lander. During the descent, CONSERT will measure direct wave propagating from orbiter to lander and waves reflected / scattered by the 67P surface and subsurface. This signal will provide information of the greatest interest for both scientific investigations of 67P and technical operations of Philae. The landing site position is known a priori with a large ellipse of dispersion due to uncertainties on the Rosetta velocity and Rosetta/Philae separation strength. This dispersion is increased by the difference between nominal and emergency separation strength. An accurate estimation of the landing position as soon as possible after landing is of the greatest interest to optimize Philae operation during FSS. So propagation delay of the direct and reflected waves measured by CONSERT will help to reconstruct the descent geometry in order to more precisely estimate the landing position. The reflected signal is determined by the surface properties: its dielectric permittivity, its roughness and layering. The signal power inversion will allow to map surface properties especially in the vicinity of the landing site. This paper details the measurement configuration. It presents the data retrieval based on Monte-Carlo simulation using Metropolis-Hastings algorithm and expected performances for both science and operations.

  6. Spirit's Descent to Mars-1706

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This image, taken by the descent image motion estimation system camera located on the bottom of the Mars Exploration Rover Spirit's lander, shows a view of Gusev Crater as the lander descends to Mars. The picture is taken at an altitude of 1706 meters. Numerous small impact craters can be seen on the surface of the planet. These images help the onboard software to minimize the lander's horizontal velocity before its bridle is cut, and it falls freely to the surface of Mars.

  7. Spirit's Descent to Mars-1433

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This image, taken by the descent image motion estimation system camera located on the bottom of the Mars Exploration Rover Spirit's lander, shows a view of Gusev Crater as the lander descends to Mars. The picture is taken at an altitude of 1433 meters. Numerous small impact craters can be seen on the surface of the planet. These images help the onboard software to minimize the lander's horizontal velocity before its bridal is cut, and it falls freely to the surface of Mars.

  8. Spirit's Descent to Mars-1983

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This image, taken by the descent image motion estimation system camera located on the bottom of the Mars Exploration Rover Spirit's lander, shows a view of Gusev Crater as the lander descends to Mars. The picture is taken at an altitude of 1983 meters. Numerous small impact craters can be seen on the surface of the planet. These images help the onboard software to minimize the lander's horizontal velocity before its bridal is cut, and it falls freely to the surface of Mars.

  9. A new steepest descent method

    NASA Astrophysics Data System (ADS)

    Abidin, Zubai'ah Zainal; Mamat, Mustafa; Rivaie, Mohd; Mohd, Ismail

    2014-06-01

    The classical steepest descent (SD) method is known as one of the earliest and the best method to minimize a function. Even though the convergence rate is quite slow, but its simplicity has made it one of the easiest methods to be used and applied especially in the form of computer codes. In this paper, a new modification of SD method is proposed using a new search direction (dk) in the form of two parameters. Numerical results shows that this new SD has far superior convergence rate and more efficient than the classical SD method.

  10. Ant colony optimization and stochastic gradient descent.

    PubMed

    Meuleau, Nicolas; Dorigo, Marco

    2002-01-01

    In this article, we study the relationship between the two techniques known as ant colony optimization (ACO) and stochastic gradient descent. More precisely, we show that some empirical ACO algorithms approximate stochastic gradient descent in the space of pheromones, and we propose an implementation of stochastic gradient descent that belongs to the family of ACO algorithms. We then use this insight to explore the mutual contributions of the two techniques. PMID:12171633

  11. Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain.

    PubMed

    Fenton, Bradford W

    2007-01-01

    Limbic associated pelvic pain is a proposed pathophysiology designed to explain features commonly encountered in patients with chronic pelvic pain, including the presence of multiple pain diagnoses, the frequency of previous abuse, the minimal or discordant pathologic changes of the involved organs, the paradoxical effectiveness of many treatments, and the recurrent nature of the condition. These conditions include endometriosis, interstitial cystitis, irritable bowel syndrome, levator ani syndrome, pelvic floor tension myalgia, vulvar vestibulitis, and vulvodynia. The hypothesis is based on recent improvements in the understanding of pain processing pathways in the central nervous system, and in particular the role of limbic structures, especially the anterior cingulate cortex, hippocampus and amygdala, in chronic and affective pain perception. Limbic associated pelvic pain is hypothesized to occur in patients with chronic pelvic pain out of proportion to any demonstrable pathology (hyperalgesia), and with more than one demonstrable pain generator (allodynia), and who are susceptible to development of the syndrome. This most likely occurs as a result of childhood sexual abuse but may include other painful pelvic events or stressors, which lead to limbic dysfunction. This limbic dysfunction is manifest both as an increased sensitivity to pain afferents from pelvic organs, and as an abnormal efferent innervation of pelvic musculature, both visceral and somatic. The pelvic musculature undergoes tonic contraction as a result of limbic efferent stimulation, which produces the minimal changes found on pathological examination, and generates a further sensation of pain. The pain afferents from these pelvic organs then follow the medial pain pathway back to the sensitized, hypervigilant limbic system. Chronic stimulation of the limbic system by pelvic pain afferents again produces an efferent contraction of the pelvic muscles, thus perpetuating the cycle. This cycle is

  12. Pelvic Inflammatory Disease

    MedlinePlus

    Pelvic inflammatory disease (PID) is an infection and inflammation of the uterus, ovaries, and other female reproductive organs. It causes scarring ... United States. Gonorrhea and chlamydia, two sexually transmitted diseases, are the most common causes of PID. Other ...

  13. Correlation as Probability of Common Descent.

    ERIC Educational Resources Information Center

    Falk, Ruma; Well, Arnold D.

    1996-01-01

    One interpretation of the Pearson product-moment correlation ("r"), correlation as the probability of originating from common descent, important to the genetic measurement of inbreeding, is examined. The conditions under which "r" can be interpreted as the probability of "identity by descent" are specified, and the possibility of generalizing this…

  14. Space Shuttle Orbiter descent navigation

    NASA Technical Reports Server (NTRS)

    Montez, M. N.; Madden, M. F.

    1982-01-01

    The entry operational sequence (OPS 3) begins approximately 2 hours prior to the deorbit maneuver and continues through atmospheric entry, terminal area energy management (TAEM), approach and landing, and rollout. During this flight phase, the navigation state vector is estimated by the Space Shuttle Orbiter onboard navigation system. This estimate is computed using a six-element sequential Kalman filter, which blends inertial measurement unit (IMU) delta-velocity data with external navaid data. The external navaids available to the filter are tactical air navigation (TACAN), barometric altimeter, and microwave scan beam landing system (MSBLS). Attention is given to the functional design of the Orbiter navigation system, the descent navigation sensors and measurement processing, predicted Kalman gains, correlation coefficients, and current flights navigation performance.

  15. Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations

    PubMed Central

    Yavagal, Sujata; de Farias, Thais F.; Medina, Carlos A.; Takacs, Peter

    2011-01-01

    A thorough insight into the female genital anatomy is crucial for understanding and performing pelvic reconstructive procedures. The intimate relationship between the genitalia and the muscles, ligaments, and fascia that provide support is complex, but critical to restore during surgery for correction of prolapse or aesthetic reasons. The external female genitalia include the mons pubis, labia majora and minora, clitoris, vestibule with glands, perineal body, and the muscles and fascia surrounding these structures. Through the perineal membrane and the perineal body, these superficial vulvar structures are structurally related to the deep pelvic muscle levator ani with its fascia. The levator ani forms the pelvic floor with the coccygeus muscle and provides vital support to all the pelvic organs and stability to the perineum. The internal female genital organs include the vagina, cervix, uterus, tubes, and ovaries with their visceral fascia. The visceral fascia also called the endopelvic fascia, surrounds the pelvic organs and connects them to the pelvic walls. It is continuous with the paraurethral and paravaginal fascia, which is attached to the perineal membrane. Thus, the internal and external genitalia are closely related to the muscles and fascia, and work as one functioning unit. PMID:22547969

  16. Predictability of Top of Descent Location for Operational Idle-Thrust Descents

    NASA Technical Reports Server (NTRS)

    Stell, Laurel L.

    2010-01-01

    To enable arriving aircraft to fly optimized descents computed by the flight management system (FMS) in congested airspace, ground automation must accurately predict descent trajectories. To support development of the trajectory predictor and its uncertainty models, commercial flights executed idle-thrust descents at a specified descent speed, and the recorded data included the specified descent speed profile, aircraft weight, and the winds entered into the FMS as well as the radar data. The FMS computed the intended descent path assuming idle thrust after top of descent (TOD), and the controllers and pilots then endeavored to allow the FMS to fly the descent to the meter fix with minimal human intervention. The horizontal flight path, cruise and meter fix altitudes, and actual TOD location were extracted from the radar data. Using approximately 70 descents each in Boeing 757 and Airbus 319/320 aircraft, multiple regression estimated TOD location as a linear function of the available predictive factors. The cruise and meter fix altitudes, descent speed, and wind clearly improve goodness of fit. The aircraft weight improves fit for the Airbus descents but not for the B757. Except for a few statistical outliers, the residuals have absolute value less than 5 nmi. Thus, these predictive factors adequately explain the TOD location, which indicates the data do not include excessive noise.

  17. Testing of the Anorectal and Pelvic Floor Area

    MedlinePlus

    ... angles and function of the puborectalis muscle and emptying. This study is particularly useful when evaluating complaints ... of the Esophagus Achalasia GERD Disorders of the Stomach Cyclic Vomiting Syndrome CVS in Adults Dumping Syndrome ...

  18. DIFFERENTIAL DIAGNOSIS OF DEEP GLUTEAL PAIN IN A FEMALE RUNNER WITH PELVIC INVOLVEMENT: A CASE REPORT

    PubMed Central

    Podschun, Laura; Kolber, Morey J.; Garcia, Ashley; Rothschild, Carey E.

    2013-01-01

    Background: Gluteal injuries, proximal hamstring injuries, and pelvic floor disorders have been reported in the literature among runners. Some suggest that hip, pelvis, and/or groin injuries occur in 3.3% to 11.5% of long distance runners. The purpose of this case report is to describe the differential diagnosis and treatment approach for a patient presenting with combined hip and pelvic pain. Case description: A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months. This pain limited her ability to tolerate sitting and caused her to cease running. Examination of the patient's lumbar spine, pelvis, and lower extremity led to the initial differential diagnosis of hamstring syndrome and ischiogluteal bursitis. The patient's primary symptoms improved during the initial four visits, which focused on education, pain management, trunk stabilization and gluteus maximus strengthening, however pelvic pain persisted. Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running. Outcomes: Pain level on the Visual Analog Scale decreased from 7/10 to 1/10 over the course of treatment. The patient was able to return to full sport activity and improved sitting tolerance to greater then two hours without significant discomfort. Discussion: This case suggests the interdependence of lumbopelvic and lower extremity kinematics in complaints of hamstring, posterior thigh and pelvic floor disorders. This case highlights the importance of a thorough examination as well as the need to consider a regional interdependence of the pelvic floor and lower quarter when treating individuals with proximal hamstring pain. Level of Evidence: Level 4 PMID:24175132

  19. Treatment of Unstable Pelvic Ring Injuries

    PubMed Central

    2014-01-01

    Pelvic fractures are classified according to the stability of the pelvic ring. Unlike stable pelvic fractures, which heal without complications, unstable fractures may lead to pelvic ring deformities, which cause severe complications. An orthopedic surgeon must determine the stability of the pelvic ring by radiography and physical examination of the patient in order to ensure early, prompt treatment. This article includes anatomy of the pelvic ring, classification of pelvic ring injuries, its treatment algorithm, and corresponding cases involving unstable pelvic ring injury.

  20. Cleaning up Floor Care.

    ERIC Educational Resources Information Center

    Carr, Richard; McLean, Doug

    1995-01-01

    Discusses how educational-facility maintenance departments can cut costs in floor cleaning through careful evaluation of floor equipment and products. Tips for choosing carpet detergents are highlighted. (GR)

  1. Surgery for Pelvic Organ Prolapse

    MedlinePlus

    ... such as pain during sex, pelvic pain, or urinary incontinence . What are the types of surgery for pelvic ... performed through the abdomen. A procedure to prevent urinary incontinence may be done at the same time. • Anterior ...

  2. The role of two- and three-dimensional dynamic ultrasonography in pelvic organ prolapse.

    PubMed

    Dietz, Hans Peter

    2010-01-01

    The assessment of pelvic organ prolapse has to date been limited to the clinical evaluation of surface anatomy. This is clearly insufficient. As a result, imaging of pelvic floor function and anatomy is moving from the fringes to the mainstream of obstetrics and gynecology. This is mainly due to the realization that pelvic floor trauma in labor is common, generally overlooked, and a major factor in the causation of pelvic organ prolapse. Modern imaging methods such as magnetic resonance and 3-dimensional ultrasonography have enabled us to diagnose such abnormalities reliably and accurately, most commonly in the form of an avulsion of the puborectalis muscle off its insertion on the os pubis. However, ultrasonography has other advantages in the assessment of pelvic organ prolapse, most notably in the differential diagnosis of posterior compartment prolapse, which can be due to at least 5 different conditions. In this review I will try to summarize the methods of prolapse and pelvic floor assessment by translabial ultrasonography and to describe the most common abnormalities and their consequences. This article will not deal with magnetic resonance imaging because I consider this technology to be of limited clinical utility due to technical restrictions, expense, and access issues. PMID:20171938

  3. FIRST FLOOR FRONT ROOM. SECOND FLOOR HAS BEEN REMOVED NOTE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    FIRST FLOOR FRONT ROOM. SECOND FLOOR HAS BEEN REMOVED-- NOTE PRESENCE OF SECOND FLOOR WINDOWS (THE LATTER FLOOR WAS REMOVED MANY YEARS AGO), See also PA-1436 B-12 - Kid-Physick House, 325 Walnut Street, Philadelphia, Philadelphia County, PA

  4. Descent Advisor Preliminary Field Test

    NASA Technical Reports Server (NTRS)

    Green, Steven M.; Vivona, Robert A.; Sanford, Beverly

    1995-01-01

    A field test of the Descent Advisor (DA) automation tool was conducted at the Denver Air Route Traffic Control Center in September 1994. DA is being developed to assist Center controllers in the efficient management and control of arrival traffic. DA generates advisories, based on trajectory predictions, to achieve accurate meter-fix arrival times in a fuel efficient manner while assisting the controller with the prediction and resolution of potential conflicts. The test objectives were: (1) to evaluate the accuracy of DA trajectory predictions for conventional and flight-management system equipped jet transports, (2) to identify significant sources of trajectory prediction error, and (3) to investigate procedural and training issues (both air and ground) associated with DA operations. Various commercial aircraft (97 flights total) and a Boeing 737-100 research aircraft participated in the test. Preliminary results from the primary test set of 24 commercial flights indicate a mean DA arrival time prediction error of 2.4 seconds late with a standard deviation of 13.1 seconds. This paper describes the field test and presents preliminary results for the commercial flights.

  5. Descent advisor preliminary field test

    NASA Technical Reports Server (NTRS)

    Green, Steven M.; Vivona, Robert A.; Sanford, Beverly

    1995-01-01

    A field test of the Descent Advisor (DA) automation tool was conducted at the Denver Air Route Traffic Control Center in September 1994. DA is being developed to assist Center controllers in the efficient management and control of arrival traffic. DA generates advisories, based on trajectory predictions, to achieve accurate meter-fix arrival times in a fuel efficient manner while assisting the controller with the prediction and resolution of potential conflicts. The test objectives were to evaluate the accuracy of DA trajectory predictions for conventional- and flight-management-system-equipped jet transports, to identify significant sources of trajectory prediction error, and to investigate procedural and training issues (both air and ground) associated with DA operations. Various commercial aircraft (97 flights total) and a Boeing 737-100 research aircraft participated in the test. Preliminary results from the primary test set of 24 commercial flights indicate a mean DA arrival time prediction error of 2.4 sec late with a standard deviation of 13.1 sec. This paper describes the field test and presents preliminary results for the commercial flights.

  6. Feature Clustering for Accelerating Parallel Coordinate Descent

    SciTech Connect

    Scherrer, Chad; Tewari, Ambuj; Halappanavar, Mahantesh; Haglin, David J.

    2012-12-06

    We demonstrate an approach for accelerating calculation of the regularization path for L1 sparse logistic regression problems. We show the benefit of feature clustering as a preconditioning step for parallel block-greedy coordinate descent algorithms.

  7. Apollo experience report: Descent propulsion system

    NASA Technical Reports Server (NTRS)

    Hammock, W. R., Jr.; Currie, E. C.; Fisher, A. E.

    1973-01-01

    The propulsion system for the descent stage of the lunar module was designed to provide thrust to transfer the fully loaded lunar module with two crewmen from the lunar parking orbit to the lunar surface. A history of the development of this system is presented. Development was accomplished primarily by ground testing of individual components and by testing the integrated system. Unique features of the descent propulsion system were the deep throttling capability and the use of a lightweight cryogenic helium pressurization system.

  8. Artist's rendering of Descent to Lunar Surface

    NASA Technical Reports Server (NTRS)

    1969-01-01

    Descent to Lunar Surface: The Commander and Lunar Module Pilot transfer to the IM, separate it from the Command and Service Module, and fire the IM descent engine to land on the Moon. After checking out the spacecraft and eating and resting, the Commander climbs down the ladder and places his left foot on the Moon while his right foot is inside the Lunar Module landing pad.

  9. Descent relations in cubic superstring field theory

    NASA Astrophysics Data System (ADS)

    Aref'eva, I. Y.; Gorbachev, R.; Medvedev, P. B.; Rychkov, D. V.

    2008-01-01

    The descent relations between string field theory (SFT) vertices are characteristic relations of the operator formulation of SFT and they provide self-consistency of this theory. The descent relations langleV2|V1rangle and langleV3|V1rangle in the NS fermionic string field theory in the κ and discrete bases are established. Different regularizations and schemes of calculations are considered and relations between them are discussed.

  10. The Relationship Between Foot and Pelvic Alignment While Standing

    PubMed Central

    Khamis, Sam; Dar, Gali; Peretz, Chava; Yizhar, Ziva

    2015-01-01

    A normal motion and segmental interrelationship has been determined as a significant factor in normal function. Yet, the relationship between distal segments and pelvic alignment needs further investigation. The aim of this study was to investigate the interrelationship between distal and proximal lower extremity segments while standing and during induced feet hyperpronation. Changes in alignment of the pelvis and lower extremities were measured at a gait laboratory using the VICON 612 computerized motion analysis system. Thirty-five healthy volunteer subjects were recruited. Four randomized repeated-measure standing modes were used: standing directly on the floor and then on three wedges angled at 10°, 15° and 20° to induce bilateral hyperpronation for 20 seconds. A significant (p<0.05) bi-variate relationship was found between the anterior pelvic tilt and thigh internal rotation, in all four standing positions (.41≤r≤.46, in all p<0.014). A combined effect of rotational alignment between segments and the cumulative effect of foot hyperpronation on pelvic tilt revealed that only the shank significantly affected pelvic alignment, acting as a mediator between a foot and a thigh with the thigh having a crude significant effect on the pelvis. When internal rotation of the shank occurs, calcaneal eversion couples with thigh internal rotation and anterior pelvic tilt. It can be concluded that in response to induced hyperpronation, the shank is a pivotal segment in postural adjustment. PMID:26240652

  11. Incidence of pelvic organ prolapse in Nigerian women.

    PubMed Central

    Okonkwo, J. E. N.; Obiechina, N. J. A.; Obionu, C. N.

    2003-01-01

    OBJECTIVE: To establish the incidence and types of utero-vaginal prolapse. METHODS: Retrospective medical records analyses of women who were subjected to reconstructive pelvic surgery for various types of pelvic relaxation at the Nnamdi Azikiwe University Teaching Hospital, Nnewi and the University Of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. The study was conducted from January 1996 to December 1999 during which there were 7515 surgical admissions. The inclusion criteria were those women who complained of feeling a mass in the vagina with demonAstrable descent of the anterior and/or posterior and/or apical vaginal walls and/or perineal descent. Excluded were patients who had other symptoms other than utero-vaginal prolapse and those whose grades and sites of prolapse were not determinable from the clinical or surgical notes. Also excluded were patients with nerve injury or disease, connective tissue disorders and neuromuscular diseases. The subjects were divided into two groups. Group I consisted of 54 women (age < or = 40 years), and group II included 105 women (age > or = 40 years). The findings between those two groups were compared with reference to sites, types and degree of prolapse. Also, coexistence of pelvic relaxation and underlying medical conditions were evaluated. RESULTS: A total of 159 subjects out of 492 charts studied met the inclusion criteria for the study. In group I, mean age was 32.839 with a standard deviation (SD) of +/- 6.012 years; and in group II the mean age was 56.543 with a SD of 8.094. Hypertrophic (elongated) cervix was determined in 15 (6.3%) subjects in group I for an incidence of 1.58% per year, cystocele (vaginal anterior wall descent) was present in 21 (8.9%) women for an incidence of 2.2% per year; rectocele (posterior vaginal wall descent) was identified in 15 (6.3%) women for an incidence of 1.58% per year; vaginal cough prolapse (apical descent) was present 21 (8.9%) women for an incidence of 2.2% per year

  12. Reference energy-altitude descent guidance: Simulator evaluation. [aircraft descent and fuel conservation

    NASA Technical Reports Server (NTRS)

    Abbot, K. H.; Knox, C. E.

    1985-01-01

    Descent guidance was developed to provide a pilot with information to ake a fuel-conservative descent and cross a designated geographical waypoint at a preselected altitude and airspeed. The guidance was designed to reduce fuel usage during the descent and reduce the mental work load associated with planning a fuel-conservative descent. A piloted simulation was conducted to evaluate the operational use of this guidance concept. The results of the simulation tests show that the use of the guidance reduced fuel consumption and mental work load during the descent. Use of the guidance also decreased the airspeed error, but had no effect on the altitude error when the designated waypoint was crossed. Physical work load increased with the use of the guidance, but remained well within acceptable levels. The pilots found the guidance easy to use as presented and reported that it would be useful in an operational environment.

  13. Descent of the larynx in chimpanzee infants.

    PubMed

    Nishimura, Takeshi; Mikami, Akichika; Suzuki, Juri; Matsuzawa, Tetsuro

    2003-06-10

    The human larynx descends during infancy and the early juvenile periods, and this greatly contributes to the morphological foundations of speech development. This developmental phenomenon is believed to be unique to humans. This concept has formed a basis for paleoanthropological studies on the origin and evolution of human speech. We used magnetic resonance imaging to study the development of three living chimpanzees and found that their larynges also descend during infancy, as in human infants. This descent was completed primarily through the rapid descent of the laryngeal skeleton relative to the hyoid, but it was not accompanied by the descent of the hyoid itself. The descent is possibly associated with developmental changes of the swallowing mechanism. Moreover, it contributes physically to an increased independence between the processes of phonation and articulation for vocalization. Thus, the descent of the larynx and the morphological foundations for speech production must have evolved in part during hominoid evolution, and not in a single shift during hominid evolution. PMID:12775758

  14. Botulinum Toxin Type A (BOTOX) for Refractory Myofascial Pelvic Pain

    PubMed Central

    ADELOWO, Amos; HACKER, Michele R.; SHAPIRO, Alex; Modest, Anna Merport; ELKADRY, Eman

    2013-01-01

    Objective To assess intralevator Botulinum toxin type A (Botox) injections for refractory myofascial pelvic pain with short tight pelvic floor. Methods Retrospective cohort study of all women with intralevator Botox injection (100-300 Units) from 2005 through 2010 for refractory myofascial pelvic pain. Primary outcomes were self-reported pain on palpation and symptom improvement. Secondary outcomes included post-injection complications and repeat injection. Pain was assessed during digital palpation of the pelvic floor muscles using a scale of 0-10, with 10 being the worst possible pain. Follow-up occurred at <6 weeks post-injection and again at ≥ 6 weeks. Data are presented as median (interquartile range) or proportion. Results Thirty-one patients met eligibility criteria; 2 were lost to follow up and excluded. Median age was 55.0 years (38.0-62.0). Before Botox injection, median pain score was 9.5 (8.0-10.0). Twenty-nine patients (93.5%) returned for the first follow-up visit; 79.3% reported improvement in pain, while 20.7% reported no improvement. Median pain with levator palpation was significantly lower than before injection (P<0.0001). Eighteen women (58.0%) had a second follow-up visit with a median pain score that remained lower than before injection (P<0.0001). Fifteen (51.7%) women elected to have repeat Botox injection; the median time to repeat injection was 4.0 (3.0-7.0) months. Three (10.3%) women developed de-novo urinary retention, 2 (6.9%) reported fecal incontinence and 3 (10.3%) reported constipation and/or rectal pain; all side effects resolved spontaneously. Conclusions Intralevator injection of Botox demonstrates effectiveness in women with refractory myofascial pelvic pain with few, self-limiting adverse effects. PMID:23982578

  15. Pelvic aneurysmal bone cyst

    PubMed Central

    Sharifah, MIA; Nor Hazla, MH; Suraya, A; Tan, SP

    2011-01-01

    This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient’s 5th decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour. PMID:22279501

  16. Pelvic Fasciae in Urology

    PubMed Central

    Raychaudhuri, B; Cahill, D

    2008-01-01

    INTRODUCTION Despite the vast literature on pelvic fascia, there is confusion over the periprostatic structures and their nomenclature, including their orientation, the neurovascular bundles and the existence of the prostatic ‘capsule’. In this review, we seek to clarify some of these issues. MATERIALS AND METHODS Review of published medical literature relating to the anatomy of the pelvic fascia including a Pubmed search using the terms – pelvic fascia, Denonvilliers' fascia, prostate capsule, neurovascular bundle of Walsh, pubo-prostatic ligament and the detrusor apron. CONCLUSIONS The findings of the study were as follows: The ‘capsule’ of the prostate does not exist. Rather, the fibromuscular band surrounding the prostate forms an integral part of the gland.The prostate is surrounded by fascial structures – anteriorly/anterolaterally by the prostatic fascia and posteriorly by the Denonvilliers' fascia. Laterally, the prostatic fascia merges with the endopelvic fascia.The posterior longitudinal fascia of the detrusor comprises a ‘posterior layer’ of the detrusor apron, extending from the bladder neck to the prostate base.The neurovascular structures tend to be located posterolaterally, but may not always form a bundle. A significant proportion of fibres may lie away from the main nerve structures, along the lateral/posterior aspects of the prostate. PMID:18828961

  17. Assessment of GPS radiosonde descent data

    NASA Astrophysics Data System (ADS)

    Venkat Ratnam, M.; Pravallika, N.; Babu, S. Ravindra; Basha, G.; Pramitha, M.; Krishna Murthy, B. V.

    2014-04-01

    Radiosondes are widely used to obtain basic meteorological parameters such as pressure (P), temperature (T), relative humidity (RH) and horizontal winds during the balloon ascent up to the altitude of balloon burst, usually ~ 32-35 km. Data from the radiosondes released from Gadanki (13.5° N, 79.2° E), a tropical station in India, have been collected during the ascent and during the descent as well without attaching any parachute or its equivalent since the year 2008. In the present study an attempt has been made to characterize the radiosonde descent data with the main objective of exploring its usefulness and reliability for scientific purposes. We compared the data obtained during ascent and descent phases of the same sounding. The mean differences in T, RH and horizontal winds between ascent and descent data are found to be small and are sometimes even within the uncertainty of the measurements and/or expected diurnal variation itself. The very good consistency observed between the ascent and the descent data shows that one more profile of the meteorological parameters can be constructed within 3 h of time of balloon launch practically at no additional cost. Further checks are done by utilizing the 3-hourly radiosonde observations collected during the Tropical Tropopause Dynamics campaigns conducted at Gadanki. In the process of checking the consistency between the radiosonde ascent and descent data, several new findings are arrived at and are reported in this study. In general, it has taken more than half an hour for the balloon to reach the ground from the burst altitude. It is also observed that the fall velocity is close to 10 m s-1 near the surface. Finally, it is suggested to record the observations also when the balloon is descending as this information is useful for scientific purposes.

  18. Assessment of GPS radiosonde descent data

    NASA Astrophysics Data System (ADS)

    Venkat Ratnam, M.; Pravallika, N.; babu, S. Ravindra; Basha, G.; Pramitha, M.; Krishna Murthy, B. V.

    2013-12-01

    Radiosondes are widely used to obtain basic meteorological parameters such as pressure (P), temperature (T), relative humidity (RH), and horizontal winds during the balloon ascent up to the altitude of balloon burst, usually ∼32-35 km. Data from the radiosondes released from Gadanki (13.5° N, 79.2° E), a tropical station in India, has been collected during the ascent and during the descent as well without attaching any parachute or its equivalent since the year 2008. In the present study an attempt has been made to characterize the radiosonde descent data with the main objective of exploring its usefulness and reliability for scientific purposes. We compared the data obtained during ascent and descent phases of the same sounding. The mean differences in T, RH and horizontal winds between ascent and descent data are found to be small and are sometimes even within the uncertainty of the measurements and/or expected diurnal variation itself. The very good consistency observed between the ascent and the descent data shows that one more profile of the meteorological parameters can be constructed within 3 h of time of balloon launch practically at no additional cost. Further checks are done by utilizing the 3 hourly radiosonde observations collected during the Tropical Tropopause Dynamics campaign conducted at Gadanki. In the process of checking the consistency between the radiosonde ascent and descent data, several new findings are arrived at and are reported in this study. In general, it has taken more than half-an-hour for the balloon to reach the ground from the burst altitude. It is also observed that the fall velocity is close to 10 m s-1 near the surface. Finally, it is suggested to record also the observations when the balloon is descending as this information is also useful for scientific purposes.

  19. Diabatic Descent In The Stratospheric Polar Vortex

    NASA Astrophysics Data System (ADS)

    Rosenfield, J.; Schoeberl, M.

    Polar regions experience diabatic cooling during the fall and winter months, resulting in a downward mass flux. An accurate measure of this fall and winter diabatic descent, as well as an understanding of the transport of air into and out of the winter polar vor- tices, is required for estimates of polar ozone depletion. We have calculated diabatic cooling rates using a radiative transfer code and U.K. Met Office (UKMO) tempera- tures for the years 1992-2000. These cooling rates, together with UKMO horizontal winds, have been used to compute three-dimensional forward and backward diabatic trajectories for the seven month fall to spring period in both the NH and the SH. The forward calculations estimate the maximum amount of descent that can occur. How- ever, they are not necessarily a good indicator of the origin of the springtime vortex air because more equatorward air from lower altitudes can be entrained within the vortex during its formation. The back trajectories, starting in the springtime lower middle stratosphere, show a complex final distribution of parcels. One population originates in the fall in the upper stratosphere and mesosphere and experiences considerable de- scent, while the remaining parcels originate at lower altitudes in the midlatitudes and are mixed into the polar regions during vortex formation. The amount of descent ex- perienced by the first population shows little variability from year to year, while the computed descent and mixing of the remaining parcels show considerable interannual variability due to the varying polar meteorology. Because of this complex parcel dis- tribution it is not meaningful to speak of a net amount of descent experienced over the entire winter period. We have also compared diabatic trajectories with kinematic tra- jectories, in which the vertical motion is given by the UKMO analysed omega fields. These show that the kinematic trajectory descent is much less than the diabatic tra- jectory descent and exhibits

  20. Entry, Descent, and Landing With Propulsive Deceleration

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan

    2012-01-01

    The future exploration of the Solar System will require innovations in transportation and the use of entry, descent, and landing (EDL) systems at many planetary landing sites. The cost of space missions has always been prohibitive, and using the natural planetary and planet s moons atmospheres for entry, descent, and landing can reduce the cost, mass, and complexity of these missions. This paper will describe some of the EDL ideas for planetary entry and survey the overall technologies for EDL that may be attractive for future Solar System missions.

  1. Floors: Care and Maintenance.

    ERIC Educational Resources Information Center

    Post Office Dept., Washington, DC.

    Guidelines, methods and policies regarding the care and maintenance of post office building floors are overviewed in this handbook. Procedures outlined are concerned with maintaining a required level of appearance without wasting manpower. Flooring types and characteristics and the particular cleaning requirements of each type are given along with…

  2. School Flooring Factors

    ERIC Educational Resources Information Center

    McGrath, John

    2012-01-01

    With all of the hype that green building is receiving throughout the school facility-management industry, it's easy to overlook some elements that may not be right in front of a building manager's nose. It is helpful to examine the role floor covering plays in a green building project. Flooring is one of the most significant and important systems…

  3. Maximizing Hard Floor Maintenance.

    ERIC Educational Resources Information Center

    Steger, Michael

    2000-01-01

    Explains the maintenance options available for hardwood flooring that can help ensure long life cycles and provide inviting spaces. Developing a maintenance system, knowing the type of traffic that the floor must endure, using entrance matting, and adhering to manufacturers guidelines are discussed. Daily, monthly or quarterly, and long-term…

  4. FIRST FLOOR REAR ROOM. SECOND FLOOR HAS BEEN REMOVED NOTE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    FIRST FLOOR REAR ROOM. SECOND FLOOR HAS BEEN REMOVED-- NOTE PRESENCE OF SECOND FLOOR WINDOWS AT LEFT. See also PA-1436 B-6 - Kid-Physick House, 325 Walnut Street, Philadelphia, Philadelphia County, PA

  5. FIRST FLOOR REAR ROOM. SECOND FLOOR HAS BEEN REMOVED NOTE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    FIRST FLOOR REAR ROOM. SECOND FLOOR HAS BEEN REMOVED-- NOTE PRESENCE OF SECOND FLOOR WINDOWS AT LEFT. See also PA-1436 B-13 - Kid-Physick House, 325 Walnut Street, Philadelphia, Philadelphia County, PA

  6. Descent Assisted Split Habitat Lunar Lander Concept

    NASA Technical Reports Server (NTRS)

    Mazanek, Daniel D.; Goodliff, Kandyce; Cornelius, David M.

    2008-01-01

    The Descent Assisted Split Habitat (DASH) lunar lander concept utilizes a disposable braking stage for descent and a minimally sized pressurized volume for crew transport to and from the lunar surface. The lander can also be configured to perform autonomous cargo missions. Although a braking-stage approach represents a significantly different operational concept compared with a traditional two-stage lander, the DASH lander offers many important benefits. These benefits include improved crew egress/ingress and large-cargo unloading; excellent surface visibility during landing; elimination of the need for deep-throttling descent engines; potentially reduced plume-surface interactions and lower vertical touchdown velocity; and reduced lander gross mass through efficient mass staging and volume segmentation. This paper documents the conceptual study on various aspects of the design, including development of sortie and outpost lander configurations and a mission concept of operations; the initial descent trajectory design; the initial spacecraft sizing estimates and subsystem design; and the identification of technology needs

  7. The hormonal control of testicular descent.

    PubMed

    Levy, J B; Husmann, D A

    1995-01-01

    Descent of the testes is a complex event mediated by hormonal and mechanical factors. At present we hypothesize that testicular descent occurs as the result of the secretion of descendin from a normal testicle. Descendin secretion results in selective growth of the gubernacular cells. Gubernacular outgrowth results in masculinization of the inguinal canal. At the beginning of testicular descent, the patent processus migrates into the inguinal canal, transmitting intraabdominal pressure to the gubernaculum. The gubernaculum in turn applies traction to the testicle to introduce the testicle into the inguinal canal. Descent of the testes into and through the inguinal canal is an interplay between intraabdominal pressure transmitted by a patent processus vaginalis and androgen-induced gubernacular regression. Specifically, we hypothesize that androgens under control of an intact fetal hypothalamic-pituitary axis alter the viscoelastic properties of the gubernaculum. Reductions in the turgidity of the gubernaculum allow intraabdominal pressure to push the testicle into the scrotum. Functional abnormalities in any of the above factors will result in cryptorchidism. PMID:8867594

  8. Ka-Band Radar Terminal Descent Sensor

    NASA Technical Reports Server (NTRS)

    Pollard, Brian; Berkun, Andrew; Tope, Michael; Andricos, Constantine; Okonek, Joseph; Lou, Yunling

    2007-01-01

    The terminal descent sensor (TDS) is a radar altimeter/velocimeter that improves the accuracy of velocity sensing by more than an order of magnitude when compared to existing sensors. The TDS is designed for the safe planetary landing of payloads, and may be used in helicopters and fixed-wing aircraft requiring high-accuracy velocity sensing

  9. Research study: STS-1 Orbiter Descent

    NASA Technical Reports Server (NTRS)

    Hickey, J. S.

    1981-01-01

    The conversion of STS-1 orbiter descent data from AVE-SESAME contact programs to the REEDA system and the reduction of raw radiosonde data is summarized. A first difference program, contact data program, plot data program, and 30 second data program were developed. Six radiosonde soundings were taken. An example of the outputs of each of the programs is presented.

  10. Coping with Discrimination among Mexican Descent Adolescents

    ERIC Educational Resources Information Center

    Edwards, Lisa M.; Romero, Andrea J.

    2008-01-01

    The current research is designed to explore the relationship among discrimination stress, coping strategies, and self-esteem among Mexican descent youth (N = 73, age 11-15 years). Results suggest that primary control engagement and disengagement coping strategies are positively associated with discrimination stress. Furthermore, self-esteem is…

  11. Method of descent for integrable lattices

    NASA Astrophysics Data System (ADS)

    Bogoyavlensky, Oleg

    2009-05-01

    A method of descent for constructing integrable Hamiltonian systems is introduced. The derived periodic and nonperiodic lattices possess Lax representations with spectral parameter and have plenty of first integrals. Examples of Liouville-integrable four-dimensional Hamiltonian Lotka-Volterra systems are presented.

  12. America's Descent into Madness

    ERIC Educational Resources Information Center

    Giroux, Henry A.

    2014-01-01

    This article describes America's descent into madness under the regime of neoliberalism that has emerged in the United States since the late 1970s. In part, this is due to the emergence of a public pedagogy produced by the corporate-owned media that now saturates Americans with a market-driven value system that undermines those formative…

  13. An Ectopic Pelvic Kidney

    PubMed Central

    Bhoil, Rohit; Sood, Dinesh; Singh, Yash Paul; Nimkar, Kshama; Shukla, Anurag

    2015-01-01

    Summary Background If a kidney does not ascend as it should in normal fetal development, it remains in the pelvic area and is called a pelvic kidney. Often a person with a pelvic kidney will go through his/her whole life unaware of this condition, unless it is discovered during neonatal kidney ultrasound screening or if complications arise later in life due to this or a completely different reason and the condition is noted during investigations. Generally, this is not a harmful condition but it can lead to complications like in our case. With appropriate testing and treatment, if needed, an ectopic kidney should cause no serious long-term health complications and all that may be required for the patient is reassurance with advice to follow up at regular intervals. Case Report A 28-year-old male presented with recurrent pain in his lower left abdomen for one month and an episode of hematuria 3 days earlier accompanied by an attack of acute pain lasting for 3–4 hours. He gave a history of passing 2 small (about 5 mm each) calculi in his urine after the occurrence of hematuria, following which pain decreased in intensity. No history of fever was present. Conclusions Although a simple ectopic kidney seldom causes symptoms, the association of malrotation of the renal pelvis with calculus increases the risk of hematuria and/or hydronephrosis, presenting with colicky pain as in the present case. The clinician should be aware of these in such a case. If asymptomatic, no treatment is required. However, the patient should be advised to have follow-up ultrasounds at regular intervals to detect complications like calculus, hydronephrosis, etc. With appropriate testing and treatment, if required, an ectopic kidney should not cause serious long-term health complications. PMID:26413178

  14. Optimum Strategies for Selecting Descent Flight-Path Angles

    NASA Technical Reports Server (NTRS)

    Wu, Minghong G. (Inventor); Green, Steven M. (Inventor)

    2016-01-01

    An information processing system and method for adaptively selecting an aircraft descent flight path for an aircraft, are provided. The system receives flight adaptation parameters, including aircraft flight descent time period, aircraft flight descent airspace region, and aircraft flight descent flyability constraints. The system queries a plurality of flight data sources and retrieves flight information including any of winds and temperatures aloft data, airspace/navigation constraints, airspace traffic demand, and airspace arrival delay model. The system calculates a set of candidate descent profiles, each defined by at least one of a flight path angle and a descent rate, and each including an aggregated total fuel consumption value for the aircraft following a calculated trajectory, and a flyability constraints metric for the calculated trajectory. The system selects a best candidate descent profile having the least fuel consumption value while the fly ability constraints metric remains within aircraft flight descent flyability constraints.

  15. A Descent Rate Control Approach to Developing an Autonomous Descent Vehicle

    NASA Astrophysics Data System (ADS)

    Fields, Travis D.

    Circular parachutes have been used for aerial payload/personnel deliveries for over 100 years. In the past two decades, significant work has been done to improve the landing accuracies of cargo deliveries for humanitarian and military applications. This dissertation discusses the approach developed in which a circular parachute is used in conjunction with an electro-mechanical reefing system to manipulate the landing location. Rather than attempt to steer the autonomous descent vehicle directly, control of the landing location is accomplished by modifying the amount of time spent in a particular wind layer. Descent rate control is performed by reversibly reefing the parachute canopy. The first stage of the research investigated the use of a single actuation during descent (with periodic updates), in conjunction with a curvilinear target. Simulation results using real-world wind data are presented, illustrating the utility of the methodology developed. Additionally, hardware development and flight-testing of the single actuation autonomous descent vehicle are presented. The next phase of the research focuses on expanding the single actuation descent rate control methodology to incorporate a multi-actuation path-planning system. By modifying the parachute size throughout the descent, the controllability of the system greatly increases. The trajectory planning methodology developed provides a robust approach to accurately manipulate the landing location of the vehicle. The primary benefits of this system are the inherent robustness to release location errors and the ability to overcome vehicle uncertainties (mass, parachute size, etc.). A separate application of the path-planning methodology is also presented. An in-flight path-prediction system was developed for use in high-altitude ballooning by utilizing the path-planning methodology developed for descent vehicles. The developed onboard system improves landing location predictions in-flight using collected flight

  16. 5. STAIR FROM SECOND FLOOR TO THIRD FLOOR, FROM NORTHWEST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. STAIR FROM SECOND FLOOR TO THIRD FLOOR, FROM NORTHWEST. Note extreme thin construction of support and outline of well ellipse on floor. Stair to first floor has been removed - Saltus-Habersham House, 802 Bay Street, Beaufort, Beaufort County, SC

  17. Rhinoplasty in the patient of African descent.

    PubMed

    Harris, Monte O

    2010-02-01

    We are in the midst of truly changing times, as patients of African descent actively embrace facial cosmetic surgery. Gaining surgical consistency in patients of African descent has proven to be elusive and unpredictable for many rhinoplasty surgeons. Surgical success relies on the surgeon's ability precisely to identify anatomic variables and reconcile these anatomic realities with the patient's expectations for aesthetic improvement and ethnic identity. An appreciation for underlying heritage provides a link culturally to connect with prospective patients and serves as a tool for establishing realistic aesthetic goals. This article highlights the significance of exploring ancestry in the rhinoplasty consultation; identifies key anatomic variables in the nasal tip, dorsum, and alar base; and reviews surgical logic that has facilitated the achievement of consistent, balanced aesthetic outcomes. PMID:20206100

  18. Mars Exploration Entry, Descent and Landing Challenges

    NASA Technical Reports Server (NTRS)

    Braun, Robert D.; Manning, Robert M.

    2006-01-01

    The United States has successfully landed five robotic systems on the surface of Mars. These systems all had landed mass below 0.6 metric tons (t), had landed footprints on the order of hundreds of km and landed at sites below -1.4 km MOLA elevation due the need to perform entry, descent and landing operations in an environment with sufficient atmospheric density. At present, robotic exploration systems engineers are struggling with the challenges of increasing landed mass capability to 0.8 t while improving landed accuracy to tens of km and landing at a site as high as +2 km MOLA elevation for the Mars Science Laboratory project. Meanwhile, current plans for human exploration of Mars call for the landing of 40-80 t surface elements at scientifically interesting locations within close proximity (tens of m) of pre-positioned robotic assets. This paper summarizes past successful entry, descent and landing systems and approaches being developed by the robotic Mars exploration program to increased landed performance (mass, accuracy and surface elevation). In addition, the entry, descent and landing sequence for a human exploration system will be reviewed, highlighting the technology and systems advances required.

  19. Simulating Descent and Landing of a Spacecraft

    NASA Technical Reports Server (NTRS)

    Balaram, J.; Jain, Abhinandan; Martin, Bryan; Lim, Christopher; Henriquez, David; McMahon, Elihu; Sohl, Garrett; Banerjee, Pranab; Steele, Robert; Bentley, Timothy

    2005-01-01

    The Dynamics Simulator for Entry, Descent, and Surface landing (DSENDS) software performs high-fidelity simulation of the Entry, Descent, and Landing (EDL) of a spacecraft into the atmosphere and onto the surface of a planet or a smaller body. DSENDS is an extension of the DShell and DARTS programs, which afford capabilities for mathematical modeling of the dynamics of a spacecraft as a whole and of its instruments, actuators, and other subsystems. DSENDS enables the modeling (including real-time simulation) of flight-train elements and all spacecraft responses during various phases of EDL. DSENDS provides high-fidelity models of the aerodynamics of entry bodies and parachutes plus supporting models of atmospheres. Terrain and real-time responses of terrain-imaging radar and lidar instruments can also be modeled. The program includes modules for simulation of guidance, navigation, hypersonic steering, and powered descent. Automated state-machine-driven model switching is used to represent spacecraft separations and reconfigurations. Models for computing landing contact and impact forces are expected to be added. DSENDS can be used as a stand-alone program or incorporated into a larger program that simulates operations in real time.

  20. Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP

    PubMed Central

    Kutch, Jason J.; Yani, Moheb S.; Asavasopon, Skulpan; Kirages, Daniel J.; Rana, Manku; Cosand, Louise; Labus, Jennifer S.; Kilpatrick, Lisa A.; Ashe-McNalley, Cody; Farmer, Melissa A.; Johnson, Kevin A.; Ness, Timothy J.; Deutsch, Georg; Harris, Richard E.; Apkarian, A. Vania; Clauw, Daniel J.; Mackey, Sean C.; Mullins, Chris; Mayer, Emeran A.

    2015-01-01

    Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28), as well as group of age-matched healthy male controls (N = 27), had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing. PMID:26106574

  1. 'Spousal Revenge Syndrome'- description of a new chronic pelvic pain syndrome patient cohort.

    PubMed

    Makovey, Iryna; Dolinga, Robert; Shoskes, Daniel A

    2016-02-01

    Psychological factors may play a role in the pathophysiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This case series describes a cohort of 10 men presenting with CP/CPPS whose symptoms began after an extramarital sexual encounter, who strongly believed they had a sexually transmitted infection (STI) despite negative testing, and who have had no improvement with empiric antibiotic treatment. Patients' clinical presentation and physical exam findings are reviewed. All men were clinically phenotyped with the UPOINT system. Pelvic floor spasm and not infection was prominent in these men. Treatment recommendations are proposed and compliance assessed. PMID:26892062

  2. Reassessing the Annual Pelvic Exam

    MedlinePlus

    ... recommendation released Tuesday, the U.S. Preventive Services Task Force said it couldn't weigh in for or ... pelvic exams based on current evidence. "The Task Force is calling for more research to better understand ...

  3. Cooling Floor AC Systems

    NASA Astrophysics Data System (ADS)

    Jun, Lu; Hao, Ding; Hong, Zhang; Ce, Gao Dian

    The present HVAC equipments for the residential buildings in the Hot-summer-and-Cold-winter climate region are still at a high energy consuming level. So that the high efficiency HVAC system is an urgently need for achieving the preset government energy saving goal. With its advantage of highly sanitary, highly comfortable and uniform of temperature field, the hot-water resource floor radiation heating system has been widely accepted. This paper has put forward a new way in air-conditioning, which combines the fresh-air supply unit and such floor radiation system for the dehumidification and cooling in summer or heating in winter. By analyze its advantages and limitations, we found that this so called Cooling/ Heating Floor AC System can improve the IAQ of residential building while keep high efficiency quality. We also recommend a methodology for the HVAC system designing, which will ensure the reduction of energy cost of users.

  4. Prevention of pelvic radiation disease.

    PubMed

    Fuccio, Lorenzo; Frazzoni, Leonardo; Guido, Alessandra

    2015-02-01

    Pelvic cancers are among the most frequently diagnosed cancers worldwide. Treatment of patients requires a multidisciplinary approach that frequently includes radiotherapy. Gastrointestinal (GI) radiation-induced toxicity is a major complication and the transient or long-term problems, ranging from mild to very severe, arising in non-cancerous tissues resulting from radiation treatment to a tumor of pelvic origin, are actually called as pelvic radiation disease. The incidence of pelvic radiation disease changes according to the radiation technique, the length of follow up, the assessment method, the type and stage of cancer and several other variables. Notably, even with the most recent radiation techniques, i.e., intensity-modulated radiotherapy, the incidence of radiation-induced GI side effects is overall reduced but still not negligible. In addition, radiation-induced GI side effects can develop even after several decades; therefore, the improvement of patient life expectancy will unavoidably increase the risk of developing radiation-induced complications. Once developed, the management of pelvic radiation disease may be challenging. Therefore, the prevention of radiation-induced toxicity represents a reasonable way to avoid a dramatic drop of the quality of life of these patients. In the current manuscript we provide an updated and practical review on the best available evidences in the field of the prevention of pelvic radiation disease. PMID:25664197

  5. Detail view of floor mosaic in first floor lobby ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail view of floor mosaic in first floor lobby - St. Elizabeths Hospital, Hitchcock Hall, 2700 Martin Luther King Jr. Avenue, Southeast, 588-604 Redwood Street, Southeast, Washington, District of Columbia, DC

  6. First floor lobby, showing stairs to ground floor Fitzsimons ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    First floor lobby, showing stairs to ground floor - Fitzsimons General Hospital, Main Hospital Building, Charlie Kelly Boulevard, North side, at intersection of Sharon A. Lane Drive, Aurora, Adams County, CO

  7. Stairwell from first floor to ground floor Fitzsimons General ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Stairwell from first floor to ground floor - Fitzsimons General Hospital, Main Hospital Building, Charlie Kelly Boulevard, North side, at intersection of Sharon A. Lane Drive, Aurora, Adams County, CO

  8. Railing detail, stairs from first floor to ground floor ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Railing detail, stairs from first floor to ground floor - Fitzsimons General Hospital, Main Hospital Building, Charlie Kelly Boulevard, North side, at intersection of Sharon A. Lane Drive, Aurora, Adams County, CO

  9. Two and Three Bedroom Units: First Floor Plan, Second Floor ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Two and Three Bedroom Units: First Floor Plan, Second Floor Plan, South Elevation (As Built), North Elevation (As Built), East Elevation (As Built), East Elevation (Existing), North Elevation (Existing) - Aluminum City Terrace, East Hill Drive, New Kensington, Westmoreland County, PA

  10. 16. SANDSORTING BUILDING, FIRST FLOOR, MEZZANINE ON LEFT (BELOW FLOOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. SAND-SORTING BUILDING, FIRST FLOOR, MEZZANINE ON LEFT (BELOW FLOOR ARE CONCRETE AND STORAGE BINS), LOOKING NORTH - Mill "C" Complex, Sand-Sorting Building, South of Dee Bennet Road, near Illinois River, Ottawa, La Salle County, IL

  11. STIRLING'S QUARTERS SMALL BARN: FIRST FLOOR PLAN; SECOND FLOOR PLAN; ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    STIRLING'S QUARTERS SMALL BARN: FIRST FLOOR PLAN; SECOND FLOOR PLAN; SOUTH ELEVATION; EAST ELEVATION; NORTH ELEVATION; WEST ELEVATION. - Stirling's Quarters, 555 Yellow Springs Road, Tredyffrin Township, Valley Forge, Chester County, PA

  12. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

    PubMed Central

    Jhang, Jia-Fong; Kuo, Hann-Chorng

    2015-01-01

    Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment. PMID:26094697

  13. System for Estimating Horizontal Velocity During Descent

    NASA Technical Reports Server (NTRS)

    Johnson, Andrew; Cheng, Yang; Wilson, Reg; Goguen, Jay; Martin, Alejandro San; Leger, Chris; Matthies, Larry

    2007-01-01

    The descent image motion estimation system (DIMES) is a system of hardware and software, designed for original use in estimating the horizontal velocity of a spacecraft descending toward a landing on Mars. The estimated horizontal velocity is used in generating rocket-firing commands to reduce the horizontal velocity as part of an overall control scheme to minimize the landing impact. DIMES can also be used for estimating the horizontal velocity of a remotely controlled or autonomous aircraft for purposes of navigation and control.

  14. APOLLO 11: Lunar Module Separates for descent

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Separation of the Lunar module for descent to the Lunar surface From the film documentary 'APOLLO 11:'The eagle Has Landed'', part of a documentary series on the APOLLO missions made in the early '70's and narrated by Burgess Meredith. APOLLO 11: First manned lunar landing and return to Earth with Neil A. Armstrong, Michael Collins, and Edwin E. Aldrin. Landed in the Sea of Tranquilityon July 20, 1969; deployed TV camera and EASEP experiments, performed lunar surface EVA, returned lunar soil samples. Mission Duration 195 hrs 18 min 35sec

  15. CAST FLOOR WITH VIEW OF TORPEDO LADLE (BENEATH CAST FLOOR) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    CAST FLOOR WITH VIEW OF TORPEDO LADLE (BENEATH CAST FLOOR) AND KEEPERS OF THE CAST HOUSE FLOOR, S.L. KIMBROUGH AND DAVID HOLMES. - U.S. Steel, Fairfield Works, Blast Furnace No. 8, North of Valley Road, West of Ensley-Pleasant Grove Road, Fairfield, Jefferson County, AL

  16. 49. TOP FLOOR OF 1852 WING LOOKING EAST. FLOOR COVERING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    49. TOP FLOOR OF 1852 WING LOOKING EAST. FLOOR COVERING INDICATES ANGLE OF INTERSECTION BETWEEN THIS AND THE EARLIER WING. NOTE ALSO CHANGE IN ORIENTATION OF COLUMNS AND HANGING LIGHT FIXTURE. BRIGHT AREA AT CEILING IN MIDDLE DISTANCE INDICATES SKYLIGHT. THIS FLOOR ADDED CA. 1880. - Boston Manufacturing Company, 144-190 Moody Street, Waltham, Middlesex County, MA

  17. Interior, view of third floor room, with original flooring, camera ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior, view of third floor room, with original flooring, camera facing northwest, this was typical of the rooms on the third floor before the rehabilitation by the Navy in the 1950s and 1960s - Naval Training Station, Senior Officers' Quarters District, Quarters No. 4, Naval Station Treasure Island, 4 Whiting Way, Yerba Buena Island, San Francisco, San Francisco County, CA

  18. Regression Analysis of Top of Descent Location for Idle-thrust Descents

    NASA Technical Reports Server (NTRS)

    Stell, Laurel; Bronsvoort, Jesper; McDonald, Greg

    2013-01-01

    In this paper, multiple regression analysis is used to model the top of descent (TOD) location of user-preferred descent trajectories computed by the flight management system (FMS) on over 1000 commercial flights into Melbourne, Australia. The independent variables cruise altitude, final altitude, cruise Mach, descent speed, wind, and engine type were also recorded or computed post-operations. Both first-order and second-order models are considered, where cross-validation, hypothesis testing, and additional analysis are used to compare models. This identifies the models that should give the smallest errors if used to predict TOD location for new data in the future. A model that is linear in TOD altitude, final altitude, descent speed, and wind gives an estimated standard deviation of 3.9 nmi for TOD location given the trajec- tory parameters, which means about 80% of predictions would have error less than 5 nmi in absolute value. This accuracy is better than demonstrated by other ground automation predictions using kinetic models. Furthermore, this approach would enable online learning of the model. Additional data or further knowl- edge of algorithms is necessary to conclude definitively that no second-order terms are appropriate. Possible applications of the linear model are described, including enabling arriving aircraft to fly optimized descents computed by the FMS even in congested airspace. In particular, a model for TOD location that is linear in the independent variables would enable decision support tool human-machine interfaces for which a kinetic approach would be computationally too slow.

  19. Is There a Relationship Between Pelvic Organ Prolapse and Tissue Fibrillin-1 Levels?

    PubMed Central

    Eser, Ayla; Unlubilgin, Eylem; Hizli, Fatih; Acar, Muradiye; Kamalak, Zeynep; Kosus, Aydin; Kosus, Nermin; Hizli, Deniz; Gunduz, Esra

    2015-01-01

    Purpose: Pelvic organ prolapse is a multifactorial disorder in which extracellular matrix defects are implicated. Fibrillin-1 level is reduced in stress urinary incontinence. In Marfan syndrome, which is associated with mutations in Fibrillin-1, pelvic floor disorders are commonly observed. We hypothesize that Fibrillin-1 gene expression is altered in pelvic organ prolapse. Methods: Thirty women undergoing colporrhaphy or hysterectomy because of cystocele, rectocele, cystorectocele, or uterine prolapse were assigned to a pelvic prolapse study group, and thirty women undergone hysterectomy for nonpelvic prolapse conditions were assigned to a control group. Real-time polymerase chain reaction was conducted on vaginal tissue samples to measure the expression of Fibrillin-1. Expression levels were compared between study and control groups by Mann-Whitney U test with Bonferroni revision. Results: Fibrillin-1 gene expression was not significantly lower in the study group than in the control group. Similarly, no significant correlation between Fibrillin-1 levels and grade of pelvic prolapse was found. Age over 40 years (P=0.018) and menopause (P=0.027) were both associated with reduced Fibrillin-1 levels in the pelvic prolapse group, whereas the delivery of babies weighing over 3,500 g at birth was associated with increased Fibrillin-1 expression (P=0.006). Conclusions: The results did not indicate a significant reduction in Fibrillin-1 gene expression in pelvic prolapse disorders; however, reduced Fibrillin-1 may contribute to increased pelvic organ prolapse risk with age and menopause. Increased Fibrillin-1 gene expression may be a compensatory mechanism in cases of delivery of babies with high birth weight. Further studies are needed for a better understanding of these observations. PMID:26620898

  20. Stair ascent and descent at different inclinations.

    PubMed

    Riener, Robert; Rabuffetti, Marco; Frigo, Carlo

    2002-02-01

    The aim of this study was to investigate the biomechanics and motor co-ordination in humans during stair climbing at different inclinations. Ten normal subjects ascended and descended a five-step staircase at three different inclinations (24 degrees, 30 degrees, 42 degrees ). Three steps were instrumented with force sensors and provided 6 dof ground reactions. Kinematics was analysed by a camera-based optoelectronic system. An inverse dynamics approach was applied to compute joint moments and powers. The different kinematic and kinetic patterns of stair ascent and descent were analysed and compared to level walking patterns. Temporal gait cycle parameters and ground reactions were not significantly affected by staircase inclination. Joint angles and moments showed a relatively low but significant dependency on the inclination. A large influence was observed in joint powers. This can be related to the varying amount of potential energy that has to be produced (during ascent) or absorbed (during descent) by the muscles. The kinematics and kinetics of staircase walking differ considerably from level walking. Interestingly, no definite signs could be found indicating that there is an adaptation or shift in the motor patterns when moving from level to stair walking. This can be clearly seen in the foot placement: compared to level walking, the forefoot strikes the ground first--independent from climbing direction and inclination. This and further findings suggest that there is a certain inclination angle or angular range where subjects do switch between a level walking and a stair walking gait pattern. PMID:11809579

  1. The association of pelvic organ prolapse severity and improvement in overactive bladder symptoms after surgery for pelvic organ prolapse

    PubMed Central

    Kim, Mi Sun; Lee, Gee Hoon; Na, Eun Duc; Jang, Ji Hyon

    2016-01-01

    Objective The purpose of this study was to evaluate the impact of pelvic organ prolapse (POP) repair on overactive bladder (OAB) symptoms in women with POP and the effect of baseline POP severity on improvement in OAB after surgical repair of POP. And we also tried to identify any preoperative factors for persistent postoperative OAB symptoms. Methods A total of 87 patients with coexisting POP and OAB who underwent surgical correction of POP were included and retrospectively analyzed and postoperative data was obtained by telephone interview. OAB was defined as an affirmative response to item no. 15 (urinary frequency) and item no. 16 (urge incontinence) of the Pelvic Floor Distress Inventory. POP severity was dichotomized by Pelvic Organ Prolapse Quantification stage 1 to 2 (n=22) versus stage 3 to 4 (n=65). Results OAB symptoms were significantly improved after surgical treatment (P<0.001). But there was no significant differences in postoperative improvement of frequency and urge incontinence between stage 1 to 2 group versus stage 3 to 4 group. Preoperative demographic factors (age, parity, and POP stage) were not significantly related to persistent postoperative OAB symptoms. Conclusion Women with coexisting POP and OAB who undergo surgical repair experience significant improvement in OAB symptoms after surgery, but severity of POP had no significant difference in improvement of OAB symptoms. Postoperative persistent OAB symptoms were not related to age, parity, body mass index, and POP stage. PMID:27200312

  2. Gynecological indications for the use of botulinum toxin in women with chronic pelvic pain.

    PubMed

    Abbott, Jason

    2009-10-01

    Chronic pelvic pain in women is a common symptom with a wide variety of etiologies that demand accurate diagnosis and appropriate treatment if pain reduction is to be effected. Superficial conditions such as provoked vestibulodynia and problems affecting deeper structures such as pelvic floor muscle spasm are difficult to treat and can have significant impacts on quality of life for the sufferer. Apart from daily pain, symptoms such as painful intercourse (dyspareunia), painful bowel motions (dyschesia) and exacerbation of period pain (dysmenorrhea) are commonly reported by patients. For inflammatory conditions, and in areas where muscle spasm is thought to contribute to pain, botulinum toxins (BoNT) are used with considerable success. For gynecological indications, there are limited data, in the form of case reports and small series, to indicate that BoNT used in the vulva may have a benefit for 3-6 months after injection of 20-40U of BOTOX; for women with provoked vestibulodynia. Re-treatment is reported to be successful and side effects are limited. Controlled studies are essential to further explore this indication. For pelvic floor muscle spasm, a greater number of women have been studied and a double blind, randomized controlled study has reported a significant reduction in pelvic floor pressures with significant pain reduction for some types of pelvic pain compared to baseline. There were no differences in pain compared to the control group who had physical therapy as an intervention. Physical therapy could be used as a non-invasive first line treatment, with BoNT injections reserved for those who are refractory to treatment. In summary, BoNT treatment for a variety of gynecological indications seems successful with limited side effects, although there are minimal data, particularly in superficial vulval conditions. To allow recommendation for wider utilization of this treatment, it is essential that more research is performed to add further evidence to our

  3. Screening Pelvic Examination in Nonpregnant Adult Women

    MedlinePlus

    ... of Internal Medicine Summaries for Patients Screening Pelvic Examination in Nonpregnant Adult Women: Recommendations From the American ... Physicians The full report is titled “Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From ...

  4. Pelvic Inflammatory Disease (PID) Treatment and Care

    MedlinePlus

    ... Herpes Gonorrhea Hepatitis HIV/AIDS & STDs Human Papillomavirus (HPV) Pelvic Inflammatory Disease ... is pelvic inflammatory disease treated? Several types of antibiotics can cure PID. Antibiotic treatment does not, however, reverse any ...

  5. Kegel Exercises for Your Pelvic Muscles

    MedlinePlus

    ... control until after 6 to 12 weeks of daily exercises. Still, most women notice an improvement after just ... Weak pelvic muscles often lead to urine leakage. Daily exercises can strengthen pelvic muscles. These exercises often improve ...

  6. Microbiota and Pelvic Inflammatory Disease

    PubMed Central

    Sharma, Harsha; Tal, Reshef; Clark, Natalie A.; Segars, James H.

    2014-01-01

    Female genital tract microbiota play a crucial role in maintaining health. Disequilibrium of the microbiota has been associated with increased risk of pelvic infections. In recent years, culture-independent molecular techniques have expanded understanding of the composition of genital microbiota and the dynamic nature of the microbiota. There is evidence that upper genital tract may not be sterile and may harbor microflora in the physiologic state. The isolation of bacterial vaginosis-associated organisms in women with genital infections establishes a link between pelvic infections and abnormal vaginal flora. With the understanding of the composition of the microbiota in healthy and diseased states, the next logical step is to identify the function of the newly identified microbes. This knowledge will further expand our understanding of the causation of pelvic infections, which may lead to more effective prevention and treatment strategies. PMID:24390920

  7. Management of Pelvic Organ Prolapse

    PubMed Central

    Choi, Kyung Hwa

    2014-01-01

    Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse. PMID:25405010

  8. Effects of a dynamic chair on pelvic mobility, fatigue, and work efficiency during work performed while sitting: a comparison of dynamic sitting and static sitting

    PubMed Central

    Tanoue, Hironori; Mitsuhashi, Toshitaka; Sako, Shunji; Goto, Ryokichi; Nakai, Tomohiro; Inaba, Ryoichi

    2016-01-01

    [Purpose] Working while sitting for long periods can cause lumbar pain, fatigue, and reduced work efficiency. How a dynamic chair with a seat that moves three-dimensionally affects pelvic mobility before and after work, work efficiency, and post-work fatigue were examined. [Subjects and Methods] Subjects were 17 healthy adults (10 males, 7 females, mean age 21.8 ± 2.7 years). Subjects performed a 30-min Kraepelin test under two conditions: sitting in a standard office chair and sitting in a dynamic sitting balance chair. Root mean square (RMS) values of pelvic movement measured by a triaxial accelerometer during 30 minutes of work, finger-floor distance before and after work, lumbar fatigue, and pelvic movement RMS values during finger-floor distance measurement were used as outcome measures. [Results] Pelvic movement RMS values collected every 5 minutes during 30 minutes of work were significantly higher while sitting in the dynamic balance chair. Changes in pelvic movement RMS values during finger-floor distance measurement after work and amount of work performed during 30 minutes were significantly higher and lumbar fatigue was significantly lower for the dynamic balance chair. [Conclusion] Dynamic sitting maintained or increased pelvic flexibility. The dynamic balance chair may effectively help workers work continuously in seated postures with little fatigue. PMID:27390410

  9. Functional Status in Older Women Diagnosed with Pelvic Organ Prolapse

    PubMed Central

    SANSES, Tatiana V.D.; SCHILTZ, Nicholas K.; COURI, Bruna M.; MAHAJAN, Sangeeta T.; RICHTER, Holly E.; WARNER, David F.; GURALNIK, Jack; KOROUKIAN, Siran M.

    2016-01-01

    Background Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there is limited data on the prevalence of functional limitations in older women with pelvic floor disorders. Objective The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse. Study Design This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files between 1992 and 2008. The analysis included 890 women ≥65 years with pelvic organ prolapse. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living, and instrumental activities of daily living domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age. Results The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in activities of daily living and 13.6% in instrumental activities of daily living. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in activities of daily living, and 30.6% vs 6.7% in instrumental activities of daily living, all p<0.01. The odds of all functional limitations also increased significantly with advancing age. Conclusion Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with pelvic organ prolapse, particularly in those with poor or fair self

  10. Modular Flooring System

    NASA Technical Reports Server (NTRS)

    Thate, Robert

    2012-01-01

    The modular flooring system (MFS) was developed to provide a portable, modular, durable carpeting solution for NASA fs Robotics Alliance Project fs (RAP) outreach efforts. It was also designed to improve and replace a modular flooring system that was too heavy for safe use and transportation. The MFS was developed for use as the flooring for various robotics competitions that RAP utilizes to meet its mission goals. One of these competitions, the FIRST Robotics Competition (FRC), currently uses two massive rolls of broadloom carpet for the foundation of the arena in which the robots are contained during the competition. The area of the arena is approximately 30 by 72 ft (approximately 9 by 22 m). This carpet is very cumbersome and requires large-capacity vehicles, and handling equipment and personnel to transport and deploy. The broadloom carpet sustains severe abuse from the robots during a regular three-day competition, and as a result, the carpet is not used again for competition. Similarly, broadloom carpets used for trade shows at convention centers around the world are typically discarded after only one use. This innovation provides a green solution to this wasteful practice. Each of the flooring modules in the previous system weighed 44 lb (.20 kg). The improvements in the overall design of the system reduce the weight of each module by approximately 22 lb (.10 kg) (50 %), and utilize an improved "module-to-module" connection method that is superior to the previous system. The MFS comprises 4-by-4-ft (.1.2-by- 1.2-m) carpet module assemblies that utilize commercially available carpet tiles that are bonded to a lightweight substrate. The substrate surface opposite from the carpeted surface has a module-to-module connecting interface that allows for the modules to be connected, one to the other, as the modules are constructed. This connection is hidden underneath the modules, creating a smooth, co-planar flooring surface. The modules are stacked and strapped

  11. A biomechanical model to assess the contribution of pelvic musculature weakness to the development of stress urinary incontinence.

    PubMed

    Yip, Clare; Kwok, Ezra; Sassani, Farrokh; Jackson, Roy; Cundiff, Geoffrey

    2014-01-01

    A biomechanical model of the female pelvic support system was developed to explore the contribution of pelvic floor muscle defect to the development of stress urinary incontinence (SUI). From a pool of 135 patients, clinical data of 26 patients with pelvic muscular defect were used in modelling. The model was employed to estimate the parameters that describe the stiffness properties of the vaginal wall and ligament tissues for individual patients. The parameters were then implemented into the model to evaluate for each patient the impact of pelvic muscular defect on the vaginal apex support and the bladder neck support, a factor that relates to the onset of SUI. For the modelling analysis, the compromise of pelvic muscular support was demonstrated to contribute to vaginal apex prolapse and bladder neck prolapse, a condition commonly seen in SUI patients, while simulated conditions of restored muscular support were shown to help re-establish both vaginal apex and bladder neck supports. The findings illustrate the significance of pelvic muscle strength to vaginal support and urinary continence; therefore, the clinical recommendation of pelvic muscle strengthening, such as Kegel exercises, has been shown to be an effective treatment for patients with SUI symptoms. PMID:22494663

  12. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Performance: Uncontrolled descent. 31.19 Section 31.19 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a) The following must be...

  13. Hair Breakage in Patients of African Descent: Role of Dermoscopy

    PubMed Central

    Quaresma, Maria Victória; Martinez Velasco, María Abril; Tosti, Antonella

    2015-01-01

    Dermoscopy represents a useful technique for the diagnosis and follow-up of hair and scalp disorders. To date, little has been published regarding dermoscopy findings of hair disorders in patients of African descent. This article illustrates how dermoscopy allows fast diagnosis of hair breakage due to intrinsic factors and chemical damage in African descent patients. PMID:27170942

  14. Mars Science Laboratory Entry, Descent and Landing System Overview

    NASA Technical Reports Server (NTRS)

    Steltzner, Adam D.; San Martin, A. Miguel; Rivellini, Tomasso P.; Chen, Allen

    2013-01-01

    The Mars Science Laboratory project recently places the Curiosity rove on the surface of Mars. With the success of the landing system, the performance envelope of entry, descent and landing capabilities has been extended over the previous state of the art. This paper will present an overview to the MSL entry, descent and landing system design and preliminary flight performance results.

  15. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Performance: Uncontrolled descent. 31.19 Section 31.19 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a) The following must be...

  16. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Performance: Uncontrolled descent. 31.19 Section 31.19 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a) The following must be...

  17. A Gradient Descent Approximation for Graph Cuts

    NASA Astrophysics Data System (ADS)

    Yildiz, Alparslan; Akgul, Yusuf Sinan

    Graph cuts have become very popular in many areas of computer vision including segmentation, energy minimization, and 3D reconstruction. Their ability to find optimal results efficiently and the convenience of usage are some of the factors of this popularity. However, there are a few issues with graph cuts, such as inherent sequential nature of popular algorithms and the memory bloat in large scale problems. In this paper, we introduce a novel method for the approximation of the graph cut optimization by posing the problem as a gradient descent formulation. The advantages of our method is the ability to work efficiently on large problems and the possibility of convenient implementation on parallel architectures such as inexpensive Graphics Processing Units (GPUs). We have implemented the proposed method on the Nvidia 8800GTS GPU. The classical segmentation experiments on static images and video data showed the effectiveness of our method.

  18. Distributed Control by Lagrangian Steepest Descent

    NASA Technical Reports Server (NTRS)

    Wolpert, David H.; Bieniawski, Stefan

    2004-01-01

    Often adaptive, distributed control can be viewed as an iterated game between independent players. The coupling between the players mixed strategies, arising as the system evolves from one instant to the next, is determined by the system designer. Information theory tells us that the most likely joint strategy of the players, given a value of the expectation of the overall control objective function, is the minimizer of a function o the joint strategy. So the goal of the system designer is to speed evolution of the joint strategy to that Lagrangian mhimbhgpoint,lowerthe expectated value of the control objective function, and repeat Here we elaborate the theory of algorithms that do this using local descent procedures, and that thereby achieve efficient, adaptive, distributed control.

  19. Error analysis of stochastic gradient descent ranking.

    PubMed

    Chen, Hong; Tang, Yi; Li, Luoqing; Yuan, Yuan; Li, Xuelong; Tang, Yuanyan

    2013-06-01

    Ranking is always an important task in machine learning and information retrieval, e.g., collaborative filtering, recommender systems, drug discovery, etc. A kernel-based stochastic gradient descent algorithm with the least squares loss is proposed for ranking in this paper. The implementation of this algorithm is simple, and an expression of the solution is derived via a sampling operator and an integral operator. An explicit convergence rate for leaning a ranking function is given in terms of the suitable choices of the step size and the regularization parameter. The analysis technique used here is capacity independent and is novel in error analysis of ranking learning. Experimental results on real-world data have shown the effectiveness of the proposed algorithm in ranking tasks, which verifies the theoretical analysis in ranking error. PMID:24083315

  20. Bridle Device in Mars Science Laboratory Descent Stage

    NASA Technical Reports Server (NTRS)

    2008-01-01

    This view of a portion of the descent stage of NASA's Mars Science Laboratory shows two of the stage's three spherical fuel tanks flanking the bridle device assembly. The photograph was taken in early October 2008 from the center of the descent stage looking outward. The top of the descent stage is toward the top of the image.

    The bridle device assembly is about two-thirds of a meter, or 2 feet, from top to bottom, and has two main parts. The cylinder on the top is the descent brake. The conical-shaped mechanism below that is the bridle assembly, including a spool of nylon and Vectran cords that will be attached to the rover.

    When pyrotechnic bolts fire to sever the rigid connection between the rover and the descent stage, gravity will pull the tethered rover away from the descent stage. The bridle or tether, attached to three points on the rover, will unspool from the bridle assembly, beginning from the larger-diameter portion. The rotation rate of the assembly, hence the descent rate of the rover, will be governed by the descent brake. Inside the housing of that brake are gear boxes and banks of mechanical resistors engineered to prevent the bridle from spooling out too quickly or too slowly. The length of the bridle will allow the rover to be lowered about 7.5 meters (25 feet) while still tethered to the descent stage.

    The Starsys division of SpaceDev Inc., Poway, Calif., provided the descent brake. NASA's Jet Propulsion Laboratory, Pasadena, Calif., built the bridle assembly. Vectran is a product of Kuraray Co. Ltd., Tokyo. JPL, a division of the California Institute of Technology, manages the Mars Science Laboratory Project for the NASA Science Mission Directorate, Washington.

  1. 9. LOOKING FROM FLOOR 1 UP THROUGH OPENING TO FLOOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    9. LOOKING FROM FLOOR 1 UP THROUGH OPENING TO FLOOR 2; OPENING IN THE FLOOR IS TO ALLOW THE RUNNER STONES TO BE FLIPPED OVER FOR SHARPENING; AT THE FIRST FLOOR ARE THE POSTS SUPPORTING THE BRIDGEBEAMS ON WHICH THE BRIDGE TREES PIVOT; THE CENTER POST RISES ABOVE THE STONES TO RECEIVE THE FOOT BEARING OF THE UPRIGHT SHAFT; ALSO SEEN ARE THE STONE SPINDLWS, UNDER SIDES OF THE BED STONES, STONE NUT AND GREAT SPUR WHEEL. - Pantigo Windmill, James Lane, East Hampton, Suffolk County, NY

  2. Floor of Juventae Chasma

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 30 May 2002) Juventae Chasma is an enormous box canyon (250 km X 100 km) which opens to the north and forms the outflow channel Maja Vallis. Most Martian outflow channels such as Maja, Kasei, and Ares Valles begin at point sources such as box canyons and chaotic terrain and then flow unconfined into a basin region. This image captures a portion of the western floor of Juventae Chasma and shows a wide variety of landforms. Conical hills, mesas, buttes and plateaus of layered material dominate this scene and seem to be 'swimming' in vast sand sheets. The conical hills have a spur and gully topography associated with them while the flat topped buttes and mesas do not. This may be indicative of different materials that compose each of these landforms or it could be that the flat-topped layer has been completely eroded off of the conical hills thereby exposing a different rock type. Both the conical hills and flat-topped buttes and mesas have extensive scree slopes (heaps of eroded rock and debris). Ripples, which are inferred to be dunes, can also be seen amongst the hills. No impact craters can be seen in this image, indicating that the erosion and transport of material down the canyon wall and across the floor is occurring at a relatively rapid rate, so that any craters that form are rapidly buried or eroded.

  3. Surface erosion caused on Mars from Viking descent engine plume

    NASA Technical Reports Server (NTRS)

    Hutton, R. E.; Moore, H. J.; Scott, R. F.; Shorthill, R. W.; Spitzer, C. R.

    1980-01-01

    During the Martian landings the descent engine plumes on Viking Lander 1 (VL-1) and Viking Lander 2 (VL-2) eroded the Martian surface materials. This had been anticipated and investigated both analytically and experimentally during the design phase of the Viking spacecraft. This paper presents data on erosion obtained during the tests of the Viking descent engine and the evidence for erosion by the descent engines of VL-1 and VL-2 on Mars. From these and other results, it is concluded that there are four distinct surface materials on Mars: (1) drift materials, (2) crusty to cloddy material, (3) blocky material, and (4) rock.

  4. Surface erosion caused on Mars from Viking descent engine plume

    USGS Publications Warehouse

    Hutton, R.E.; Moore, H.J.; Scott, R.F.; Shorthill, R.W.; Spitzer, C.R.

    1980-01-01

    During the Martian landings the descent engine plumes on Viking Lander 1 (VL-1) and Viking Lander 2 (VL-2) eroded the Martian surface materials. This had been anticipated and investigated both analytically and experimentally during the design phase of the Viking spacecraft. This paper presents data on erosion obtained during the tests of the Viking descent engine and the evidence for erosion by the descent engines of VL-1 and VL-2 on Mars. From these and other results, it is concluded that there are four distinct surface materials on Mars: (1) drift material, (2) crusty to cloddy material, (3) blocky material, and (4) rock. ?? 1980 D. Reidel Publishing Co.

  5. [Ultrasonography in acute pelvic pain].

    PubMed

    Kupesić, Sanja; Aksamija, Alenka; Vucić, Niksa; Tripalo, Ana; Kurjak, Asim

    2002-01-01

    Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more

  6. 4. STAIR, FROM SECOND FLOOR TO THIRD FLOOR, FROM NORTHEAST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. STAIR, FROM SECOND FLOOR TO THIRD FLOOR, FROM NORTHEAST. Plan of stair is elliptical, the inside well measuring 54' on major axis and 14' on minor axis. ALSO NOTE HIGH REEDED WAINSCOT - Saltus-Habersham House, 802 Bay Street, Beaufort, Beaufort County, SC

  7. 18. FOURTH FLOOR BLDG. 28, RAISED CONCRETE SLAB FLOOR WITH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. FOURTH FLOOR BLDG. 28, RAISED CONCRETE SLAB FLOOR WITH BLOCKS AND PULLEYS OVERHEAD LOOKING NORTHEAST. - Fafnir Bearing Plant, Bounded on North side by Myrtle Street, on South side by Orange Street, on East side by Booth Street & on West side by Grove Street, New Britain, Hartford County, CT

  8. 13. Bottom floor, tower interior showing concrete floor and cast ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. Bottom floor, tower interior showing concrete floor and cast iron bases for oil butts (oil butts removed when lighthouse lamp was converted to electric power.) - Block Island Southeast Light, Spring Street & Mohegan Trail at Mohegan Bluffs, New Shoreham, Washington County, RI

  9. Floor Plans: Section "AA", Section "BB"; Floor Framing Plans: Section ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Floor Plans: Section "A-A", Section "B-B"; Floor Framing Plans: Section "A-A", Section "B-B" - Fort Washington, Fort Washington Light, Northeast side of Potomac River at Fort Washington Park, Fort Washington, Prince George's County, MD

  10. 18. MAIN FLOOR HOLDING TANKS Main floor, looking at ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. MAIN FLOOR - HOLDING TANKS Main floor, looking at holding tanks against the west wall, from which sluice gates are seen protruding. Right foreground-wooden holding tanks. Note narrow wooden flumes through which fish were sluiced into holding and brining tanks. - Hovden Cannery, 886 Cannery Row, Monterey, Monterey County, CA

  11. Orion Entry, Descent, and Landing Simulation

    NASA Technical Reports Server (NTRS)

    Hoelscher, Brian R.

    2007-01-01

    The Orion Entry, Descent, and Landing simulation was created over the past two years to serve as the primary Crew Exploration Vehicle guidance, navigation, and control (GN&C) design and analysis tool at the National Aeronautics and Space Administration (NASA). The Advanced NASA Technology Architecture for Exploration Studies (ANTARES) simulation is a six degree-of-freedom tool with a unique design architecture which has a high level of flexibility. This paper describes the decision history and motivations that guided the creation of this simulation tool. The capabilities of the models within ANTARES are presented in detail. Special attention is given to features of the highly flexible GN&C architecture and the details of the implemented GN&C algorithms. ANTARES provides a foundation simulation for the Orion Project that has already been successfully used for requirements analysis, system definition analysis, and preliminary GN&C design analysis. ANTARES will find useful application in engineering analysis, mission operations, crew training, avionics-in-the-loop testing, etc. This paper focuses on the entry simulation aspect of ANTARES, which is part of a bigger simulation package supporting the entire mission profile of the Orion vehicle. The unique aspects of entry GN&C design are covered, including how the simulation is being used for Monte Carlo dispersion analysis and for support of linear stability analysis. Sample simulation output from ANTARES is presented in an appendix.

  12. Auroral precipitation and descent of thermospheric NO

    NASA Astrophysics Data System (ADS)

    Kühl, Sven; Espy, Patrick; Hibbins, Robert; Paxton, Larry; Funke, Bernd

    2016-07-01

    Energetic particle precipitation in Auroras (E <20 keV) produces nitric oxide (NO) in the upper meso- and lower thermosphere region (UMLT). The subsequent descent of the NO produced in the UMLT to the lower meso- and upper stratosphere is referred to as the energetic particle precipitation indirect effect (EPP IE). The downwelling of NO produced in Auroras alters the chemistry of the mesosphere and upper stratosphere (e.g. by the NOx cycle) and possibly has important effects also on its dynamics. By observations of auroral precipitation from SSUSI(DMSP) and measurements of NO from MIPAS(ENVISAT) and SMR(ODIN) we investigate the quantitative relation of the electron fluxes and characteristic energies of auroral precipitation to the NO produced in the lower thermosphere and the subsequent downwelling of NO. Using additional ground-based (e.g. Meteor Radar, Microwave Radiometer) and satellite observations (SOFIE) we attempt to quantify the EPP IE and its impact on atmospheric chemistry and dynamics.

  13. Floor-plan radar

    NASA Astrophysics Data System (ADS)

    Falconer, David G.; Ueberschaer, Ronald M.

    2000-07-01

    Urban-warfare specialists, law-enforcement officers, counter-drug agents, and counter-terrorism experts encounter operational situations where they must assault a target building and capture or rescue its occupants. To minimize potential casualties, the assault team needs a picture of the building's interior and a copy of its floor plan. With this need in mind, we constructed a scale model of a single- story house and imaged its interior using synthetic-aperture techniques. The interior and exterior walls nearest the radar set were imaged with good fidelity, but the distal ones appear poorly defined and surrounded by ghosts and artifacts. The latter defects are traceable to beam attenuation, wavefront distortion, multiple scattering, traveling waves, resonance phenomena, and other effects not accounted for in the traditional (noninteracting, isotropic point scatterer) model for radar imaging.

  14. Design and Development of the MSL Descent Stage Propulsion System

    NASA Technical Reports Server (NTRS)

    Weiss, Jeffrey M.; Guernsey, Carl S.

    2013-01-01

    On August 5, 2012, The Mars Science Laboratory mission successfully landed the largest interplanetary rover ever built, Curiosity, on the surface of Mars. The Entry, Descent, and Landing (EDL) phase of this mission was by far the most complex landing ever attempted on a planetary body. The Descent Stage Propulsion System played an integral and critical role during Curiosity's EDL. The Descent Stage Propulsion System was a one of a kind hydrazine propulsion system designed specifically for the EDL phase of the MSL mission. It was designed, built, and tested at the Jet Propulsion Laboratory (JPL). The purpose of this paper is to present an overview of the design and development of the MSL Descent Stage Propulsion System. Driving requirements, system design, component selection, operational sequence of the system at Mars, new developments, and key challenges will be discussed.

  15. Men of African Descent and Carcinoma of the Prostate Consortium

    Cancer.gov

    The Men of African Descent and Carcinoma of the Prostate Consortium collaborates on epidemiologic studies to address the high burden of prostate cancer and to understand the causes of etiology and outcomes among men of African ancestry.

  16. Automation for Accommodating Fuel-Efficient Descents in Constrained Airspace

    NASA Technical Reports Server (NTRS)

    Coopenbarger, Richard A.

    2010-01-01

    Continuous descents at low engine power are desired to reduce fuel consumption, emissions and noise during arrival operations. The challenge is to allow airplanes to fly these types of efficient descents without interruption during busy traffic conditions. During busy conditions today, airplanes are commonly forced to fly inefficient, step-down descents as airtraffic controllers work to ensure separation and maximize throughput. NASA in collaboration with government and industry partners is developing new automation to help controllers accommodate continuous descents in the presence of complex traffic and airspace constraints. This automation relies on accurate trajectory predictions to compute strategic maneuver advisories. The talk will describe the concept behind this new automation and provide an overview of the simulations and flight testing used to develop and refine its underlying technology.

  17. Ascent/descent ancillary data production user's guide

    NASA Technical Reports Server (NTRS)

    Brans, H. R.; Seacord, A. W., II; Ulmer, J. W.

    1986-01-01

    The Ascent/Descent Ancillary Data Product, also called the A/D BET because it contains a Best Estimate of the Trajectory (BET), is a collection of trajectory, attitude, and atmospheric related parameters computed for the ascent and descent phases of each Shuttle Mission. These computations are executed shortly after the event in a post-flight environment. A collection of several routines including some stand-alone routines constitute what is called the Ascent/Descent Ancillary Data Production Program. A User's Guide for that program is given. It is intended to provide the reader with all the information necessary to generate an Ascent or a Descent Ancillary Data Product. It includes descriptions of the input data and output data for each routine, and contains explicit instructions on how to run each routine. A description of the final output product is given.

  18. Recommendations on routine screening pelvic examination

    PubMed Central

    Tonelli, Marcello; Gorber, Sarah Connor; Moore, Ainsley; Thombs, Brett D.

    2016-01-01

    Abstract Objective To review the 2014 American College of Physicians (ACP) guideline on the use of pelvic examinations to screen for cancer (other than cervical), pelvic inflammatory disease, or other benign gynecologic conditions to determine whether the ACP guideline on routine pelvic examinations was consistent with Canadian Task Force on Preventive Health Care (CTFPHC) standards and could be adapted or adopted. Methods The SNAP-IT (Smooth National Adaptation and Presentation of Guidelines to Improve Thrombosis Treatment) method was used to determine whether the ACP guideline was consistent with CTFPHC standards and could be adapted or adopted. Recommendations The CTFPHC recommends not performing a screening pelvic examination to screen for noncervical cancer, pelvic inflammatory disease, or other gynecological conditions in asymptomatic women. This is a strong recommendation with moderate-quality evidence. Conclusion The CTFPHC adopts the recommendation on screening pelvic examination as published by the ACP in 2014. PMID:26975912

  19. Chronic pelvic pain: An imaging approach.

    PubMed

    Juhan, V

    2015-10-01

    Chronic pelvic pain is defined as disabling pain of at least six months duration. Chronic pelvic pain has often multiple causative factors. Careful analysis of clinical history and detailed clinical examination must be carried out to guide further imaging investigations. Endometriosis is a common cause of chronic pelvic pain, although there is no correlation between the severity of lesions and pain intensity. Pelvic ultrasonography should be the first line imaging examination to search for causative conditions that include endometriosis, adenomyosis, pelvic varices and chronic infection. Magnetic resonance imaging (MRI) is useful for making the positive diagnosis and assessing the spread of endometriosis. MRI is more accurate than ultrasonography for the diagnosis of tubo-ovarian abscess when an adnexal mass is identified. Duplex and color Doppler ultrasonography as well as MR angiography are the best imaging technique for the diagnosis of pelvic congestion syndrome. In patients with pudendal neuralgia, cross-sectional imaging help exclude nerve compression. PMID:26441020

  20. Air-Traffic Controllers Evaluate The Descent Advisor

    NASA Technical Reports Server (NTRS)

    Tobias, Leonard; Volckers, Uwe; Erzberger, Heinz

    1992-01-01

    Report describes study of Descent Advisor algorithm: software automation aid intended to assist air-traffic controllers in spacing traffic and meeting specified times or arrival. Based partly on mathematical models of weather conditions and performances of aircraft, it generates suggested clearances, including top-of-descent points and speed-profile data to attain objectives. Study focused on operational characteristics with specific attention to how it can be used for prediction, spacing, and metering.

  1. Design principles of descent vehicles with an inflatable braking device

    NASA Astrophysics Data System (ADS)

    Alexashkin, S. N.; Pichkhadze, K. M.; Finchenko, V. S.

    2013-12-01

    A new type of descent vehicle (DVs) is described: a descent vehicle with an inflatable braking device (IBD DV). IBD development issues, as well as materials needed for the design, manufacturing, and testing of an IBD and its thermal protection, are discussed. A list is given of Russian integrated test facilities intended for testing IBD DVs. Progress is described in the development of IBD DVs in Russia and abroad.

  2. Descent from the Summit of 'Husband Hill'

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Click on the image for Descent from the Summit of 'Husband Hill' (QTVR)

    In late November 2005 while descending 'Husband Hill,' NASA's Mars Exploration Rover Spirit took the most detailed panorama so far of the 'Inner Basin,' the rover's next target destination. Spirit acquired the 405 individual images that make up this 360-degree view of the surrounding terrain using five different filters on the panoramic camera. The rover took the images on Martian days, or sols, 672 to 677 (Nov. 23 to 28, 2005 -- the Thanksgiving holiday weekend).

    This image is an approximately true-color rendering using camera's 750-, 530-, and 430-nanometer filters. Seams between individual frames have been eliminated from the sky portion of the mosaic to better simulate the vista a person standing on Mars would see.

    'Home Plate,' a bright, semi-circular feature scientists hope to investigate, is harder to discern in this image than in earlier views taken from higher up the hill. Spirit acquired this more oblique view, known as the 'Seminole panorama,' from about halfway down the south flank of Husband Hill, 50 meters (164 feet) or so below the summit. Near the center of the panorama, on the horizon, are 'McCool Hill' and 'Ramon Hill,' named, like Husband Hill, in honor of the fallen astronauts of the space shuttle Columbia. Husband Hill is visible behind the rover, on the right and left sides of the panorama. An arc of rover tracks made while avoiding obstacles and getting into position to examine rock outcrops can be traced over a long distance by zooming in to explore the panorama in greater detail.

    Spirit is now significantly farther downhill toward the center of this panorama, en route to Home Plate and other enigmatic soils and outcrop rocks in the quest to uncover the history of Gusev Crater and the 'Columbia Hills.'

  3. A descent of the aurora over Lapland

    NASA Astrophysics Data System (ADS)

    Whiter, Daniel; Partamies, Noora

    2014-05-01

    A very large statistical study (≃ 4 × 105 measurements) into the peak emission height of the aurora has shown that the aurora over Lapland descended significantly between 1996 and 2007. The study was performed using images from a network of ground-based all-sky cameras which form part of the MIRACLE (Magnetometers-Ionospheric Radar-All-sky Cameras Large Experiment) network, and are located at various observation stations across northern Finland and Sweden. The height of the aurora was first measured about a century ago. Since then, it has generally been assumed that the peak emission height of any particular auroral emission is constant for similar geomagnetic conditions. The present work was motivated by the need to improve estimates of the height of the aurora used to calculate other ionospheric and auroral properties, such as optical flow velocities and auroral arc widths. In recent years MIRACLE has produced approximately 105 images of the aurora per station per year. In order to analyse such a large number of images, a novel fast and automatic method was developed for finding the peak emission height of an auroral structure from a pair of all-sky camera images with overlapping fields of view. This method has been applied to all auroral images recorded by the MIRACLE intensified CCD cameras in operation between 1996 and 2007. Such a large data set allows the study of variations in the height of the aurora with time (yearly, monthly, hourly) and with solar and geomagnetic indices such as F10.7 and Kp. Results from the statistical study show that the peak emission height of green (557.7 nm, O1S - O1D transition) aurora over Lapland descended by about 10 km between 1996 and 2007. This descent occurred independently of the solar cycle, and is thought to be due to a cooling and contraction of the mesosphere and lower thermosphere.

  4. The Role of Transcatheter Arterial Embolization in Traumatic Pelvic Hemorrhage: Not Only Pelvic Fracture

    PubMed Central

    Zatelli, Marianna; Haglmuller, Thomas; Bonatti, Giampietro

    2016-01-01

    Purpose: The most common life-threatening complication of pelvic trauma is bleeding. Arterial bleedings frequently require active management, preferably with transcatheter arterial embolization (TAE). Hemodynamic instability and/or contrast extravasation at computer tomography (CT) examination are reliable indicators of arterial injury. Unstable pelvic fractures are much more hemorrhagic than stable fractures. Nevertheless, an absent or isolated pelvic fracture does not exclude pelvic hemorrhage. Materials and Methods: A retrospective study was conducted on our institutional database by collecting data of patients who underwent pelvic angiography and/or embolization due to pelvic blunt trauma in the period between August 2010 and August 2015. Results: In a period of five years, 39 patients with traumatic pelvic bleeding underwent angiography at our institution. Thirty-six of the 39 (92%) patients did show CT signs of active pelvic bleeding. Nineteen of 39 (49%) patients were hemodynamically unstable at presentation. Three of the 39 patients did not require embolization. Technical success was 35/36 (97%), and overall mortality was 3/39 (8%). Notably, 5/39 (13%) patients did not have any pelvic fracture at presentation, and 18/39 (46%) had only isolated or stable pelvic ring fracture. Conclusions: TAE is an effective technique to treat arterial pelvic bleeding after trauma. The absence of a major pelvic fracture does not exclude the risk of active bleeding requiring prompt treatment. PMID:27625908

  5. Waterproof Raised Floor Makes Utility Lines Accessible

    NASA Technical Reports Server (NTRS)

    Cohen, M. M.

    1984-01-01

    Floor for laboratories, hospitals and factories waterproof yet allows access to subfloor utilities. Elevated access floor system designed for installations with multitude of diverse utility systems routed under and up through floor and requirement of separation of potentially conflicting utility services. Floor covered by continuous sheet of heat resealable vinyl. Floor system cut open when changes are made in utility lines and ducts. After modifications, floor covering resealed to protect subfloor utilities from spills and leaks.

  6. Making A Precisely Level Floor

    NASA Technical Reports Server (NTRS)

    Simpson, William G.; Walker, William H.; Cather, Jim; Burch, John B.; Clark, Keith M.; Johnston, Dwight; Henderson, David E.

    1989-01-01

    Floor-pouring procedure yields large surface level, smooth, and hard. Floor made of self-leveling, slow-curing epoxy with added black pigment. Epoxy poured to thickness no greater than 0.33 in. (0.84 cm) on concrete base. Base floor seasoned, reasonably smooth and level, and at least 4 in. (10cm) thick. Base rests on thermal barrier of gravel or cinders and contains no steel plates, dividers, or bridges to minimize thermal distortion. Metal retaining wall surrounds base.

  7. Low floor mass transit vehicle

    DOEpatents

    Emmons, J. Bruce; Blessing, Leonard J.

    2004-02-03

    A mass transit vehicle includes a frame structure that provides an efficient and economical approach to providing a low floor bus. The inventive frame includes a stiff roof panel and a stiff floor panel. A plurality of generally vertical pillars extend between the roof and floor panels. A unique bracket arrangement is disclosed for connecting the pillars to the panels. Side panels are secured to the pillars and carry the shear stresses on the frame. A unique seating assembly that can be advantageously incorporated into the vehicle taking advantage of the load distributing features of the inventive frame is also disclosed.

  8. 21. VIEW OF THE FIRST FLOOR PLAN. THE FIRST FLOOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. VIEW OF THE FIRST FLOOR PLAN. THE FIRST FLOOR WAS USED FOR DEPLETED AND ENRICHED URANIUM FABRICATION. THE ORIGINAL DRAWING HAS BEEN ARCHIVED ON MICROFILM. THE DRAWING WAS REPRODUCED AT THE BEST QUALITY POSSIBLE. LETTERS AND NUMBERS IN THE CIRCLES INDICATE FOOTER AND/OR COLUMN LOCATIONS. - Rocky Flats Plant, Uranium Rolling & Forming Operations, Southeast section of plant, southeast quadrant of intersection of Central Avenue & Eighth Street, Golden, Jefferson County, CO

  9. 23. VIEW OF THE FIRST FLOOR PLAN. THE FIRST FLOOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. VIEW OF THE FIRST FLOOR PLAN. THE FIRST FLOOR HOUSED ADMINISTRATIVE OFFICES, THE CENTRAL COMPUTING, UTILITY SYSTEMS, ANALYTICAL LABORATORIES, AND MAINTENANCE SHOPS. THE ORIGINAL DRAWING HAS BEEN ARCHIVED ON MICROFILM. THE DRAWING WAS REPRODUCED AT THE BEST QUALITY POSSIBLE. LETTERS AND NUMBERS IN THE CIRCLES INDICATE FOOTER AND/OR COLUMN LOCATIONS. - Rocky Flats Plant, General Manufacturing, Support, Records-Central Computing, Southern portion of Plant, Golden, Jefferson County, CO

  10. 22. VIEW OF THE SECOND FLOOR PLAN. THE SECOND FLOOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    22. VIEW OF THE SECOND FLOOR PLAN. THE SECOND FLOOR CONTAINS THE AIR PLENUM ND SOME OFFICE SPACE. THE ORIGINAL DRAWING HAS BEEN ARCHIVED ON MICROFILM. THE DRAWING WAS REPRODUCED AT THE BEST QUALITY POSSIBLE. LETTERS AND NUMBERS IN THE CIRCLES INDICATE FOOTER AND/OR COLUMN LOCATIONS. - Rocky Flats Plant, Uranium Rolling & Forming Operations, Southeast section of plant, southeast quadrant of intersection of Central Avenue & Eighth Street, Golden, Jefferson County, CO

  11. Design of automation tools for management of descent traffic

    NASA Technical Reports Server (NTRS)

    Erzberger, Heinz; Nedell, William

    1988-01-01

    The design of an automated air traffic control system based on a hierarchy of advisory tools for controllers is described. Compatibility of the tools with the human controller, a key objective of the design, is achieved by a judicious selection of tasks to be automated and careful attention to the design of the controller system interface. The design comprises three interconnected subsystems referred to as the Traffic Management Advisor, the Descent Advisor, and the Final Approach Spacing Tool. Each of these subsystems provides a collection of tools for specific controller positions and tasks. This paper focuses primarily on the Descent Advisor which provides automation tools for managing descent traffic. The algorithms, automation modes, and graphical interfaces incorporated in the design are described. Information generated by the Descent Advisor tools is integrated into a plan view traffic display consisting of a high-resolution color monitor. Estimated arrival times of aircraft are presented graphically on a time line, which is also used interactively in combination with a mouse input device to select and schedule arrival times. Other graphical markers indicate the location of the fuel-optimum top-of-descent point and the predicted separation distances of aircraft at a designated time-control point. Computer generated advisories provide speed and descent clearances which the controller can issue to aircraft to help them arrive at the feeder gate at the scheduled times or with specified separation distances. Two types of horizontal guidance modes, selectable by the controller, provide markers for managing the horizontal flightpaths of aircraft under various conditions. The entire system consisting of descent advisor algorithm, a library of aircraft performance models, national airspace system data bases, and interactive display software has been implemented on a workstation made by Sun Microsystems, Inc. It is planned to use this configuration in operational

  12. Mars Descent Imager (MARDI) on the Mars Polar Lander

    USGS Publications Warehouse

    Malin, M.C.; Caplinger, M.A.; Carr, M.H.; Squyres, S.; Thomas, P.; Veverka, J.

    2001-01-01

    The Mars Descent Imager, or MARDI, experiment on the Mars Polar Lander (MPL) consists of a camera characterized by small physical size and mass (???6 ?? 6 ?? 12 cm, including baffle; <500 gm), low power requirements (<2.5 W, including power supply losses), and high science performance (1000 x 1000 pixel, low noise). The intent of the investigation is to acquire nested images over a range of resolutions, from 8 m/pixel to better than 1 cm/pixel, during the roughly 2 min it takes the MPL to descend from 8 km to the surface under parachute and rocket-powered deceleration. Observational goals will include studies of (1) surface morphology (e.g., nature and distribution of landforms indicating past and present environmental processes); (2) local and regional geography (e.g., context for other lander instruments: precise location, detailed local relief); and (3) relationships to features seen in orbiter data. To accomplish these goals, MARDI will collect three types of images. Four small images (256 x 256 pixels) will be acquired on 0.5 s centers beginning 0.3 s before MPL's heatshield is jettisoned. Sixteen full-frame images (1024 X 1024, circularly edited) will be acquired on 5.3 s centers thereafter. Just after backshell jettison but prior to the start of powered descent, a "best final nonpowered descent image" will be acquired. Five seconds after the start of powered descent, the camera will begin acquiring images on 4 s centers. Storage for as many as ten 800 x 800 pixel images is available during terminal descent. A number of spacecraft factors are likely to impact the quality of MARDI images, including substantial motion blur resulting from large rates of attitude variation during parachute descent and substantial rocket-engine-induced vibration during powered descent. In addition, the mounting location of the camera places the exhaust plume of the hydrazine engines prominently in the field of view. Copyright 2001 by the American Geophysical Union.

  13. A life of pelvic pain.

    PubMed

    Berkley, Karen J

    2005-10-15

    Pelvic pain associated with menstruation, i.e., dysmenorrhea, is a chronic pelvic pain that not only interferes with a woman's wellbeing for a large part of her life but also often co-occurs with other chronic painful conditions such as interstitial cystitis and irritable bowel syndrome and others. Little has been known about mechanisms underlying these chronic pelvic pains. This paper reviews 37 years of research in my laboratory at Florida State University on such mechanisms. Our research, mostly on rats, has contributed to the following findings: (1) Female reproductive organs are innervated in a topographic fashion by afferents in the pelvic (vagina/cervix) and hypogastric (cervix/uterine horn) nerves. (2) The input contributes to uterine and vaginal perceptions (nociception) that are modified by reproductive status. (3) Throughout the CNS, neurons responsive to stimulation of the reproductive tract also respond to stimulation of skin and other internal organs, in a manner modifiable by reproductive status and peripheral pathophysiology. (4) This dynamic physiological convergence may reflect extensive anatomical divergence of and interconnections between pathways entering the CNS via gateways through the spinal cord, dorsal column nuclei, and solitary nucleus. (5) The convergence also indicates the existence of extensive cross-system, viscero-visceral interactions within the CNS, that, while organized for coherent bodily functioning, serves as a substrate by which pathophysiology in one organ can influence physiology and responses to pathophysiology in other organs. (6) Some cross-system effects observed so far include: (a) Bladder inflammation reduces the rate of uterine contractions and the effects of drugs on the uterus. (b) Colon inflammation produces signs of inflammation in the otherwise healthy bladder and uterus. (c) A surgical model of endometriosis produces vaginal hyperalgesia, exacerbates pain behaviors induced by a ureteral stone, and reduces

  14. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Pelvic bones. 4.67 Section 4.67 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.67 Pelvic bones. The variability of...

  15. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Pelvic bones. 4.67 Section 4.67 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.67 Pelvic bones. The variability of...

  16. The relationship between pelvic alignment and dysmenorrhea

    PubMed Central

    Kim, Moon-jeong; Baek, Il-hun; Goo, Bong-oh

    2016-01-01

    [Purpose] The purpose of this study was to investigate the relationship between pelvic alignment and dysmenorrhea in general women. [Subjects and Methods] One hundred two females participated in this study. They were divided into a dysmenorrhea group and a normal group based on the results of a Visual Analogue Scale (VAS) assessment of pain and the Menstrual Distress Questionnaire (MDQ). The survey data was collecting from 5th July to 20th September, 2014. Formetric 4D was used to measure the pelvic alignment, including the values of Trunk Imbalance, Pelvic Tilt, Surface Rotation, Lateral Deviation, Kyphosis Angle, Lordosis Angle. [Results] There was a difference in the spine alignments of each group. The value of pelvic torsion was 2.4 ± 1.8 degree in those with dysmenorrhea, while it was 1.7 ± 1.1 degree in those without. [Conclusion] In conclusion, the results suggest that there is a relationship between menstrual pain and pelvic torsion. PMID:27134354

  17. Long-term functional stability of sacrospinous ligament-fixation repair of pelvic organ prolapse.

    PubMed

    Souviat, C; Bricou, A; Porcher, R; Demaria, F; Fritel, X; Benifla, J-L; Pigné, A

    2012-11-01

    The objective of this study was to evaluate the variation over 5 years of functional discomfort associated with pelvic organ prolapse (POP) repaired by sacrospinous ligament fixation (SLF). A total of 178 women who had undergone SLF from 1992 to 2001. In 2002 and 2008, patients were sent a questionnaire including the pelvic floor distress inventory (PFDI-20); 79 responded and comparison of those data served to evaluate subjective signs at 5 years. This population was divided into two groups: ≤60 and >60 years old, and their 2002-2008 differences were compared. The outcomes were satisfaction, functional results and sexuality. Mean follow-up was 115 (72-173) months. Our results showed the long-term stability of SLF functional outcomes for women >60 years. However, for those≤60 years, functional outcomes and satisfaction had declined at 5 years. PMID:23075356

  18. Channel Floor Yardangs

    NASA Technical Reports Server (NTRS)

    2004-01-01

    [figure removed for brevity, see original site]

    Released 19 July 2004 The atmosphere of Mars is a dynamic system. Water-ice clouds, fog, and hazes can make imaging the surface from space difficult. Dust storms can grow from local disturbances to global sizes, through which imaging is impossible. Seasonal temperature changes are the usual drivers in cloud and dust storm development and growth.

    Eons of atmospheric dust storm activity has left its mark on the surface of Mars. Dust carried aloft by the wind has settled out on every available surface; sand dunes have been created and moved by centuries of wind; and the effect of continual sand-blasting has modified many regions of Mars, creating yardangs and other unusual surface forms.

    The yardangs in this image are forming in channel floor deposits. The channel itself is funneling the wind to cause the erosion.

    Image information: VIS instrument. Latitude 4.5, Longitude 229.7 East (133.3 West). 19 meter/pixel resolution.

    Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time.

    NASA's Jet Propulsion Laboratory manages the 2001 Mars Odyssey mission for NASA's Office of Space Science, Washington, D.C. The Thermal Emission Imaging System (THEMIS) was developed by Arizona State University, Tempe, in collaboration with Raytheon Santa Barbara Remote Sensing. The THEMIS investigation is led by Dr. Philip Christensen at Arizona State University. Lockheed Martin Astronautics, Denver, is the prime contractor for the Odyssey project, and developed and built the orbiter. Mission operations are

  19. Crew Procedures for Continuous Descent Arrivals Using Conventional Guidance

    NASA Technical Reports Server (NTRS)

    Oseguera-Lohr, Rosa M.; Williams, David H.; Lewis, Elliot T,

    2007-01-01

    This paper presents results from a simulation study which investigated the use of Continuous Descent Arrival (CDA) procedures for conducting a descent through a busy terminal area, using conventional transport-category automation. This research was part of the Low Noise Flight Procedures (LNFP) element within the Quiet Aircraft Technology (QAT) Project, that addressed development of flight guidance, and supporting pilot and Air Traffic Control (ATC) procedures for low noise operations. The procedures and chart were designed to be easy to understand, and to make it easy for the crew to make changes via the Flight Management Computer Control-Display Unit (FMC-CDU) to accommodate changes from ATC. The test runs were intended to represent situations typical of what exists in many of today's terminal areas, including interruptions to the descent in the form of clearances issued by ATC.

  20. MSL Entry, Descent and Landing Performance and Environments

    NASA Technical Reports Server (NTRS)

    Lockwood, Mary Kae; Dwyer-Cianciola, Alicia; Dyakonov, Artem; Edquist, Karl; Powell, Dick; Striepe, Scott; Way, David; Graves, Claude; Carman, Gil; Sostaric, Ron

    2005-01-01

    A viewgraph presentation on the MARS Science Laboratory (MSL) Entry, Descent and Landing (EDL) performance and environments is shown. The topics include: 1) High Altitude and Precision Landing; 2) Guided, Lifting, Ballistic Trade; 3) Supersonic Chute Deploy Altitude; 4) Guided, Lifting, Ballistic Landing Footprint Video; 5) Transition Indicator at Peak Heating Point on Trajectory; 6) Aeroheating at Peak Heating Point on Trajectory Nominal, No Uncertainty Included; 7) Comparison to Previous Missions; 8) Pork Chop Plots - EDL Performance for Mission Design; 9) Max Heat Rate Est (CBE+Uncert) W/cm2; 10) Nominal Super Chute Deploy Alt Above MOLA (km); 11) Monte Carlo; 12) MSL Option M2 Entry, Descent and Landing; 13) Entry Performance; 14) Entry Aeroheating and Entry g's; 15) Terminal Descent; and 16) How An Ideal Chute Deployment Altitude Varies with Time of Year and Latitude (JSC Chart).

  1. Tangential Floor in a Classroom Setting

    ERIC Educational Resources Information Center

    Marti, Leyla

    2012-01-01

    This article examines floor management in two classroom sessions: a task-oriented computer lesson and a literature lesson. Recordings made in the computer lesson show the organization of floor when a task is given to students. Temporary or "incipient" side floors (Jones and Thornborrow, 2004) emerge beside the main floor. In the literature lesson,…

  2. Mars Smart Lander Simulations for Entry, Descent, and Landing

    NASA Technical Reports Server (NTRS)

    Striepe, S. A.; Way, D. W.; Balaram, J.

    2002-01-01

    Two primary simulations have been developed and are being updated for the Mars Smart Lander Entry, Descent, and Landing (EDL). The high fidelity engineering end-to-end EDL simulation that is based on NASA Langley's Program to Optimize Simulated Trajectories (POST) and the end-to-end real-time, hardware-in-the-loop simulation testbed, which is based on NASA JPL's (Jet Propulsion Laboratory) Dynamics Simulator for Entry, Descent and Surface landing (DSENDS). This paper presents the status of these Mars Smart Lander EDL end-to-end simulations at this time. Various models, capabilities, as well as validation and verification for these simulations are discussed.

  3. Flight Data Entry, Descent, and Landing (EDL) Repository

    NASA Technical Reports Server (NTRS)

    Martinez, Elmain M.; Winterhalter, Daniel

    2012-01-01

    Dr. Daniel Winterhalter, NASA Engineering and Safety Center Chief Engineer at the Jet Propulsion Laboratory, requested the NASA Engineering and Safety Center sponsor a 3-year effort to collect entry, descent, and landing material and to establish a NASA-wide archive to serve the material. The principle focus of this task was to identify entry, descent, and landing repository material that was at risk of being permanently lost due to damage, decay, and undocumented storage. To provide NASA-wide access to this material, a web-based digital archive was created. This document contains the outcome of the effort.

  4. Space shuttle descent design: From development to operations

    NASA Technical Reports Server (NTRS)

    Crull, T. J.; Hite, R. E., III

    1985-01-01

    The descent guidance system, the descent trajectories design, and generating of the associated flight products are discussed. The programs which allow the successful transitions from development to STS operations, resulting in reduced manpower requirements and compressed schedules for flight design cycles are addressed. The topics include: (1) continually upgraded tools for the job, i.e., consolidating tools via electronic data transfers, tailoring general purpose software for needs, easy access to tools through an interactive approach, and appropriate flexibility to allow design changes and provide growth capability; (2) stabilizing the flight profile designs (I-loads) in an uncertain environment; and (3) standardizing external interfaces within performance and subsystems constraints of the Orbiter.

  5. Rosetta Mission's "7 Hours of Terror" and Philae's Descent

    NASA Astrophysics Data System (ADS)

    Blanco, Philip

    2015-09-01

    In November 2014 the Rosetta mission to Comet 67P/Churyumov-Gerasimenko made the headlines when its Philae lander completed a successful unpowered descent onto the surface of the comet nucleus after "7 hours of terror" for the mission scientists. 67P's irregular shape and rotation made this task even more challenging. Philae fell almost radially towards 67P, as shown in an animation produced by the European Space Agency (ESA) prior to the event. Below, we investigate whether it is possible to model the spacecraft's descent time and impact speed using concepts taught in an introductory physics course.

  6. Gradient descent learning algorithm overview: a general dynamical systems perspective.

    PubMed

    Baldi, P

    1995-01-01

    Gives a unified treatment of gradient descent learning algorithms for neural networks using a general framework of dynamical systems. This general approach organizes and simplifies all the known algorithms and results which have been originally derived for different problems (fixed point/trajectory learning), for different models (discrete/continuous), for different architectures (forward/recurrent), and using different techniques (backpropagation, variational calculus, adjoint methods, etc.). The general approach can also be applied to derive new algorithms. The author then briefly examines some of the complexity issues and limitations intrinsic to gradient descent learning. Throughout the paper, the author focuses on the problem of trajectory learning. PMID:18263297

  7. Entry, Descent and Landing Systems Analysis Study: Phase 1 Report

    NASA Technical Reports Server (NTRS)

    DwyerCianciolo, Alicia M.; Davis, Jody L.; Komar, David R.; Munk, Michelle M.; Samareh, Jamshid A.; Powell, Richard W.; Shidner, Jeremy D.; Stanley, Douglas O.; Wilhite, Alan W.; Kinney, David J.; McGuire, M. Kathleen; Arnold, James O.; Howard, Austin R.; Sostaric, Ronald R.; Studak, Joseph W.; Zumwalt, Carlie H.; Llama, Eduardo G.; Casoliva, Jordi; Ivanov, Mark C.; Clark, Ian; Sengupta, Anita

    2010-01-01

    NASA senior management commissioned the Entry, Descent and Landing Systems Analysis (EDL-SA) Study in 2008 to identify and roadmap the Entry, Descent and Landing (EDL) technology investments that the agency needed to make in order to successfully land large payloads at Mars for both robotic and human-scale missions. This paper summarizes the motivation, approach and top-level results from Year 1 of the study, which focused on landing 10-50 mt on Mars, but also included a trade study of the best advanced parachute design for increasing the landed payloads within the EDL architecture of the Mars Science Laboratory (MSL) mission

  8. Evaluation of acute pelvic pain in women.

    PubMed

    Kruszka, Paul S; Kruszka, Stephen J

    2010-07-15

    Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. A careful history focusing on pain characteristics, review of systems, and gynecologic, sexual, and social history, in addition to physical examination helps narrow the differential diagnosis. The most common urgent causes of pelvic pain are pelvic inflammatory disease, ruptured ovarian cyst, and appendicitis; however, many other diagnoses in the differential may mimic these conditions, and imaging is often needed. Transvaginal ultrasonography should be the initial imaging test because of its sensitivities across most etiologies and its lack of radiation exposure. A high index of suspicion should be maintained for pelvic inflammatory disease when other etiologies are ruled out, because the presentation is variable and the prevalence is high. Multiple studies have shown that 20 to 50 percent of women presenting with pelvic pain have pelvic inflammatory disease. Adolescents and pregnant and postpartum women require unique considerations. PMID:20642266

  9. Endometriosis and Chronic Pelvic Pain

    PubMed Central

    Bloski, Terri; Pierson, Roger

    2010-01-01

    Nurses often encounter patients with chronic pelvic pain associated with endometriosis, which is a puzzling and problematic gynecologic condition that has continued to plague women and baffle doctors and researchers worldwide since it was first identified by Dr. J. Sampson in the 1920s (Sampson, 1940). Endometriosis is defined as the growth, adhesion and progression of endometrial glands and stroma outside of the uterine cavity, with cellular activity evident in lesions, nodules, cysts or endometriomas (Audebert et al., 1992). Although it typically appears benign on histopathology, endometriosis has been likened to a malignant tumor since the lesions grow, infiltrate and adhere to adjacent tissues and interfere with physiologic processes (Kitawaki et al., 2002; Noble, Simpson, Johns, & Bulun, 1996). Ectopic endometriotic growths respond to cyclic changes of estrogen and proliferate and shed in a manner similar to eutopic endometrium. This cyclic ectopic activity results in internal bleeding, formation of scar tissue, inflammation and sometimes debilitating chronic pain (Kitawaki et al.). PMID:18837717

  10. The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

    PubMed Central

    Lei, Jianyin; Zhang, Yue; Wu, Guiying; Wang, Zhihua; Cai, Xianhua

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated. PMID:26495033

  11. A Portfolio of Outstanding Americans of Mexican Descent.

    ERIC Educational Resources Information Center

    Lelevier, Benjamin, Jr.

    A cross section of Mexican American achievement is presented in a portfolio of 37 portraits of outstanding Americans of Mexican descent. Drawn in black and white on heavy paper stock by Mr. David L. Rodriguez, the sketches are suitable for display purposes. With the likenesses are biographical sketches in both English and Spanish which were…

  12. LANDER program manual: A lunar ascent and descent simulation

    NASA Technical Reports Server (NTRS)

    1988-01-01

    LANDER is a computer program used to predict the trajectory and flight performance of a spacecraft ascending or descending between a low lunar orbit of 15 to 500 nautical miles (nm) and the lunar surface. It is a three degree-of-freedom simulation which is used to analyze the translational motion of the vehicle during descent. Attitude dynamics and rotational motion are not considered. The program can be used to simulate either an ascent from the Moon or a descent to the Moon. For an ascent, the spacecraft is initialized at the lunar surface and accelerates vertically away from the ground at full thrust. When the local velocity becomes 30 ft/s, the vehicle turns downrange with a pitch-over maneuver and proceeds to fly a gravity turn until Main Engine Cutoff (MECO). The spacecraft then coasts until it reaches the requested holding orbit where it performs an orbital insertion burn. During a descent simulation, the lander begins in the holding orbit and performs a deorbit burn. It then coasts to pericynthion, where it reignites its engines and begins a gravity turn descent. When the local horizontal velocity becomes zero, the lander pitches up to a vertical orientation and begins to hover in search of a landing site. The lander hovers for a period of time specified by the user, and then lands.

  13. "Rosetta" Mission's "7 Hours of Terror" and "Philae's" Descent

    ERIC Educational Resources Information Center

    Blanco, Philip

    2015-01-01

    In November 2014 the "Rosetta" mission to Comet 67P/Churyumov-Gerasimenko made the headlines when its "Philae" lander completed a successful unpowered descent onto the surface of the comet nucleus after "7 hours of terror" for the mission scientists. 67P's irregular shape and rotation made this task even more…

  14. Stress within a Bicultural Context for Adolescents of Mexican Descent.

    ERIC Educational Resources Information Center

    Romero, Andrea J.; Roberts, Robert E.

    2003-01-01

    Folkman and Lazarus's theory of stress and coping was used to develop a measure assessing the perceived stress within a bicultural context. Middle school students of Mexican descent (N=881) reported their perceived stress from intergenerational acculturation gaps, within-group discrimination, out-group discrimination, and monolingual stress.…

  15. A Comparison of Inexact Newton and Coordinate Descent Meshoptimization Technqiues

    SciTech Connect

    Diachin, L F; Knupp, P; Munson, T; Shontz, S

    2004-07-08

    We compare inexact Newton and coordinate descent methods for optimizing the quality of a mesh by repositioning the vertices, where quality is measured by the harmonic mean of the mean-ratio metric. The effects of problem size, element size heterogeneity, and various vertex displacement schemes on the performance of these algorithms are assessed for a series of tetrahedral meshes.

  16. Abuse against Women with Disabilities of Mexican Descent: Cultural Considerations

    ERIC Educational Resources Information Center

    Graf, Noreen M.; Reed, Bruce J.; Sanchez, Rubi

    2008-01-01

    Although considerable attention has been focused on violence against women with disabilities, environmental and cultural factors that contribute to this violence have received limited attention. This paper examines violence against women of Mexican descent with disabilities. Recommendations are offered to researchers, educators, and service…

  17. 14 CFR 23.69 - Enroute climb/descent.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Enroute climb/descent. 23.69 Section 23.69 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Flight Performance § 23.69...

  18. The Challenge of Mars EDL (Entry, Descent, and Landing)

    NASA Technical Reports Server (NTRS)

    Sostaric, Ronald

    2010-01-01

    This slide presentation reviews the some of the challenges of Martian atmospheric entry, descent and landing (EDL) on the surface of Mars. It reviews some of the technological difficulties, and some solutions that are being developed for future unmanned missions with larger payloads than previous landers, and ultimately human spacecraft landing.

  19. Simulation Results for Airborne Precision Spacing along Continuous Descent Arrivals

    NASA Technical Reports Server (NTRS)

    Barmore, Bryan E.; Abbott, Terence S.; Capron, William R.; Baxley, Brian T.

    2008-01-01

    This paper describes the results of a fast-time simulation experiment and a high-fidelity simulator validation with merging streams of aircraft flying Continuous Descent Arrivals through generic airspace to a runway at Dallas-Ft Worth. Aircraft made small speed adjustments based on an airborne-based spacing algorithm, so as to arrive at the threshold exactly at the assigned time interval behind their Traffic-To-Follow. The 40 aircraft were initialized at different altitudes and speeds on one of four different routes, and then merged at different points and altitudes while flying Continuous Descent Arrivals. This merging and spacing using flight deck equipment and procedures to augment or implement Air Traffic Management directives is called Flight Deck-based Merging and Spacing, an important subset of a larger Airborne Precision Spacing functionality. This research indicates that Flight Deck-based Merging and Spacing initiated while at cruise altitude and well prior to the Terminal Radar Approach Control entry can significantly contribute to the delivery of aircraft at a specified interval to the runway threshold with a high degree of accuracy and at a reduced pilot workload. Furthermore, previously documented work has shown that using a Continuous Descent Arrival instead of a traditional step-down descent can save fuel, reduce noise, and reduce emissions. Research into Flight Deck-based Merging and Spacing is a cooperative effort between government and industry partners.

  20. Women of African Descent: Persistence in Completing Doctorates

    ERIC Educational Resources Information Center

    Iddrisu, Vannetta Bailey

    2010-01-01

    This study examines the educational persistence of women of African descent (WOAD) in pursuit of a doctorate degree at universities in the southeastern United States. WOAD are women of African ancestry born outside the African continent. These women are heirs to an inner dogged determination and spirit to survive despite all odds (Pulliam, 2003,…

  1. The Huygens Descent Trajectory Working Group and the Reconstruction of the Huygens Probe Entry and Descent Trajectory at Titan

    NASA Astrophysics Data System (ADS)

    Atkinson, David H.; Kazeminejad, Bobby; Lebreton*, Jean-Pierre

    2015-04-01

    Cassini/Huygens, a flagship mission to explore the rings, atmosphere, magnetic field, and moons that make up the Saturn system, is a joint endeavor of NASA, the European Space Agency, and Agenzia Spaziale Italiana. Comprising two spacecraft - a Saturn orbiter built by NASA and a Titan entry/descent probe built by the European Space Agency - Cassini/Huygens was launched in October 1997 and arrived at Saturn in 2004. The Huygens probe parachuted to the surface of Titan in January 2005. During the descent, six science instruments provided measurements of Titan's atmosphere, clouds, and winds, and photographed Titan's surface. It was recognized early in the Huygens program that to correctly interpret and correlate results from the probe science experiments and to provide a reference set of data for ground truth calibration of the Cassini orbiter remote sensing observations, an accurate reconstruction of the probe entry and descent trajectory and surface landing location would be necessary. The Huygens Descent Trajectory Working Group (DTWG) was chartered in 1996 as a subgroup of the Huygens Science Working Team. With membership comprising representatives from all the probe engineering and instrument teams as well as representatives of industry and the Cassini and Huygens Project Scientists, the DTWG presented an organizational framework within which instrument data was shared, the entry and descent trajectory reconstruction implemented, and the trajectory reconstruction efficiently disseminated. The primary goal of the Descent Trajectory Working Group was to develop retrieval methodologies for the probe descent trajectory reconstruction from the entry interface altitude of 1270 km to the surface using navigation data, and engineering and science data acquired by the instruments on the Huygens Probe, and to provide a reconstruction of the Huygens probe trajectory from entry to the surface of Titan that is maximally consistent with all available engineering and science

  2. Measurement of CPAS Main Parachute Rate of Descent

    NASA Technical Reports Server (NTRS)

    Ray, Eric S.

    2011-01-01

    The Crew Exploration Vehicle Parachute Assembly System (CPAS) is being designed to land the Orion Crew Module (CM) at a safe rate of descent at splashdown. Flight test performance must be measured to a high degree of accuracy to ensure this requirement is met with the most efficient design possible. Although the design includes three CPAS Main parachutes, the requirement is that the system must not exceed 33 ft/s under two Main parachutes, should one of the Main parachutes fail. Therefore, several tests were conducted with clusters of two Mains. All of the steady-state rate of descent data are normalized to standard sea level conditions and checked against the limit. As the Orion design gains weight, the system is approaching this limit to within measurement precision. Parachute "breathing," cluster interactions, and atmospheric anomalies can cause the rate of descent to vary widely and lead to challenges in characterizing parachute terminal performance. An early test had contradictory rate of descent results from optical trajectory and Differential Global Positioning Systems (DGPS). A thorough analysis of the data sources and error propagation was conducted to determine the uncertainty in the trajectory. It was discovered that the Time Space Position Information (TSPI) from the optical tracking provided accurate position data. However, the velocity from TPSI must be computed via numerical differentiation, which is prone to large error. DGPS obtains position through pseudo-range calculations from multiple satellites and velocity through Doppler shift of the carrier frequency. Because the velocity from DGPS is a direct measurement, it is more accurate than TSPI velocity. To remedy the situation, a commercial off-the-shelf product that combines GPS and an Inertial Measurement Unit (IMU) was purchased to significantly improve rate of descent measurements. This had the added benefit of solving GPS dropouts during aircraft extraction. Statistical probability

  3. Can I prevent Pelvic Organ Prolapse

    MedlinePlus

    ... Pelvic Organ Prolapse POP Symptoms & Types Can I Prevent POP? POP Diagnosis POP Treatments 3 Resources + More Bladder Control UI Symptoms & Types Can I Prevent UI? UI Diagnosis UI Treatments 3 Resources + More ...

  4. Major pelvic injuries in equestrian sports

    PubMed Central

    O'Farrell, D A; Irshad, F; Thorns, B S; McElwain, J P

    1997-01-01

    A series of pelvic and acetabular injuries caused by horse riding accidents is reported. The importance of wearing appropriate protective clothing when riding is emphasised. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:9298563

  5. RITD - Adapting Mars Entry, Descent and Landing System for Earth

    NASA Astrophysics Data System (ADS)

    Heilimo, Jyri; Harri, Ari-Matti; Aleksashkin, Sergei; Koryanov, Valeri; Arruego, Ignacio; Schmidt, Walter; Haukka, Harri; Finchenko, Valeri; Martynov, Maxim; Ponomarenko, Andrey; Kazakovtsev, Victor; Martin, Susana

    2015-04-01

    We have developed an atmospheric re-entry and descent system concept based on inflatable hypersonic decelerator techniques that were originally developed for Mars. The ultimate goal of this EU-funded RITD-project (Re-entry: Inflatable Technology Development) was to assess the benefits of this technology when deploying small payloads from low Earth orbits to the surface of the Earth with modest costs. The principal goal was to assess and develop a preliminary EDLS design for the entire relevant range of aerodynamic regimes expected to be encountered in Earth's atmosphere during entry, descent and landing. Low Earth Orbit (LEO) and even Lunar applications envisaged include the use of the EDLS approach in returning payloads of 4-8 kg down to the surface. Our development and assessments show clearly that this kind of inflatable technology originally developed for the Martian atmosphere, is feasible for use by Earth entry and descent applications. The preliminary results are highly promising indicating that the current Mars probe design could be used as it is for the Earth. According tp our analyses, the higher atmospheric pressure at an altitude of 12 km and less requires an additional pressurizing device for the in atable system increasing the entry mass by approximately 2 kg. These analyses involved the calculation of 120 different atmospheric entry and descent trajectories. The analysis of the existing technologies and current trends have indicated that the kind of inflatable technology pursued by RITD has high potential to enhance the European space technology expertise. This kind of technology is clearly feasible for utilization by Earth entry and descent applications.

  6. [Laparoscopic therapy of functional disorders of the rectum and pelvic floor].

    PubMed

    Herold, A; Bruch, H P

    1997-01-01

    Within 4.5 years, 72 laparoscopic rectopexies were performed. The indications included rectal prolapse, morphologic outlet-constipation and a combination of both. Using a modified suture rectopexy (according to Sudeck), without taking any foreign material we resected the sigmoid in 39 patients. In four cases, a resection of the sigmoid colon was carried out. Conversion rate was 2% and complications that needed reoperation occurred in 9%. No patient died; laparotomy rate was only 4%. In the mean follow up period of 24.1 months (max. 50 months), no recurrent prolapse occurred. Incontinence was abolished or improved in 64% and outlet-constipation was improved in 85%. Laparoscopic rectopexy with or without sigmoid resection seems to be of benefit for the patient: quicker convalescence; less pain; small scars; no recurrence; and improvement of constipation and incontinence. PMID:9574296

  7. Use of Silodosin to Visualize the Posterior Urethra in Pelvic Floor Urethral Distraction Defect Patients

    PubMed Central

    Ranjan, Nikhil; Singh, Rana Pratap; Ahmed, Ahsan; Kumar, Vijoy; Singh, Mahendra

    2015-01-01

    Background: Retrograde urethrogram and voiding cystourethrogram are used to define length and location of urethral stricture prior to surgery. We used a single dose of silodosin prior to VCUG to relax the bladder neck and achieve visualization of posterior urethra. Objectives: To evaluate the efficacy of silodosin in visualization of posterior urethra during VCUG, and to compare the findings with a control group. Patients and Methods: Patients were divided into two groups A and B containing 20 and 15 patients, respectively. Patients in group A were given a single dose of silodosin prior to radiological studies. Results: In group A 19 out of 20 patients were able to achieve satisfactory bladder neck opening while in group B 10 out of 15 patients were able to achieve bladder neck opening. Conclusions: Silodosin use prior to VCUG confers a statistically significant increase in bladder neck opening and visualization of posterior urethra. PMID:26543831

  8. Ploughing the deep sea floor.

    PubMed

    Puig, Pere; Canals, Miquel; Company, Joan B; Martín, Jacobo; Amblas, David; Lastras, Galderic; Palanques, Albert

    2012-09-13

    Bottom trawling is a non-selective commercial fishing technique whereby heavy nets and gear are pulled along the sea floor. The direct impact of this technique on fish populations and benthic communities has received much attention, but trawling can also modify the physical properties of seafloor sediments, water–sediment chemical exchanges and sediment fluxes. Most of the studies addressing the physical disturbances of trawl gear on the seabed have been undertaken in coastal and shelf environments, however, where the capacity of trawling to modify the seafloor morphology coexists with high-energy natural processes driving sediment erosion, transport and deposition. Here we show that on upper continental slopes, the reworking of the deep sea floor by trawling gradually modifies the shape of the submarine landscape over large spatial scales. We found that trawling-induced sediment displacement and removal from fishing grounds causes the morphology of the deep sea floor to become smoother over time, reducing its original complexity as shown by high-resolution seafloor relief maps. Our results suggest that in recent decades, following the industrialization of fishing fleets, bottom trawling has become an important driver of deep seascape evolution. Given the global dimension of this type of fishery, we anticipate that the morphology of the upper continental slope in many parts of the world’s oceans could be altered by intensive bottom trawling, producing comparable effects on the deep sea floor to those generated by agricultural ploughing on land. PMID:22951970

  9. Flooring for Schools: Unsightly Walkways

    ERIC Educational Resources Information Center

    Baxter, Mark

    2011-01-01

    Many mattress manufacturers recommend that consumers rotate their mattresses at least twice a year to help prevent soft spots from developing and increase the product's life span. It's unfortunate that the same kind of treatment can't be applied to flooring for schools, such as carpeting, especially in hallways. Being able to flip or turn a carpet…

  10. Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

    SciTech Connect

    Ganeshan, Arul; Upponi, Sara; Hon, Lye-Quen; Uthappa, M. C.; Warakaulle, Dinuke R.; Uberoi, Raman

    2007-11-15

    Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.

  11. Demonstration of Pelvic Anatomy by Modified Midline Transection that Maintains Intact Internal Pelvic Organs

    ERIC Educational Resources Information Center

    Steinke, Hanno; Saito, Toshiyuki; Herrmann, Gudrun; Miyaki, Takayoshi; Hammer, Niels; Sandrock, Mara; Itoh, Masahiro; Spanel-Borowski, Katharina

    2010-01-01

    Gross dissection for demonstrating anatomy of the human pelvis has traditionally involved one of two approaches, each with advantages and disadvantages. Classic hemisection in the median plane through the pelvic ring transects the visceral organs but maintains two symmetric pelvic halves. An alternative paramedial transection compromises one side…

  12. Effect of compliant flooring on impact force during falls on the hip.

    PubMed

    Laing, Andrew C; Tootoonchi, Iman; Hulme, Paul A; Robinovitch, Stephen N

    2006-07-01

    Compliant flooring represents a promising but understudied strategy for reducing impact force and hip fracture risk due to falls in high-risk environments such as nursing homes, hospitals, gymnasiums, and senior centers. We conducted "pelvis release experiments" with young women (n=15) to determine whether floor stiffness influences peak hip impact force during safe, low-height falls. During the trials, we used a pelvic sling and electromagnet to lift and instantly release the participant from a height of 5 cm above a force plate, which measured the force applied to the hip region during impact. Trials were conducted for rigid floor conditions and with layers of ethylene vinyl acetate foam rubber overlying the floor that we regarded as firm (1.5-cm thick; stiffness=263 kN/m), semifirm (4.5-cm thick; stiffness=95 kN/m), semisoft (7.5-cm thick; stiffness=67 kN/m), and soft (10.5-cm thick; stiffness=59 kN/m). When compared to the rigid condition, peak hip impact force averaged 8% lower in the firm condition and 15% lower in the semifirm condition. Peak forces were not significantly different between the semifirm, semisoft, and soft floor conditions, indicating that a 4.5 cm-thick foam mat provides nearly the same force attenuation as a 10.5 cm-thick mat. These results support the need for laboratory experiments to measure the effect of floor stiffness on postural stability and for clinical trials to determine the effect of compliant flooring on hip fracture incidence in high-risk environments. PMID:16705716

  13. Sea-Floor Spreading and Transform Faults

    ERIC Educational Resources Information Center

    Armstrong, Ronald E.; And Others

    1978-01-01

    Presents the Crustal Evolution Education Project (CEEP) instructional module on Sea-Floor Spreading and Transform Faults. The module includes activities and materials required, procedures, summary questions, and extension ideas for teaching Sea-Floor Spreading. (SL)

  14. Analysis of various descent trajectories for a hypersonic-cruise, cold-wall research airplane

    NASA Technical Reports Server (NTRS)

    Lawing, P. L.

    1975-01-01

    The probable descent operating conditions for a hypersonic air-breathing research airplane were examined. Descents selected were cruise angle of attack, high dynamic pressure, high lift coefficient, turns, and descents with drag brakes. The descents were parametrically exercised and compared from the standpoint of cold-wall (367 K) aircraft heat load. The descent parameters compared were total heat load, peak heating rate, time to landing, time to end of heat pulse, and range. Trends in total heat load as a function of cruise Mach number, cruise dynamic pressure, angle-of-attack limitation, pull-up g-load, heading angle, and drag-brake size are presented.

  15. Pelvic peritoneum in male armadillo and anteater (Xenarthra, Mammalia): a comparative survey.

    PubMed

    Rezende, Lorenna Cardoso; Ferreira, Jussara Rocha

    2013-01-01

    The literature supports the hypothesis that the pelvic excavation is the bottom of the abdominal cavity, which is covered by the peritoneal serous membrane in order to promote visceral dynamics. We studied the peritoneum in eight specimens of Xenarthra (Euphractus sexcinctus, Myrmecophaga tridactyla and Tamandua tetradactyla). The animals were fixed in formaldehyde (10%). For description and analyzes of the pelvic peritoneum, dissection and photo documentation were performed. We saw that the parietal serous membrane reflected, involving the pelvic viscera. The urorectal septum is the floor of the higher pelvis as a serosa reflection between the bladder and the rectum. The bladder and gonads are completely peritonized in adult armadillo. In anteaters and young armadillos, the testicles are in a position analogous to the uterus, joined by the conjunctive septum at the midline and along with the bladder, they partially project to the higher and lower pelvis. In Myrmecophagidae, vesicogenital, rectogenital and sacrorectal recesses were observed. In Dasypodidae, the recesses are similar to those of other recent vertebrates. PMID:23317367

  16. Pelvic Organ Support in Animals with Partial Loss of Fibulin-5 in the Vaginal Wall

    PubMed Central

    Shi, Haolin; Balgobin, Sunil; Montoya, T. Ignacio; Yanagisawa, Hiromi; Word, R. Ann

    2016-01-01

    Compromise of elastic fiber integrity in connective tissues of the pelvic floor is most likely acquired through aging, childbirth-associated injury, and genetic susceptibility. Mouse models of pelvic organ prolapse demonstrate systemic deficiencies in proteins that affect elastogenesis. Prolapse, however, does not occur until several months after birth and is thereby acquired with age or after parturition. To determine the impact of compromised levels of fibulin-5 (Fbln5) during adulthood on pelvic organ support after parturition and elastase-induced injury, tissue-specific conditional knockout (cKO) mice were generated in which doxycycline (dox) treatment results in deletion of Fbln5 in cells that utilize the smooth muscle α actin promoter-driven reverse tetracycline transactivator and tetracycline responsive element-Cre recombinase (i.e., Fbln5f/f/SMA++-rtTA/Cre+, cKO). Fbln5 was decreased significantly in the vagina of cKO mice compared with dox-treated wild type or controls (Fbln5f/f/SMA++-rtTA/Cre-/-). In controls, perineal body length (PBL) and bulge increased significantly after delivery but declined to baseline values within 6–8 weeks. Although overt prolapse did not occur in cKO animals, these transient increases in PBL postpartum were amplified and, unlike controls, parturition-induced increases in PBL (and bulge) did not recover to baseline but remained significantly increased for 12 wks. This lack of recovery from parturition was associated with increased MMP-9 and nondetectable levels of Fbln5 in the postpartum vagina. This predisposition to prolapse was accentuated by injection of elastase into the vaginal wall in which overt prolapse occurred in cKO animals, but rarely in controls. Taken together, our model system in which Fbln5 is conditionally knock-downed in stromal cells of the pelvic floor results in animals that undergo normal elastogenesis during development but lose Fbln5 as adults. The results indicate that vaginal fibulin-5 during

  17. Pelvic Organ Support in Animals with Partial Loss of Fibulin-5 in the Vaginal Wall.

    PubMed

    Chin, Kathleen; Wieslander, Cecilia; Shi, Haolin; Balgobin, Sunil; Montoya, T Ignacio; Yanagisawa, Hiromi; Word, R Ann

    2016-01-01

    Compromise of elastic fiber integrity in connective tissues of the pelvic floor is most likely acquired through aging, childbirth-associated injury, and genetic susceptibility. Mouse models of pelvic organ prolapse demonstrate systemic deficiencies in proteins that affect elastogenesis. Prolapse, however, does not occur until several months after birth and is thereby acquired with age or after parturition. To determine the impact of compromised levels of fibulin-5 (Fbln5) during adulthood on pelvic organ support after parturition and elastase-induced injury, tissue-specific conditional knockout (cKO) mice were generated in which doxycycline (dox) treatment results in deletion of Fbln5 in cells that utilize the smooth muscle α actin promoter-driven reverse tetracycline transactivator and tetracycline responsive element-Cre recombinase (i.e., Fbln5f/f/SMA++-rtTA/Cre+, cKO). Fbln5 was decreased significantly in the vagina of cKO mice compared with dox-treated wild type or controls (Fbln5f/f/SMA++-rtTA/Cre-/-). In controls, perineal body length (PBL) and bulge increased significantly after delivery but declined to baseline values within 6-8 weeks. Although overt prolapse did not occur in cKO animals, these transient increases in PBL postpartum were amplified and, unlike controls, parturition-induced increases in PBL (and bulge) did not recover to baseline but remained significantly increased for 12 wks. This lack of recovery from parturition was associated with increased MMP-9 and nondetectable levels of Fbln5 in the postpartum vagina. This predisposition to prolapse was accentuated by injection of elastase into the vaginal wall in which overt prolapse occurred in cKO animals, but rarely in controls. Taken together, our model system in which Fbln5 is conditionally knock-downed in stromal cells of the pelvic floor results in animals that undergo normal elastogenesis during development but lose Fbln5 as adults. The results indicate that vaginal fibulin-5 during

  18. A Symmetric Time-Varying Cluster Rate of Descent Model

    NASA Technical Reports Server (NTRS)

    Ray, Eric S.

    2015-01-01

    A model of the time-varying rate of descent of the Orion vehicle was developed based on the observed correlation between canopy projected area and drag coefficient. This initial version of the model assumes cluster symmetry and only varies the vertical component of velocity. The cluster fly-out angle is modeled as a series of sine waves based on flight test data. The projected area of each canopy is synchronized with the primary fly-out angle mode. The sudden loss of projected area during canopy collisions is modeled at minimum fly-out angles, leading to brief increases in rate of descent. The cluster geometry is converted to drag coefficient using empirically derived constants. A more complete model is under development, which computes the aerodynamic response of each canopy to its local incidence angle.

  19. Helicopter optimal descent and landing after power loss

    NASA Technical Reports Server (NTRS)

    Johnson, W.

    1977-01-01

    An optimal control solution is obtained for the descent and landing of a helicopter after the loss of power in level flight. The model considers the helicopter vertical velocity, horizontal velocity, and rotor speed; and it includes representations of ground effect, rotor inflow time lag, pilot reaction time, rotor stall, and the induced velocity curve in the vortex ring state. The control (rotor thrust magnitude and direction) required to minimize the vertical and horizontal velocity at contact with the ground is obtained using nonlinear optimal control theory. It is found that the optimal descent after power loss in hover is a purely vertical flight path. Good correlation, even quantitatively, is found between the calculations and (non-optimal) flight test results.

  20. Efficient Sensor Placement Optimization Using Gradient Descent and Probabilistic Coverage

    PubMed Central

    Akbarzadeh, Vahab; Lévesque, Julien-Charles; Gagné, Christian; Parizeau, Marc

    2014-01-01

    We are proposing an adaptation of the gradient descent method to optimize the position and orientation of sensors for the sensor placement problem. The novelty of the proposed method lies in the combination of gradient descent optimization with a realistic model, which considers both the topography of the environment and a set of sensors with directional probabilistic sensing. The performance of this approach is compared with two other black box optimization methods over area coverage and processing time. Results show that our proposed method produces competitive results on smaller maps and superior results on larger maps, while requiring much less computation than the other optimization methods to which it has been compared. PMID:25196164

  1. RITD - Adapting Mars Entry, Descent and Landing System for Earth

    NASA Astrophysics Data System (ADS)

    Haukka, H.; Heilimo, J.; Harri, A.-M.; Aleksashkin, S.; Koryanov, V.; Arruego, I.; Schmidt, W.; Finchenko, V.; Martynov, M.; Ponomarenko, A.; Kazakovtsev, V.; Martin, S.

    2015-10-01

    We have developed an atmospheric re-entry and descent system concept based on inflatable hypersonic decelerator techniques that were originally developed for Mars. The ultimate goal of this EU-funded RITD-project (Re-entry: Inflatable Technology Development) was to assess the benefits of this technology when deploying small payloads from low Earth orbits to the surface of the Earth with modest costs. The principal goal was to assess and develop a preliminary EDLS design for the entire relevant range of aerodynamic regimes expected to be encountered in Earth's atmosphere during entry, descent and landing. Low Earth Orbit (LEO) and even Lunar applications envisaged include the use of the EDLS approach in returning payloads of 4-8 kg down to the surface.

  2. Optimum climb and descent trajectories for airline missions

    NASA Technical Reports Server (NTRS)

    Erzberger, H.

    1981-01-01

    The characteristics of optimum fixed-range trajectories whose structure is constrained to climb, steady cruise, and descent segments are derived by application of optimal control theory. The performance function consists of the sum of fuel and time costs, referred to as direct operating cost (DOC). The state variable is range to go and the independent variable is energy. In this formulation a cruise segment always occurs at the optimum cruise energy for sufficiently large range. At short ranges (400 n. mi. and less), a cruise segment may also occur below the optimum cruise energy. The existence of such a cruise segment depends primarily on the fuel flow vs thrust characteristics and on thrust constraints. If thrust is a free control variable along with airspeed, it is shown that such cruise segments will not generally occur. If thrust is constrained to some maximum value in climb and to some minimum in descent, such cruise segments generally will occur.

  3. Apollo LM guidance computer software for the final lunar descent.

    NASA Technical Reports Server (NTRS)

    Eyles, D.

    1973-01-01

    In all manned lunar landings to date, the lunar module Commander has taken partial manual control of the spacecraft during the final stage of the descent, below roughly 500 ft altitude. This report describes programs developed at the Charles Stark Draper Laboratory, MIT, for use in the LM's guidance computer during the final descent. At this time computational demands on the on-board computer are at a maximum, and particularly close interaction with the crew is necessary. The emphasis is on the design of the computer software rather than on justification of the particular guidance algorithms employed. After the computer and the mission have been introduced, the current configuration of the final landing programs and an advanced version developed experimentally by the author are described.

  4. Design issues for floor control protocols

    NASA Astrophysics Data System (ADS)

    Dommel, Hans-Peter; Garcia-Luna-Aceves, Jose J.

    1995-03-01

    Floor control allows users of networked multimedia applications to remotely share resources like cursors, data views, video and audio channels, or entire applications without access conflicts. Floors are mutually exclusive permissions, granted dynamically to collaborating users, mitigating race conditions and guaranteeing fair and deadlock- free resource access. Although floor control is an early concept within computer-supported cooperative work, no framework exists and current floor control mechanisms are often limited to simple objects. While small-scale collaboration can be facilitated by social conventions, the importance of floors becomes evident for large-scale application sharing and teleconferencing orchestration. In this paper, the concept of a scalable session protocol is enhanced with floor control. Characteristics of collaborative environments are discussed, and session and floor control are discerned. The system's and user's requirements perspectives are discussed, including distributed storage policies, packet structure and user-interface design for floor presentation, manipulation, and triggering conditions for floor migration. Interaction stages between users, and scenarios of participant withdrawal, late joins, and establishment of subgroups are elicited with respect to floor generation, bookkeeping, and passing. An API is proposed to standardize and integrate floor control among shared applications. Finally, a concise classification for existing systems with a notion of floor control is introduced.

  5. 49 CFR 38.59 - Floor surfaces.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Floor surfaces. 38.59 Section 38.59 Transportation Office of the Secretary of Transportation AMERICANS WITH DISABILITIES ACT (ADA) ACCESSIBILITY SPECIFICATIONS FOR TRANSPORTATION VEHICLES Rapid Rail Vehicles and Systems § 38.59 Floor surfaces. Floor...

  6. 14 CFR 25.793 - Floor surfaces.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Floor surfaces. 25.793 Section 25.793 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS... Floor surfaces. The floor surface of all areas which are likely to become wet in service must have...

  7. 14 CFR 25.793 - Floor surfaces.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Floor surfaces. 25.793 Section 25.793 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS... Floor surfaces. The floor surface of all areas which are likely to become wet in service must have...

  8. 36 CFR 1192.59 - Floor surfaces.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Floor surfaces. 1192.59 Section 1192.59 Parks, Forests, and Public Property ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE... Rail Vehicles and Systems § 1192.59 Floor surfaces. Floor surfaces on aisles, places for standees,...

  9. 49 CFR 38.59 - Floor surfaces.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 1 2011-10-01 2011-10-01 false Floor surfaces. 38.59 Section 38.59 Transportation Office of the Secretary of Transportation AMERICANS WITH DISABILITIES ACT (ADA) ACCESSIBILITY SPECIFICATIONS FOR TRANSPORTATION VEHICLES Rapid Rail Vehicles and Systems § 38.59 Floor surfaces. Floor...

  10. 36 CFR 1192.59 - Floor surfaces.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Floor surfaces. 1192.59 Section 1192.59 Parks, Forests, and Public Property ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE... Rail Vehicles and Systems § 1192.59 Floor surfaces. Floor surfaces on aisles, places for standees,...

  11. Urinary incontinence, fecal incontinence and pelvic organ prolapse in a population-based, racially diverse cohort. Prevalence and risk factors

    PubMed Central

    RORTVEIT, Guri; SUBAK, Leslee L.; THOM, David H.; CREASMAN, Jennifer M.; VITTINGHOFF, Eric; VAN DEN EEDEN, Stephen K.; BROWN, Jeanette S.

    2016-01-01

    Objectives We investigated the prevalence of and risk factors for combinations of urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) in racially diverse women over age 40. Methods The Reproductive Risks for Incontinence Study at Kaiser (RRISK) is a population-based study with data from 2106 women > 40 years. Pelvic floor conditions were determined by self-report. Risk factors were assessed by self-report, interview and record review. Independent risk factors were identified by multinomial logistic regression analysis. Results At least one pelvic floor condition was reported by 714 (34%) women. Of these, 494 (69%) had UI only, 60 (8%) POP only, and 46 (6%) had FI only. Both UI and FI were reported by 64 (9%), both UI and POP by 51 (7%). Among women with FI, 60% reported more than one condition. Corresponding figures for POP and UI were 49% and 18%. Estrogen use and constipation were shared risk factors for UI, FI and POP. BMI was a unique risk factor for UI only, diabetes for FI only and parity for POP only. No clear pattern could be found to support the hypothesis that risk factors for single conditions are more strongly associated with combined conditions. Conclusions Patients with FI or POP often have concomitant UI. These diseases both share and have unique risk factors in a complex pattern. PMID:22453506

  12. Flight Management System Execution of Idle-Thrust Descents in Operations

    NASA Technical Reports Server (NTRS)

    Stell, Laurel L.

    2011-01-01

    To enable arriving aircraft to fly optimized descents computed by the flight management system (FMS) in congested airspace, ground automation must accurately predict descent trajectories. To support development of the trajectory predictor and its error models, commercial flights executed idle-thrust descents, and the recorded data includes the target speed profile and FMS intent trajectories. The FMS computes the intended descent path assuming idle thrust after top of descent (TOD), and any intervention by the controllers that alters the FMS execution of the descent is recorded so that such flights are discarded from the analysis. The horizontal flight path, cruise and meter fix altitudes, and actual TOD location are extracted from the radar data. Using more than 60 descents in Boeing 777 aircraft, the actual speeds are compared to the intended descent speed profile. In addition, three aspects of the accuracy of the FMS intent trajectory are analyzed: the meter fix crossing time, the TOD location, and the altitude at the meter fix. The actual TOD location is within 5 nmi of the intent location for over 95% of the descents. Roughly 90% of the time, the airspeed is within 0.01 of the target Mach number and within 10 KCAS of the target descent CAS, but the meter fix crossing time is only within 50 sec of the time computed by the FMS. Overall, the aircraft seem to be executing the descents as intended by the designers of the onboard automation.

  13. A new steepest descent method with global convergence properties

    NASA Astrophysics Data System (ADS)

    Abidin, Zubai'ah Zainal; Mamat, Mustafa; Rivaie, Mohd.

    2016-06-01

    One of the earliest and the best method to minimize a function is the classical steepest descent (SD) method. In this paper, a new modification of SD method is suggested using a new search direction, d k. The numerical results are presented based on number of iterations and CPU time. It shows that the new d k are efficient when compared to the classical SD.

  14. Floor furnace burns to children.

    PubMed

    Berger, L R; Kalishman, S

    1983-01-01

    Three children with grid-like second-degree burns of their extremities from contact with floor furnace registers prompted an examination of this thermal hazard. Average temperature of the gratings was 294 degrees F (146 degrees C), with a range of 180 degrees to 375 degrees F (82.2 degrees to 191 degrees C). All of the furnaces tested were positioned at the entrance to bedrooms and had so little clearance that it was impossible to walk around them without contact with their surface. Infants and toddlers are at particular risk: 1 or 2 seconds of exposure would be expected to produce a serious burn. Suggestions for preventing burns from floor furnaces include turning them off when young children are at home; installing barrier gates to prevent children from coming in contact with the registers; and developing a surface coating or replacement grate with less hazardous thermal properties. PMID:6848984

  15. Random versus Deterministic Descent in RNA Energy Landscape Analysis

    PubMed Central

    Day, Luke; Abdelhadi Ep Souki, Ouala; Albrecht, Andreas A.; Steinhöfel, Kathleen

    2016-01-01

    Identifying sets of metastable conformations is a major research topic in RNA energy landscape analysis, and recently several methods have been proposed for finding local minima in landscapes spawned by RNA secondary structures. An important and time-critical component of such methods is steepest, or gradient, descent in attraction basins of local minima. We analyse the speed-up achievable by randomised descent in attraction basins in the context of large sample sets where the size has an order of magnitude in the region of ~106. While the gain for each individual sample might be marginal, the overall run-time improvement can be significant. Moreover, for the two nongradient methods we analysed for partial energy landscapes induced by ten different RNA sequences, we obtained that the number of observed local minima is on average larger by 7.3% and 3.5%, respectively. The run-time improvement is approximately 16.6% and 6.8% on average over the ten partial energy landscapes. For the large sample size we selected for descent procedures, the coverage of local minima is very high up to energy values of the region where the samples were randomly selected from the partial energy landscapes; that is, the difference to the total set of local minima is mainly due to the upper area of the energy landscapes. PMID:27110241

  16. Biomechanical Analysis of Stair Descent in Patients with Knee Osteoarthritis

    PubMed Central

    Igawa, Tatsuya; Katsuhira, Junji

    2014-01-01

    [Purpose] The purposes of this study were to investigate the lower extremity joint kinematics and kinetics of patients with the knee osteoarthritis (knee OA) during stair descent and clarify the biomechanical factors related to their difficulty in stair descent. [Subjects and Methods] Eight healthy elderly persons and four knee OA patients participated in this study. A 3-D motion analysis system and force plates were employed to measure lower extremity joint angles, ranges of motion, joint moments, joint powers, and ratios of contribution for the joint powers while descending stairs. [Results] Knee joint flexion angle, extension moment, and negative power during the early stance phase in the knee OA group were smaller than those in the healthy subjects group. However, no significant changes in these parameters in the ankle joint were observed between the two subject groups. [Conclusion] Knee OA patients could not use the knee joint to absorb impact during the early stance phase of stair descent. Hence, they might compensate for the roles played by the intact knee joint by mainly using ipsilateral ankle kinematics and kinetics. PMID:24926119

  17. Entry, Descent, and Landing Performance of the Mars Phoenix Lander

    NASA Technical Reports Server (NTRS)

    Desai, Prasun N.; Prince, Jill L.; Wueen, Eric M.; Cruz, Juan R.; Grover, Myron R.

    2008-01-01

    On May 25, 2008, the Mars Phoenix Lander successfully landed on the northern arctic plains of Mars. An overview of a preliminary reconstruction analysis performed on each entry, descent, and landing phase to assess the performance of Phoenix as it descended is presented and a comparison to pre-entry predictions is provided. The landing occurred 21 km further downrange than the predicted landing location. Analysis of the flight data revealed that the primary cause of Phoenix s downrange landing was a higher trim total angle of attack during the hypersonic phase of the entry, which resulted in Phoenix flying a slightly lifting trajectory. The cause of this higher trim attitude is not known at this time. Parachute deployment was 6.4 s later than prediction. This later deployment time was within the variations expected and is consistent with a lifting trajectory. The parachute deployment and inflation process occurred as expected with no anomalies identified. The subsequent parachute descent and powered terminal landing also behaved as expected. A preliminary reconstruction of the landing day atmospheric density profile was found to be lower than the best apriori prediction, ranging from a few percent less to a maximum of 8%. A comparison of the flight reconstructed trajectory parameters shows that the actual Phoenix entry, descent, and landing was close to pre-entry predictions. This reconstruction investigation is currently ongoing and the results to date are in the process of being refined.

  18. Airborne Management of Traffic Conflicts in Descent With Arrival Constraints

    NASA Technical Reports Server (NTRS)

    Doble, Nathan A.; Barhydt, Richard; Krishnamurthy, Karthik

    2005-01-01

    NASA is studying far-term air traffic management concepts that may increase operational efficiency through a redistribution of decisionmaking authority among airborne and ground-based elements of the air transportation system. One component of this research, En Route Free Maneuvering, allows trained pilots of equipped autonomous aircraft to assume responsibility for traffic separation. Ground-based air traffic controllers would continue to separate traffic unequipped for autonomous operations and would issue flow management constraints to all aircraft. To evaluate En Route Free Maneuvering operations, a human-in-the-loop experiment was jointly conducted by the NASA Ames and Langley Research Centers. In this experiment, test subject pilots used desktop flight simulators to resolve conflicts in cruise and descent, and to adhere to air traffic flow constraints issued by test subject controllers. Simulators at NASA Langley were equipped with a prototype Autonomous Operations Planner (AOP) flight deck toolset to assist pilots with conflict management and constraint compliance tasks. Results from the experiment are presented, focusing specifically on operations during the initial descent into the terminal area. Airborne conflict resolution performance in descent, conformance to traffic flow management constraints, and the effects of conflicting traffic on constraint conformance are all presented. Subjective data from subject pilots are also presented, showing perceived levels of workload, safety, and acceptability of autonomous arrival operations. Finally, potential AOP functionality enhancements are discussed along with suggestions to improve arrival procedures.

  19. Free-falls and parachute descents in the standard atmosphere

    NASA Technical Reports Server (NTRS)

    Webster, A P

    1947-01-01

    A detailed table of the standard equilibrium velocity and standard equilibrium time is presented for bodies falling in the standard atmosphere. This table gives the velocity at various altitudes and the time of fall from sea level to -4000 feet and from 80,000 feet to sea level. In addition to this standard table, there are given short tables and charts of an open-parachute descent and free-falls; the terminal velocity at sea level, and the variation of the weight-to-drag ratio (2w/cds)1/2 for various weight jumpers from 90 to 30 feet in open-parachute descent; and estimations of drag coefficients of silk and nylon parachutes. The table of standard equilibrium velocities and standard equilibrium times may be used directly for open-parachute descents, given the weight of the jumper, the diameter of the parachute, and the drag coefficient. For free-falls starting from horizontal flight, approximately 14 seconds must be added to the equilibrium time given in the table to obtain the total time to sea level. (author)

  20. Factors Associated with Sleep Disturbance in Women of Mexican Descent

    PubMed Central

    Heilemann, MarySue V.; Choudhury, Shonali M.; Kury, Felix Salvador; Lee, Kathryn A.

    2014-01-01

    Aims The aims were to identify the most useful parameters of acculturation in relation to self reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent. Background Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States. Methods These personal factors were incorporated into a modification of the Conceptual Framework of Impaired Sleep to guide our secondary analysis of self-reported sleep disturbance. Cross sectional data from a convenience sample of 312 women of Mexican descent of childbearing age (21-40 years) located in an urban California community were collected and previously analyzed in relation to depressive symptoms and post traumatic stress disorder. The General Sleep Disturbance Scale (in English and Spanish) was used to assess sleep disturbance. Results Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income, and higher depressive symptoms) were significant in accounting for 40% of the variance in sleep disturbance. Conclusion When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding, and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribe a sleep medication. PMID:22221152

  1. Inflammatory bowel disease in children of middle eastern descent.

    PubMed

    Naidoo, Christina Mai Ying; Leach, Steven T; Day, Andrew S; Lemberg, Daniel A

    2014-01-01

    Increasing rates of inflammatory bowel disease (IBD) are now seen in populations where it was once uncommon. The pattern of IBD in children of Middle Eastern descent in Australia has never been reported. This study aimed to investigate the burden of IBD in children of Middle Eastern descent at the Sydney Children's Hospital, Randwick (SCHR). The SCHR IBD database was used to identify patients of self-reported Middle Eastern ethnicity diagnosed between 1987 and 2011. Demographic, diagnosis, and management data was collected for all Middle Eastern children and an age and gender matched non-Middle Eastern IBD control group. Twenty-four patients of Middle Eastern descent were identified. Middle Eastern Crohn's disease patients had higher disease activity at diagnosis, higher use of thiopurines, and less restricted colonic disease than controls. Although there were limitations with this dataset, we estimated a higher prevalence of IBD in Middle Eastern children and they had a different disease phenotype and behavior compared to the control group, with less disease restricted to the colon and likely a more active disease course. PMID:24987422

  2. Lunar Surface Access Module Descent Engine Turbopump Technology: Detailed Design

    NASA Technical Reports Server (NTRS)

    Alvarez, Erika; Forbes, John C.; Thornton, Randall J.

    2010-01-01

    The need for a high specific impulse LOX/LH2 pump-fed lunar lander engine has been established by NASA for the new lunar exploration architecture. Studies indicate that a 4-engine cluster in the thrust range of 9,000-lbf each is a candidate configuration for the main propulsion of the manned lunar lander vehicle. The lander descent engine will be required to perform multiple burns including the powered descent onto the lunar surface. In order to achieve the wide range of thrust required, the engines must be capable of throttling approximately 10:1. Working under internal research and development funding, NASA Marshall Space Flight Center (MSFC) has been conducting the development of a 9,000-lbf LOX/LH2 lunar lander descent engine technology testbed. This paper highlights the detailed design and analysis efforts to develop the lander engine Fuel Turbopump (FTP) whose operating speeds range from 30,000-rpm to 100,000-rpm. The capability of the FTP to operate across this wide range of speeds imposes several structural and dynamic challenges, and the small size of the FTP creates scaling and manufacturing challenges that are also addressed in this paper.

  3. Lunar Surface Access Module Descent Engine Turbopump Technology: Detailed Design

    NASA Technical Reports Server (NTRS)

    Alarez, Erika; Thornton, Randall J.; Forbes, John C.

    2008-01-01

    The need for a high specific impulse LOX/LH2 pump-fed lunar lander engine has been established by NASA for the new lunar exploration architecture. Studies indicate that a 4-engine cluster in the thrust range of 9,000-lbf each is a candidate configuration for the main propulsion of the manned lunar lander vehicle. The lander descent engine will be required to perform minor mid-course corrections, a Lunar Orbit Insertion (LOI) burn, a de-orbit burn, and the powered descent onto the lunar surface. In order to achieve the wide range of thrust required, the engines must be capable of throttling approximately 10:1. Working under internal research and development funding, NASA Marshall Space Flight Center (MSFC) has been conducting the development of a 9,000-lbf LOX/LH2 lunar lander descent engine testbed. This paper highlights the detailed design and analysis efforts to develop the lander engine Fuel Turbopump (FTP) whose operating speeds range from 30,000-rpm to 100,000-rpm. The capability of the FTP to operate across this wide range of speeds imposes several structural and dynamic challenges, and the small size of the FTP creates scaling and manufacturing challenges that are also addressed in this paper.

  4. Titan Explorer Entry, Descent and Landing Trajectory Design

    NASA Technical Reports Server (NTRS)

    Fisher, Jody L.; Lindberg, Robert E.; Lockwood, Mary Kae

    2006-01-01

    The Titan Explorer mission concept includes an orbiter, entry probe and inflatable airship designed to take remote and in-situ measurements of Titan's atmosphere. A modified entry, descent and landing trajectory at Titan that incorporates mid-air airship inflation (under a parachute) and separation is developed and examined for Titan Explorer. The feasibility of mid-air inflation and deployment of an airship under a parachute is determined by implementing and validating an airship buoyancy and inflation model in the trajectory simulation program, Program to Optimize Simulated Trajectories II (POST2). A nominal POST2 trajectory simulation case study is generated which examines different descent scenarios by varying airship inflation duration, orientation, and separation. The buoyancy model incorporation into POST2 is new to the software and may be used in future trajectory simulations. Each case from the nominal POST2 trajectory case study simulates a successful separation between the parachute and airship systems with sufficient velocity change as to alter their paths to avoid collision throughout their descent. The airship and heatshield also separate acceptably with a minimum distance of separation from the parachute system of 1.5 km. This analysis shows the feasibility of airship inflation on a parachute for different orientations, airship separation at various inflation times, and preparation for level-flight at Titan.

  5. Data-Analysis System for Entry, Descent, and Landing

    NASA Technical Reports Server (NTRS)

    Pham, Timothy; Chang, Christine; Sartorius, Edgar; Finley, Susan; White, Leslie; Estabrook, Polly; Fort, David

    2005-01-01

    A report describes the Entry Descent Landing Data Analysis (EDA), which is a system of signal-processing software and computer hardware for acquiring status data conveyed by multiple-frequency-shift-keying tone signals transmitted by a spacecraft during descent to the surface of a remote planet. The design of the EDA meets the challenge of processing weak, fluctuating signals that are Doppler-shifted by amounts that are only partly predictable. The software supports both real-time and post processing. The software performs fast-Fourier-transform integration, parallel frequency tracking with prediction, and mapping of detected tones to specific events. The use of backtrack and refinement parallel-processing threads helps to minimize data gaps. The design affords flexibility to enable division of a descent track into segments, within each of which the EDA is configured optimally for processing in the face of signal conditions and uncertainties. A dynamic-lock-state feature enables the detection of signals using minimum required computing power less when signals are steadily detected, more when signals fluctuate. At present, the hardware comprises eight dual-processor personal-computer modules and a server. The hardware is modular, making it possible to increase computing power by adding computers.

  6. Inflammatory Bowel Disease in Children of Middle Eastern Descent

    PubMed Central

    Naidoo, Christina Mai Ying; Leach, Steven T.; Day, Andrew S.; Lemberg, Daniel A.

    2014-01-01

    Increasing rates of inflammatory bowel disease (IBD) are now seen in populations where it was once uncommon. The pattern of IBD in children of Middle Eastern descent in Australia has never been reported. This study aimed to investigate the burden of IBD in children of Middle Eastern descent at the Sydney Children's Hospital, Randwick (SCHR). The SCHR IBD database was used to identify patients of self-reported Middle Eastern ethnicity diagnosed between 1987 and 2011. Demographic, diagnosis, and management data was collected for all Middle Eastern children and an age and gender matched non-Middle Eastern IBD control group. Twenty-four patients of Middle Eastern descent were identified. Middle Eastern Crohn's disease patients had higher disease activity at diagnosis, higher use of thiopurines, and less restricted colonic disease than controls. Although there were limitations with this dataset, we estimated a higher prevalence of IBD in Middle Eastern children and they had a different disease phenotype and behavior compared to the control group, with less disease restricted to the colon and likely a more active disease course. PMID:24987422

  7. Matrix metalloproteinase-3 gene promoter polymorphisms: A potential risk factor for pelvic organ prolapse

    PubMed Central

    Karachalios, Charalampos; Bakas, Panagiotis; Kaparos, Georgios; Demeridou, Styliani; Liapis, Ilias; Grigoriadis, Charalampos; Liapis, Aggelos

    2016-01-01

    Pelvic organ prolapse (POP) is a common multifactorial condition. Matrix metalloproteinases (MMPs) are enzymes capable of breaking down various connective tissue elements. Single-nucleotide polymorphisms (SNPs) in regulatory areas of MMP-encoding genes can alter their transcription rate, and therefore the possible effect on pelvic floor supporting structures. The insertion of an adenine (A) base in the promoter of the MMP-3 gene at position −1612/−1617 produces a sequence of six adenines (6A), whereas the other allele has five (5A). The aim of the present study was to investigate the possible association of MMP-3 gene promoter SNPs with the risk of POP. The patient group comprised 80 women with clinically significant POP [Stage II, III or IV; POP quantification (POP-Q) system]. The control group consisted of 80 females without any or important pelvic floor support defects (Stages 0 or I; POP-Q system). All the participants underwent the same preoperative evaluation. SNP detection was determined with whole blood sample DNA analysis by quantitative polymerase chain reaction (PCR) in LightCycler® PCR platforms, using the technique of sequence-specific hybridization probe-binding assays and melting temperature curve analysis. The results showed there was no statistically significant difference between 5A/5A, 5A/6A and 6A/6A MMP-3 gene promoter variants in the two study groups (P=0.4758). Therefore, MMP-3 gene promoter SNPs alone is insufficient to increase the genetic susceptibility to POP development. PMID:27588175

  8. Pelvic Incidence: The Great Biomechanical Effort.

    PubMed

    Diebo, Bassel G; Lafage, Virginie; Schwab, Frank

    2016-04-01

    Medical textbooks present the pelvis and the spine as distinct entities-an unfortunate practice that does not reflect the crucial and critical role that the pelvis plays in regulating spino-pelvic alignment. Researchers are working to delineate this role. Dubousset proposed the concept of the 3-dimensional pelvic vertebra, which suggested that the pelvis is just another caudal vertebra of the spine, and that analysis of the spine requires simultaneous analysis of pelvic morphology. To quantify pelvic morphology, Legaye introduced the pelvic incidence angle (PI) and espoused the theory that this angle regulates sagittal curvature of the spine. The PI is formed from 2 lines: line 1, perpendicular to the sacrum from the midline of the sacral plate, aims to quantify spatial orientation and dictate the lumbar curve; line 2, extending from the midline of the sacrum to the midpoint between femoral heads, illustrates the importance of sacral position inside the pelvis (SDC Figure 1, http://links.lww.com/BRS/B99). PMID:27015063

  9. Pelvic girdle and fin of Tiktaalik roseae

    PubMed Central

    Shubin, Neil H.; Daeschler, Edward B.; Jenkins, Farish A.

    2014-01-01

    A major challenge in understanding the origin of terrestrial vertebrates has been knowledge of the pelvis and hind appendage of their closest fish relatives. The pelvic girdle and appendage of tetrapods is dramatically larger and more robust than that of fish and contains a number of structures that provide greater musculoskeletal support for posture and locomotion. The discovery of pelvic material of the finned elpistostegalian, Tiktaalik roseae, bridges some of these differences. Multiple isolated pelves have been recovered, each of which has been prepared in three dimensions. Likewise, a complete pelvis and partial pelvic fin have been recovered in association with the type specimen. The pelves of Tiktaalik are paired and have broad iliac processes, flat and elongate pubes, and acetabulae that form a deep socket rimmed by a robust lip of bone. The pelvis is greatly enlarged relative to other finned tetrapodomorphs. Despite the enlargement and robusticity of the pelvis of Tiktaalik, it retains primitive features such as the lack of both an attachment for the sacral rib and an ischium. The pelvic fin of Tiktaalik (NUFV 108) is represented by fin rays and three endochondral elements: other elements are not preserved. The mosaic of primitive and derived features in Tiktaalik reveals that the enhancement of the pelvic appendage of tetrapods and, indeed, a trend toward hind limb-based propulsion have antecedents in the fins of their closest relatives. PMID:24449831

  10. The Surgical Treatment of Pelvic Bone Metastases

    PubMed Central

    Müller, Daniel A.; Capanna, Rodolfo

    2015-01-01

    Pelvic bone metastases are a growing concern in the field of orthopedic surgery. Patients with pelvic metastasis are individually different with different needs of treatment in order to attain the best possible quality of life despite the advanced stage of disease. A holistic collaboration among the oncologist, radiation therapist, and orthopedic surgeon is mandatory. Special attention has to be directed to osteolytic lesions in the periacetabular region as they can provoke pathological fractures and subsequent functional impairment. Different reconstruction techniques for the pelvis are available; the choice depends on the patient's prognosis, size of the bone defect, and response of the tumor to adjuvant treatment. If all the conservative treatments are exhausted and the patient is not eligible for surgery, one of the various percutaneous ablation procedures can be considered. We propose a pelvic analogue to the treatment algorithm in long bone metastasis and a scoring system in pelvic metastasis. This algorithm aims to simplify the teamwork and to avoid under- or overtreatment of pelvic bone metastases. PMID:25810925

  11. Pelvic-fracture urethral injury in children

    PubMed Central

    Hagedorn, Judith C.; Voelzke, Bryan B.

    2015-01-01

    Objective To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial. Methods We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25 years. The search was limited to the keywords ‘pediatric’, ‘pelvic fracture’, ‘urethral injury’, ‘stricture’, ‘trauma’ and ‘reconstruction’. Results Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries. Conclusion Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist. PMID:26019977

  12. Mars Science Laboratory: Entry, Descent, and Landing System Performance

    NASA Technical Reports Server (NTRS)

    Way, David W.; Powell, Richard W.; Chen, Allen; Steltzner, Adam D.; San Martin, Alejandro M.; Burkhart, Paul D.; mendeck, Gavin F.

    2006-01-01

    In 2010, the Mars Science Laboratory (MSL) mission will pioneer the next generation of robotic Entry, Descent, and Landing (EDL) systems, by delivering the largest and most capable rover to date to the surface of Mars. To do so, MSL will fly a guided lifting entry at a lift-to-drag ratio in excess of that ever flown at Mars, deploy the largest parachute ever at Mars, and perform a novel Sky Crane maneuver. Through improved altitude capability, increased latitude coverage, and more accurate payload delivery, MSL is allowing the science community to consider the exploration of previously inaccessible regions of the planet. The MSL EDL system is a new EDL architecture based on Viking heritage technologies and designed to meet the challenges of landing increasing massive payloads on Mars. In accordance with level-1 requirements, the MSL EDL system is being designed to land an 850 kg rover to altitudes as high as 1 km above the Mars Orbiter Laser Altimeter defined areoid within 10 km of the desired landing site. Accordingly, MSL will enter the largest entry mass, fly the largest 70 degree sphere-cone aeroshell, generate the largest hypersonic lift-to-drag ratio, and deploy the largest Disk-Gap-Band supersonic parachute of any previous mission to Mars. Major EDL events include a hypersonic guided entry, supersonic parachute deploy and inflation, subsonic heatshield jettison, terminal descent sensor acquisition, powered descent initiation, sky crane terminal descent, rover touchdown detection, and descent stage flyaway. Key performance metrics, derived from level-1 requirements and tracked by the EDL design team to indicate performance capability and timeline margins, include altitude and range at parachute deploy, time on radar, and propellant use. The MSL EDL system, which will continue to develop over the next three years, will enable a notable extension in the advancement of Mars surface science by delivering more science capability than ever before to the surface of

  13. Mars Science Laboratory: Entry, Descent, and Landing System Performance

    NASA Technical Reports Server (NTRS)

    Way, David W.; Powell, Richard W.; Chen, Allen; SanMartin, A. Miguel; Burkhart, P. Daniel; Mendeck, Gavin F.

    2007-01-01

    In 2010, the Mars Science Laboratory (MSL) mission will pioneer the next generation of robotic Entry, Descent, and Landing (EDL) systems, by delivering the largest and most capable rover to date to the surface of Mars. To do so, MSL will fly a guided lifting entry at a lift-to-drag ratio in excess of that ever flown at Mars, deploy the largest parachute ever at Mars, and perform a novel Sky Crane maneuver. Through improved altitude capability, increased latitude coverage, and more accurate payload delivery, MSL is allowing the science community to consider the exploration of previously inaccessible regions of the planet. The MSL EDL system is a new EDL architecture based on Viking heritage technologies and designed to meet the challenges of landing increasing massive payloads on Mars. In accordance with level-1 requirements, the MSL EDL system is being designed to land an 850 kg rover to altitudes as high as 1 km above the Mars Orbiter Laser Altimeter defined areoid within 10 km of the desired landing site. Accordingly, MSL will enter the largest entry mass, fly the largest 70 degree sphere-cone aeroshell, generate the largest hypersonic lift-to-drag ratio, and deploy the largest Disk-Gap-Band supersonic parachute of any previous mission to Mars. Major EDL events include a hypersonic guided entry, supersonic parachute deploy and inflation, subsonic heatshield jettison, terminal descent sensor acquisition, powered descent initiation, sky crane terminal descent, rover touchdown detection, and descent stage flyaway. Key performance metrics, derived from level-1 requirements and tracked by the EDL design team to indicate performance capability and timeline margins, include altitude and range at parachute deploy, time on radar, and propellant use. The MSL EDL system, which will continue to develop over the next three years, will enable a notable extension in the advancement of Mars surface science by delivering more science capability than ever before to the surface of

  14. Pelvic girdle pain: updating current practice.

    PubMed

    Fishburn, Sarah

    2015-11-01

    Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during pregnancy and exacerbated by the weight of the baby. Customary advice was for rest, support belts and to await recovery following the baby's birth. However, the outcome of this management resulted in many women experiencing short or long-term physical disability, as well as the psychological impact of pain and immobility. Recent research links an asymmetry of the pelvic joints to the incidence and severity of PGP and shows the cause is biomechanical and not due to pregnancy hormones. Evidence supports manual therapy as the effective way to resolve PGP quickly during pregnancy through a realignment and restoration of symmetry of movement in the pelvic joints, thereby avoiding the adverse long-term consequences of the condition. PMID:26669047

  15. Imaging for acute pelvic pain in pregnancy.

    PubMed

    Masselli, Gabriele; Brunelli, Roberto; Monti, Riccardo; Guida, Marianna; Laghi, Francesca; Casciani, Emanuele; Polettini, Elisabetta; Gualdi, Gianfranco

    2014-04-01

    Acute pelvic pain in pregnancy presents diagnostic and therapeutic challenges. Standard imaging techniques need to be adapted to reduce harm to the foetus from X-rays because of their teratogenic and carcinogenic potential. Ultrasound remains the primary imaging investigation of the pregnant abdomen. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of gynaecological and obstetric problems during pregnancy and in the setting of acute abdomen during pregnancy. MRI overcomes some of the limitations of ultrasound, mainly the size of the gravid uterus. MRI poses theoretical risks to the foetus and care must be taken to minimise these with the avoidance of contrast agents. Teaching Points • Ultrasound and MRI are the preferred investigations for acute pelvic pain during pregnancy. • Ultrasound remains the primary imaging investigation because of availability and portability. • MRI helps differentiate causes of acute pelvic pain when ultrasound is inconclusive. PMID:24535757

  16. Pelvic Fractures in Children Results from the German Pelvic Trauma Registry: A Cohort Study.

    PubMed

    Zwingmann, Jörn; Aghayev, Emin; Südkamp, Norbert P; Neumann, Mirjam; Bode, Gerrit; Stuby, Fabian; Schmal, Hagen

    2015-12-01

    As pelvic fractures in children and adolescents are very rare, the surgical management is not well delineated nor are the postoperative complications. The aim of this study using the prospective data from German Pelvic Trauma Registry study was to evaluate the various treatment approaches compared to adults and delineated the differences in postoperative complications after pelvic injuries.Using the prospective pelvic trauma registry established by the German Society of Traumatology and the German Section of the Arbeitsgemeinschaft für Osteosynthesefragen (AO), International in 1991, patients with pelvic fractures over a 12-year time frame submitted by any 1 of the 23 member level I trauma centers were reviewed.We identified a total of 13,525 patients including pelvic fractures in 13,317 adults and 208 children aged ≤14 years and compared these 2 groups. The 2 groups' Injury Severitiy Score (ISS) did not differ statistically. Lethality in the pediatric group was 6.3%, not statistically different from the adults' 4.6%. In all, 18.3% of the pediatric pelvic fractures were treated surgically as compared to 22.7% in the adult group. No child suffered any thrombosis/embolism, acute respiratory distress syndrome (ARDS), multiorgan failure (MOF), or neurologic deficit, nor was any septic MOF detected. The differences between adults and children were statistically significant in that the children suffered less frequently from thrombosis/embolism (P = 0.041) and ARDS and MOF (P = 0.006).This prospective multicenter study addressing patients with pelvic fractures reveals that the risk for a thrombosis/embolism, ARDS, and MOF is significant lower in pediatric patients than in adults. No statistical differences could be found in the ratios of operative therapy of the pelvic fractures in children compared to adults. PMID:26705223

  17. Pelvic Fractures in Children Results from the German Pelvic Trauma Registry

    PubMed Central

    Zwingmann, Jörn; Aghayev, Emin; Südkamp, Norbert P.; Neumann, Mirjam; Bode, Gerrit; Stuby, Fabian; Schmal, Hagen

    2015-01-01

    Abstract As pelvic fractures in children and adolescents are very rare, the surgical management is not well delineated nor are the postoperative complications. The aim of this study using the prospective data from German Pelvic Trauma Registry study was to evaluate the various treatment approaches compared to adults and delineated the differences in postoperative complications after pelvic injuries. Using the prospective pelvic trauma registry established by the German Society of Traumatology and the German Section of the Arbeitsgemeinschaft für Osteosynthesefragen (AO), International in 1991, patients with pelvic fractures over a 12-year time frame submitted by any 1 of the 23 member level I trauma centers were reviewed. We identified a total of 13,525 patients including pelvic fractures in 13,317 adults and 208 children aged ≤14 years and compared these 2 groups. The 2 groups’ Injury Severitiy Score (ISS) did not differ statistically. Lethality in the pediatric group was 6.3%, not statistically different from the adults’ 4.6%. In all, 18.3% of the pediatric pelvic fractures were treated surgically as compared to 22.7% in the adult group. No child suffered any thrombosis/embolism, acute respiratory distress syndrome (ARDS), multiorgan failure (MOF), or neurologic deficit, nor was any septic MOF detected. The differences between adults and children were statistically significant in that the children suffered less frequently from thrombosis/embolism (P = 0.041) and ARDS and MOF (P = 0.006). This prospective multicenter study addressing patients with pelvic fractures reveals that the risk for a thrombosis/embolism, ARDS, and MOF is significant lower in pediatric patients than in adults. No statistical differences could be found in the ratios of operative therapy of the pelvic fractures in children compared to adults. PMID:26705223

  18. Pelvic arteriography in obstetrics and gynecology: arteriovenous fistulas

    SciTech Connect

    Schneider, G.T.

    1984-12-01

    Pelvic arteriography has become an increasingly useful diagnostic and therapeutic tool in the past decade along with angiography of other areas of the body. A brief historical review of its development in obstetrics and gynecology since 1950 is presented, including placental localization and study of pelvic arterial adequacy. Modern practical uses include (1) diagnosis and therapy of pelvic arteriovenous fistulas, and (2) arterial embolization for intractable recurrent pelvic hemorrhage associated either with malignancy or with trauma or uncontrollable surgical bleeding.

  19. [Influence of the pelvic trauma registry of the DGU on treatment of pelvic ring fractures].

    PubMed

    Holstein, J H; Stuby, F M; Herath, S C; Culemann, U; Aghayev, E; Pohlemann, T

    2016-06-01

    Fractures of the pelvic ring are comparatively rare with an incidence of 2-8 % of all fractures depending on the study in question. The severity of pelvic ring fractures can be very different ranging from simple and mostly "harmless" type A fractures up to life-threatening complex type C fractures. Although it was previously postulated that high-energy trauma was necessary to induce a pelvic ring fracture, over the past decades it became more and more evident, not least from data in the pelvic trauma registry of the German Society for Trauma Surgery (DGU), that low-energy minor trauma can also cause pelvic ring fractures of osteoporotic bone and in a rapidly increasing population of geriatric patients insufficiency fractures of the pelvic ring are nowadays observed with no preceding trauma.Even in large trauma centers the number of patients with pelvic ring fractures is mostly insufficient to perform valid and sufficiently powerful monocentric studies on epidemiological, diagnostic or therapeutic issues. For this reason, in 1991 the first and still the only registry worldwide for the documentation and evaluation of pelvic ring fractures was introduced by the Working Group Pelvis (AG Becken) of the DGU. Originally, the main objectives of the documentation were epidemiological and diagnostic issues; however, in the course of time it developed into an increasingly expanding dataset with comprehensive parameters on injury patterns, operative and conservative therapy regimens and short-term and long-term outcome of patients. Originally starting with 10 institutions, in the meantime more than 30 hospitals in Germany and other European countries participate in the documentation of data. In the third phase of the registry alone, which was started in 2004, data from approximately 15,000 patients with pelvic ring and acetabular fractures were documented. In addition to the scientific impact of the pelvic trauma registry, which is reflected in the numerous national and

  20. [Imaging of acute pelvic pain in women].

    PubMed

    Genevois, A; Marouteau, N; Lemercier, E; Dacher, J N; Thiebot, J

    2008-01-01

    Acute pelvic pain in women is a routine situation in any emergency unit. The radiologist should know how to explore the patient with regards to the history and clinical findings. Ultrasonography is the primary and sometimes the only necessary imaging tool in the assessment of acute pelvic pain in women. MRI is the preferred technique in pregnant or young women. CT is more valuable for assessing nongynecologic disorders or post-partum and post-operative infections. This article reviews the contribution of each imaging technique in this clinical situation. Emphasis is put on the importance of age and clinical findings in the diagnostic strategy. PMID:18288036

  1. Pelvic applications of diffusion magnetic resonance images.

    PubMed

    Coutinho, Antonio C; Krishnaraj, Arun; Pires, Cintia E; Bittencourt, Leonardo K; Guimarães, Alexander R

    2011-02-01

    Diffusion-weighted imaging (DWI) is a powerful imaging technique in neuroimaging; its value in abdominal and pelvic imaging has only recently been appreciated as a result of improvements in magnetic resonance imaging technology. There is growing interest in the use of DWI for evaluating pathology in the pelvis. Its ability to noninvasively characterize tissues and to depict changes at a cellular level allows DWI to be an effective complement to conventional sequences of pelvic imaging, especially in oncologic patients. The addition of DWI may obviate contrast material in those with renal insufficiency or contrast material allergy. PMID:21129639

  2. Early Introduction to the Pelvic Examination: An Anatomical Approach.

    ERIC Educational Resources Information Center

    And Others; Munger, Bryce L.

    1981-01-01

    The use of a special cadaver is discussed that could be used during the first-year gross anatomy course to supplement the usual dissection of pelvic viscera. Pelvic anatomy is emphasized from the perineal approach as used in a typical pelvic exam. (MLW)

  3. Pelvic congestion syndrome: demonstration and diagnosis by helical CT.

    PubMed

    Desimpelaere, J H; Seynaeve, P C; Hagers, Y M; Appel, B J; Mortelmans, L L

    1999-01-01

    Pelvic pain is a common gynaecological complaint, sometimes without any obvious etiology. We report a case of pelvic congestion syndrome, an often overlooked cause of pelvic pain, diagnosed by helical computed tomography. This seems to be an effective and noninvasive imaging modality. PMID:9933685

  4. Scaling on a limestone flooring

    NASA Astrophysics Data System (ADS)

    Carmona-Quiroga, P. M.; Blanco-Varela, M. T.; Martínez-Ramírez, S.

    2012-04-01

    Natural stone can be use on nearly every surface, inside and outside buildings, but decay is more commonly reported from the ones exposed to outdoor aggressively conditions. This study instead, is an example of limestone weathering of uncertain origin in the interior of a residential building. The stone, used as flooring, started to exhibit loss of material in the form of scaling. These damages were observed before the building, localized in the South of Spain (Málaga), was inhabited. Moreover, according to the company the limestone satisfies the following European standards UNE-EN 1341: 2002, UNE-EN 1343: 2003; UNE-EN 12058: 2004 for floorings. Under these circumstances the main objective of this study was to assess the causes of this phenomenon. For this reason the composition of the mortar was determined and the stone was characterized from a mineralogical and petrological point of view. The last material, which is a fossiliferous limestone from Egypt with natural fissure lines, is mainly composed of calcite, being quartz, kaolinite and apatite minor phases. Moreover, under different spectroscopic and microscopic techniques (FTIR, micro-Raman, SEM-EDX, etc) samples of the weathered, taken directly from the buildings, and unweathered limestone tiles were examined and a new mineralogical phase, trona, was identified at scaled areas which are connected with the natural veins of the stone. In fact, through BSE-mapping the presence of sodium has been detected in these veins. This soluble sodium carbonate would was dissolved in the natural waters from which limestone was precipitated and would migrate with the ascendant capilar humidity and crystallized near the surface of the stone starting the scaling phenomenon which in historic masonry could be very damaging. Therefore, the weathering of the limestone would be related with the hygroscopic behaviour of this salt, but not with the constructive methods used. This makes the limestone unable to be used on restoration

  5. PELVIC ACTINOMYCOSIS MIMICKING A LOCALLY ADVANCED PELVIC MALIGNANCY--CASE REPORT.

    PubMed

    Velenciuc, Natalia; Velenciuc, I; Makkai Popa, S; Roată, C; Ferariu, D; Luncă, S

    2016-01-01

    We present the case of a former user of an intrauterine contraceptive device (IUD) for 10 years, diagnosed with a bulky, fixed pelvic tumor involving the internal genital organs and the recto sigmoid, causing luminal narrowing of the rectum, interpreted as locally advanced pelvic malignancy, probably of genital origin. Intraoperatively, a high index of suspicion made us collect a sample from the fibrous wall of the tumor mass, large Actinomyces colonies were thus identified. Surgery consisted in debridement, removal of a small amount of pus and appendectomy, thus avoiding a mutilating and useless surgery. Specific antibiotic therapy was administered for 3 months, with favorable postoperative and long-term outcomes. Pelvic actinomycosis should always be considered in the differential diagnosis of pelvic tumors in women using an IUD. The association of long-term antibiotic treatment is essential to eradicate the infection and prevent relapses. PMID:27483724

  6. MUSCLE TENDERNESS IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME: THE CHRONIC PROSTATITIS COHORT STUDY

    PubMed Central

    Shoskes, Daniel A.; Berger, Richard; Elmi, Angelo; Landis, J. Richard; Propert, Kathleen J.; Zeitlin, Scott

    2009-01-01

    Introduction Myofascial pain is a possible etiology for category III chronic prostatitis/chronic pelvic pain syndrome (CPPS), either secondary to infection/inflammation or as the primary cause. We wished to document tenderness on physical exam in a large multicenter cohort of CPPS patients, and compare to controls. Methods Data were reviewed from the NIH Chronic Prostatitis Cohort study on 384 men with CPPS and 121 asymptomatic controls who had complete unblinded physical exam data, from 7 clinical centers between 10/98 - 8/01. Tenderness in 11 sites including prostate, genitals, abdomen and pelvic floor together with prostate size and consistency was evaluated. Data was correlated with cultures and symptoms. Results Overall, 51% of CPPS patients and 7% of controls had any tenderness. The most common site was prostate (41% CPPS, 5% controls), followed by external and internal pelvic floor (13% and 14% CPPS, 0 controls) and suprapubic (9% CPPS, 0 controls). In CPPS patients, 25% had 1 tender site, 11% had 2 and 6% had 3. Tenderness did not correlate with inflammation or infection in the prostate fluid. Prostate consistency was normal in 79% of CPPS patients and in 95% of controls, and did not correlate with symptom severity. CPPS patients with any tenderness had significantly higher CPSI scores at baseline, and at 1 year (24.1 vs 21.2 and 20.2 vs 17.5, p<0.0001), compared to patients without tenderness. Conclusions Abdominal/pelvic tenderness is present in half of CPPS patients, but only 7% of controls. Extraprostatic tenderness may identify a cohort of patients with a neuromuscular source of pain. PMID:18082223

  7. Powered Descent Guidance with General Thrust-Pointing Constraints

    NASA Technical Reports Server (NTRS)

    Carson, John M., III; Acikmese, Behcet; Blackmore, Lars

    2013-01-01

    The Powered Descent Guidance (PDG) algorithm and software for generating Mars pinpoint or precision landing guidance profiles has been enhanced to incorporate thrust-pointing constraints. Pointing constraints would typically be needed for onboard sensor and navigation systems that have specific field-of-view requirements to generate valid ground proximity and terrain-relative state measurements. The original PDG algorithm was designed to enforce both control and state constraints, including maximum and minimum thrust bounds, avoidance of the ground or descent within a glide slope cone, and maximum speed limits. The thrust-bound and thrust-pointing constraints within PDG are non-convex, which in general requires nonlinear optimization methods to generate solutions. The short duration of Mars powered descent requires guaranteed PDG convergence to a solution within a finite time; however, nonlinear optimization methods have no guarantees of convergence to the global optimal or convergence within finite computation time. A lossless convexification developed for the original PDG algorithm relaxed the non-convex thrust bound constraints. This relaxation was theoretically proven to provide valid and optimal solutions for the original, non-convex problem within a convex framework. As with the thrust bound constraint, a relaxation of the thrust-pointing constraint also provides a lossless convexification that ensures the enhanced relaxed PDG algorithm remains convex and retains validity for the original nonconvex problem. The enhanced PDG algorithm provides guidance profiles for pinpoint and precision landing that minimize fuel usage, minimize landing error to the target, and ensure satisfaction of all position and control constraints, including thrust bounds and now thrust-pointing constraints.

  8. Entry, Descent, and Landing for Human Mars Missions

    NASA Technical Reports Server (NTRS)

    Munk, Michelle M.; DwyerCianciolo, Alicia M.

    2012-01-01

    One of the most challenging aspects of a human mission to Mars is landing safely on the Martian surface. Mars has such low atmospheric density that decelerating large masses (tens of metric tons) requires methods that have not yet been demonstrated, and are not yet planned in future Mars missions. To identify the most promising options for Mars entry, descent, and landing, and to plan development of the needed technologies, NASA's Human Architecture Team (HAT) has refined candidate methods for emplacing needed elements of the human Mars exploration architecture (such as ascent vehicles and habitats) on the Mars surface. This paper explains the detailed, optimized simulations that have been developed to define the mass needed at Mars arrival to accomplish the entry, descent, and landing functions. Based on previous work, technology options for hypersonic deceleration include rigid, mid-L/D (lift-to-drag ratio) aeroshells, and inflatable aerodynamic decelerators (IADs). The hypersonic IADs, or HIADs, are about 20% less massive than the rigid vehicles, but both have their technology development challenges. For the supersonic regime, supersonic retropropulsion (SRP) is an attractive option, since a propulsive stage must be carried for terminal descent and can be ignited at higher speeds. The use of SRP eliminates the need for an additional deceleration system, but SRP is at a low Technology Readiness Level (TRL) in that the interacting plumes are not well-characterized, and their effect on vehicle stability has not been studied, to date. These architecture-level assessments have been used to define the key performance parameters and a technology development strategy for achieving the challenging mission of landing large payloads on Mars.

  9. Sexual selection targets cetacean pelvic bones.

    PubMed

    Dines, James P; Otárola-Castillo, Erik; Ralph, Peter; Alas, Jesse; Daley, Timothy; Smith, Andrew D; Dean, Matthew D

    2014-11-01

    Male genitalia evolve rapidly, probably as a result of sexual selection. Whether this pattern extends to the internal infrastructure that influences genital movements remains unknown. Cetaceans (whales and dolphins) offer a unique opportunity to test this hypothesis: since evolving from land-dwelling ancestors, they lost external hind limbs and evolved a highly reduced pelvis that seems to serve no other function except to anchor muscles that maneuver the penis. Here, we create a novel morphometric pipeline to analyze the size and shape evolution of pelvic bones from 130 individuals (29 species) in the context of inferred mating system. We present two main findings: (1) males from species with relatively intense sexual selection (inferred by relative testes size) tend to evolve larger penises and pelvic bones compared to their body length, and (2) pelvic bone shape has diverged more in species pairs that have diverged in inferred mating system. Neither pattern was observed in the anterior-most pair of vertebral ribs, which served as a negative control. This study provides evidence that sexual selection can affect internal anatomy that controls male genitalia. These important functions may explain why cetacean pelvic bones have not been lost through evolutionary time. PMID:25186496

  10. Sexual selection targets cetacean pelvic bones

    PubMed Central

    Dines, J. P.; Otárola-Castillo, E.; Ralph, P.; Alas, J.; Daley, T.; Smith, A. D.; Dean, M. D.

    2014-01-01

    Male genitalia evolve rapidly, probably as a result of sexual selection. Whether this pattern extends to the internal infrastructure that influences genital movements remains unknown. Cetaceans (whales and dolphins) offer a unique opportunity to test this hypothesis: since evolving from land-dwelling ancestors, they lost external hind limbs and evolved a highly reduced pelvis which seems to serve no other function except to anchor muscles that maneuver the penis. Here we create a novel morphometric pipeline to analyze the size and shape evolution of pelvic bones from 130 individuals (29 species) in the context of inferred mating system. We present two main findings: 1) males from species with relatively intense sexual selection (inferred by relative testes size) have evolved relatively large penises and pelvic bones compared to their body size, and 2) pelvic bone shape diverges more quickly in species pairs that have diverged in inferred mating system. Neither pattern was observed in the anterior-most pair of vertebral ribs, which served as a negative control. This study provides evidence that sexual selection can affect internal anatomy that controls male genitalia. These important functions may explain why cetacean pelvic bones have not been lost through evolutionary time. PMID:25186496

  11. Severe pelvic abscess formation following caesarean section.

    PubMed

    Muin, Dana A; Takes, Martin Thanh-Long; Hösli, Irene; Lapaire, Olav

    2015-01-01

    We report a case of a 24-year-old woman with severe pelvic abscess formation 2 weeks after secondary caesarean section. The isolated pathogens were a mixture of Gardnerella vaginalis, Mycoplasma hominis and Ureaplasma urealyticum. After initial resistance to systemic antibiotic treatment, she underwent radiologically-guided drainage of the abscesses, whereon she had a continuous recovery. PMID:25911355

  12. A piloted simulator evaluation of a ground-based 4D descent advisor algorithm

    NASA Technical Reports Server (NTRS)

    Green, Steven M.; Davis, Thomas J.; Erzberger, Heinz

    1987-01-01

    A ground-based, four-dimensional (4D) descent-advisor algorithm is under development at NASA Ames Research Center. The algorithm combines detailed aerodynamic, propulsive, and atmospheric models with an efficient numerical integration scheme to generate 4D descent advisories. This paper investigates the ability of the 4D descent advisor algorithm to provide adequate control of arrival time for aircraft not equipped with on-board 4D guidance systems. A piloted simulation was conducted to determine the precision with which the descent advisor could predict the 4D trajectories of typical straight-in descents flown by airline pilots under different wind conditions. The effects of errors in the estimation of wind and initial aircraft weight were also studied. A description of the descent advisor as well as the results of the simulation studies are presented.

  13. A piloted simulator evaluation of a ground-based 4-D descent advisor algorithm

    NASA Technical Reports Server (NTRS)

    Davis, Thomas J.; Green, Steven M.; Erzberger, Heinz

    1990-01-01

    A ground-based, four dimensional (4D) descent-advisor algorithm is under development at NASA-Ames. The algorithm combines detailed aerodynamic, propulsive, and atmospheric models with an efficient numerical integration scheme to generate 4D descent advisories. The ability is investigated of the 4D descent advisor algorithm to provide adequate control of arrival time for aircraft not equipped with on-board 4D guidance systems. A piloted simulation was conducted to determine the precision with which the descent advisor could predict the 4D trajectories of typical straight-in descents flown by airline pilots under different wind conditions. The effects of errors in the estimation of wind and initial aircraft weight were also studied. A description of the descent advisor as well as the result of the simulation studies are presented.

  14. STS-1 operational flight profile. Volume 5: Descent, cycle 3. Appendix C: Monte Carlo dispersion analysis

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The results of three nonlinear the Monte Carlo dispersion analyses for the Space Transportation System 1 Flight (STS-1) Orbiter Descent Operational Flight Profile, Cycle 3 are presented. Fifty randomly selected simulation for the end of mission (EOM) descent, the abort once around (AOA) descent targeted line are steep target line, and the AOA descent targeted to the shallow target line are analyzed. These analyses compare the flight environment with system and operational constraints on the flight environment and in some cases use simplified system models as an aid in assessing the STS-1 descent flight profile. In addition, descent flight envelops are provided as a data base for use by system specialists to determine the flight readiness for STS-1. The results of these dispersion analyses supersede results of the dispersion analysis previously documented.

  15. OFT ascent/descent ancillary data requirements document

    NASA Technical Reports Server (NTRS)

    Bond, A. C., Jr.; Abramson, B.

    1978-01-01

    Requirements are presented for the ascent/descent (A/D) navigation and attitude-dependent ancillary data products to be generated for the space shuttle orbiter in support of orbital flight test requirements, MPAD guidance and navigation performance assessment, and the mission evaluation team. It was intended that this document serve as the sole requirements control instrument between MPB/MPAD and the A/D ancillary data users. The requirements are primarily functional in nature, but some detail level requirements are also included.

  16. Revalidation of the Huygens Descent Control Sub-System

    NASA Technical Reports Server (NTRS)

    2005-01-01

    The Huygens probe, part of the Cassini mission to Saturn, is designed to investigate the atmosphere of Titan, Saturn's largest moon. The passage of the probe through the atmosphere is controlled by the Descent Control Sub-System (DCSS), which consists of three parachutes and associated mechanisms. The Cassini / Huygens mission was launched in October 1997 and was designed during the early 1990's. During the time since the design and launch, analysis capabilities have improved significantly, knowledge of the Titan environment has improved and the baseline mission has been modified. Consequently, a study was performed to revalidate the DCSS design against the current predictions.

  17. [Thyrotoxic hypokalemic periodic paralysis in patients of African descent].

    PubMed

    Maia, Morgana Lima e; Trevisam, Paula Grasiele Carvalho; Minicucci, Marcos; Mazeto, Glaucia M F S; Azevedo, Paula S

    2014-10-01

    Thyrotoxic hypokalemic periodic paralysis (THPP) is an endocrine emergency marked by recurrent attacks of muscle weakness associated with hypokalemia and thyrotoxicosis. Asiatic male patients are most often affected. On the other hand, African descents rarely present this disease. The case described shows an afrodescendant patient with hypokalemia and tetraparesis, whose diagnosis of hyperthyroidism was considered during this crisis. The THPP, although rare, is potentially lethal. Therefore, in cases of flaccid paresis crisis this diagnosis should always be considered, especially if associated with hypokalemia. In this situation, if no previous diagnosis of hyperthyroidism, this should also be regarded. PMID:25372590

  18. Shuttle program: OFT ascent/descent ancillary data requirements document

    NASA Technical Reports Server (NTRS)

    Bond, A. C., Jr.; Knoedler, J.

    1980-01-01

    Requirements are presented for the ascent/descent (A/D) navigation and attitude-dependent ancillary data products to be generated for the space shuttle orbiter in support of the orbital flight test (OFT) flight test requirements, MPAD guidance and navigation performance assessment, and the mission evaluation team. The A/D ancillary data support for OFT mission evaluation activities is confined to providing postflight position, velocity, attitude, and associated navigation and attitude derived parameters for the Orbiter over particular flight phases and time intervals.

  19. Conceptual design of "Exomars-2018" Descent Module developed by federal enterprise "Lavochkin Association"

    NASA Astrophysics Data System (ADS)

    Khartov, V. V.; Martynov, M. B.; Lukiyanchikov, A. V.; Alexashkin, S. N.

    2015-12-01

    Goals and tasks for "ExoMars-2018" mission and share of responsibilities between European partners and p]Russia are presented. The main design requirements for a Descent Module (DM) that define its design concept as well as design specific features are given. The structure of the descent module, thermal control, means for securing systems interaction onboard the spacecraft "ExoMars-2018", and radio communication with the descent module are examined.

  20. An evaluation of descent strategies for TNAV-equipped aircraft in an advanced metering environment

    NASA Technical Reports Server (NTRS)

    Izumi, K. H.; Schwab, R. W.; Groce, J. L.; Coote, M. A.

    1986-01-01

    Investigated were the effects on system throughput and fleet fuel usage of arrival aircraft utilizing three 4D RNAV descent strategies (cost optimal, clean-idle Mach/CAS and constant descent angle Mach/CAS), both individually and in combination, in an advanced air traffic control metering environment. Results are presented for all mixtures of arrival traffic consisting of three Boeing commercial jet types and for all combinations of the three descent strategies for a typical en route metering airport arrival distribution.

  1. Pelvic fractures: part 1. Evaluation, classification, and resuscitation.

    PubMed

    Langford, Joshua R; Burgess, Andrew R; Liporace, Frank A; Haidukewych, George J

    2013-08-01

    Pelvic fractures range in severity from low-energy, generally benign lateral compression injuries to life-threatening, unstable fracture patterns. Initial management of severe pelvic fractures should follow Advanced Trauma Life Support protocols. Initial reduction of pelvic blood loss can be provided by binders, sheets, or some form of external fixation, which serve to reduce pelvic volume, stabilize clot formation, and reduce ongoing tissue damage. Persistently unstable patients may benefit from angiography with selective embolization, pelvic packing, or a combination of these interventions. Open pelvic fractures involving the perineum or bowel injury benefit from fecal diversion by colostomy. Trauma team coordination facilitates efficient resuscitative efforts and may affect definitive management by optimizing incision, ostomy, or catheter placement. Established protocols for both open and closed pelvic fractures help to standardize care. PMID:23908251

  2. Prevention of pelvic sepsis in major open pelviperineal injury.

    PubMed

    Govaert, Geertje; Siriwardhane, Mehan; Hatzifotis, Michael; Malisano, Lawrence; Schuetz, Michael

    2012-04-01

    Compound pelvic fractures are deemed to be one of the most severe orthopaedic injuries with an extremely high morbidity and mortality. After the initial resuscitation phase the prevention of pelvic sepsis is one of the main treatment goals for patients with an open pelvic fracture. If there is a suspicion of a rectal injury or if the wounds are in the perineal area, The Princess Alexandra Hospital's management plan includes early faecal diversion combined with vigorous soft tissue debridement, VAC(®) therapy and (if indicated) external fixation of the pelvic fracture. We present our flowchart for the treatment of trauma patients with compound pelvic fractures illustrated by a case report describing a 32 year old patient who sustained an open pelvic ring injury in a workplace accident. The aim of this paper is to underline the importance of a safe, straightforward approach to compound pelvic fractures. PMID:22222367

  3. Elongation of the active anterior wall of the uro-genital pelvic diaphragm, a late unusual complication of paraplegia.

    PubMed

    Jurascheck, F; Dollfus, P; Jacob-Chia, D

    1980-08-01

    The situation of the usual bladder, prostate, membranous urethra channel, can vary, according to the morphology of the perineum which can be overstretched. A case of a young man with a T10 complete upper motor neurone lesion is presented. The normal anterior angulation at the prostate and membranous urethra junction was reduced anteriorly and pushed backwards, thus causing an added indirect factor of dysuria. The mechanism is discussed in comparison with other such late, but often overlooked consequences of alterations of the pelvic floor during micturition. PMID:7422341

  4. Crash Tests of Protective Airplane Floors

    NASA Technical Reports Server (NTRS)

    Carden, H. D.

    1986-01-01

    Energy-absorbing floors reduce structural buckling and impact forces on occupants. 56-page report discusses crash tests of energy-absorbing aircraft floors. Describes test facility and procedures; airplanes, structural modifications, and seats; crash dynamics; floor and seat behavior; and responses of anthropometric dummies seated in airplanes. Also presents plots of accelerations, photographs and diagrams of test facility, and photographs and drawings of airplanes before, during, and after testing.

  5. The floor plate: multiple cells, multiple signals.

    PubMed

    Placzek, Marysia; Briscoe, James

    2005-03-01

    One of the key organizers in the CNS is the floor plate - a group of cells that is responsible for instructing neural cells to acquire distinctive fates, and that has an important role in establishing the elaborate neuronal networks that underlie the function of the brain and spinal cord. In recent years, considerable controversy has arisen over the mechanism by which floor plate cells form. Here, we describe recent evidence that indicates that discrete populations of floor plate cells, with characteristic molecular properties, form in different regions of the neuraxis, and we discuss data that imply that the mode of floor plate induction varies along the anteroposterior axis. PMID:15738958

  6. Efficient Love wave modeling via Sobolev gradient steepest descent

    NASA Astrophysics Data System (ADS)

    Browning, Matt; Ferguson, John; McMechan, George

    2016-02-01

    A new method for finding solutions to ordinary differential equation boundary value problems is introduced, in which Sobolev gradient steepest descent is used to determine eigenfunctions and eigenvalues simultaneously in an iterative scheme. The technique is then applied to the 1-D Love wave problem. The algorithm has several advantages when computing dispersion curves. It avoids the problem of mode skipping, and can handle arbitrary Earth structure profiles in depth. For a given frequency range, computation times scale approximately as the square root of the number of frequencies, and the computation of dispersion curves can be implemented in a fully parallel manner over the modes involved. The steepest descent solutions are within a fraction of a percent of the analytic solutions for the first 25 modes for a two-layer model. Since all corresponding eigenfunctions are computed along with the dispersion curves, the impact on group and phase velocity of the displacement behavior with depth is thoroughly examined. The dispersion curves are used to compute synthetic Love wave seismograms that include many higher order modes. An example includes addition of attenuation to a model with a low velocity zone, with values as low as Q = 20. Finally, a confirming comparison is made with a layer matrix method on the upper 700 km of a whole Earth model.

  7. Mars 2020 Entry, Descent and Landing Instrumentation 2 (MEDLI2)

    NASA Technical Reports Server (NTRS)

    Hwang, Helen H.; Bose, Deepak; White, Todd R.; Wright, Henry S.; Schoenenberger, Mark; Kuhl, Christopher A.; Trombetta, Dominic; Santos, Jose A.; Oishi, Tomomi; Karlgaard, Christopher D.; Mahzari, Milad; Pennington, Steven P.

    2016-01-01

    The Mars Entry Descent and Landing Instrumentation 2 (MEDLI2) sensor suite will measure aerodynamic, aerothermodynamic, and TPS performance during the atmospheric entry, descent, and landing phases of the Mars 2020 mission. The key objectives are to reduce design margin and prediction uncertainties for the aerothermal environments and aerodynamic database. For MEDLI2, the sensors are installed on both the heatshield and backshell, and include 7 pressure transducers, 17 thermal plugs, and 3 heat flux sensors (including a radiometer). These sensors will expand the set of measurements collected by the highly successful MEDLI suite, collecting supersonic pressure measurements on the forebody, a pressure measurement on the aftbody, direct heat flux measurements on the aftbody, a radiative heating measurement on the aftbody, and multiple near-surface thermal measurements on the thermal protection system (TPS) materials on both the forebody and aftbody. To meet the science objectives, supersonic pressure transducers and heat flux sensors are currently being developed and their qualification and calibration plans are presented. Finally, the reconstruction targets for data accuracy are presented, along with the planned methodologies for achieving the targets.

  8. Efficient Love wave modelling via Sobolev gradient steepest descent

    NASA Astrophysics Data System (ADS)

    Browning, Matt; Ferguson, John; McMechan, George

    2016-05-01

    A new method for finding solutions to ordinary differential equation boundary value problems is introduced, in which Sobolev gradient steepest descent is used to determine eigenfunctions and eigenvalues simultaneously in an iterative scheme. The technique is then applied to the 1-D Love wave problem. The algorithm has several advantages when computing dispersion curves. It avoids the problem of mode skipping, and can handle arbitrary Earth structure profiles in depth. For a given frequency range, computation times scale approximately as the square root of the number of frequencies, and the computation of dispersion curves can be implemented in a fully parallel manner over the modes involved. The steepest descent solutions are within a fraction of a per cent of the analytic solutions for the first 25 modes for a two-layer model. Since all corresponding eigenfunctions are computed along with the dispersion curves, the impact on group and phase velocity of the displacement behaviour with depth is thoroughly examined. The dispersion curves are used to compute synthetic Love wave seismograms that include many higher order modes. An example includes addition of attenuation to a model with a low-velocity zone, with values as low as Q = 20. Finally, a confirming comparison is made with a layer matrix method on the upper 700 km of a whole Earth model.

  9. High mammographic density in women of Ashkenazi Jewish descent

    PubMed Central

    2013-01-01

    Introduction Percent mammographic density (PMD) adjusted for age and body mass index is one of the strongest risk factors for breast cancer and is known to be approximately 60% heritable. Here we report a finding of an association between genetic ancestry and adjusted PMD. Methods We selected self-identified Caucasian women in the California Pacific Medical Center Research Institute Cohort whose screening mammograms placed them in the top or bottom quintiles of age-adjusted and body mass index-adjusted PMD. Our final dataset included 474 women with the highest adjusted PMD and 469 with the lowest genotyped on the Illumina 1 M platform. Principal component analysis (PCA) and identity-by-descent analyses allowed us to infer the women's genetic ancestry and correlate it with adjusted PMD. Results Women of Ashkenazi Jewish ancestry, as defined by the first principal component of PCA and identity-by-descent analyses, represented approximately 15% of the sample. Ashkenazi Jewish ancestry, defined by the first principal component of PCA, was associated with higher adjusted PMD (P = 0.004). Using multivariate regression to adjust for epidemiologic factors associated with PMD, including age at parity and use of postmenopausal hormone therapy, did not attenuate the association. Conclusions Women of Ashkenazi Jewish ancestry, based on genetic analysis, are more likely to have high age-adjusted and body mass index-adjusted PMD. Ashkenazi Jews may have a unique set of genetic variants or environmental risk factors that increase mammographic density. PMID:23668689

  10. Controller evaluations of the descent advisor automation aid

    NASA Technical Reports Server (NTRS)

    Tobias, Leonard; Volckers, Uwe; Erzberger, Heinz

    1989-01-01

    An automation aid to assist air traffic controllers in efficiently spacing traffic and meeting arrival times at a fix has been developed at NASA Ames Research Center. The automation aid, referred to as the descent advisor (DA), is based on accurate models of aircraft performance and weather conditions. The DA generates suggested clearances, including both top-of-descent point and speed profile data, for one or more aircraft in order to achieve specific time or distance separation objectives. The DA algorithm is interfaced with a mouse-based, menu-driven controller display that allows the air traffic controller to interactively use its accurate predictive capability to resolve conflicts and issue advisories to arrival aircraft. This paper focuses on operational issues concerning the utilization of the DA, specifically, how the DA can be used for prediction, intrail spacing, and metering. In order to evaluate the DA, a real time simulation was conducted using both current and retired controller subjects. Controllers operated in teams of two, as they do in the present environment; issues of training and team interaction will be discussed. Evaluations by controllers indicated considerable enthusiasm for the DA aid, and provided specific recommendations for using the tool effectively.

  11. Mars Exploration Rover Terminal Descent Mission Modeling and Simulation

    NASA Technical Reports Server (NTRS)

    Raiszadeh, Behzad; Queen, Eric M.

    2004-01-01

    Because of NASA's added reliance on simulation for successful interplanetary missions, the MER mission has developed a detailed EDL trajectory modeling and simulation. This paper summarizes how the MER EDL sequence of events are modeled, verification of the methods used, and the inputs. This simulation is built upon a multibody parachute trajectory simulation tool that has been developed in POST I1 that accurately simulates the trajectory of multiple vehicles in flight with interacting forces. In this model the parachute and the suspended bodies are treated as 6 Degree-of-Freedom (6 DOF) bodies. The terminal descent phase of the mission consists of several Entry, Descent, Landing (EDL) events, such as parachute deployment, heatshield separation, deployment of the lander from the backshell, deployment of the airbags, RAD firings, TIRS firings, etc. For an accurate, reliable simulation these events need to be modeled seamlessly and robustly so that the simulations will remain numerically stable during Monte-Carlo simulations. This paper also summarizes how the events have been modeled, the numerical issues, and modeling challenges.

  12. Vascular considerations in glaucoma patients of African and European descent.

    PubMed

    Huck, Andrew; Harris, Alon; Siesky, Brent; Kim, Nathaniel; Muchnik, Michael; Kanakamedala, Priyanka; Amireskandari, Annahita; Abrams-Tobe, Leslie

    2014-08-01

    Glaucoma is the leading cause of blindness in individuals of African descent (AD). While open-angle glaucoma (OAG) disproportionately affects individuals of AD compared with persons of European descent (ED), the physiological mechanisms behind this disparity are largely unknown. The more rapid progression and greater severity of the disease in persons of AD further raise the concern for identifying these underlying differences in disease pathophysiology between AD and ED glaucoma patients. Ocular structural differences between AD and ED patients, including larger optic disc area, cup:disc ratio and thinner corneas, have been found. AD individuals are also disproportionately affected by systemic vascular diseases, including hypertension, cardiovascular disease, stroke and diabetes mellitus. Abnormal ocular blood flow has been implicated as a risk factor for glaucoma, and pilot research is beginning to identify localized ocular vascular differences between AD and ED OAG patients. Given the known systemic vascular deficits and the relationship between glaucoma and ocular blood flow, exploring these concepts in terms of glaucoma risk factors may have a significant impact in elucidating the mechanisms behind the disease disparity in the AD population. PMID:24460758

  13. Mars Science Laboratory Entry Descent and Landing Simulation Using DSENDS

    NASA Technical Reports Server (NTRS)

    Burkhart, P. Daniel; Casoliva, Jordi; Balaram, Bob

    2013-01-01

    The most recent planetary science mission to Mars is Mars Science Laboratory (MSL) with the Curiosity rover, launched November 26, 2011 and landed at Gale Crater on August 6, 2012. This spacecraft was the first use at Mars of a complete closed-loop Guidance Navigation and Control (GN&C) system, including guided entry with a lifting body that greatly reduces dispersions during the Entry, Descent and Landing (EDL) phase to achieve a 25 km x 20 km landing error relative to the selected Gale Crater landing target. In order to confirm meeting the above landing criteria, high-fidelity simulation of the EDL phase is required. The tool used for 6DOF EDL trajectory verification analysis is Dynamics Simulator for Entry, Descent and Surface landing (DSENDS), which is a high-fidelity simulation tool from JPLs Dynamics and Real-Time Simulation Laboratory for the development, test and operations of aero-flight vehicles. DSENDS inherent capability is augmented for MSL with project-specific models of atmosphere, aerodynamics, sensors and thrusters along with GN&C flight software to enable high-fidelity trajectory simulation. This paper will present the model integration and independent verification experience of the JPL EDL trajectory analysis team.

  14. Mars Science Laboratory Entry Descent and Landing Simulation Using DSENDS

    NASA Technical Reports Server (NTRS)

    Burkhart, P. Daniel; Casoliva, Jordi; Balaram, Bob

    2013-01-01

    The most recent planetary science mission to Mars was Mars Science Laboratory (MSL) with the Curiosity rover, launched November 26, 2011 and landed at Gale Crater on August 6, 2012. This spacecraft was the first use at Mars of a complete closed-loop Guidance Navigation and Control (GN&C) system, including guided entry with a lifting body that greatly reduces dispersions during the Entry, Descent and Landing (EDL) phase to achieve a 25 km X 20 km landing error relative to the selected Gale Crater landing target. In order to confirm meeting the above landing criteria, high-fidelity simulation of the EDL phase is required. The tool used for 6DOF EDL trajectory verification analysis is Dynamics Simulator for Entry, Descent and Surface landing (DSENDS), which is a high-fidelity simulation tool from JPLs Dynamics and Real-Time Simulation Laboratory for the development, test and operations of aero-flight vehicles. DSENDS inherent capability is augmented for MSL with project-specific models of atmosphere, aerodynamics, sensors and thrusters along with GN&C flight software to enable high-fidelity trajectory simulation. This paper will present the model integration and independent verification experience of the JPL EDL trajectory analysis team.

  15. Accelerated Mini-batch Randomized Block Coordinate Descent Method

    PubMed Central

    Zhao, Tuo; Yu, Mo; Wang, Yiming; Arora, Raman; Liu, Han

    2014-01-01

    We consider regularized empirical risk minimization problems. In particular, we minimize the sum of a smooth empirical risk function and a nonsmooth regularization function. When the regularization function is block separable, we can solve the minimization problems in a randomized block coordinate descent (RBCD) manner. Existing RBCD methods usually decrease the objective value by exploiting the partial gradient of a randomly selected block of coordinates in each iteration. Thus they need all data to be accessible so that the partial gradient of the block gradient can be exactly obtained. However, such a “batch” setting may be computationally expensive in practice. In this paper, we propose a mini-batch randomized block coordinate descent (MRBCD) method, which estimates the partial gradient of the selected block based on a mini-batch of randomly sampled data in each iteration. We further accelerate the MRBCD method by exploiting the semi-stochastic optimization scheme, which effectively reduces the variance of the partial gradient estimators. Theoretically, we show that for strongly convex functions, the MRBCD method attains lower overall iteration complexity than existing RBCD methods. As an application, we further trim the MRBCD method to solve the regularized sparse learning problems. Our numerical experiments shows that the MRBCD method naturally exploits the sparsity structure and achieves better computational performance than existing methods. PMID:25620860

  16. Effects of pelvic adjustment on pelvic posture and angles of the lower limb joints during walking in female university students

    PubMed Central

    Cho, Misuk

    2016-01-01

    [Purpose] This study investigated the effects of pelvic adjustment on pelvic posture and lower limb joint angles during walking in female university students. [Subjects] Thirty healthy female university students were randomly assigned to an experimental group (pelvic adjustment group, n = 15) and a control group (stretching group, n = 15). [Methods] Pelvic adjustment was performed three times on the experimental group. The control group performed three sets of pelvic muscle stretching for 15 minutes. A back mapper and motion analysis equipment were used to measure pelvic posture and angles of lower limb joints for the experimental and control group. [Results] The values obtained before and after the intervention were compared. For the experimental group, the results were significantly different in terms of reduced differences in hip flexion between the left and right hips and in knee abduction between the left and right knees. Differences in pelvic position and pelvic torsion were also found in the experimental group. No significant differences in the control group were identified. [Conclusion] Pelvic adjustment affects pelvic position and torsion and this enhancement to pelvic stability decreases hip flexion and knee abduction during walking. PMID:27190468

  17. Side Elevation; 1/4 Plans of Floor Framing, Floor Planking, Roof ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Side Elevation; 1/4 Plans of Floor Framing, Floor Planking, Roof Framing and Roof; Longitudinal Section, Cross Section, End Elevation - Eames Covered Bridge, Spanning Henderson Creek, Oquawka, Henderson County, IL

  18. 17. 4th floor roof, view south, 4th and 5th floor ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    17. 4th floor roof, view south, 4th and 5th floor setback to left and atrium structure to right - Sheffield Farms Milk Plant, 1075 Webster Avenue (southwest corner of 166th Street), Bronx, Bronx County, NY

  19. Eastern Floor of Holden Crater

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 15 April 2002) The Science Today's THEMIS image covers territory on the eastern floor of Holden Crater, which is located in region of the southern hemisphere called Noachis Terra. Holden Crater is 154 km in diameter and named after American Astronomer Edward Holden (1846-1914). This image shows a mottled surface with channels, hills, ridges and impact craters. The largest crater seen in this image is 5 km in diameter. This crater has gullies and what appears to be horizontal layers in its walls. The Story With its beautiful symmetry and gullies radially streaming down to the floor, the dominant crater in this image is an impressive focal point. Yet, it is really just a small crater within a much larger one named Holden Crater. Take a look at the context image to the right to see just how much bigger Holden Crater is. Then come back to the image strip that shows the mottled surface of Holden Crater's eastern floor in greater detail, and count how many hills, ridges, channels, and small impact craters can be seen. No perfectly smooth terrain abounds there, that's for sure. The textured terrain of Holden Crater has been particularly intriguing ever since the Mars Orbital Camera on the Mars Global Surveyor spacecraft found evidence of sedimentary rock layers there that might have formed in lakes or shallow seas in Mars' ancient past. This finding suggests that Mars may have been more like Earth long ago, with water on its surface. Holden Crater might even have held a lake long ago. No one knows for sure, but it's an exciting possibility. Why? If water was once on the surface of Mars long enough to form sedimentary materials, maybe it was there long enough for microbial life to have developed too. (Life as we know it just isn't possible without the long-term presence of liquid water.) The question of life on the red planet is certainly tantalizing, but scientists will need to engage in a huge amount of further investigation to begin to know the answer. That

  20. Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors

    SciTech Connect

    Oh, Dongryul; Huh, Seung Jae Nam, Heerim; Park, Won; Han, Youngyih; Lim, Do Hoon; Ahn, Yong Chan; Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Lee, Je Ho

    2008-03-15

    Purpose: To investigate the incidence, clinical characteristics, and risk factors of pelvic insufficiency fracture (PIF) after pelvic radiotherapy (RT) in cervical cancer. Methods and Materials: Medical records and imaging studies, including bone scintigraphy, CT, and MRI of 557 patients with cervical cancer who received whole-pelvic RT between January 1998 and August 2005 were reviewed. Results: Eighty-three patients were diagnosed as having PIF after pelvic RT. The 5-year cumulative incidence of PIF was 19.7%. The most commonly involved site was the sacroiliac joint. Pelvic pain developed in 48 patients (57.8%) at diagnosis. Eleven patients (13.3%) needed admission or narcotics because of severe pain, and others had good relief of symptoms with conservative management. In univariate analysis, age {>=}55 years (p < 0.001), anteroposterior/posteroanterior parallel opposing technique (p = 0.001), curative treatment (p < 0.001), and radiation dose {>=}50.4 Gy (p = 0.005) were the predisposing factors for development of PIF. Concurrent chemotherapy (p = 0.78) was not significant. Multivariate analysis showed that age {>=}55 years (p < 0.001), body weight <55 kg (p = 0.02), curative treatment (p = 0.03), and radiation dose {>=}50.4 Gy (p = 0.04) were significant predisposing factors for development of PIF. Conclusion: The development of PIF is not rare after pelvic RT. The use of multibeam arrangements to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture, especially in elderly women with low body weight.

  1. Neutrino floor at ultralow threshold

    NASA Astrophysics Data System (ADS)

    Strigari, Louis E.

    2016-05-01

    By lowering their energy threshold, direct dark matter searches can reach the neutrino floor with experimental technology that is now in development. The 7Be flux can be detected with ˜10 eV nuclear recoil energy threshold and 50 kg/yr exposure. The p e p flux can be detected with ˜3 ton/yr exposure, and the first detection of the CNO flux is possible with similar exposure. The p p flux can be detected with threshold of ˜eV and only ˜ kg /yr exposure. These can be the first pure neutral current measurements of the low-energy solar neutrino flux. Measuring this flux is important for low mass dark matter searches and for understanding the solar interior.

  2. 16. THIRD FLOOR BLDG. 28A, DETAIL CUTOUT IN FLOOR FOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. THIRD FLOOR BLDG. 28A, DETAIL CUTOUT IN FLOOR FOR WOOD BLOCK FLOORING LOOKING EAST. - Fafnir Bearing Plant, Bounded on North side by Myrtle Street, on South side by Orange Street, on East side by Booth Street & on West side by Grove Street, New Britain, Hartford County, CT

  3. 9 CFR 91.26 - Concrete flooring.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Concrete flooring. 91.26 Section 91.26... LIVESTOCK FOR EXPORTATION Inspection of Vessels and Accommodations § 91.26 Concrete flooring. (a) Pens aboard an ocean vessel shall have a 3 inch concrete pavement, proportioned and mixed to give 2000...

  4. 9 CFR 91.26 - Concrete flooring.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Concrete flooring. 91.26 Section 91.26... LIVESTOCK FOR EXPORTATION Inspection of Vessels and Accommodations § 91.26 Concrete flooring. (a) Pens aboard an ocean vessel shall have a 3 inch concrete pavement, proportioned and mixed to give 2000...

  5. 9 CFR 91.26 - Concrete flooring.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Concrete flooring. 91.26 Section 91.26... LIVESTOCK FOR EXPORTATION Inspection of Vessels and Accommodations § 91.26 Concrete flooring. (a) Pens aboard an ocean vessel shall have a 3 inch concrete pavement, proportioned and mixed to give 2000...

  6. 9 CFR 91.26 - Concrete flooring.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Concrete flooring. 91.26 Section 91.26... LIVESTOCK FOR EXPORTATION Inspection of Vessels and Accommodations § 91.26 Concrete flooring. (a) Pens aboard an ocean vessel shall have a 3 inch concrete pavement, proportioned and mixed to give 2000...

  7. 9 CFR 91.26 - Concrete flooring.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Concrete flooring. 91.26 Section 91.26... LIVESTOCK FOR EXPORTATION Inspection of Vessels and Accommodations § 91.26 Concrete flooring. (a) Pens aboard an ocean vessel shall have a 3 inch concrete pavement, proportioned and mixed to give 2000...

  8. Floor Time: Rethinking Play in the Classroom

    ERIC Educational Resources Information Center

    Kordt-Thomas, Chad; Lee, Ilene M.

    2006-01-01

    Floor time is a play-based, one-to-one approach to helping children develop relationships, language, and thinking. Developed by child psychiatrist Stanley Greenspan, floor time is helpful not only for children with special needs but also for children who are developing typically. It can be used by teachers, caregivers, and families in brief…

  9. Learning4Life on the Exhibit Floor

    ERIC Educational Resources Information Center

    Sullivan, Margaret

    2009-01-01

    The exhibit floor is a wealth of knowledge. One can read, view, and listen to information presented in many formats. Somewhere on the exhibit floor there are experts on every topic, ready and waiting for one's questions. But like any research topic, frequently a structured search is required to find the best answers. This article discusses how to…

  10. Male chronic pelvic pain: An update

    PubMed Central

    Smith, Christopher P.

    2016-01-01

    Introduction: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and interstitial cystitis/bladder pain syndrome collectively referred to as urologic CPPS (UCPPS) is defined by the absence of identifiable bacterial infection as a cause for the chronic pain and urinary symptoms. Methods: A PubMed search of all recent relevant articles using the keywords/phrases: CPPS, CPPS, and male pelvic pain, was conducted. Results: CPPS has a high worldwide prevalence and its negative impact on quality of life compares with or exceeds common chronic morbidities. Triggers include certain comestibles as well as psychosocial factors that promote catastrophizing and illness focused behavior. Several validated tools are currently available to help diagnose and direct targeted therapy. Treatment should begin with the most simple and least invasive based on the presenting clinical phenotype. Conclusions: Although no gold-standard treatment exists, a multidisciplinary approach with multimodal therapy gives the UCPPS patient the best chance of symptom relief. PMID:26941492

  11. Pelvic Retroperitoneal Cellular Leiomyoma: A Case Report.

    PubMed

    Tantitamit, Tanitra; Hamontri, Suttha; Rangsiratanakul, Likit; Suksamarnwong, Maysita

    2015-10-01

    Leiomyomas are common benign gynecological tumors and usually arise in the uterus. The retroperitoneal cellular leiomyoma, one of the unusual manifestations, is a rare tumor. Diagnosis and treatment are challenges. We report a case of 65-year-old women presented with an asymptomatic mass beneath the right posterior vaginal mucosa. CT imaging revealed heterogeneous mass 6 cm in the pelvic cavity abutted lower segment of uterus, cervix, and vagina. The provisional diagnosis was subserosal cervical leiomyoma. She underwent exploratory laparotomy. Intra-operative, a normal size uterus was found separately from retroperitoneal pelvic mass at the level of internal os. Histological report confirmed cellular leiomyoma later Total hysterectomy, bilateral salpingoophorectomy and completely excision of tumor were achieved with good outcome. Our patient represents the rare case of retroperitoneal cellular leiomyoma, which is hardly identified from internal examination and preoperative imaging. Surgical removal is essential for pathological diagnosis and treatment. PMID:26817226

  12. Pessary use in advanced pelvic organ prolapse.

    PubMed

    Powers, Kenneth; Lazarou, George; Wang, Andrea; LaCombe, Julie; Bensinger, Giti; Greston, Wilma M; Mikhail, Magdy S

    2006-02-01

    The objective of this study was to review our experience with pessary use for advanced pelvic organ prolapse. Charts of patients treated for Stage III and IV prolapse were reviewed. Comparisons were made between patients who tried or refused pessary use. A successful trial of pessary was defined by continued use; a failed trial was defined by a patient's discontinued use. Thirty-two patients tried a pessary; 45 refused. Patients who refused a pessary were younger, had lesser degree of prolapse, and more often had urinary incontinence. Most patients (62.5%) continued pessary use and avoided surgery. Unsuccessful trial of pessary resorting to surgery included four patients (33%) with unwillingness to maintain, three patients (25%) with inability to retain and two patients (17%) with vaginal erosion and/or discharge. Our findings suggest that pessary use is an acceptable first-line option for treatment of advanced pelvic organ prolapse. PMID:15883856

  13. [Contraception and pelvic infection in women].

    PubMed

    Keith, L; Berger, G S; Brown, E R

    1986-01-01

    Although sexually transmitted diseases are a major public health problem at the international level, the relationship between contraception and pelvic infection is seldom examined. Numerous STDs are more difficult to diagnose, more frequent, and more serious in women than in men. Differential diagnosis between pelvic infection and other intraabdominal syndromes has been a concern for practitioners for years, and many pelvic infections are probably never diagnosed. Lower abdominal pain and sensitivity as well as fever, leucocytosis, accelerated sedimentation rate, inflammatory annexial mass evident on sonography, and microorganisms in the pouch of Douglass and presence of leucocytes in the peritoneal fluid are diagnostic criteria. Apart from errors in treatment resulting from errors in diagnosis, pelvic infections are often inadequately treated, especially in the initial phase before symptoms are confirmed. The exact incidence of pelvic infections in the US is unknown, but pelvic inflammatory disease (PID) accounted for over 200,000 hospitalizations per year between 1970-75. PID carries grave risks of subsequent ectopic pregnancy, chronic pelvic pain, and infertility which is more likely as the number of acute episodes increases. The female genital tract has diverse microenvironments propitious for growth of microorganisms of different types, aerobic and anaerobic. Each anatomic site has specific features conditioning bacterial growth. Histological modifications during the menstrual cycle and pregnancy affect the microbial flora. Except in the case of gonorrhea, it is not known how many female lower genital tract infections spread to the upper tract. Since 1970, several studies have domonstrated a growing diversity of cervical and vaginal flora in asymptomatic subjects. The principal risk factors for PID have been well described in the literature. All contraceptive methods except the IUD provide some degree of protection against PID. Even among IUD users the risk of

  14. Evaluation of vertical profiles to design continuous descent approach procedure

    NASA Astrophysics Data System (ADS)

    Pradeep, Priyank

    The current research focuses on predictability, variability and operational feasibility aspect of Continuous Descent Approach (CDA), which is among the key concepts of the Next Generation Air Transportation System (NextGen). The idle-thrust CDA is a fuel economical, noise and emission abatement procedure, but requires increased separation to accommodate for variability and uncertainties in vertical and speed profiles of arriving aircraft. Although a considerable amount of researches have been devoted to the estimation of potential benefits of the CDA, only few have attempted to explain the predictability, variability and operational feasibility aspect of CDA. The analytical equations derived using flight dynamics and Base of Aircraft and Data (BADA) Total Energy Model (TEM) in this research gives insight into dependency of vertical profile of CDA on various factors like wind speed and gradient, weight, aircraft type and configuration, thrust settings, atmospheric factors (deviation from ISA (DISA), pressure and density of the air) and descent speed profile. Application of the derived equations to idle-thrust CDA gives an insight into sensitivity of its vertical profile to multiple factors. This suggests fixed geometric flight path angle (FPA) CDA has higher degree of predictability and lesser variability at the cost of non-idle and low thrust engine settings. However, with optimized design this impact can be overall minimized. The CDA simulations were performed using Future ATM Concept Evaluation Tool (FACET) based on radar-track and aircraft type data (BADA) of the real air-traffic to some of the busiest airports in the USA (ATL, SFO and New York Metroplex (JFK, EWR and LGA)). The statistical analysis of the vertical profiles of CDA shows 1) mean geometric FPAs derived from various simulated vertical profiles are consistently shallower than 3° glideslope angle and 2) high level of variability in vertical profiles of idle-thrust CDA even in absence of

  15. Delaying pelvic exams to encourage contraceptive use.

    PubMed

    Donovan, P

    1992-01-01

    The Family Planning Council of Southeastern Pennsylvania created a project called Start Smart, permitting some new adolescent clients to delay blood tests and pelvic exams up to 6 months after their oral contraceptive prescription. The rationale for the trial is the perception that fear of the pelvic exam is one of the reasons why teen women delay coming to medical care for contraception for 1 year on average after becoming sexually active. 5 clinics participated in the pilot trial from November 1988 to March 1990, giving anticipatory counseling and follow-up telephone calls to all young women in the program, and permitting postponement of the medical work-up to certain teens in 3 of the clinics. Special waivers from the Department of Health and Human Services were needed to permit the exception under Title K. These women had a comprehensive family, social, and medical history, weight, height, blood pressure, urinalysis, and pregnancy test. 627 teens aged 11-17 participated in the pilot trail; 90% were already sexually active; 33% had been so for 1 year; 25% had never used contraception. 25% decided to delay pelvic exams and 40% elected to delay blood tests. Most accepted pelvic exams on their 2nd visit. Those who delayed attended the clinic slightly more often than did others. Although there were no significant results, there were also no adverse medical consequences, such as missed sexually transmitted disease infections. The staff participating in this trial thought the teens had an added sense of control over their medical care. PMID:1628718

  16. The Role of la Familia for Women of Mexican Descent Who Are Leaders in Higher Education

    ERIC Educational Resources Information Center

    Elizondo, Sandra Gray

    2012-01-01

    The purpose of this qualitative case study was to describe the role of "la familia" for women of Mexican descent as it relates to their development as leaders and their leadership in academia. Purposeful sampling was utilized to reach the goal of 18 participants who were female academic leaders of Mexican descent teaching full time in…

  17. The Yearly Variation in Fall-Winter Arctic Winter Vortex Descent

    NASA Technical Reports Server (NTRS)

    Schoeberl, Mark R.; Newman, Paul A.

    1999-01-01

    Using the change in HALOE methane profiles from early September to late March, we have estimated the minimum amount of diabatic descent within the polar which takes place during Arctic winter. The year to year variations are a result in the year to year variations in stratospheric wave activity which (1) modify the temperature of the vortex and thus the cooling rate; (2) reduce the apparent descent by mixing high amounts of methane into the vortex. The peak descent amounts from HALOE methane vary from l0km -14km near the arrival altitude of 25 km. Using a diabatic trajectory calculation, we compare forward and backward trajectories over the course of the winter using UKMO assimilated stratospheric data. The forward calculation agrees fairly well with the observed descent. The backward calculation appears to be unable to produce the observed amount of descent, but this is only an apparent effect due to the density decrease in parcels with altitude. Finally we show the results for unmixed descent experiments - where the parcels are fixed in latitude and longitude and allowed to descend based on the local cooling rate. Unmixed descent is found to always exceed mixed descent, because when normal parcel motion is included, the path average cooling is always less than the cooling at a fixed polar point.

  18. The ExoMars Entry & Descent system: an enabler for European planetary science

    NASA Astrophysics Data System (ADS)

    Lebleu, D.; Monier, J.; Marchand, B.; Squillaci, J.-R.; Lubrano, G.; Capus, P.; Laurenti, P.; Poncy, J.; Couzin, P.

    2013-09-01

    After HUYGENS and thanks to the ExoMars Entry and Descent System, Europe will confirm the capacity to land on planetary bodies. This presentation reports the development status of ExoMars EDM Entry & Descent system. All development tests are performed, and the subsystems flight models manufacturing are in progress.

  19. Miniature coherent velocimeter and altimeter (MCVA) for terminal descent control on lunar and planetary landers

    NASA Technical Reports Server (NTRS)

    Chang, Dan; Cardell, Greg; Szwaykowski, Piotr; Shaffat, Syed T.; Meras, Patrick

    2005-01-01

    While the overall architecture of an Entry Descent and Landing (EDL) system may vary depending on specific mission requirementsw, measurements of the rate vector with respect to the surface is a primary requirement for the Terminal Descent Control (TDC) phase of any controlled lander.

  20. Ethnic Identity and Acculturative Stress as Mediators of Depression in Students of Asian Descent

    ERIC Educational Resources Information Center

    Lantrip, Crystal; Mazzetti, Francesco; Grasso, Joseph; Gill, Sara; Miller, Janna; Haner, Morgynn; Rude, Stephanie; Awad, Germine

    2015-01-01

    This study underscored the importance of addressing the well-being of college students of Asian descent, because these students had higher rates of depression and lower positive feelings about their ethnic group compared with students of European descent, as measured by the Affirmation subscale of the Ethnic Identity Scale. Affirmation mediated…

  1. The treatment of pelvic inflammatory disease.

    PubMed

    Rees, E

    1980-12-01

    The treatment of pelvic inflammatory disease depends upon the etiology of the condition. Pelvic infection (PI) after parturition and abortion, gynecologic surgery, and a variety of invasive procedures is commonly associated with the isolation of anaerobic and aerobic flora of the vagina. The factors which influence the choice of antimicrobial treatment and the role of Bacteroides fragilis and Escherichia coli are discussed. Sexually transmissible agents of importance are Neisseria gonorrhoeae and Chlamydia trachomatis. Pelvic infections associated with these pathogens require antibiotics which exert an optimum effect against them. Examination and treatment of the sexual partner(s) are important. The possible role of the anaerobic and aerobic vaginal flora as opportunistic secondary pathogens is discussed. Developments in the surgical treatment of the sequelae of PID are reviewed. The results of treatment of uncomplicated gonorrhea in 262 women are reported. C. trachomatis was isolated from 53% of women before treatment. After treatment, PI developed in 11 women who had been given penicillin and in one woman who had been given tetracycline (P = 0.0071). It is suggested that recognition and treatment of postgonococcal cervicitis in women treated for uncomplicated gonorrhea with penicillin might provide one form of preventive treatment for nongonococcal PI. PMID:6894059

  2. Pelvic radiation disease: Updates on treatment options.

    PubMed

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-12-10

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  3. Pelvic radiation disease: Updates on treatment options

    PubMed Central

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-01-01

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  4. Apollo 16 LM-11 descent propulsion system final flight evaluation

    NASA Technical Reports Server (NTRS)

    Avvenire, A. T.

    1973-01-01

    The performance of the LM-11 Descent Propulsion System during the Apollo 16 Mission was evaluated and found to be satisfactory. The average engine effective specific impulse was 0.1 second higher than predicted, but well within the predicted 1 sigma uncertainty of 0.2 seconds. The engine performance corrected to standard inlet conditions for the FTP portion of the burn at 50 seconds after ignition was as follows: thrust, 9839 lbf; specific impulse, 306.9 sec; and propellant mixture ratio, 1.592. These values are +0.34, +0.03 and +0.0 percent different, respectively, from the values reported from engine acceptance tests and were within specification limits. Several flight measurement discrepancies that existed during the flight are discussed.

  5. Mars Exploration Rover: Launch, Cruise, Entry, Descent, and Landing

    NASA Technical Reports Server (NTRS)

    Erickson, James K.; Manning, Robert M.; Adler, M.

    2004-01-01

    The Mars Exploration Rover Project was an ambitious effort to land two highly capable rovers on Mars and concurrently explore the Martian surface for three months each. Launched in June and July of 2003, cruise operations were conducted through January 4, 2004 with the first landing, followed by the second landing on January 25. The prime mission for the second rover ended on April 27, 2004. This paper will provide an overview of the launch, cruise, and landing phases of the mission, including the engineering and science objectives and challenges involved in the selection and targeting of the landing sites, as well as the excitement and challenges of atmospheric entry, descent and landing execution.

  6. Mars Exploration Rover Mission: Entry, Descent, and Landing System Validation

    NASA Technical Reports Server (NTRS)

    Mitcheltree, Robert A.; Lee, Wayne; Steltzner, Adam; SanMartin, Alejanhdro

    2004-01-01

    System validation for a Mars entry, descent, and landing system is not simply a demonstration that the electrical system functions in the associated environments. The function of this system is its interaction with the atmospheric and surface environment. Thus, in addition to traditional test-bed, hardware-in-the-loop, testing, a validation program that confirms the environmental interaction is required. Unfortunately, it is not possible to conduct a meaningful end-to-end test of a Mars landing system on Earth. The validation plan must be constructed from an interconnected combination of simulation, analysis and test. For the Mars Exploration Rover mission, this combination of activities and the logic of how they combined to the system's validation was explicitly stated, reviewed, and tracked as part of the development plan.

  7. Time-controlled descent guidance in uncertain winds

    NASA Technical Reports Server (NTRS)

    Menga, G.; Erzberger, H.

    1975-01-01

    A procedure has been developed for constructing a statistical model of the altitude-dependent mean wind profile from the historical record of wind measurements at particular locations. The model is constructed by fitting a Markov process, with altitude as the stage variable, to the historical wind data. The wind model, together with the aircraft dynamics and the error characteristics of the navigation system, are incorporated in the design of a state estimator, which gives the minimum variance estimate of the aircraft state and the wind vector. The state and wind estimates are used as inputs to a linear feedback law for guiding the aircraft along the nominal trajectory. An example design of a time-constrained (4D RNAV) descent guidance system is presented, showing tracking accuracy, control activity, and probability of arrival time with and without the wind estimator.

  8. Overview of the Phoenix Entry, Descent and Landing System Architecture

    NASA Technical Reports Server (NTRS)

    Grover, Myron R., III; Cichy, Benjamin D.; Desai, Prasun N.

    2008-01-01

    NASA s Phoenix Mars Lander began its journey to Mars from Cape Canaveral, Florida in August 2007, but its journey to the launch pad began many years earlier in 1997 as NASA s Mars Surveyor Program 2001 Lander. In the intervening years, the entry, descent and landing (EDL) system architecture went through a series of changes, resulting in the system flown to the surface of Mars on May 25th, 2008. Some changes, such as entry velocity and landing site elevation, were the result of differences in mission design. Other changes, including the removal of hypersonic guidance, the reformulation of the parachute deployment algorithm, and the addition of the backshell avoidance maneuver, were driven by constant efforts to augment system robustness. An overview of the Phoenix EDL system architecture is presented along with rationales driving these architectural changes.

  9. Mars Exploration Rovers Entry, Descent, and Landing Trajectory Analysis

    NASA Technical Reports Server (NTRS)

    Desai, Prasun N.; Knocke, Philip C.

    2004-01-01

    The Mars Exploration Rover mission successfully landed two rovers "Spirit" and "Opportunity" on Mars on January 4th and 25th of 2004, respectively. The trajectory analysis performed to define the entry, descent, and landing (EDL) scenario is described. The entry requirements and constraints are presented, as well as uncertainties used in a Monte Carlo dispersion analysis to statistically assess the robustness of the entry design to off-nominal conditions. In the analysis, six-degree-of-freedom and three-degree-of-freedom trajectory results are compared to assess the entry characteristics of the capsule. Comparison of the preentry results to preliminary post-landing reconstruction data shows that all EDL parameters were within the requirements. In addition, the final landing position for both "Spirit" and "Opportunity" were within 15 km of the predicted landing location.

  10. RITD - Adapting Mars Entry, Descent and Landing System for Earth

    NASA Astrophysics Data System (ADS)

    Heilimo, Jyri; Aleksashkin, Sergey; Martynov, Maxim; Schmidt, Walter; Harri, Ari-Matti; Vsevolod Koryanov, D.; Kazakovtcev, Victor; Haukka, Harri; Arruego, Ignacio; Finchenko, Valery; Ostresko, Boris; Ponomarenko, Andrei; Martin, Susanna; Siili, Tero

    Abstract A new generation of inflatable Entry, Descent and Landing System (EDLS) or Mars has been developed. It is used in both the initial atmospheric entry and atmospheric descent before the semi-hard impact of the penetrator into Martian surface. The EDLS applicability to Earth’s atmosphere is studied by the EU/RITD [1] project. Project focuses to the analysis and tests of the transonic behaviour of this compact and light weight payload entry system at the Earth re-entry 1. EDLS for Earth The dynamical stability of the craft is analysed, concentrating on the most critical part of the atmospheric re-entry, the transonic phase. In Martian atmosphere the MetNet vehicle stability during the transonic phase is understood. However, in the more dense Earth’s atmosphere, the transonic phase is shorter and turbulence more violent. Therefore, the EDLS has to be sufficiently dynamically stable to overcome the forces tending to deflect the craft from its nominal trajectory and attitude. The preliminary design of the inflatable EDLS for Earth will be commenced once the scaling of the re-entry system and the dynamical stability analysis have been performed. The RITD-project concentrates on mission and applications achievable with the current MetNet-type (i.e. “Mini-1” category) of lander, and on requirements posed by other type Earth re-entry concepts. 2. Entry Angle Determination for Mini-1 - lander For successful Earth landing, the suitable re-entry angle and velocity with specific descent vehicle (DV) mass and heat flux parameters need to be determined. These key parameters in determining the Earth re-entry for DV are: - qmax (kW/m2): maximal specific heat flux, - Q (MJ/m2): specific integral heat flux to DV front shield, - m (kg): descent vehicle (DV) mass, - V (m/s): re-entry velocity and - theta(deg.): flight-path angle at Earth re-entry For Earth re-entry, the calculation results in the optimal value of entry velocity for MetNet (“Mini-1” category) -type

  11. RITD - Adapting Mars Entry, Descent and Landing System for Earth

    NASA Astrophysics Data System (ADS)

    Heilimo, Jyri; Harri, Ari-Matti; Aleksashkin, Sergey; Koryanov, Vsevolod; Arruego, Ignacio; Schmidt, Walter; Haukka, Harri; Finchenko, Valery; Martynov, Maxim; Ostresko, Boris; Ponomarenko, Andrey; Kazakovtsev, Viktor; Martin, Susanna; Siili, Tero

    2014-05-01

    A new generation of inflatable Entry, Descent and Landing System (EDLS) for Mars has been developed. It is used in both the initial atmospheric entry and atmospheric descent before the semi-hard impact of the penetrator into Martian surface. The EDLS applicability to Earth's atmosphere is studied by the EU/RITD [1] project. Project focuses to the analysis and tests of the transonic behaviour of this compact and light weight payload entry system at the Earth re-entry. 1. EDLS for Earth The dynamical stability of the craft is analysed, concentrating on the most critical part of the atmospheric re-entry, the transonic phase. In Martian atmosphere the MetNet vehicle stability during the transonic phase is understood. However, in the more dense Earth's atmosphere, the transonic phase is shorter and turbulence more violent. Therefore, the EDLS has to be sufficiently dynamically stable to overcome the forces tending to deflect the craft from its nominal trajectory and attitude. The preliminary design of the inflatable EDLS for Earth will be commenced once the scaling of the re-entry system and the dynamical stability analysis have been performed. The RITD-project concentrates on mission and applications achievable with the current MetNet-type (i.e. 'Mini-1' category) of lander, and on requirements posed by other type Earth re-entry concepts. 2. Entry Angle Determination for Mini-1 - lander For successful Earth landing, the suitable re-entry angle and velocity with specific descent vehicle (DV) mass and heat flux parameters need to be determined. These key parameters in determining the Earth re-entry for DV are: qmax (kW/m2): maximal specific heat flux, Q (MJ/m2): specific integral heat flux to DV front shield, m (kg): descent vehicle (DV) mass, V (m/s): re-entry velocity and Θ (deg.): flight-path angle at Earth re-entry For Earth re-entry, the calculation results in the optimal value of entry velocity for MetNet ('Mini-1' category) -type lander, with mass of 22kg, being

  12. The stabilization interval system of a tethered descent underwater vehicle

    NASA Astrophysics Data System (ADS)

    Gayvoronskiy, S. A.; Ezangina, T.; Khozhaev, I.; Efimov, S. V.

    2016-04-01

    To damp the vertical oscillations of a descent submersible caused by dusting the control system utilizing a shock-absorbing hoist located on the submersible was developed. A robust proportional-plus-integral action controller was included in the control loop to ensure acceptable dynamic properties of the system by interval variations of the module mass, the rope length, the equivalent value of stiffness of a spring linkage and the equivalent value of damping factor of the spring linkage. A parametric synthesis of the controller was carried out on the basis of the robust expansion of the coefficient method of the quality rating estimation. The system operability was confirmed by the results of the digital simulation parameters

  13. On Belonging: The American Adolescent of Arab Descent.

    PubMed

    Khouri, Lama Z

    2016-08-01

    Although American families of Arab origin come from 22 countries and from varied backgrounds and cultures, reports suggest that they suffer equally from acculturation stress, stereotyping, discrimination, and the reverberations of the aftermath of September 11 as well as global affairs. However, because children and adolescents from these families, particularly those who are newly arrived immigrants, tend to do well in school, they are rarely targeted by research or policy. This article uses the narratives of 5 middle school age male students from Arab descent who were in a support group that met for 3 years (2004-2007), beginning shortly after President George W. Bush's declaration of the war on the "axis of evil." I used vignettes from this group to illustrate the stressors this population faces. The final section suggests an option for supporting this population. PMID:27472891

  14. Adapting Mars Entry, Descent and Landing System for Earth

    NASA Astrophysics Data System (ADS)

    Heilimo, J.; Harri, A.-M.; Aleksashkin, S.; Koryanov, V.; Guerrero, H.; Schmidt, W.; Haukka, H.; Finchenko, V.; Martynov, M.; Ostresko, B.; Ponomarenko, A.; Kazakovtsev, V.; Arruego, I.; Martin, S.; Siili, T.

    2013-09-01

    In 2001 - 2011 an inflatable Entry, Descent and Landing System (EDLS) for Martian atmosphere was developed by FMI and the MetNet team. This MetNet Mars Lander EDLS is used in both the initial deceleration during atmospheric entry and in the final deceleration before the semi-hard impact of the penetrator to Martian surface. The EDLS design is ingenious and its applicability to Earth's atmosphere is studied in the on-going project. In particular, the behavior of the system in the critical transonic aerodynamic (from hypersonic to subsonic) regime will be investigated. This project targets to analyze and test the transonic behavior of this compact and light weight payload entry system to Earth's atmosphere [1]. Scaling and adaptation for terrestrial atmospheric conditions, instead of a completely new design, is a favorable approach for providing a new re-entry vehicle for terrestrial space applications.

  15. Y chromosome lineages in men of west African descent.

    PubMed

    Torres, Jada Benn; Doura, Menahem B; Keita, Shomarka O Y; Kittles, Rick A

    2012-01-01

    The early African experience in the Americas is marked by the transatlantic slave trade from ∼1619 to 1850 and the rise of the plantation system. The origins of enslaved Africans were largely dependent on European preferences as well as the availability of potential laborers within Africa. Rice production was a key industry of many colonial South Carolina low country plantations. Accordingly, rice plantations owners within South Carolina often requested enslaved Africans from the so-called "Grain Coast" of western Africa (Senegal to Sierra Leone). Studies on the African origins of the enslaved within other regions of the Americas have been limited. To address the issue of origins of people of African descent within the Americas and understand more about the genetic heterogeneity present within Africa and the African Diaspora, we typed Y chromosome specific markers in 1,319 men consisting of 508 west and central Africans (from 12 populations), 188 Caribbeans (from 2 islands), 532 African Americans (AAs from Washington, DC and Columbia, SC), and 91 European Americans. Principal component and admixture analyses provide support for significant Grain Coast ancestry among African American men in South Carolina. AA men from DC and the Caribbean showed a closer affinity to populations from the Bight of Biafra. Furthermore, 30-40% of the paternal lineages in African descent populations in the Americas are of European ancestry. Diverse west African ancestries and sex-biased gene flow from EAs has contributed greatly to the genetic heterogeneity of African populations throughout the Americas and has significant implications for gene mapping efforts in these populations. PMID:22295064

  16. Y Chromosome Lineages in Men of West African Descent

    PubMed Central

    Keita, Shomarka O. Y.; Kittles, Rick A.

    2012-01-01

    The early African experience in the Americas is marked by the transatlantic slave trade from ∼1619 to 1850 and the rise of the plantation system. The origins of enslaved Africans were largely dependent on European preferences as well as the availability of potential laborers within Africa. Rice production was a key industry of many colonial South Carolina low country plantations. Accordingly, rice plantations owners within South Carolina often requested enslaved Africans from the so-called “Grain Coast” of western Africa (Senegal to Sierra Leone). Studies on the African origins of the enslaved within other regions of the Americas have been limited. To address the issue of origins of people of African descent within the Americas and understand more about the genetic heterogeneity present within Africa and the African Diaspora, we typed Y chromosome specific markers in 1,319 men consisting of 508 west and central Africans (from 12 populations), 188 Caribbeans (from 2 islands), 532 African Americans (AAs from Washington, DC and Columbia, SC), and 91 European Americans. Principal component and admixture analyses provide support for significant Grain Coast ancestry among African American men in South Carolina. AA men from DC and the Caribbean showed a closer affinity to populations from the Bight of Biafra. Furthermore, 30–40% of the paternal lineages in African descent populations in the Americas are of European ancestry. Diverse west African ancestries and sex-biased gene flow from EAs has contributed greatly to the genetic heterogeneity of African populations throughout the Americas and has significant implications for gene mapping efforts in these populations. PMID:22295064

  17. Comparison of pelvic muscle architecture between humans and commonly used laboratory species

    PubMed Central

    Alperin, Marianna; Tuttle, Lori J.; Conner, Blair R.; Dixon, Danielle M.; Mathewson, Margie A.; Ward, Samuel R.

    2014-01-01

    Introduction and hypothesis Pelvic floor muscles (PFM) are deleteriously affected by vaginal birth, which contributes to the development of pelvic floor disorders. To mechanistically link these events, experiments using animal models are required, as access to human PFM tissue is challenging. In choosing an animal model, a comparative study of PFM design is necessary, since gross anatomy alone is insufficient to guide the selection. Methods Human PFM architecture was measured using micromechanical dissection and then compared with mouse (n=10), rat (n=10), and rabbit (n=10) using the Architectural Difference Index (ADI) (parameterizing a combined measure of sarcomere length-to-optimal-sarcomere ratio, fiber-to-muscle-length ratio, and fraction of total PFM mass and physiological cross-sectional area (PCSA) contributed by each muscle). Coccygeus (C), iliocaudalis (IC), and pubocaudalis (PC) were harvested and subjected to architectural measurements. Parameters within species were compared using repeated measures analysis of variance (ANOVA) with post hoc Tukey's tests. The scaling relationships of PFM across species were quantified using least-squares regression of log-10-transformed variables. Results Based on the ADI, rat was found to be the most similar to humans (ADI = 2.5), followed by mouse (ADI = 3.3). When animals' body mass was regressed against muscle mass, muscle length, fiber length, and PCSA scaling coefficients showed a negative allometric relationship or smaller increase than predicted by geometric scaling. Conclusion In terms of muscle design among commonly used laboratory animals, rat best approximates the human PFM, followed by mouse. Negative allometric scaling of PFM architectural parameters is likely due to the multifaceted function of these muscles. PMID:24915840

  18. Pelvic Static Magnetic Stimulation to Control Urinary Incontinence in Older Women: A Randomized Controlled Trial

    PubMed Central

    Wallis, Marianne C.; Davies, Elizabeth A.; Thalib, Lukman; Griffiths, Susan

    2012-01-01

    Objectives To determine the efficacy of non-invasive static magnetic stimulation (SMS) of the pelvic floor compared to placebo in the treatment of women aged 60 years and over with urinary incontinence for 6 months or more. Subjects and Methods A single-blinded randomized, placebo-controlled, parallel-group trial. Subjects were excluded if they had an implanted electronic device, had experienced a symptomatic urinary tract infection, or had commenced pharmacotherapy for the same in the previous 4 weeks, or if they were booked for pelvic floor or gynecological surgery within the next 3 months. Once written consent was obtained, subjects were randomly assigned to the active SMS group (n=50) or the placebo group (n=51). Treatment was an undergarment incorporating 15 static magnets of 800–1200 Gauss anterior, posterior, and inferior to the pelvis for at least 12 hours a day for 3 months. Placebo was the same protocol with inert metal disks replacing the magnets. Primary outcome measure was cessation of incontinence as measured by a 24-hour pad test. Secondary outcomes were frequency and severity of symptoms as measured by the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF), the Incontinence Severity Index, a Bothersomeness Visual Analog scale, and a 24-hour bladder diary. Data were collected at baseline and 12 weeks later. Results There were no statistically significant differences between groups in any of the outcome measures from baseline to 12 weeks. Initial evidence of subjective improvement in the treatment group compared to the placebo group was not sustained with sensitivity analysis. Conclusion This study found no evidence that static magnets cure or decrease the symptoms of urinary incontinence. Additional work into the basic physics of the product and garment design is recommended prior to further clinical trials research. PMID:21817123

  19. Ultrasonic Inspection Of The LTAB Floor

    SciTech Connect

    Thomas, G

    2001-07-31

    The National Ignition Facility's (NIF) floor is damaged by transporter operations. Two basic operations, rotating the wheels in place and traversing the floor numerous times can cause failure in the grout layer. The floor is composed of top wear surface (Stonhard) and an osmotic grout layer on top of concrete, Fig. 1. An ultrasonic technique was implemented to assess the condition of the floor as part of a study to determine the damage mechanisms. The study considered damage scenarios and ways to avoid the damage. A possible solution is to install thin steel plates where the transporter traverses on the floor. These tests were conducted with a fully loaded transporter that applies up to 1300 psi loads to the floor. A contact ultrasonic technique evaluated the condition of the grout layer in NIF's floor. Figure 1 displays the configuration of the ultrasonic transducer on the floor. We inspected the floor after wheel rotation damage and after wheel traversal damage. Figure 2a and 2b are photographs of the portable ultrasonic system and data acquisition. We acquired ultrasonic signals in a known pristine area and a damaged area to calibrate the inspection. Figure 3 is a plot of the typical ultrasonic response from an undamaged area (black) overlapped with a signal (red) from a damaged area. The damage area data was acquired at a location next to a hole in the floor that was caused by the transporter. Five megahertz pulses are propagated from the transducer and through a Plexiglas buffer rod into the floor. The ultrasonic pulse reflects from each discontinuity in the floor. The ultrasonic signal reflects from the top surface, the Stonhard-to-grout interface, and the grout to concrete interface. We expect to see reflections from each of these interfaces in an undamaged floor. If the grout layer pulverizes then the high frequency signal cannot traverse the layer and the grout to concrete interface signal will decrease or vanish. The more damage to the grout the more the

  20. The pain management approach to chronic pelvic pain.

    PubMed

    Rapkin, A J; Kames, L D

    1987-05-01

    Chronic pelvic pain remains a difficult management problem that is often refractory to traditional medical or surgical therapy. The pain management center approach used successfully for the treatment of cancer pain and headache can be adapted to the treatment of chronic pelvic pain. The results of this pilot study suggest that the multidisciplinary techniques of pain management promise to be an effective modality for the treatment of chronic pelvic pain. PMID:2439689