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  1. Pelvic Floor Disorders

    MedlinePlus

    ... NICHD Research Information Clinical Trials Resources and Publications Pelvic Floor Disorders: Condition Information Skip sharing on social media links Share this: Page Content What is the pelvic floor? The term "pelvic floor" refers to the group ...

  2. [Pelvic floor and pregnancy].

    PubMed

    Fritel, X

    2010-05-01

    Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders.

  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.

  4. [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.

  5. Laparoscopy for pelvic floor disorders.

    PubMed

    Van Geluwe, B; Wolthuis, A; D'Hoore, A

    2014-02-01

    Surgical treatment of pelvic floor disorders has significantly evolved during the last decade, with increasing understanding of anatomy, pathophysiology and the minimally-invasive 'revolution' of laparoscopic surgery. Laparoscopic pelvic floor repair requires a thorough knowledge of pelvic floor anatomy and its supportive components before repair of defective anatomy is possible. Several surgical procedures have been introduced and applied to treat rectal prolapse syndromes. Transabdominal procedures include a variety of rectopexies with the use of sutures or prosthesis and with or without resection of redundant sigmoid colon. Unfortunately there is lack of one generally accepted standard treatment technique. This article will focus on recent advances in the management of pelvic floor disorders affecting defecation, with a brief overview of contemporary concepts in pelvic floor anatomy and different laparoscopic treatment options.

  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. Pelvic Floor Ultrasound: A Review.

    PubMed

    Dietz, Hans Peter

    2017-03-01

    Female pelvic floor dysfunction encompasses a number of prevalent conditions and includes pelvic organ prolapse, urinary and fecal incontinence, obstructed defecation, and sexual dysfunction. In most cases neither etiology nor pathophysiology are well understood. Imaging has great potential to enhance both research and clinical management capabilities, and to date this potential is underutilized. Of the available techniques such as x-ray, computed tomography, magnetic resonance imaging, and ultrasound, the latter is generally superior for pelvic floor imaging, especially in the form of perineal or translabial imaging. The technique is safe, simple, cheap, easily accessible and provides high spatial and temporal resolutions.

  8. Functional anatomy of pelvic floor.

    PubMed

    Rocca Rossetti, Salvatore

    2016-03-31

    Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.

  9. The pelvic floor in health and disease.

    PubMed Central

    Shelton, A A; Welton, M L

    1997-01-01

    Normal pelvic floor function involves a set of learned and reflex responses that are essential for the normal control and evacuation of stool. A variety of functional disturbances of the pelvic floor, including incontinence and constipation, are not life threatening, but can cause significant distress to affected patients. Understanding the normal anatomy and physiology of the pelvic floor is essential to understanding and treating these disorders of defecation. This article describes the normal function of the pelvic floor, the diagnostic tools available to investigate pelvic floor dysfunction, and the etiology, diagnosis, and management of the functional pelvic floor disorders that lead to incontinence and constipation. Images Figure 1. PMID:9291746

  10. How Are Pelvic Floor Disorders Diagnosed?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How are pelvic floor disorders diagnosed? Skip sharing on social media links ... fee ). This test is used to evaluate the pelvic floor and rectum while the patient is having a ...

  11. 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.

  12. Obesity and pelvic floor dysfunction.

    PubMed

    Ramalingam, Kalaivani; Monga, Ash

    2015-05-01

    Obesity is associated with a high prevalence of pelvic floor disorders. Patients with obesity present with a range of urinary, bowel and sexual dysfunction problems as well as uterovaginal prolapse. Urinary incontinence, faecal incontinence and sexual dysfunction are more prevalent in patients with obesity. Uterovaginal prolapse is also more common than in the non-obese population. Weight loss by surgical and non-surgical methods plays a major role in the improvement of these symptoms in such patients. The treatment of symptoms leads to an improvement in their quality of life. However, surgical treatment of these symptoms may be accompanied by an increased risk of complications in obese patients. A better understanding of the mechanism of obesity-associated pelvic floor dysfunction is essential.

  13. 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.

  14. Ultrasound Imaging of the Pelvic Floor.

    PubMed

    Stone, Daniel E; Quiroz, Lieschen H

    2016-03-01

    This article discusses the background and appraisal of endoluminal ultrasound of the pelvic floor. It provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variability and pathology, such as prolapse, fecal incontinence, urinary incontinence, vaginal wall cysts, synthetic implanted material, and pelvic pain, are easily assessed with endoluminal vaginal ultrasound. With pelvic organ prolapse in particular, not only is the prolapse itself seen but the underlying cause related to the anatomic and functional abnormalities of the pelvic floor muscle structures are also visualized.

  15. Male pelvic floor: history and update.

    PubMed

    Dorey, Grace

    2005-08-01

    Our understanding of the male pelvic floor has evolved over more than 2,000 years. Gradually medical science has sought to dispel ancient myths and untruths. The male pelvic floor has many diverse functions. Importantly, it helps to support the abdominal contents, maintains urinary and fecal continence, and plays a major role in gaining and maintaining penile erection. Weakness of the male pelvic floor muscles may cause urinary and fecal incontinence and erectile dysfunction. Function may be restored in each of these areas by a comprehensive pelvic floor muscle training program. Spasm of the pelvic floor muscles may produce pain and require relaxation techniques. Additional research is needed to add further evidence to our knowledge base.

  16. [Functional anatomy of the female pelvic floor: interdisciplinary continence and pelvic floor surgery].

    PubMed

    Muctar, S; Schmidt, W U; Batzill, W; Westphal, J

    2011-07-01

    Knowledge of functional anatomy is a prerequisite for the safe and targeted reconstructive therapy of incontinence and the prolapse syndrome of the female pelvic floor. We illustrate the interaction of muscles and connective tissue of the pelvic floor with anatomical illustrations and demonstrate their impact on the function of the urethra, bladder, vagina, uterus and rectum. Examples for the therapeutic rationale for a surgical reconstruction of the pelvic floor are defined and justified from their functional anatomy.

  17. 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.

  18. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs.

    PubMed

    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.

  19. [Aging-related changes of the female pelvic floor].

    PubMed

    Scheiner, David; Betschart, Cornelia; Perucchini, Daniele

    2010-01-01

    The pelvic floor as lower closure of the abdominal cavity has to withstand the abdominal pressure. Meanwhile, the pelvic floor has to allow physiologic functions like micturition, defecation, sexual function and reproduction. But while pregnancy and vaginal delivery damage the pelvic floor directly, chronic stress like caugh, heavy lifting, or obesity lead to a chronic overstraining of the pelvic floor. Aging, structural changes, and possibly estrogen deficiency have a negative impact on the pelvic floor.

  20. 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

  1. The Impact of Pelvic Floor Disorders and Pelvic Surgery on Women's Sexual Satisfaction and Function.

    PubMed

    Yount, Susan M

    2013-01-01

    Pelvic floor disorders have a significant impact on women's daily lives. Sexual health, which includes sexual satisfaction and function, can be altered by pelvic floor disorders and pelvic surgery. This article reviews common pelvic floor disorders (pelvic organ prolapse, urinary and fecal incontinence) and the effect they have on sexual satisfaction and function. Associations between sexual function and pelvic floor disorders are described, as are the relationships between sexual function and pelvic surgery. Women of all ages need to know their options and understand the impact pelvic surgery can have on sexual satisfaction, function, and activity.

  2. 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

  3. PHYSICAL ACTIVITY AND THE PELVIC FLOOR

    PubMed Central

    Nygaard, Ingrid E.; Shaw, Janet M.

    2015-01-01

    Pelvic floor disorders (PFDs) are common, with one in four U.S. 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 is to summarize studies reporting the association between physical activity and PFDs. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include: 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 exam 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 women. However

  4. Female pelvic floor dysfunction--an imaging perspective.

    PubMed

    Dietz, Hans Peter

    2011-12-20

    Female pelvic floor dysfunction encompasses a range of morbidities, including urinary incontinence, female pelvic organ prolapse, anal incontinence and obstructed defecation. Patients often present with symptoms covered by several specialties including gastroenterology, colorectal surgery, urology and gynecology. Imaging can therefore bring clinicians from multiple specialties together by revealing that we frequently deal with different aspects of one underlying problem or pathophysiological process. This article provides an interdisciplinary imaging perspective on the pelvic floor. Modern pelvic floor imaging comprises defecation proctography, translabial and endorectal ultrasound, and static and dynamic MRI. This Perspectives focuses on the potential use of translabial ultrasound, including 3D and 4D applications, for diagnosis of pelvic floor disorders. Over the next decade, pelvic floor imaging will most likely be integrated into mainstream diagnostics in obstetrics and gynecology and colorectal surgery. Using imaging to facilitate communication between different specialties has the potential to greatly improve the multidisciplinary management of complex pelvic floor disorders.

  5. [Pelvic floor disorders from the surgeon's viewpoint].

    PubMed

    Schiedeck, T H

    2013-10-01

    Pelvic floor disorders present very differently with regard to symptoms and manifestation. Both diagnostic and treatment options require specific experience and an interdisciplinary approach. Diagnostic work-up is primarily based on medical history, physical examination and procto-rectoscopy. Furthermore, endosonography and perineal sonography have also gained importance. In almost all cases following these basic examinations conservative therapy options should be considered. As the interdisciplinary concept is very important, for careful diagnosis of pelvic floor disorders it became crucial to find an adequate form of treatment. Every decision for surgical therapy should not only focus on the results of previous examinations but should also consider the individual situation of each patient. In pelvic floor disorders a large variety of symptoms are confronted with a vast number of different and often highly specific procedures. The decisions on who to treat and how to treat are not only based on individual patient requests and desires but also on the experience and preference of the surgeon.

  6. Pelvic floor muscle training in males: practical applications.

    PubMed

    Siegel, Andrew L

    2014-07-01

    The pelvic floor muscles are vital to male genitourinary health. Pelvic floor muscle training may prove helpful in a variety of clinical circumstances: stress urinary incontinence that follows prostate surgery, overactive bladder, postvoid dribbling, erectile dysfunction, ejaculation issues including premature ejaculation, and pelvic pain due to levator muscle spasm.

  7. 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

  8. "How-To" Guide to Pelvic Floor Muscle Dysfunction.

    PubMed

    Albrecht, Katie B

    2015-09-01

    The purpose of this paper is to assist the clinician in recognizing pelvic floor muscle dysfunction in women with vulvar symptoms, to provide general treatment algorithms, and to facilitate understanding of the scientific rationale behind appropriate treatment. In short, this paper is meant to provide a "how-to" guide to pelvic floor pain management for the Ob/Gyn.

  9. 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

  10. Sexual function in women with pelvic floor disorders

    PubMed Central

    Rogers, Rebecca G.

    2013-01-01

    Pelvic floor disorders (PFDs) can impact sexual function. This summary provides an overview of the impact of stress urinary incontinence and pelvic organ prolapse and their treatments on sexual function. In general, interventions that successfully address PFDs will generally improve sexual function as well. However, there are patients whose sexual function will remain unchanged despite treatment, and a small but significant minority who will report worsened sexual function following treatment for their pelvic floor dysfunction. PMID:24523846

  11. 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

  12. 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

  13. Knowledge of the pelvic floor in nulliparous women.

    PubMed

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

    2016-05-01

    [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.

  14. Pelvic Floor and Urinary Distress in Women with Fibromyalgia.

    PubMed

    Jones, Kim Dupree; Maxwell, Charlene; Mist, Scott D; King, Virginia; Denman, Mary Anna; Gregory, W Thomas

    2015-12-01

    Fibromyalgia (FM) patients were recently found to have more symptom burden from bothersome pelvic pain syndromes that women seeking care for pelvic floor disease at a urogynecology clinic. We sought to further characterize pelvic floor symptoms in a larger sample of FM patients using of validated questionnaires. Female listserv members of the Fibromyalgia Information Foundation completed an online survey of three validated questionnaires: the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Pain, Urgency and Frequency Questionnaire (PUF), and the Revised Fibromyalgia Impact Questionnaire (FIQR). Scores were characterized using descriptive statistics. Patients (n = 204 with complete data on 177) were on average 52.3 ± 11.4 years with a mean parity of 2.5 ± 1.9. FM severity based on FIQR score (57.2 ± 14.9) positively correlated with PFDI-20 total 159.08 ± 55.2 (r = .34, p < .001) and PUF total 16.54 ± 7 (r = .36, p < .001). Women with FM report significantly bothersome pelvic floor and urinary symptoms. Fibromyalgia management should include evaluation and treatment of pelvic floor disorders recognizing that pelvic distress and urinary symptoms are associated with more severe FM symptoms. Validated questionnaires, like the ones used in this study, are easily incorporated into clinical practice.

  15. Role of pelvic floor in lower urinary tract function.

    PubMed

    Chermansky, Christopher J; Moalli, Pamela A

    2016-10-01

    The pelvic floor plays an integral part in lower urinary tract storage and evacuation. Normal urine storage necessitates that continence be maintained with normal urethral closure and urethral support. The endopelvic fascia of the anterior vaginal wall, its connections to the arcus tendineous fascia pelvis (ATFP), and the medial portion of the levator ani muscles must remain intact to provide normal urethral support. Thus, normal pelvic floor function is required for urine storage. Normal urine evacuation involves a series of coordinated events, the first of which involves complete relaxation of the external urethral sphincter and levator ani muscles. Acquired dysfunction of these muscles will initially result in sensory urgency and detrusor overactivity; however, with time the acquired voiding dysfunction can result in intermittent urine flow and incomplete bladder emptying, progressing to urinary retention in severe cases. This review will start with a discussion of normal pelvic floor anatomy and function. Next various injuries to the pelvic floor will be reviewed. The dysfunctional pelvic floor will be covered subsequently, with a focus on levator ani spasticity and stress urinary incontinence (SUI). Finally, future research directions of the interaction between the pelvic floor and lower urinary tract function will be discussed.

  16. 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

  17. Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction.

    PubMed

    Khan, Z A; Whittal, C; Mansol, S; Osborne, Lisa A; Reed, P; Emery, S

    2013-10-01

    The objective of this study was to determine the impact of the psychiatric symptoms of anxiety and depression, as assessed by validated questionnaires on the success of pelvic floor muscle training (PFMT). A prospective observational study was carried out by the Uro-gynaecological Physiotherapy Department at the Singleton Hospital, Swansea. A total of 108 consecutive women with pelvic floor dysfunction were referred for physiotherapy and admitted to the 6-month physiotherapy programme. They underwent subjective and objective assessments of their pelvic floor and psychological health at the beginning and end of the programme. A strong correlation was noted between the severity of anxiety and depression symptoms and the severity of their pelvic floor dysfunction. Following physiotherapy, apart from sexual function, all domains of pelvic floor dysfunction showed significant improvement. Based on the severity of their anxiety/depression symptoms, the patients were stratified into three groups. The group of patients that benefitted most had either no or only mild anxiety/depression. This study raises the question of whether a targeted approach should be undertaken for managing patients who, in addition to their pelvic floor dysfunction, demonstrate psychiatric symptoms.

  18. 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.

  19. 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.

  20. A strong pelvic floor: how nurses can spread the word.

    PubMed

    Berzuk, Kelli

    2007-02-01

    The pelvic floor contains muscles that support continence, sexual functioning, childbirth and more. Yet, few people even know these muscles exist or how important they are to overall health and well-being. This article explains in detail the anatomy, functions and importance of the pelvic floor musculature (PFM) and how nurses can educate and empower women of all ages about its important role in many aspects of their health and well-being. Accompanying this article is a patient education page with specific instructions on how to exercise the PFM.

  1. 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

  2. What harm does a second delivery to the pelvic floor?

    PubMed Central

    2010-01-01

    Objective To compare the pelvic floor function of primiparous women to women after a second delivery regarding symptoms of urinary and anal incontinence, anal sphincter ruptures and bladder-neck mobility. Methods A questionnaire evaluating symptoms of urinary and anal incontinence was used in nulliparous women before and 27 months after childbirth. Furthermore these symptoms were correlated with functional changes of the pelvic floor based on a careful gynecologic examination as well as perineal and endoanal ultrasound. Results 112 nulliparous women were included, 49 women returned for follow-up on average 27 months (SD 4.4 months) after the first delivery. 39 women (group A) had just one delivery, 10 women (group B - 10/49) had had a second delivery. Apart from levator ani muscle strength, no significant difference between pelvic floor function of group A vs group B was demonstrable. Furthermore, we could show no significant difference for symptoms of urinary (11 (28.2%) vs. 5 (50.0%)) and anal incontinence (14 (35.9%) vs. 4 (40.0%)) between both groups. However, we found a lasting increase of stress urinary and anal incontinence as well as overactive bladder symptoms after one or more deliveries. The position of the bladder neck at rest was lower in both groups compared to the position before the first delivery and bladder neck mobility increased after one or more deliveries. Discussion Our study shows several statistically significant changes of the pelvic floor function even on average 27 months after delivery, but a subsequent delivery did not compromise the pelvic floor any further. PMID:20947474

  3. 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.

  4. Functional anatomy of the female pelvic floor.

    PubMed

    Ashton-Miller, James A; DeLancey, John O L

    2007-04-01

    The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric and supportive systems. In the urethra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendinous arch of the pelvic fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vaginal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions.

  5. Study on the influence of the fetus head molding on the biomechanical behavior of the pelvic floor muscles, during vaginal delivery.

    PubMed

    Silva, M E T; Oliveira, D A; Roza, T H; Brandão, S; Parente, M P L; Mascarenhas, T; Natal Jorge, R M

    2015-06-25

    Pelvic floor injuries during vaginal delivery are considered a significant risk factor to develop pelvic floor dysfunction. The molding of the fetus head during vaginal delivery facilitates the labor progress, since it adjusts to the birth canal geometry. In this work, a finite element model was used to represent the effects induced by the passage of the fetus head on the pelvic floor. The numerical model used for this simulation included the pelvic floor muscles attached to the bones, and a fetus body. The model of the fetus head included the skin and soft tissues, the skull with sutures and fontanelles, and the brain. The fetus head movements during birth in vertex position were simulated: descent, internal rotation and extension. Two models of the fetus head were compared: a rigid and a deformable one, with the inclusion of the cranial sutures. The influence of the fetus head molding on the pelvic floor muscles was analyzed by evaluating their reaction forces, stretch, and stress and strain fields. Additionally, anatomical indices for the molding of the fetal skull were obtained and compared with clinical data. The passage of the deformable fetus head through the birth canal leads to a reduction of 17.3% on the reaction forces on the pelvic floor muscles when compared to the ones of a rigid head. Furthermore, the fetus head molding implies inferior resistance to rotation resulting in a reduction of 1.86% in muscle stretching. Quantitative evaluation of the fetus head molding showed good agreement with clinical experiments.

  6. Accuracy of concepts in female pelvic floor anatomy: facts and myths!

    PubMed

    Fritsch, H; Zwierzina, M; Riss, P

    2012-08-01

    The pelvic floor is characterized by a complex morphology because different functional systems join here. Since a clear understanding of the pelvic floor region is crucial for female pelvic surgery and fundamental mechanisms of urogenital dysfunction and treatment, we here describe the accurate and functional anatomy of important pelvic structures and landmarks, clarify their terminology and point out possible errors or misunderstandings as to their existence.

  7. Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? Radiologic and manometric studies in 41 patients.

    PubMed

    Siproudhis, L; Ropert, A; Lucas, J; Raoul, J L; Heresbach, D; Bretagne, J F; Gosselin, M

    1992-06-01

    A consecutive series of 41 patients with defecatory disorders was prospectively studied by anal manometry and evacuation proctography to determine the relationship between abnormalities and symptoms. The patients (29 female, 12 male, aged 41 +/- 2.3 years) all complained of difficulty in evacuation. All had normal colonoscopy and biochemistry. There was no evidence of megacolon or megarectum, and no symptoms had been previously treated by pelvic floor surgery. All subjects completed detailed questionnaires related to gastrointestinal symptoms with special reference to excessive straining and discomfort, digital manipulations during defecation, a sense of pelvic heaviness and incomplete evacuation. Each patient underwent clinical examination, anal manometry and defecography during a single outpatient visit. Rectocele (16 patients) was significantly associated with vaginal digitation, lower stool frequency, delayed rectal emptying and decreased rectal sensation to distension. Increased anal pressure on straining (14 patients) was also related to a poor rectal emptying in 13 patients. Neither perineal descent (24 patients) nor external rectal prolapse (12 patients) was related to objective obstruction. Nevertheless there was an association with pelvic heaviness and lower anal manometric recordings. Five among 16 patients with rectocele had manometric anismus. Forty percent of patients with intussusception also had a paradoxical sphincter response during defaecation. Furthermore, associated abnormalities were extremely common (34 of 41 patients), accurate interpretation of which was necessary for planning effective therapy.

  8. The Virtual Pelvic Floor, a tele-immersive educational environment.

    PubMed Central

    Pearl, R. K.; Evenhouse, R.; Rasmussen, M.; Dech, F.; Silverstein, J. C.; Prokasy, S.; Panko, W. B.

    1999-01-01

    This paper describes the development of the Virtual Pelvic Floor, a new method of teaching the complex anatomy of the pelvic region utilizing virtual reality and advanced networking technology. Virtual reality technology allows improved visualization of three-dimensional structures over conventional media because it supports stereo vision, viewer-centered perspective, large angles of view, and interactivity. Two or more ImmersaDesk systems, drafting table format virtual reality displays, are networked together providing an environment where teacher and students share a high quality three-dimensional anatomical model, and are able to converse, see each other, and to point in three dimensions to indicate areas of interest. This project was realized by the teamwork of surgeons, medical artists and sculptors, computer scientists, and computer visualization experts. It demonstrates the future of virtual reality for surgical education and applications for the Next Generation Internet. Images Figure 1 Figure 2 Figure 3 PMID:10566378

  9. A review of functional pelvic floor imaging modalities and their effectiveness.

    PubMed

    Ahmad, Aminah N; Hainsworth, Alison; Williams, Andrew B; Schizas, Alexis M P

    2015-01-01

    The anatomy of the pelvic floor is complex and clinical examination alone is often insufficient to diagnose and assess pathology. With a greater understanding of pelvic floor dysfunction and treatment options, imaging is becoming increasingly common. This review compares three imaging techniques. Ultrasound has the potential for dynamic assessment of the entire pelvic floor. Magnetic resonance imaging is able to rapidly image the entire pelvic floor but it is expensive and tends to underestimate pathology. Dynamic defaecating proctography or cystocolpoproctography is the current gold standard for posterior compartment imaging but requires opacification of the bladder to provide a global view.

  10. The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update.

    PubMed

    Hallock, Jennifer L; Handa, Victoria L

    2016-03-01

    Using a lifespan model, this article presents new scientific findings regarding risk factors for pelvic floor disorders (PFDs), focusing on the role of childbirth in the development of single or multiple coexisting PFDs. Phase I of the model includes predisposing factors, such as genetic predisposition and race. Phase II includes inciting factors, such as obstetric events. Prolapse, urinary incontinence (UI), and fecal incontinence (FI) are more common among vaginally parous women, although the impact of vaginal delivery on risk of FI is less dramatic than prolapse and UI. Phase III includes intervening factors, such as age and obesity.

  11. Cortical activation associated with muscle synergies of the human male pelvic floor.

    PubMed

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

    2014-10-08

    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.

  12. 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

  13. 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

  14. Medical and surgical management of pelvic floor disorders affecting defecation.

    PubMed

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

    2012-11-01

    Pelvic floor disorders that affect stool evacuation include structural (for example, rectocele) and functional disorders (for example, dyssynergic defecation (DD)). Meticulous history, digital rectal examination (DRE), and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion, and imaging studies such as anal ultrasound, defecography, and static and dynamic magnetic resonance imaging (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 finally surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating DD. Because DD may coexist 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 transabdominal approach, stapled transanal rectal resection, and robotic colon and rectal resections. However, there is lack of well-controlled randomized studies and the efficacy of these surgical procedures remains to be established.

  15. 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

  16. Pelvic Floor Disorders in Female Veterans: What a Difference an X Makes

    DTIC Science & Technology

    2011-07-22

    PELVIC FLOOR DISORDERS IN FEMALE VETERANS What a difference an X Makes July 22, 2011 Christine L. G. Sears MD CDR MC USN Report Documentation Page...DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Pelvic Floor Disorders in Female Veterans 5a. CONTRACT NUMBER 5b. GRANT NUMBER...Urinary Tract Infection and related symptoms  Pelvic Organ Prolapse  Urinary Incontinence  Bladder Pain Syndrome  Graphics non intrusive  Discuss

  17. 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

  18. Significant Linkage Evidence for a Predisposition Gene for Pelvic Floor Disorders on Chromosome 9q21

    PubMed Central

    Allen-Brady, Kristina; Norton, Peggy A.; Farnham, James M.; Teerlink, Craig; Cannon-Albright, Lisa A.

    2009-01-01

    Predisposition factors for pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress urinary incontinence (SUI), urge urinary incontinence (UUI), and hernias, are not well understood. We assessed linkage evidence for PFDs in mostly sister pairs who received treatment for moderate-to-severe POP. We genotyped 70 affected women of European descent from 32 eligible families with at least two affected cases by using the Illumina 1 million single-nucleotide polymorphism (SNP) marker set. Parametric linkage analysis with general dominant and recessive models was performed by the Markov chain Monte Carlo linkage analysis method, MCLINK, and a set of SNPs was formed, from which those in high linkage disequilibrium were eliminated. Significant genome-wide evidence for linkage was identified on chromosome 9q21 with a HLOD score of 3.41 under a recessive model. Seventeen pedigrees (53%) had at least nominal evidence for linkage on a by-pedigree basis at this region. These results provide evidence for a predisposition gene for PFDs on chromosome 9q. PMID:19393595

  19. Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

    PubMed Central

    Sultan, Abdul H; Stankiewicz, Aleksandra; Thakar, Ranee

    2016-01-01

    Objective: To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. Methods: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) 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. PFUS measurements were independently analysed by two clinicians. Results: 158 females had PFUS assessment. Good-to-excellent interobserver agreement was observed for bladder–symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland–Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. Conclusion: Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. Advances in knowledge: We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor. PMID:26800394

  20. Modeling the contraction of the pelvic floor muscles.

    PubMed

    Brandão, Fernanda Sofia Quintela da Silva; Parente, Marco Paulo Lages; Rocha, Paulo Alexandre Gomes Gonçalves; Saraiva, Maria Teresa da Quinta E Costa de Mascarenhas; Ramos, Isabel Maria Amorim Pereira; Natal Jorge, Renato Manuel

    2016-01-01

    We performed numerical simulation of voluntary contraction of the pelvic floor muscles to evaluate the resulting displacements of the organs and muscles. Structures were segmented in Magnetic Resonance (MR) images. Different material properties and constitutive models were attributed. The Finite Element Method was applied, and displacements were compared with dynamic MRI findings. Numerical simulation showed muscle magnitude displacement ranging from 0 to 7.9 mm, more evident in the posterior area. Accordingly, the anorectum moved more than the uterus and bladder. Dynamic MRI showed less 0.2 mm and 4.1 mm muscle dislocation in the anterior and cranial directions, respectively. Applications of this model include evaluating muscle impairment, subject-specific mesh implant planning, or effectiveness of rehabilitation.

  1. The epidemiology of pelvic floor disorders and childbirth: an update

    PubMed Central

    Hallock, Jennifer L.; Handa, Victoria L.

    2015-01-01

    SYNOPSIS Using a life span model, this article presents new scientific findings regarding risk factors for pelvic floor disorders (PFDs), with a focus on the role of childbirth in the development of single or multiple co-existing PFDs. Phase I of the life span model includes predisposing factors such as genetic predisposition and race. Phase II of the model includes inciting factors such as obstetric events. Prolapse, urinary incontinence (UI) and fecal incontinence (FI) are more common among vaginally parous women, although the impact of vaginal delivery on risk of FI is less dramatic than for prolapse and UI. Finally, Phase III includes intervening factors such as age and obesity. Both age and obesity are associated with prevalence of PFDs. The prevention and treatment of obesity is an important component to PFD prevention. PMID:26880504

  2. 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

  3. 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

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

    PubMed

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

    2016-06-03

    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.

  5. 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.

  6. Measuring morphological parameters of the pelvic floor for finite element modelling purposes.

    PubMed

    Janda, Stepán; van der Helm, Frans C T; de Blok, Sjoerd B

    2003-06-01

    The goal of this study was to obtain a complete data set needed for studying the complex biomechanical behaviour of the pelvic floor muscles using a computer model based on the finite element (FE) theory. The model should be able to predict the effect of surgical interventions and give insight into the function of pelvic floor muscles. Because there was a lack of any information concerning morphological parameters of the pelvic floor muscle structures, we performed an experimental measurement to uncover those morphological parameters. Geometric parameters as well as muscle parameters of the pelvic floor muscles were measured on an embalmed female cadaver. A three-dimensional (3D) geometric data set of the pelvic floor including muscle fibre directions was obtained using a palpator device. A 3D surface model based on the experimental data, needed for mathematical modelling of the pelvic floor, was created. For all parts of the diaphragma pelvis, the optimal muscle fibre length was determined by laser diffraction measurements of the sarcomere length. In addition, other muscle parameters such as physiological cross-sectional area and total muscle fibre length were determined. Apart from these measurements we obtained a data set of the pelvic floor structures based on nuclear magnetic resonance imaging (MRI) on the same cadaver specimen. The purpose of this experiment was to discover the relationship between the MRI morphology and geometrical parameters obtained from the previous measurements. The produced data set is not only important for biomechanical modelling of the pelvic floor muscles, but it also describes the geometry of muscle fibres and is useful for functional analysis of the pelvic floor in general. By the use of many reference landmarks all these morphologic data concerning fibre directions and optimal fibre length can be morphed to the geometrical data based on segmentation from MRI scans. These data can be directly used as an input for building a

  7. 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.

  8. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series.

    PubMed

    O'Sullivan, Peter B; Beales, Darren J

    2007-08-01

    This study was a case series design. The objectives of the study were to investigate the ability of a motor learning intervention to change aberrant pelvic floor and diaphragm kinematics and respiratory patterns observed in subjects with sacroiliac joint pain (SIJP) during the active straight leg raise (ASLR) test. The ASLR test is a valid and reliable tool to assist in the assessment of load transference through the pelvis. Irregular respiratory patterns, decreased diaphragmatic excursion and descent of the pelvic floor have been reported in subjects with SIJP during this test. To date the ability to alter these patterns has not been determined. Respiratory patterns, kinematics of the diaphragm and pelvic floor during the ASLR test and the ability to consciously elevate the pelvic floor in conjunction with changes in pain and disability levels were assessed in nine subjects with a clinical diagnosis of SIJP. Each subject then undertook an individualized motor learning intervention. The initial variables were then reassessed. Results showed that abnormal kinematics of the diaphragm and pelvic floor during the ASLR improved following intervention. Respiratory patterns were also influenced in a positive manner. An inability to consciously elevate the pelvic floor pre-treatment was reversed. These changes were associated with improvement in pain and disability scores. This study provides preliminary evidence that aberrant motor control strategies in subjects with SIJP during the ASLR can be enhanced with a motor learning intervention. Positive changes in motor control were associated with improvements in pain and disability. Randomized controlled research is required to validate these results.

  9. Assessment of sexual function in women with pelvic floor dysfunction.

    PubMed

    Kammerer-Doak, Dorothy

    2009-05-01

    This article reviews sexual function questionnaires used in urogynecology, impact of pelvic floor dysfunction (PFD) on sexual function, and impact of surgical treatment of PFD on sexual function, with a focus on the experience and publications of validated sexual function questionnaires in the urogynecologic literature. A review of the literature was performed to obtain data on sexual function and PFD focusing on those studies that utilized validated sexual function questionnaires. Validated questionnaires assure data that are reliable, quantifiable, and reproducible. Quality-of-life questionnaires, such as The King's Health Questionnaire and the Incontinence Impact Questionnaire, include a few questions addressing sexual function but really deal with the overall impact of incontinence and/or prolapse on the patient's QOL or well-being and do not focus on sexual function. General questionnaires focused on sexual function include the Female Sexual Function Index and the Sexual History Form 12, which were designed to evaluate sexual function and have undergone validation and reliability testing in a general population. General questionnaires are not condition-specific and may not be sensitive enough to detect differences due to PFD. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ) is a condition-specific questionnaire focused on sexual function for use in women with PFD and has undergone rigorous validation and reliability testing. Many recent publications examining the impact of urinary incontinence (UI), fecal incontinence, and pelvic organ prolapse (POP) using validated generalized and disease-specific questionnaires have reported poorer sexual function in women with PFD. The PISQ has been used most commonly to evaluate sexual function after surgery for PFD, with increased PISQ scores in approximately 70%. Significant improvement is noted for sexual function related to physical and partner-related factors, with no changes for orgasm

  10. Role of conventional radiology and MRi defecography of pelvic floor hernias

    PubMed Central

    2013-01-01

    Background Purpose of the study is to define the role of conventional radiology and MRI in the evaluation of pelvic floor hernias in female pelvic floor disorders. Methods A MEDLINE and PubMed search was performed for journals before March 2013 with MeSH major terms 'MR Defecography' and 'pelvic floor hernias'. Results The prevalence of pelvic floor hernias at conventional radiology was higher if compared with that at MRI. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on conventional radiology than on MRI, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at conventional radiology was significantly higher than that at MRI. Conclusions MRI shows lower sensitivity than conventional radiology in the detection of pelvic floor hernias development. The less-invasive MRI may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery. PMID:24267789

  11. 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

  12. Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence.

    PubMed

    Chen, Shu-Yueh; Tzeng, Ya-Ling

    2009-06-01

    This study developed and tested the accuracy of a model designed to predict adherence to a pelvic floor muscle exercise regimen by Taiwanese women with urinary incontinence. The sample was composed of 106 women treated for urinary incontinence at urban hospitals in central and northern Taiwan from April 2000 to March 2003. All participants had practiced prescribed pelvic floor muscle exercises for at least 6 weeks at the time they completed study measures, which included adherence to pelvic floor muscle exercise, self-efficacy for the exercise, knowledge of the exercise, attitudes toward the exercise, dyadic cohesion, perceived benefits of the exercise, and severity of urine loss. After stepwise multiple regression analysis, a path analysis was conducted, with significant paths retained as modifiers. Self-efficacy for pelvic floor muscle exercise strongly and directly affected adherence to the exercise regimen. Attitudes toward the exercise, dyadic cohesion, and perceived benefits of the exercise affected adherence when mediated by self-efficacy for pelvic floor muscle exercise. Severity of urine loss also directly affected adherence. Exercise knowledge affected neither self-efficacy nor adherence. The model fit the data and accounted for 40% of adherence variance. Findings affirm the significant role of self-efficacy in predicting adherence to pelvic floor muscle exercise. Thus, self-efficacy for exercise can be an indicator for nurses to tailor exercise-training programs for women with urinary incontinence. Nurses can use the study findings to develop interventions to increase women's adherence to the exercise.

  13. Hip and groin pain in a cyclist resolved after performing a pelvic floor fascial mobilization.

    PubMed

    Navot, Sivan; Kalichman, Leonid

    2016-07-01

    Pelvic floor muscle assessment in situations of hip/groin pain in both male and female patients can be a key element in treatment success. We present herein, a 32 year old male professional cyclist, exhibiting right hip and groin pain during cycling and prolonged sitting. The pain commenced after the patient suffered a right hip severe contusion in 2013 causing a tear in the tensor fascia lata and gluteus medius muscle. The patient did not complain of pelvic floor dysfunctions. After receiving several series of conventional physical therapy for the hip/groin pain, the patient experienced partial pain relief and slight improvement of hip range of motion. His pelvic floor muscles and fascial involvement were subsequently assessed. Two sessions of Pelvic Floor Fascial Mobilization (PFFM) were performed and the patient fully recovered. The authors suggest that PFFM, a novel fascial-oriented manual therapy of the pelvic floor approach, can be used for both hip/groin and pelvic floor pain or dysfunction.

  14. Childbirth and pelvic floor dysfunction: An epidemiologic approach to the assessment of prevention opportunities at delivery

    PubMed Central

    Patel, Divya A.; Xu, Xiao; Thomason, Angela D.; Ransom, Scott B.; Ivy, Julie S.; DeLancey, John O. L.

    2006-01-01

    Female pelvic floor dysfunction is integral to the woman’s role in the reproductive process, largely because of the unique anatomic features that facilitate vaginal birth and also because of the trauma that can occur during that event. Interventions such as primary elective cesarean delivery have been discussed for the primary prevention of pelvic floor dysfunction; however, existing data about potentially causal factors limit our ability to evaluate such strategies critically. Here we consider the conceptual principles of epidemiologic function and the availability of data that are necessary to make informed recommendations about prevention opportunities for pelvic floor dysfunction at delivery. Available epidemiologic data on pelvic floor dysfunction suggest that there may be substantial opportunities for the primary prevention of pelvic organ prolapse at delivery. Although definitive recommendations await further epidemiologic studies of the potential risk and benefits of obstetric practice change, it is hoped that this discussion will provide a novel, quantitative framework for the assessment of pelvic floor dysfunction prevention opportunities. PMID:16579934

  15. 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.

  16. Knowledge of the pelvic floor in menopausal women and in peripartum women.

    PubMed

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

    2016-11-01

    [Purpose] Pelvic floor dysfunction is an important health-care issue, with pregnancy, childbirth, and menopause as the most important risk factors. Insufficient knowledge about pelvic floor dysfunction is the largest barrier to seeking care. The aim of this study was to investigate the level of knowledge and information on pelvic floor dysfunction in peripartum and menopausal women. [Subjects and Methods] The present study was a cross-sectional survey. A valid and reliable questionnaire of 48 items was distributed to 402 women who were pregnant or had recently given birth and to 165 postmenopausal women. All answers were analyzed and interpreted. The study was approved by an ethics committee (B300201318334). [Results] On a VAS scale of 0 to 10, the mean ratings of the peripartum and postmenopausal women concerning their knowledge were 4.38 (SD 2.71) and 4.92 (SD 2.72). Peripartum women held significantly more pessimistic perceptions about the occurrence of postpartum pelvic floor dysfunction. The results showed that 75% of the peripartum women and 68% of the postmenopausal women felt insufficiently informed or want to get better informed. [Conclusion] The results reveal sparse knowledge about the pelvic floor among women of all ages and that a major proportion of them would be interested in more information. Amelioration of common knowledge could improve help-seeking behavior in women.

  17. Knowledge of the pelvic floor in menopausal women and in peripartum women

    PubMed Central

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

    2016-01-01

    [Purpose] Pelvic floor dysfunction is an important health-care issue, with pregnancy, childbirth, and menopause as the most important risk factors. Insufficient knowledge about pelvic floor dysfunction is the largest barrier to seeking care. The aim of this study was to investigate the level of knowledge and information on pelvic floor dysfunction in peripartum and menopausal women. [Subjects and Methods] The present study was a cross-sectional survey. A valid and reliable questionnaire of 48 items was distributed to 402 women who were pregnant or had recently given birth and to 165 postmenopausal women. All answers were analyzed and interpreted. The study was approved by an ethics committee (B300201318334). [Results] On a VAS scale of 0 to 10, the mean ratings of the peripartum and postmenopausal women concerning their knowledge were 4.38 (SD 2.71) and 4.92 (SD 2.72). Peripartum women held significantly more pessimistic perceptions about the occurrence of postpartum pelvic floor dysfunction. The results showed that 75% of the peripartum women and 68% of the postmenopausal women felt insufficiently informed or want to get better informed. [Conclusion] The results reveal sparse knowledge about the pelvic floor among women of all ages and that a major proportion of them would be interested in more information. Amelioration of common knowledge could improve help-seeking behavior in women. PMID:27942113

  18. 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

  19. Testing of the Anorectal and Pelvic Floor Area

    MedlinePlus

    ... minutes and is well tolerated by most people. Balloon capacity and compliance A balloon capacity and compliance ... while measurements of volume and pressure are recorded. Balloon evacuation study A balloon evacuation study tests pelvic ...

  20. Tissue Selective Androgen Receptor Modulators (SARMs) Increase Pelvic Floor Muscle Mass in Ovariectomized Mice.

    PubMed

    Ponnusamy, Suriyan; Sullivan, Ryan D; Thiyagarajan, Thirumagal; Tillmann, Heather; Getzenberg, Robert H; Narayanan, Ramesh

    2017-03-01

    Stress urinary incontinence (SUI), a prevalent condition, is represented by an involuntary leakage of urine that results, at least in part, from weakened or damaged pelvic floor muscles and is triggered by physical stress. Current treatment options are limited with no oral therapies available. The pelvic floor is rich in androgen receptor and molecules with anabolic activity including selective androgen receptor modulators (SARMs) may serve as therapeutic options for individuals with SUI. In this study, two SARMs (GTx-024 and GTx-027) were evaluated in a post-menopausal animal model in order to determine their effect on pelvic floor muscles. Female C57BL/6 mice were ovariectomized and their pelvic muscles allowed to regress. The animals were then treated with vehicle or doses of GTx-024 or GTx-027. Animal total body weight, lean body mass, and pelvic floor muscle weights were measured along with the expression of genes associated with muscle catabolism. Treatment with the SARMs resulted in a restoration of the pelvic muscles to the sham-operated weight. Coordinately, the induction of genes associated with muscle catabolism was inhibited. Although a trend was observed towards an increase in total lean body mass in the SARM-treated groups, no significant differences were detected. Treatment of an ovariectomized mouse model with SARMs resulted in an increase in pelvic floor muscles, which may translate to an improvement of symptoms associated with SUI and serves as the basis for evaluating their clinical use. J. Cell. Biochem. 118: 640-646, 2017. © 2016 Wiley Periodicals, Inc.

  1. 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

  2. [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.

  3. Registries as Tools for Clinical Excellence and the Development of the Pelvic Floor Disorders Registry.

    PubMed

    Weber LeBrun, Emily E

    2016-03-01

    Surgical device innovation has been less regulated than drug development, allowing integration of unproven techniques and materials into standard practice. Successful device registries gather information on patient outcomes and can provide postmarket surveillance of new technologies and allow comparison with currently established treatments or devices. The Pelvic Floor Disorders Registry was developed in collaboration with the Food and Drug Administration, device manufacturers, and other stakeholders to serve as a platform for industry-sponsored postmarket device surveillance, investigator-initiated research, and quality and effectiveness benchmarking, all designed to improve the care of women with pelvic floor disorders.

  4. 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

  5. Comparison of bony dimensions at the level of the pelvic floor in women with and without pelvic organ prolapse

    PubMed Central

    Stein, Tamara A.; Kaur, Gurpreet; Summers, Aimee; Larson, Kindra A.; Delancey, John O. L.

    2010-01-01

    Objective Compare bony pelvis dimensions at the level of pelvic support in women with and without pelvic organ prolapse (POP). Study Design Pelvic floor dimensions of 42 Caucasian women with POP ≥ 1cm beyond the hymen were compared to 42 age and parity-matched women with normal support. Bony landmarks relevant to connective tissue and levator attachments were identified on MRI. Dimensions were independently measured by two examiners and averaged for each subject. Results Measurements (cms) for cases and controls are as follows: Interspinous Diameter, 11.2±0.8 vs. 11.1±0.7, p=0.19; Anterior-Posterior Outlet Diameter, 11.7±0.7 vs. 11.7±0.8, p=0.71; Pubic Symphysis to Ischial Spine - Left, 9.5±0.5 vs. 9.5±0.4, p=0.91; -Right, 9.5±0.4 vs. 9.5±0.5, p=0.81; Sacrococcygeal junction to Ischial Spine - Left, 7.0±0.6 vs. 7.0±0.5, p=0.54; - Right, 7.0±0.6 vs. 6.9±0.4, p=0.32. Conclusion Bony pelvis dimensions are similar at the level of the muscular pelvic floor in Caucasian women with and without POP. PMID:19254580

  6. Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence.

    PubMed

    Manley, Lauren; Gibson, Luke; Papa, Nathan; Beharry, Bhawanie Koonj; Johnson, Liana; Lawrentschuk, Nathan; Bolton, Damien M

    2016-12-01

    The aim of the study was to evaluate the effect of pelvic floor muscle (PFM) assessment and training before and after robot-assisted laparoscopic radical prostatectomy (RARP) in improving PFM strength and urinary continence. We performed an analysis of a database of patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) performed by two urologists from 2011 to 2013. Pelvic floor muscle (PFM) activation and strength were graded by a trained pelvic floor physiotherapist. Patients were given an exercise program, grouped according to the strength of their pelvic floor as graded by assessment, to complete before and after surgery. PFM strength was recorded preoperatively, 4 days post-catheter removal and 4 weeks post-catheter removal. Continence was recorded at 4 weeks postop and was defined as the requirement of no continence aids. A total of 98 patients had RARP and a preoperative physiotherapy assessment plus postoperative appointments at around 1 and 4 weeks post-RARP. The majority of men improved their PFM strength regardless of preoperative strength with no significant predictors of postoperative strength found. Age was the only significant predictor of postoperative incontinence. In this pilot study, a majority of patients increased their pelvic floor strength with time. Pelvic floor physiotherapy is an important modifiable patient factor, which does have an impact in improving patients' urinary continence by strengthening the pelvic floor muscles. Patient age influences response to pelvic floor physiotherapy.

  7. Efficacy of transvaginal biofeedback and electrical stimulation in women with urinary urgency and frequency and associated pelvic floor muscle spasm.

    PubMed

    Bendaña, Emma E; Belarmino, James M; Dinh, Jenny H; Cook, Cynthia L; Murray, Brian P; Feustel, Paul J; De, Elise J B

    2009-01-01

    Women with urinary urgency and frequency may also have pelvic floor muscle spasm. Transvaginal biofeedback (TVBF) and electrical stimulation (EStim) is a treatment modality that has been used to treat vaginismus and chronic pelvic pain. In this study, TVBF/EStim was evaluated in women with pelvic floor muscle spasm associated with urinary symptoms. Fifty-two women underwent therapy with TVBF/EStim and reported a mean symptom improvement of 64.5%.

  8. 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

  9. A new treatment for premature ejaculation: the rehabilitation of the pelvic floor.

    PubMed

    La Pera, G; Nicastro, A

    1996-01-01

    This study evaluated pelvic floor rehabilitation as a possible treatment for premature ejaculation. In this treatment it is assumed that the pelvic muscles are involved in the control of the ejaculatory reflex. The treatment avails itself of a method already used for fecal and urinary incontinence. Eighteen patients with premature ejaculation were recruited. Fifteen (83%) of them had suffered from this disturbance for at least five years. Most of them had experienced other therapies without success. After 15-20 sessions of pelvic floor rehabilitation, 11 (61%) patients were cured and are able to control the ejaculatory reflex; seven (39%) patients had no improvement. All patients were followed for a minimum of 6 months to a maximum of 14 months. This therapy is easy to perform, has no side effects, and can be included among the therapuetic options for patients with premature ejaculation.

  10. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care

    PubMed Central

    Wiegersma, Marian; Panman, Chantal M C R; Kollen, Boudewijn J; Berger, Marjolein Y; Lisman-Van Leeuwen, Yvonne

    2014-01-01

    Objective To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. Design Randomised controlled trial. Setting Dutch primary care. Participants Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. Interventions Pelvic floor muscle training versus watchful waiting. Main outcome measures The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients’ perceived change in symptoms. Results Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. Conclusions Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points

  11. Sexual function in older women with pelvic floor symptoms: a cross-sectional study in general practice

    PubMed Central

    Panman, Chantal MCR; Wiegersma, Marian; Talsma, Marrit N; Kollen, Boudewijn J; Berger, Marjolein Y; Leeuwen, Yvonne Lisman-Van; Dekker, Janny H

    2014-01-01

    Background Pelvic floor symptoms are common and are negatively associated with sexual function which, in turn, is an important aspect of quality of life. The majority of older women with pelvic floor symptoms are treated in general practice but evidence from studies in general practice on the sexual functioning of these women is scarce. Aim This study examined predictors of sexual inactivity in older women with pelvic floor symptoms in general practice and of sexual functioning in those women who are sexually active. Design and setting Cross-sectional study in women (aged ≥55 years) from 20 general practices who screened positive on a pelvic floor symptom questionnaire. Method Logistic and linear regression analyses were used to determine predictors of sexual inactivity and sexual functioning (PISQ-12) by assessing their association with patient characteristics, symptoms (PFDI-20) and degree of prolapse (POP-Q). Results A total of 639 women were included (sexually active n = 393, sexually inactive n = 246). Predictors of sexual inactivity were increasing age (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10 to 1.17) and lower education (OR = 2.31; 95% CI = 1.50 to 3.54; Nagelkerke R2 = 0.208). In sexually active women, sexual functioning was associated with pelvic floor symptom distress (P<0.001) and pelvic floor surgery (P = 0.018; R2 = 0.138). Conclusion In older women with pelvic floor symptoms, increasing age and lower educational level are predictors of sexual inactivity. Many of these older women are sexually active and pelvic floor symptom distress is negatively associated with sexual functioning. These results may encourage GPs to ask about sexual problems in women with pelvic floor symptoms. PMID:24567653

  12. Dynamic assessment of women pelvic floor function by using a fiber Bragg grating sensor system

    NASA Astrophysics Data System (ADS)

    Ferreira, Luis A.; Araújo, Francisco M.; Mascarenhas, Teresa; Natal Jorge, Renato M.; Fernandes, António A.

    2006-02-01

    We present a novel sensing system consisting of an intravaginal probe and an optoelectronic measurement unit, which allows an easy, comfortable and quantitative dynamic evaluation of women pelvic floor muscle strength. The sensing probe is based on a silicone cylinder that transduces radial muscle pressure into axial load applied to a fiber Bragg grating strain sensor. The performance of a first sensor probe prototype with temperature referentiation and of the autonomous, portable optoelectronic measurement unit with data logging capabilities and graphical user interface is disclosed. The presented results refer to an ongoing collaboration work between researchers from the Medical, Optoelectronics and Mechanical areas, directed to the development of equipment that can assist in medical practice and help in the research of primary mechanisms responsible for several pelvic floor disorders, in particular urogenital prolapses.

  13. The influence of the material properties on the biomechanical behavior of the pelvic floor muscles during vaginal delivery.

    PubMed

    Parente, M P L; Natal Jorge, R M; Mascarenhas, T; Fernandes, A A; Martins, J A C

    2009-06-19

    In this work, a finite element model intends to represent the effects that the passage of a fetal head can induce on the muscles of the pelvic floor, from a mechanical point of view. The finite element method is a valuable tool, that is contributing to the clarification of the mechanisms behind pelvic floor disorders related to vaginal deliveries, although some care is necessary in order to obtain correct results. The present work shows how the variation of the material parameters, used in the constitutive model, can affect the obtained results from a finite element simulation. The constitutive equation adopted in this work for the pelvic floor muscles is a modified form of the incompressible transversely isotropic hyperelastic model proposed earlier by Humphrey and Yin. Results for the pelvic floor strain and stresses obtained during the passage of the fetus head are presented. The results show the importance of the material parameters and the need for a correct constitutive model.

  14. Characterization of Pelvic Floor Symptoms in Women of Northeastern Liberia

    PubMed Central

    Bowling, C. Bryce; Munoz, Oxana; Gerten, Kimberly A.; Mann, MerryLynn; Taryor, Rebecca; Norman, Andy M.; Szychowski, Jeff M.; Richter, Holly E.

    2013-01-01

    Objective To characterize prevalence and quality of life (QoL) impact of urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) symptoms in women of Liberia. Methods A questionnaire addressing symptoms and QoL impact of UI, FI and POP was administered to women in a community setting in Ganta, Liberia. Questionnaires were analyzed to determine prevalence rates, QoL impact, and risk factors for these conditions. Results 424 participants were surveyed; 1.7% reported UI, 0.10% reported any form of FI, and 3.3% reported some degree of POP symptoms. QoL responses varied among symptom groups. Previous hysterectomy, cesarean delivery, vaginal deliveries, and body mass index had no significant association with UI, FI, or POP. Participants with UI symptoms were more likely to report FI symptoms (p=0.002). Conclusion Prevalence rates for UI, FI and POP in this population are low; there was a significant association of FI symptoms in subjects with UI. PMID:20206351

  15. Vaginal High Pressure Zone Assessed by Dynamic 3-Dimensional Ultrasound Images of the Pelvic Floor

    PubMed Central

    JUNG, Sung-Ae; PRETORIUS, Dolores H.; PADDA, Bikram S.; WEINSTEIN, Milena M.; NAGER, Charles W.; den BOER, Derkina J.; MITTAL, Ravinder K.

    2009-01-01

    Objective To study the shape and characteristics of the vaginal high pressure zone (HPZ) by imaging a compliant fluid-filled bag placed in the vaginal HPZ with the 3-dimensional ultrasound (3D US) system. Study Design Nine nulliparous asymptomatic women underwent 3D US imaging and vaginal pressure measurements. A compliant bag was placed in the vagina and filled with various volumes of water. 3D US volumes of the pelvic floor were obtained at each bag volume while the subjects were at rest and during pelvic floor contraction. Results At low volumes, the bag was collapsed for a longitudinal extent of approximately 3.3 ± 0.2 cm (length of vaginal HPZ). With increasing bag volume, there was opening of the vaginal HPZ in the lateral dimension before the anterior-posterior (AP) dimension. Pelvic floor contraction produced a decrease in the AP dimension but not the lateral dimension of the bag in the region of the vaginal HPZ. Conclusion We propose that the shape and characteristics of the vaginal HPZ are consistent with the hypothesis that the puborectalis muscle is responsible for the genesis of the vaginal HPZ. PMID:17618755

  16. 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.

  17. Patient Understanding of Pelvic Floor Disorders: What Women Want to Know

    PubMed Central

    Kiyosaki, Krista; Ackerman, A. Lenore; Histed, Stephanie; Sevilla, Claudia; Eilber, Karyn; Maliski, Sally; Anger, Jennifer

    2013-01-01

    Objective To assess the effect of initial visit with a specialist on disease understanding in women with pelvic floor disorders. Methods Women with referrals or chief complaints suggestive of urinary incontinence (UI) or pelvic organ prolapse (POP) were recruited from an academic urology clinic. Patients completed a Test of Functional Health Literacy in Adults (TOFHLA) and scripted interview sessions before and after the physician encounter. Physician treatment plans were standardized based on diagnosis and were explained using models. Interview transcripts were analyzed using qualitative grounded theory methodology. Results Twenty women with pelvic floor disorders (UI or POP) were recruited and enrolled in this pilot study. The mean age was 60.5 years (range 31–87 years) and the majority of women were Caucasian with a college degree or beyond. TOFHLA scores indicated adequate to high levels of health literacy. Preliminary themes before and after the physician encounter were extracted from interviews, and two main concepts emerged: 1) After the initial physician visit, knowledge of their diagnosis and the ability to treat their symptoms relieved patient concerns related to misunderstandings of the severity of their disease 2) Patients tended to focus on treatment and had difficulty grasping certain diagnostic terms. This resulted in good understanding of treatment plans despite an inconsistent understanding of diagnosis. Conclusion Our findings demonstrated a significant effect of the initial physician visit on patient understanding of her pelvic floor disorder. Despite the variation in diagnostic recall after the physician encounter, patients had good understanding of treatment plans. This served to increase perceived control and adequately relieve patient fears. PMID:22543763

  18. Effects of nonlinear muscle elasticity on pelvic floor mechanics during vaginal childbirth.

    PubMed

    Li, Xinshan; Kruger, Jennifer A; Nash, Martyn P; Nielsen, Poul M F

    2010-11-01

    The role of the pelvic floor soft tissues during the second stage of labor, particularly the levator ani muscle, has attracted much interest recently. It has been postulated that the passage of the fetal head through the pelvis may cause excessive stretching of the levator ani muscle, which may lead to pelvic floor dysfunction and pelvic organ prolapse later in life. In order to study the complex biomechanical interactions between the levator ani muscle and the fetal head during the second stage of labor, finite element models have been developed for quantitative analysis of this process. In this study we have simulated vaginal delivery using individual-specific anatomical computer models of the pelvic floor interacting with a fetal head model with minimal restrictions placed upon its motion. Two constitutive relations were considered for the levator ani muscle (of exponential and neo-Hookean forms). For comparison purposes, the exponential relation was chosen to exhibit much greater stiffening at higher strains beyond the range of the experimental data. We demonstrated that increased nonlinearity in the elastic response of the tissues leads to considerably higher (56%) estimated force required for delivery, accompanied by a more homogeneous spatial distribution of maximum principal stretch ratio across the muscle. These results indicate that the form of constitutive relation beyond the presently available experimental data markedly affects the estimated function of the levator ani muscle during vaginal delivery, due to the large strains that occur. Further experimental data at higher strains are necessary in order to more reliably characterize the constitutive behavior required for modeling vaginal childbirth.

  19. Architectural differences in the anterior and middle compartments of the pelvic floor of young-adult and postmenopausal females.

    PubMed

    Wu, Yi; Dabhoiwala, Noshir F; Hagoort, Jaco; Tan, Li-Wen; Zhang, Shao-Xiang; Lamers, Wouter H

    2017-05-01

    The pelvic floor guards the passage of the pelvic organs to the exterior. The near-epidemic prevalence of incontinence in women continues to generate interest in the functional anatomy of the pelvic floor. However, due to its complex architecture and poor accessibility, the classical 'dissectional' approach has been unable to come up with a satisfactory description, so that many aspects of its anatomy continue to raise debate. For this reason, we opted for a 'sectional' approach, using the Chinese Visible Human project (four females, 21-35 years) and the Visible Human Project (USA; one female, 59 years) datasets to investigate age-related changes in the architecture of the anterior and middle compartments of the pelvic floor. The puborectal component of the levator ani muscle defined the levator hiatus boundary. The urethral sphincter complex consisted of a circular proximal portion (urethral sphincter proper), a sling that passed on the vaginal wall laterally to attach to the puborectal muscle (urethral compressor), and a circular portion that surrounded the distal urethra and vagina (urethrovaginal sphincter). The exclusive attachment of the urethral sphincter to soft tissues implies dependence on pelvic-floor integrity for optimal function. The vagina was circular at the introitus and gradually flattened between bladder and rectum. Well-developed fibrous tissue connected the inferior vaginal wall with urethra, rectum and pelvic floor. With eight-muscle insertions, the perineal body was a strong, irregular fibrous node that guarded the levator hiatus. Only loose areolar tissue comprising a remarkably well developed venous plexus connecting the middle and superior parts of the vagina with the lateral pelvic wall. The posterolateral boundary of the putative cardinal and sacrouterine ligaments coincided with the adventitia surrounding the mesorectum. The major difference between the young-adult and postmenopausal pelvic floor was the expansion of fat in between

  20. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study.

    PubMed

    Smith, A R; Hosker, G L; Warrell, D W

    1989-01-01

    Single-fibre electromyography of the pubococcygeus muscle of the pelvic floor was performed in 69 asymptomatic women and 105 women with stress incontinence of urine or genitourinary prolapse or both. The results suggest that partial denervation of the pelvic floor with subsequent reinnervation is a normal accompaniment of ageing and is increased by childbirth. Women with stress incontinence of urine or genitourinary prolapse or both have a significant increase in denervation of the pelvic floor compared with asymptomatic women.

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

    PubMed

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

    2009-03-01

    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.

  2. Sexual health in women with pelvic floor disorders: measuring the sexual activity and function with questionnaires--a summary.

    PubMed

    Espuña Pons, Montserrat

    2009-05-01

    The integration of sexual health into the health care services is important. In women attending urogynecological clinics, the urinary function, anorectal function, and anatomical defects are more often evaluated than those related to sexual activity and function. A group of experts in urogynecology, sexuality, and patient reported outcome development, met in a roundtable with the final objective of reviewing what is currently available and what is needed to accurately evaluate sexual function in women with pelvic floor dysfunction. An article was prepared for each of the issued presented during the roundtable and combined into this supplement. This article is a summary of all articles included in this supplement. The pathophysiology of sexual dysfunction as related to pelvic floor disorders has not been well established. Sexuality questionnaires and scales play an integral role in the diagnosis and treatment of female sexual dysfunction. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) is the only validated female sexual function questionnaire specifically developed to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse; however, the PISQ does not screen for sexual activity. The effects of treatments for pelvic floor problems on sexual function have received little attention. There is a need for a validated sexual function measure that evaluates not only the impact of pelvic floor dysfunction on sexual function but also the impact on sexual activity.

  3. Pelvic floor neuropathy in relation to the outcome of Burch colposuspension.

    PubMed

    Kjølhede, P; Lindehammar, H

    1997-01-01

    The aim of the study was to determine the role of neurogenic damage to pelvic floor muscles on the outcome of Burch colposuspension. Thirty women objectively continent after Burch colposuspension and 18 women with recurrent stress urinary incontinence (RSUI) were investigated with concentric needle electrode electromyography (EMG) in both pubococcygeus muscles and the external anal sphincter muscle. Neurogenic EMG patterns were significantly more often seen in the pubococcygeus muscles in women with RSUI than in women continent after the colposuspension (P < 0.05). The distribution of neurogenic EMG patterns in the investigated muscles was significantly more pronounced in women with RSUI than in continent women: at least one pubococcygeus muscle with neurogenic EMG pattern, 72% vs. 34% (P < 0.05); both pubococcygeus muscles, 50% vs. 13% (P < 0.05); and all three investigated muscles 41% vs. 10% (P < 0.05). In conclusion, the results imply an association between the outcome of the Burch colposuspension and the occurrence of neuropathy in the pelvic floor muscles. Occurrence of neurogenic damage in the pubococcygeus muscles seems to impair the outcome of Burch colposuspension.

  4. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

    PubMed Central

    Pereira, Vanessa S.; Hirakawa, Humberto S.; Oliveira, Ana B.; Driusso, Patricia

    2014-01-01

    Background: The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. Objective: To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. Method: This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05). Results: There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively). Conclusions: This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment. PMID:25372005

  5. 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

  6. 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

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

    PubMed

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

    2015-10-28

    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.

  8. Reproducibility of ultrasonic measurements of pelvic floor structures in women suffering from urinary incontinence.

    PubMed

    Gottlieb, Ditza; Dvir, Zeevi; Golomb, Jacob; Beer-Gabel, Marc

    2009-03-01

    The aim of this study was to examine the reproducibility of ultrasound (US) findings relating to pelvic floor muscle in women with urinary incontinence (UI). Eighteen women with UI were examined twice by the same examiners over an interval of 1 month. The US findings comprised of (1) distance between bladder neck and symphysis pubis (BN/SP) at rest, during contraction, and while performing the Valsalva maneuver and (2) distance between anorectal angle and symphysis pubis (AR-SP) during the same conditions. Statistical analysis included test-retest correlations (ICC(3,K)), and the assessment of measurement error and smallest real difference (SRD) for change. BN-SP and AR-SP exhibited high ICCs. The lowest SRD values related to the AR-SP variables (10-19%). US-based measures of the bladder neck and the anorectal angle, distance, and displacement seem to offer reasonable clinical reproducibility.

  9. Clinical and urodynamic evaluation of women with detrusor instability before and after functional pelvic floor electrostimulation.

    PubMed

    Arruda, R M; Castro, R A; Sartori, M G F; Takano, C C; Baracat, E C; Rodrigues de Lima, G; Girão, M J B C

    2003-01-01

    Detrusor instability is the second most frequent cause of female urinary incontinence. There are many therapeutic options, including non-invasive and surgical procedures. In this study, we evaluated the effects of pelvic floor vaginal electrostimulation using equipment designed in our institution, over three consecutive months, for treatment of 29 women with detrusor instability. After treatment 22 patients (76%) considered themselves cured or symptomatically improved; seven patients (24%) had no change in symptoms after therapy. There was objective cure and improvement in ten (34.5%) and in eight (27.5%) patients, respectively, and the urodynamic parameters did not change in 11 patients (38%). Electrical stimulation resulted in a gradual decrease in the number of urinary leakage episodes and increase in maximum cystometric capacity in first desire to void and in urinary volume.

  10. Antenatal pelvic floor exercises: a survey of both patients' and health professionals' beliefs and practice.

    PubMed

    Guerrero, K; Owen, L; Hirst, G; Emery, S

    2007-10-01

    The aim was to discover how often women perform pelvic floor exercises (PFE) in the antenatal period and how they wished to be taught. We compared this with the opinions of the health professionals looking after them. A total of 54 women attending the antenatal day assessment unit completed questionnaires. A total of 21 obstetricians, 29 midwives and 25 GPs returned similar questionnaires. Most women think they should be performing PFE daily but only 15% do so. Some 57% of the women wanted to be taught in the antenatal period. Over 50% of the women/midwives believed that PFE should be taught in an individual basis. Obstetricians/GPs favoured classes. A total of 76% of the women want midwives to teach them PFE and 57% of midwives agree. Most health professionals felt that they had not received adequate training on PFE. The midwife is felt to be the best placed person to teach PFE. Health professionals give PFE low priority.

  11. Female perineal membrane: a study using pelvic floor semiserial sections from elderly nulliparous and multiparous women.

    PubMed

    Kato, Masao; Matsubara, Akio; Murakami, Gen; Abe, Shin-Ichi; Ide, Yoshinobu; Sato, Iwao; Usui, Tsuguru

    2008-12-01

    To describe the architecture and topohistology of the female perineal structures, especially the perineal membrane (PM), we examined frontal sections (one side) and horizontal or transverse sections (another side) of 15 bisectioned pelvic floors. The PM, notably comprising elastic fibers, extended mediolaterally or transversely on the immediately inferior side of the rhabdosphincter area. More posteriorly, the elastic fibers more tilted along the long axis of the vagina and became lining the lateral vaginal wall as a fibrous skeleton. The compressor urethrae and urethrovaginal sphincter were embedded in and interdigitated with the PM. The elastic fiber architecture of the PM was similar to the rectovaginal septum. We hypothesize that the PM plays a role of a shock-absorber at the interface between the levator ani and distalmost vagina. A standard diagram of the female perineal structures is necessary to be revised.

  12. 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

  13. 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.

  14. 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

  15. Vaginal probe transducer: characterization and measurement of pelvic-floor strength.

    PubMed

    Sanches, Paulo R S; Silva, Danton P; Müller, André Frotta; Schmidt, Adriana P; Ramos, José G L; Nohama, Percy

    2009-11-13

    The pelvic-floor muscles (PFM) play an important role in urinary and fecal continence. Several investigators have studied the PFM using intra-vaginal pressure measurements, but their methods have not been validated. We describe the characteristics of a probe transducer developed to measure PFM strength according to its dynamic response and the effects of temperature variation. This probe transducer was used to evaluate changes in the contraction strength of pelvic muscles in a group of patients who participated in a PFM training program. Experiments allowed the identification of the probe's characteristics at different temperatures, definition of a calibration equation, and measurements of the dynamic response to pressure pulse. Evaluation of patients before and after the PFM training program showed significant differences in the peak pressure achieved during the contraction (p<0.001) and in pressure-rise time (p<0.01). The tests performed with the probe allowed the characterization of the proposed transducer, and the intra-vaginal pressure measurements in volunteers undergoing a PFM training program allowed a quantitative evaluation of the PFM strength.

  16. Immediate and perioperative outcomes of polypropylene mesh in pelvic floor repair in a predominantly obese population.

    PubMed

    Adedipe, T O; Vine, S J

    2010-01-01

    This retrospective study was to identify perioperative and postoperative complications associated with use of polypropylene mesh for pelvic floor repair in a UK district general hospital in a predominantly obese population. The sample size was 27 women with data retrieved from records. Total mesh was used in 37.1%, isolated anterior mesh in 44.4%, and an isolated posterior mesh in 18.5%. There was a high incidence of obese (BMI kg/m2 > or = 30.0) women (66.67%). The highest recorded thus far. A high proportion of the women (44.4%) were also over the age of 65 years with attendant comorbidities. The age range was 45-77 years. Complications included mesh exposure (7.4%), catheterization at discharge (7.4%), bladder injury during dissection (3.7%) and recurrent prolapse (7.4%). In the carefully selected individuals, polypropylene mesh for prolapse repair appears to be a safe technique to correct pelvic organ prolapse. However, long-term follow-up is needed with further research.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. Pelvic Organ Prolapse

    MedlinePlus

    ... occurs when the tissue and muscles of the pelvic floor no longer support the pelvic organs resulting in ... organ prolapse. Supporting muscles and tissue of the pelvic floor may become torn or stretched because of labor ...

  2. Pelvic Organ Prolapse--Surgery

    MedlinePlus

    ... That Answers to FAQs Learn the Terms Glossary Pelvic Floor Dialogues Printable PDFs on PFDs Patient Fact Sheets ... treatments have failed. The goal of all reconstructive pelvic floor procedures is to restore normal pelvic floor anatomy ...

  3. Electrospun Matrices for Pelvic Floor Repair: Effect of Fiber Diameter on Mechanical Properties and Cell Behavior.

    PubMed

    Vashaghian, Mahshid; Zandieh-Doulabi, Behrouz; Roovers, Jan-Paul; Smit, Theodoor Henri

    2016-12-01

    Electrospun matrices are proposed as an alternative for polypropylene meshes in reconstructive pelvic surgery. Here, we investigated the effect of fiber diameter on (1) the mechanical properties of electrospun poly (lactic-co-glycolic acid)-blended-poly(caprolactone) (PLGA/PCL) matrices; (2) cellular infiltration; and (3) the newly formed extracellular matrix (ECM) in vitro. We compared electrospun matrices with 1- and 8 μm fiber diameter and used nonporous PLGA/PCL films as controls. The 8-μm matrices were almost twice as stiff as the 1-μm matrices with 1.38 and 0.66 MPa, respectively. Matrices had the same ultimate tensile strength, but with 80% the 1-μm matrices were much more ductile than the 8-μm ones (18%). Cells infiltrated deeper into the matrices with larger pores, but cellular activity was comparable on both substrates. New ECM was deposited faster on the electrospun samples, but after 2 and 4 weeks the amount of collagen was comparable with that on nonporous films. The ECM deposited on the 1-μm matrices, and the nonporous film was about three times stiffer than the ECM found on the 8-μm matrices. Cell behavior in terms of myofibroblastic differentiation and remodeling was similar on the 1-μm matrices and nonporous films, in comparison to that on the 8-μm matrices. We conclude that electrospinning enhances the integration of host cells as compared with a nonporous film of the same material. The 1-μm matrices result in better mechanical behavior and qualitatively better matrix production than the 8-μm matrices, but with limited cellular infiltration. These data are useful for designing electrospun matrices for the pelvic floor.

  4. 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

  5. Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

    PubMed Central

    Petricelli, Carla Dellabarba; Resende, Ana Paula Magalhães; Elito Júnior, Julio; Araujo Júnior, Edward; Alexandre, Sandra Maria; Zanetti, Miriam Raquel Diniz; Nakamura, Mary Uchiyama

    2014-01-01

    Objective. The objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography—EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no). Methods. This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. The methods used were bidigital palpation (modified Oxford scale, graded 0–5), surface EMG (electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). The Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. The Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores. Results. Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. The average maternal age and gestational age were 26.06 (±5.58) and 36.56 (±1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 ± 0.57 versus 2.06 ± 0.64; P = 0.005) and higher electrical activity (45.35 ± 12.24 μV versus 35.79 ± 11.66 μV; P = 0.003), while among the multiparous women, distensibility was higher (19.39 ± 1.92 versus 18.05 ± 2.14; P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction (r = − 0.193; P = 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785). Conclusion. The electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the

  6. 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

  7. Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders.

    PubMed

    Lowenstein, Lior; FitzGerald, Mary P; Kenton, Kimberly; Dooley, Yashika; Templehof, Mike; Mueller, Elizabeth R; Brubaker, Linda

    2008-01-01

    The purpose of the study was to assess the relationship between self-expressed urogynecologic goals, symptoms, and treatment choice. Charts of women presenting for urogynecology consultation were reviewed. Demographics, diagnoses and responses to the pelvic floor distress inventory and medical, social, and epidemiologic aspects of aging questionnaires were recorded. Patients listed urogynecology goals before consultation. We categorized goals into five categories and then compared these categories by symptom type, severity, and treatment. Three hundred five women reported 635 goals (median 2, range 1-6). The number of goals listed per patient did not differ by age, race, comorbidities, or clinical diagnosis (p > 0.05). The most frequent goal category was symptoms (67%), followed by information seeking (12%), lifestyle (11%), emotional (4%), and "other" (6%). Women selecting non-surgical treatment were more likely to list information seeking as primary goal than those who chose surgery (p = 0.009). One third of participants expressed a primary non-symptom goal and were more likely to seek non-surgical therapy.

  8. Intra-abdominal Pressure during Pilates: Unlikely to Cause Pelvic Floor Harm

    PubMed Central

    Coleman, Tanner J.; Holder, Dannielle N.; Egger, Marlene J.; Hitchcock, Robert

    2015-01-01

    Aims To describe intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. Methods Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22 – 59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. Results There were no statistically significant differences in mean max IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean max IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). Conclusion Our results support recommending this series of introductory Pilates exercises including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health. PMID:25672647

  9. Reliability of superficial male pelvic floor structural measurements using linear-array transperineal sonography.

    PubMed

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

    2015-02-01

    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 patients by three raters with varied study knowledge and sonographic experience. Intra- and inter-rater 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.

  10. Racial disparities in knowledge of pelvic floor disorders among community-dwelling women

    PubMed Central

    MANDIMIKA, Charisse Laura; MURK, William; MCPENCOW, Alexandra M.; LAKE, AeuMuro; Miller, Devin; CONNELL, Kathleen Anne; GUESS, Marsha Kathleen

    2015-01-01

    Objective To evaluate racial and ethnic differences in knowledge about preventative and curative treatments for pelvic floor disorders (PFD). Methods The is a secondary analysis of responses from 416 community-dwelling women, aged 19-98 years, living in New Haven County, Connecticut, who completed the Prolapse and Incontinence Knowledge Questionnaire. Associations between race/ethnicity (categorized as White, African American, and Other Women of Color [OWOC, combined group of Hispanic, Asian or ‘Other’ women] and knowledge proficiency about modifiable risk factors and treatments for PFD were evaluated. Associations were adjusted for age, marital status, socioeconomic status, education, working in a medical field, and PFD history. Results Compared to White women, African American women were significantly less likely to recognize childbirth as a risk factor for UI and POP, to know that exercises can help control leakage, and to recognize pessaries as a treatment option for POP. OWOC were also significantly less likely to know about risk factors, preventative strategies and curative treatment options for POP and UI; however, these findings may not be generalizable given the heterogeneity and small size of this group. Conclusions Significant racial disparities exist in women's baseline knowledge regarding risk factors and treatment options for POP and UI. Targeted, culturally-sensitive educational interventions are essential to enhancing success in reducing the personal and economic burden of PFD, which have proven negative effects on women's quality of life. PMID:26313495

  11. Impact of different body positions on bioelectrical activity of the pelvic floor muscles in nulliparous continent women.

    PubMed

    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.

  12. 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

  13. 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

  14. Sexual Complaints, Pelvic Floor Symptoms, and Sexual Distress in Women over Forty

    PubMed Central

    Knoepp, Leise R.; Shippey, Stuart H.; Chen, Chi Chiung Grace; Cundiff, Geoffrey W.; Derogatis, Leonard R.; Handa, Victoria L.

    2011-01-01

    Introduction The American Psychiatric Association recommends considering sexually related personal distress when assessing female sexual dysfunction. Currently, there is little data regarding the impact of sexual complaints on sexual distress. Aim To investigate the association between sexual complaints and perceived sexual distress in a population of ambulatory adult women. Methods Using the short forms of the Personal Experiences Questionnaire and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, we assessed sexual complaints among 305 women seeking outpatient gynecologic care. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression (CESD) score. Sexual distress was measured using the Female Sexual Distress Scale (FSDS). Using multivariable logistic regression, we compared sexual complaints between distressed and nondistressed women. Main Outcome Measures Sexual distress, defined by FSDS score ≥15. Results FSDS scores were available for 292/305 participants. Seventy-six (26%) scores reflected distress. Distressed women were more likely to be younger (55.2 ± 1.0 years vs. 56.7 ± 0.8 years, P = 0.017); have higher CESD scores (16.6 vs. 9.5, P = 0.001); and report decreased arousal (56.8% vs. 25.1%, P = 0.001), infrequent orgasm (54% vs. 28.8%, P = 0.001), and dyspareunia (39.7% vs. 10.6%, P = 0.001). Women with sexual distress were also more likely to report sexual difficulty related to pelvic floor symptoms, including urinary incontinence with sexual activity (9% vs. 1.3%, P = 0.005), sexual avoidance due to vaginal prolapse (13.9% vs. 1%, P = 0.001), or sexual activity restriction due to fear of urinary incontinence (14.9% vs. 0.5%, P = 0.001). After multivariate analysis, sexual distress was significantly associated with dyspareunia (odds ratio [OR] 3.11, P = 0.008) and depression score (OR 1.05, P = 0.006), and inversely associated with feelings of arousal during sex (OR 0.19, P = 0.001). Conclusion

  15. Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders

    PubMed Central

    EREKSON, Elisabeth A.; LI, Fang-Yong; MARTIN, Deanna K.; FRIED, Terri R.

    2015-01-01

    Objective The primary objective of this study was to utilize the Vulvovaginal Symptom Questionnaire (VSQ) to estimate the prevalence and examine the emotional, life style and sexual impact of vulvovaginal symptoms in postmenopausal women. Methods We administered the VSQ questionnaire, a previous validated instrument to 358 postmenopausal women recruited from primary care physician offices and local senior centers. The first 7 questions of the VSQ comprise the symptom subscale (itching, burning, hurting, irritation, dryness, discharge and odor). Women who answered “Yes” to any of the first 7 symptom questions were considered to have vulvovaginal symptoms. Results Two hundred seventy nine women were recruited from primary care offices and 79 women were recruited from senior centers. One hundred eighty-three post-menopausal women (51.1%; 95% CI 45.9%, 56.3%) reported at least one vulvovaginal symptom. The most common symptom was being dry 35.8% (n/N = 128/358). Ten percent of women (n/N = 38/358) reported ≥ 5 symptoms and 6% of women reported all 7 symptoms in the last week. For women reporting ≥ 1vulvovaginal symptoms, 40.4% (n/N = 74/183) reported emotional impact (Yes to ≥ 1 out of 4 emotional impact subscale items) and 32.8% (n/N = 60/183) reported life style impact (Yes to ≥ 1 out of 5 life impact subscale items) from these symptoms. For sexually active women reporting vulvovaginal symptoms, 75.3% (n/N = 67/89) reported sexual impact (Yes to ≥ 1 out of 4 sexual impact subscale items). Vulvovaginal symptoms were associated with increased co-occurrence of specific pelvic floor disorders, including pelvic organ prolapse (p=0.001), anal incontinence to solid stool (p=0.001), urinary frequency (p=0.02), urgency urinary incontinence (p=0.001), and dysuria (p<0.001). Conclusion Vulvovaginal symptoms are common and present in over 50% of postmenopausal women. Sizeable proportions of women with vulvovaginal symptoms report emotional, life style and sexual

  16. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study

    PubMed Central

    Nygaard, Ingrid E; Clark, Erin; Clark, Lauren; Egger, Marlene J; Hitchcock, Robert; Hsu, Yvonne; Norton, Peggy; Sanchez-Birkhead, Ana; Shaw, Janet; Sheng, Xiaoming; Varner, Michael

    2017-01-01

    Introduction Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, ‘Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery’, uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. Methods and analysis Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. Ethics and dissemination The University of Utah and Intermountain Healthcare

  17. 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

  18. 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

  19. Constriction of the levator hiatus during instruction of pelvic floor or transversus abdominis contraction: a 4D ultrasound study.

    PubMed

    Bø, Kari; Braekken, Ingeborg H; Majida, Memona; Engh, Marie E

    2009-01-01

    A new theory claims that the pelvic floor muscles (PFM) can be trained via the transversus abdominis (TrA). The aim of the present study was to compare the effect of instruction of PFM and TrA contraction on constriction of the levator hiatus, using 4D perineal ultrasonography. Thirteen women with pelvic organ prolapse participated in the study. Perineal ultrasound in standing position was used to assess constriction of the levator hiatus. Analyses were conducted off-line with measurements in the axial plane of minimal hiatal dimensions. The reduction of all the hiatal dimensions was significantly greater during PFM than TrA contraction. All patients had a reduction of the levator hiatus area during PFM contraction (mean reduction 24.0%; range 6.1-49.2%). In two patients, there was an increase of the levator hiatus area during TrA contraction. Instruction of PFM contraction is more effective than TrA contraction.

  20. Pelvic organ prolapse.

    PubMed

    Jelovsek, J Eric; Maher, Christopher; Barber, Matthew D

    2007-03-24

    Pelvic organ prolapse is downward descent of female pelvic organs, including the bladder, uterus or post-hysterectomy vaginal cuff, and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development is multifactorial, with vaginal child birth, advancing age, and increasing body-mass index as the most consistent risk factors. Vaginal delivery, hysterectomy, chronic straining, normal ageing, and abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, stretching, or dysfunction of the levator ani complex, connective-tissue attachments of the vagina, or both, resulting in prolapse. Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms; however, with the exception of vaginal bulging, none is specific to prolapse. Women with symptoms suggestive of prolapse should undergo a pelvic examination and medical history check. Radiographic assessment is usually unnecessary. Many women with pelvic organ prolapse are asymptomatic and do not need treatment. When prolapse is symptomatic, options include observation, pessary use, and surgery. Surgical strategies for prolapse can be categorised broadly by reconstructive and obliterative techniques. Reconstructive procedures can be done by either an abdominal or vaginal approach. Although no effective prevention strategy for prolapse has been identified, considerations include weight loss, reduction of heavy lifting, treatment of constipation, modification or reduction of obstetric risk factors, and pelvic-floor physical therapy.

  1. 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

  2. Incidence and Risk Factors of De novo Stress Urinary Incontinence after Pelvic Floor Reconstruction: A Nested Case-control Study

    PubMed Central

    Wang, Shi-Yan; Cao, Ting-Ting; Wang, Run-Zhi; Yang, Xin; Sun, Xiu-Li; Wang, Jian-Liu

    2017-01-01

    Background: Some patients with pelvic organ prolapse may suffer from lower urinary tract symptoms (LUTS), especially stress urinary incontinence (SUI) named de novo SUI after pelvic floor reconstruction. This study aimed to investigate the incidence and risk factors of de novo SUI. Methods: This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse (POP) at the Department of Gynecology in Peking University People's Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% (101 patients lost to follow-up). There were 75 patients with de novo SUI postoperatively. According to the ratio of 1:3, we ensured the number of control group (n = 225). The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results: The incidence of de novo SUI was 25% (75/300). Univariate analysis showed that the ratio of lower urinary tract obstruction (LUTO) before surgery in de novo SUI group was significantly higher than the control group (odds ratio [OR] = 2.1, 95% confidence interval [CI] [1.1–4.0], P = 0.022). The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher (OR = 2.1, 95% CI [1.0–3.7], P = 0.045). After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery (OR = 2.3, 95% CI [1.2–4.6], P = 0.013). Conclusions: Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder

  3. 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

  4. 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

  5. Strain Elastography as a New Method for Assessing Pelvic Floor Biomechanics.

    PubMed

    Kreutzkamp, Jana Marie; Schäfer, Sebastian Daniel; Amler, Susanne; Strube, Felix; Kiesel, Ludwig; Schmitz, Ralf

    2017-04-01

    Strain elastography (SE) is a new technique of parametric imaging that allows quantification of the elasticity of tissue. The aim of our study was to determine if the elasticity of para-urethral tissue correlates with urethral mobility and urinary incontinence (UI). Ninety-nine unselected women were investigated with SE. They were given a standardized interview about UI, and SE raw data for the para-urethral tissue were acquired in a sagittal standard urethra-symphysis view while being stimulated by a coughing fit. We placed one region of interest (ROI A) in the tissue between the urethra and vagina at midlevel of the urethra bordering the urethral wall. The second ROI (ROI B) was set at the level of the os urethra internum in the tissue of the bladder neck in one line to ROI A. We measured elasticity in both ROIs with TDI-Q (Tissue Doppler Imaging-Quantification Software) and calculated the ratio between ROI A and ROI B (A/B). Mobility of the urethra was quantified by measuring the angle between a line parallel to the urethra and a line parallel to the bladder neck during stress and rest. SE analysis was feasible in all cases. A/B was found to be correlated with the incidence of urethral mobility (p < 0.001). The incidence of UI was associated with an increase in urethral mobility (p = 0.04). No correlation between UI and A/B could be shown (p = 0.24). We observed a correlation between urethral mobility and elasticity of the para-urethral tissue. In case of increasing urethral mobility, the para-urethral tissue close to the bladder neck seems to be more elastic, and the patients reported about more symptoms of UI. No noticeable correlation between UI and urethral elasticity was shown. SE may be a useful technique for direct quantification of tissue elasticity and assessment of pelvic floor biomechanics.

  6. The role of lumbopelvic posture in pelvic floor muscle activation in continent women.

    PubMed

    Capson, Angela Christine; Nashed, Joseph; Mclean, Linda

    2011-02-01

    This study was undertaken to determine the effect of changing standing lumbopelvic posture on pelvic floor muscle (PFM) activation amplitude and timing and the resultant vaginal manometry values recorded during static and dynamic tasks. Sixteen nulliparous, continent women between the ages of 22 and 41 years performed five tasks (quiet standing, maximal effort cough, Valsalva manoeuvre, maximum voluntary contraction (MVC) of the PFMs, and a load-catching task) in three different standing postures (normal lumbopelvic posture, hyperlordosis and hypolordosis). Electromyographic (EMG) data were recorded from the PFMs bilaterally using a Periform™ vaginal probe coupled to Delsys™ Bagnoli-8 EMG amplifiers. In separate trials, vaginal manometry was obtained using a Peritron™ perineometer. Lumbopelvic angle was recorded simultaneously with EMG and vaginal manometry using an Optotrak™ 3D motion analysis system to ensure that subjects maintained the required posture throughout the three trials of each task. All data were filtered using a moving 100 ms RMS window and peak values were determined for each trial and task. Repeated-measures analyses of variance were performed on the peak PFM EMG, intra-vaginal pressure amplitudes, and lumbopelvic angles as well as activation onset data for the cough and load-catching tasks. There was significantly higher resting PFM activity in all postures in standing as compared to supine, and in the standing position, there was higher resting PFM activity in the hypo-lordotic posture as compared to the normal and hyperlordotic postures. During the MVC, cough, Valsalva, and load-catching tasks, subjects generated significantly more PFM EMG activity when in their habitual posture than when in hyper- or hypo-lordotic postures. Conversely, higher peak vaginal manometry values were generated in the hypo-lordotic posture for all tasks in all cases. These results clearly indicate that changes in lumbopelvic posture influence both the

  7. Pelvic Support Problems

    MedlinePlus

    The pelvic floor is a group of muscles and other tissues that form a sling or hammock across the pelvis. ... place so that they can work properly. The pelvic floor can become weak or be injured. The main ...

  8. Determining the Posture and Vibration Frequency that Maximize Pelvic Floor Muscle Activity During Whole-Body Vibration

    PubMed Central

    Lee, Juhyun; Lee, Kyeongjin; Song, Changho

    2016-01-01

    Background The aim of this study was to investigate the electromyogram (EMG) response of pelvic floor muscle (PFM) to whole-body vibration (WBV) while using different body posture and vibration frequencies. Material/Methods Thirteen healthy adults (7 men, 6 women) voluntarily participated in this cross-sectional study in which EMG data from PFM were collected in a total of 12 trials for each subject (4 body postures, 3 vibration frequencies). Pelvic floor EMG activity was recorded using an anal probe. The rating of perceived exertion (RPE) was assessed with a modified Borg scale. Results We found that vibration frequency, body posture, and muscle stimulated had a significant effect on the EMG response. The PFM had high activation at 12 Hz and 26 Hz (p<0.05). PFM activation significantly increased with knee flexion (p<0.05). The RPE significantly increased with increased frequency (p<0.05). Conclusions The knee flexion angle of 40° at 12 Hz frequency can be readily promoted in improving muscle activation during WBV, and exercise would be performed effectively. Based on the results of the present investigation, sports trainers and physiotherapists may be able to optimize PFM training programs involving WBV. PMID:27787476

  9. Botulinum neurotoxin type A injection of the pelvic floor muscle in pain due to spasticity: a review of the current literature.

    PubMed

    Bhide, Alka A; Puccini, Federica; Khullar, Vik; Elneil, Suzy; Digesu, G Alessandro

    2013-09-01

    The role of muscle spasm is not a new concept in the genesis of pain. Botulinum neurotoxin type A (BoNTA) has been successfully employed in a variety of muscular and inflammatory conditions. The aim of our study was to review the published literature on the role of BoNTA injection of the pelvic floor muscle in the management of women with chronic pelvic pain (CPP). A systematic search of the literature published up to June 2012 on the use of BoNTA in the treatment of female pelvic floor muscle spasm was carried out using relevant search terms in MEDLINE and EMBASE databases. The results were limited to full-text English language articles. Relevant trials as well as relevant reviews were selected and analyzed by two independent reviewers. Five studies (2 case reports, 1 prospective pilot study, 1 retrospective study and 1 randomised double-blind placebo controlled study) were included in this systematic review. Overall, BoNTA has shown to be beneficial in relieving CPP related to pelvic floor spasm. The role of BoNTA as a treatment of CPP has been recognized for more than 10 years. Although data are still scarce preliminary results are encouraging. BoNTA is an attractive option for refractory CPP related to pelvic floor muscle spasm, but further studies using validated and reproducible outcome measures are needed, to establish its effectiveness, safeness, technique, optimal dosage, and duration of symptom relief.

  10. How well can levator ani muscle morphology on 3D pelvic floor ultrasound predict the levator ani muscle function?

    PubMed Central

    Rostaminia, G.; Peck, J. D.; Quiroz, L. H.; Shobeiri, S. A.

    2016-01-01

    Introduction and hypothesis The aim of our study was to assess the performance of levator ani muscle deficiency (LAD) evaluated by 3D endovaginal ultrasound (EVUS) to detect pelvic floor muscle function as assessed by digital examination. Methods This cross-sectional study was conducted among 77 patients referred to our urogynecology clinic for pelvic floor dysfunction symptoms. Patients underwent physical examinations including digital pelvic muscle strength assessment using the Modified Oxford scale (MOS). EVUS volumes were evaluated and levator ani muscles were scored according to a validated LAD scoring system. MOS scores were categorized as nonfunctional (scores 0–1) and functional (scores 2–5). Results Mean age of participants was 56 (SD± 12.5) and 71% were menopausal. Overall, 32.5% had nonfunctional muscle strength and 44.2% were classified as having significant LAD. LAD identified by ultrasound had a sensitivity of 60% (95% CI 41%–79%) for detecting nonfunctional muscle and a specificity of 63% (95% CI 50%–77%) for detecting functional muscle. Overall, LAD demonstrated fair ability to discriminate between patient with and without poor muscle function (area under the ROC curve = 0.70 (95% CI 0.58–0.83). Among patients with an LAD score of 16–18, representing almost total muscle avulsion, 70% had nonfunctional MOS scores. Whereas, in patients with normal/minimal LAD (scores of 0–4), 89.5% had functional MOS scores Conclusions LAD and MOS scales were moderately negatively correlated Among patients with normal morphology or the most severe muscle deficiency, LAD scores can identify the majority of patients with functional or non-functional MOS scores, respectively. PMID:25246297

  11. 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

  12. 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

  13. 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

  14. 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

  15. Biomechanical properties of the pelvic floor muscles of continent and incontinent women using an inverse finite element analysis.

    PubMed

    Silva, M E T; Brandão, S; Parente, M P L; Mascarenhas, T; Natal Jorge, R M

    2017-03-17

    Pelvic disorders can be associated with changes in the biomechanical properties in the muscle, ligaments and/or connective tissue form fascia and ligaments. In this sense, the study of their mechanical behavior is important to understand the structure and function of these biological soft tissues. The aim of this study was to establish the biomechanical properties of the pelvic floor muscles of continent and incontinent women, using an inverse finite element analysis (FEA). The numerical models, including the pubovisceral muscle and pelvic bones were built from magnetic resonance (MR) images acquired at rest. The numerical simulation of Valsalva maneuver was based on the finite element method and the material constants were determined for different constitutive models (Neo-Hookean, Mooney-Rivlin and Yeoh) using an iterative process. The material constants (MPa) for Neo-Hookean (c1) were 0.039 ± 0.022 and 0.024 ± 0.004 for continent vs. incontinent women. For Mooney-Rivlin (c1) the values obtained were 0.026 ± 0.010 vs. 0.016 ± 0.003, and for Yeoh (c1) the values obtained were 0.031 ± 0.023 vs. 0.016 ± 0.002, (p < 0.05). Muscle displacements obtained in the numerical simulations of Valsalva maneuver were compared with the muscle displacements obtained through additional dynamic MRI. Incontinent women presented a higher antero-posterior displacement than the continent women. The results were also similar between MRI and numerical simulations (40.27% vs. 42.17% for Neo-Hookean, 39.87% for Mooney-Rivlin and 41.61% for Yeoh). Using an inverse FEA coupled with MR images allowed to obtain the in vivo biomechanical properties of the pelvic floor muscles, leading to a relationship between them for the continent and incontinent women in a non-invasive manner.

  16. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

    PubMed

    Bo, Kari; Frawley, Helena C; Haylen, Bernard T; Abramov, Yoram; Almeida, Fernando G; Berghmans, Bary; Bortolini, Maria; Dumoulin, Chantale; Gomes, Mario; McClurg, Doreen; Meijlink, Jane; Shelly, Elizabeth; Trabuco, Emanuel; Walker, Carolina; Wells, Amanda

    2017-02-01

    Introduction and hypothesis There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. Methods This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. Results A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. Conclusion A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.

  17. [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.

  18. 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.

  19. 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.

  20. [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.

  1. Structural Position of the Posterior Vagina and Pelvic Floor in Women with and without Posterior Vaginal Prolapse

    PubMed Central

    LEWICKY-GAUPP, Christina; YOUSUF, Aisha; LARSON, Kindra A; FENNER, Dee E; DeLANCEY, John OL

    2012-01-01

    Objective Compare pelvic structure location on MRI during maximal Valsalva among women with posterior prolapse and those with normal support. Methods and Materials Cases (n=37) had posterior vaginal wall (PVW) prolapse > +1cm. All underwent mid-sagittal, dynamic MRI. Structure locations (distal vagina, apex, perineal body, external anal sphincter) were determined. PVW length, levator and urogenital hiatus diameters, and prolapse diameter were measured. Results Cases had more caudal structures (p<0.001) and larger hiatus diameters (p<0.005); the posterior wall was longer, while the straight-line distance between the apex and distal vagina was shorter. In enteroceles, the apex was more ventrally displaced compared to rectoceles (p=0.003). Unlike apical descent (r=-0.3, p=0.1), PVW length and point Bp were correlated with MRI prolapse size (r=0.5, p=0.002; r=0.7, P<0.001, respectively). Conclusion At maximal Valsalva on MRI, structures are more caudal in women with posterior prolapse. The posterior vaginal wall is longer; this length strongly correlates with prolapse size. PMID:20452497

  2. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: mass contraction of the pelvic floor muscles.

    PubMed

    Shafik, A

    1998-01-01

    We have previously demonstrated both anatomically and physiologically that the external anal (EAS) and urethral (EUS) sphincters and the bulbocavernosus muscle (BC) originate from the puborectalis muscle (PR). It is hypothesized that stimulation of any of these muscles would lead to contraction of all the others. Because the levator ani (pubococcygeus) muscle (LA) also has the same innervation as the above-mentioned muscles, it is further suggested that it, too, contracts reflexly upon stimulation of any of those muscles. The purpose of this study was to test this hypothesis. The study comprised 18 healthy volunteers (mean age 36.6 +/- 8.4 years; 10 men, 8 women). The EAS was stimulated and the response of the EUS, PR, LA and BC was determined. Each muscle was thereafter stimulated separately and the response of the other pelvic floor muscles registered. Stimulation of any of the pelvic floor muscles effected an increased EMG activity of the rest of the muscles. The muscle contraction was instantaneous with no latency in all the muscles except the LA EMG activity, which showed a mean latency of 21.3 +/- 6.6 ms. The pelvic floor muscles' response seems to be attributable to muscle stimulation both directly and indirectly through activation of pudendal nerve fibers in the muscles. The study demonstrated that the pelvic floor muscles behave as one muscle: they contract or relax en masse. This 'mass contraction' might explain some of the physiologic phenomena that occur during pelvic organ evacuation. However, besides this mass contraction, a voluntary 'selective' individual muscle activity exists by which each individual muscle acts independently of the others.

  3. Can I prevent Pelvic Organ Prolapse

    MedlinePlus

    ... That Answers to FAQs Learn the Terms Glossary Pelvic Floor Dialogues Printable PDFs on PFDs Patient Fact Sheets ... or retrain the nerves and muscles of the pelvic floor. Regular daily exercising of the pelvic muscles can ...

  4. Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study

    PubMed Central

    Halski, Tomasz; Ptaszkowski, Kuba; Słupska, Lucyna; Dymarek, Robert; Paprocka-Borowicz, Małgorzata

    2017-01-01

    Objectives In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position. Materials and methods This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance. Results In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104). Conclusion The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM. PMID:28115836

  5. Does post-caesarean dyspareunia reflect sexual malfunction, pelvic floor and perineal dysfunction?

    PubMed

    Lal, M; Pattison, H M; Allan, T F; Callender, R

    2011-10-01

    The aim was to define post-caesarean dyspareunia as a sexual and pelvic-perineal symptom. Post-caesarean (80 elective, 104 emergency) and 100 vaginally delivered primiparae had domiciliary interviews at 10 months postpartum. A total of 50 (28% and 27%) post-caesarean and 46 (46%) vaginally delivered, reported dyspareunia. Severely impaired general sexual health occurred in 82 (24% elective, 25% emergency, 35% vaginally delivered) as category 3 (dyspareunia with sexual symptoms) and 27 (10% elective, 7% emergency, 12% vaginally delivered) as category 4 (reduced frequency < 6). The risk of dyspareunia (RR 1.14, CI 0.73, 1.77) or impaired general sexual health (RR 0.93, CI 0.32, 2.74) was similar among those with or without perineal trauma. Both caesarean and perineal scars were associated with sexual malfunction. Primiparae with new incontinence had a lower risk of dyspareunia than impaired general sexual health. Awareness of the associations of post-caesarean dyspareunia and impaired general sexual health with incontinence would facilitate appropriate obstetric decision-making. Further research is indicated.

  6. 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

  7. Pelvic floor muscles and the external urethral sphincter have different responses to applied bladder pressure during continence

    PubMed Central

    Jiang, Hai-Hong; Salcedo, Levilester B.; Song, Bo; Damaser, Margot S.

    2010-01-01

    Objectives To determine the functional innervation of the pelvic floor muscles (PFM) and if there is PFM activity during an external pressure increase to the bladder in female rats. Methods Thirty-one female adult virgin Sprague Dawley rats received an external increase in bladder pressure until urinary leakage was noted while bladder pressure was recorded (leak point pressure; LPP) under urethane anesthesia. Six of the rats underwent repeat LPP testing after bilateral transection of the levator ani nerve. Another 6 rats underwent repeat LPP testing after bilateral transection of the pudendal nerve. Simultaneous recordings of PFM (pubo-/iliococcygeus muscles) electromyogram (EMG) and external urethral sphincter (EUS) EMG were recorded during cystometry and LPP testing. Results Thirteen rats (42%) showed tonic PFM EMG activity during filling cystometry. Eighteen rats (58%) showed no tonic PFM EMG activity at baseline, but PFM EMG could be activated by pinching the perineal skin. This activity could be maintained unless voiding occurred. The external increase in bladder pressure caused significantly increased EUS EMG activity as demonstrated by increased amplitude and frequency. However, there was no such response in PFM EMG. LPP was not significantly different after levator ani nerve transection, but was significantly decreased after pudendal nerve transection. Conclusions PFM activity was not increased during external pressure increases to the bladder in female rats. Experimental designs using rats should consider this result. PMID:20206969

  8. Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound.

    PubMed

    Arab, Amir Massoud; Behbahani, Roxana Bazaz; Lorestani, Leila; Azari, Afsaneh

    2010-06-01

    Pelvic floor muscle (PFM) dysfunction has been recently associated with the development of low back pain (LBP). Transabdominal ultrasound imaging has been established as an appropriate method for visualizing and measuring PFM function. No study has directly evaluated PFM function in individuals with and without LBP. The purpose of this study was to investigate the PFM function in women with and without LBP using transabdominal ultrasound. Convenience sample of 40 non-pregnant female participated in the study. Subjects were categorized into two groups: with LBP (n = 20) and without LBP (n = 20). The amount of bladder base movement on ultrasound (normalized to body mass index) was measured in all subjects and considered as an indicator of PFM function. Statistical analysis (Independent t-test) revealed significant difference in transabdominal ultrasound measurements for PFM function between the two groups (P = 0.04, 95% CI of difference: 0.002-0.27). The results of this study indicate PFM dysfunction in individuals with LBP compared to those without LBP. The results could be beneficial to clinicians when assessing and prescribing therapeutic exercises for patients with LBP.

  9. A process of informed consent for student learning through peer physical examination in pelvic floor physiotherapy practice.

    PubMed

    Delany, Clare; Frawley, Helena

    2012-03-01

    Peer physical examination (PPE) is a method of teaching and learning clinical skills in which students use fellow students as surrogate patients or models. PPE is recognised as useful as an experiential learning method to increase skill development for physiotherapy clinical practice. However students may feel pressured to participate despite discomfort and embarrassment when practising physical examination and treatment skills with their peers. Obtaining students' informed consent to participate in PPE is an important process to address these disadvantages of PPE. This paper proposes a three stage process for obtaining informed consent from postgraduate physiotherapy students learning pelvic floor examination and treatment skills. The process is designed to encourage educators to articulate the ethical issues that are relevant in this area of teaching; to provide information to students to enable them to understand what is involved and to choose to participate, and to offer alternatives to participation through a formalised process of informed consent. These steps mirror students' future obligations and actions when communicating with their patients.

  10. The interplay of dyadic and individual planning of pelvic-floor exercise in prostate-cancer patients following radical prostatectomy.

    PubMed

    Burkert, Silke; Knoll, Nina; Luszczynska, Aleksandra; Gralla, Oliver

    2012-06-01

    This study broadens the current understanding of the role of planning by focusing on the interplay between individual and dyadic planning (i.e. making plans about the target person's behaviour together with a partner). Self-report data from N=141 prostatectomy-patients and their partners were assessed at three times within 1 year post-surgery. Direct and indirect effects of dyadic and individual planning on patients' pelvic-floor exercise (PFE) were tested. Proposed mediators were social support, social control, and action control. Cross-sectionally, the dyadic planning-PFE relationship was mediated by patients' received support and partners' provided social control. Longitudinally, mediators of dyadic planning were partners' provided social control and support. Effects of individual planning on PFE were mediated by action control at baseline only. Also, at lower levels of individual planning, patients' dyadic planning was more strongly associated with receipt of social control. Results underscore the importance of social factors in the planning process and its mechanisms in health-behaviour change.

  11. Pelvic floor muscle activity, quality of life, and sexual function in peri- and recently postmenopausal women with and without dyspareunia: a cross-sectional study.

    PubMed

    Schvartzman, Renata; Bertotto, Adriane; Schvartzman, Luiza; Wender, Maria Celeste Osório

    2014-01-01

    Pelvic floor alterations during menopausal years, resulting from aging and hormonal decline, may lead to several forms of sexual dysfunction. Dyspareunia-pain during sexual intercourse-is among the most frequent. Nevertheless, few studies so far have evaluated pelvic floor muscle function in postmenopausal women with dyspareunia. The authors thus carried out a cross-sectional study to assess myoelectric activity in pelvic floor muscles in peri- and postmenopausal women with and without dyspareunia receiving routine care at an outpatient clinic. In addition, sexual function (using the Female Sexual Function Index) and quality of life (using the Cervantes Scale) were assessed. Fifty-one peri- and postmenopausal women between 45 to 60 years of age (M = 52.1, SD = 4.9) were evaluated, 27 with and 24 without dyspareunia. There were no statistically significant differences in resting muscle activity, maximal voluntary contraction, and sustained contraction between women with and without dyspareunia. There were statistically significant between-group differences on the Cervantes Scale (p =.009) and in all Female Sexual Function Index domains except desire and satisfaction (arousal, p =.019; lubrication, p =.030; orgasm, p =.032; pain, p <.001; desire, p =.061; satisfaction, p =.081), indicating that women with dyspareunia experience worse quality of life and less satisfactory sexual function as compared with women without dyspareunia.

  12. The Joanna Briggs Institute best practice information sheet: the effectiveness of pelvic floor muscle exercises on urinary incontinence in women following childbirth.

    PubMed

    2011-09-01

    This Best Practice Information Sheet is derived from 21 studies and aims to synthesize the best available evidence on the effectiveness of pelvic floor muscle exercises on urinary incontinence in women following childbirth. The information that is contained in this sheet has been derived from studies that were included in a systematic review that was conducted by the Joanna Briggs Institute. The original references can be sourced from the systematic review. Pregnancy and childbirth are major risk factors for the development of urinary incontinence as the muscles of the pelvic floor become stretched and weakened. For some women, such incontinence after childbirth is temporary, but for others, their suffering can be of much longer-term duration. A number of risk factors has been identified for urinary incontinence following childbirth, including antenatal urinary incontinence, obesity, and significant perineal trauma. The aim of pelvic floor muscle exercises is to strengthen the perivaginal and perianal musculature in order to increase a woman's control of urinary leakage.

  13. Elongation of textile pelvic floor implants under load is related to complete loss of effective porosity, thereby favoring incorporation in scar plates.

    PubMed

    Otto, Jens; Kaldenhoff, E; Kirschner-Hermanns, R; Mühl, Thomas; Klinge, Uwe

    2014-04-01

    Use of textile structures for reinforcement of pelvic floor structures has to consider mechanical forces to the implant, which are quite different to the tension free conditions of the abdominal wall. Thus, biomechanical analysis of textile devices has to include the impact of strain on stretchability and effective porosity. Prolift(®) and Prolift + M(®), developed for tension free conditions, were tested by measuring stretchability and effective porosity applying mechanical strain. For comparison, we used Dynamesh-PR4(®), which was designed for pelvic floor repair to withstand mechanical strain. Prolift(®) at rest showed moderate porosity with little stretchability but complete loss of effective porosity at strain of 4.9 N/cm. Prolift + M(®) revealed an increased porosity at rest, but at strain showed high stretchability, with subsequent loss of effective porosity at strain of 2.5 N/cm. Dynamesh PR4(®) preserved its high porosity even under strain, but as consequence of limited stretchability. Though in tension free conditions Prolift(®) and Prolift + M(®) can be considered as large pore class I meshes, application of mechanical strain rapidly lead to collapse of pores. The loss of porosity at mechanical stress can be prevented by constructions with high structural stability. Assessment of porosity under strain was found helpful to define requirements for pelvic floor devices. Clinical studies have to prove whether devices with high porosity as well as high structural stability can improve the patients' outcome.

  14. 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 ...

  15. 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

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

    PubMed Central

    2015-01-01

    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

  17. A comparative study of pelvic floor muscle training in women with multiple sclerosis: its impact on lower urinary tract symptoms and quality of life

    PubMed Central

    Lúcio, Adélia Correia; Perissinoto, Maria Carolina; Natalin, Ricardo Aydar; Prudente, Alessandro; Damasceno, Benito Pereira; D'ancona, Carlos Arturo Levi

    2011-01-01

    OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention. PMID:22179160

  18. Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus.

    PubMed

    van der Velde, J; Laan, E; Everaerd, W

    2001-01-01

    This study investigates the mechanism underlying vaginismus, which may be part of a general defense mechanism. Exposure to a threatening situation will evoke an increase in muscle activity. This muscle reaction will not be restricted to the pelvic floor but will also occur in postural muscles, such as in the trapezius region. Women with and without vaginismus were exposed to four stimuli: excerpts from threatening, erotic, neutral and sexual-threatening films. Subjects were 45 physician- or self-referred patients with vaginismus and 32 controls with no sexual or pelvic floor complaints. The activity of the pelvic floor muscles and of the muscles in the trapezius region was recorded with surface electrodes. There were no differences between women with and without vaginistic reactions. EMG measurement of both the pelvic floor muscles and the trapezius muscle showed an increase in muscle activity during the threatening and sexual-threatening excerpts in women with and without vaginismus. This increase of involuntary pelvic floor muscle activity is part of a general defense mechanism that occurs during exposure to threatening situations. This reaction is not restricted to a situation with a sexual content. The results of this study shed new light on the concept of vaginismus as a primarily sexual dysfunction.

  19. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements.

    PubMed

    Thompson, Judith A; O'Sullivan, Peter B; Briffa, N Kathryn; Neumann, Patricia

    2006-11-01

    The aims of the study were: (1) to assess women performing voluntary pelvic floor muscle (PFM) contractions, on initial instruction without biofeedback teaching, using transperineal ultrasound, manual muscle testing, and perineometry and (2) to assess for associations between the different measurements of PFM function. Sixty continent (30 nulliparous and 30 parous) and 60 incontinent (30 stress urinary incontinence (SUI) and 30 urge urinary incontinence (UUI)) women were assessed. Bladder neck depression during attempts to perform an elevating pelvic floor muscle (PFM) contraction occurred in 17% of continent and 30% of incontinent women. The UUI group had the highest proportion of women who depressed the bladder neck (40%), although this was not statistically significant (p=0.060). The continent women were stronger on manual muscle testing (p=0.001) and perineometry (p=0.019) and had greater PFM endurance (p<0.001) than the incontinent women. There was a strong tendency for the continent women to have a greater degree of bladder neck elevation than the incontinent women (p=0.051). There was a moderate correlation between bladder neck movement during PFM contraction measured by ultrasound and PFM strength assessed by manual muscle testing (r=0.58, p=0.01) and perineometry (r=0.43, p=0.01). The observation that many women were performing PFM exercises incorrectly reinforces the need for individual PFM assessment with a skilled practitioner. The significant correlation between the measurements of bladder neck elevation during PFM contraction and PFM strength measured using MMT and perineometry supports the use of ultrasound in the assessment of PFM function; however, the correlation was only moderate and, therefore, indicates that the different measurement tools assess different aspects of PFM function. It is recommended that physiotherapists use a combination of assessment tools to evaluate the different aspects of PFM function that are important for continence

  20. 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

  1. Pelvic Floor Dyssynergia

    MedlinePlus

    ... 1799 Donate Find a Doctor Join eNewsletter Sidebar × MOBILE MENU About Us Learn About GI Motility Digestive ... voluntarily, their function can be improved through various learning procedures – such as biofeedback. What is biofeedback? Biofeedback ...

  2. Pelvic Floor Dysfunction

    MedlinePlus

    ... During the normal process of defecation, as one bears down to pass stool, the puborectalis reflexively relaxes ... when the muscle does not relax when one bears down to pass stool. In some cases, it ...

  3. 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

  4. Lower urogenital tract anatomical and functional phenotype in lysyl oxidase like-1 knockout mice resembles female pelvic floor dysfunction in humans.

    PubMed

    Lee, Una J; Gustilo-Ashby, A Marcus; Daneshgari, Firouz; Kuang, Mei; Vurbic, Drina; Lin, Dan Li; Flask, Chris A; Li, Tiansen; Damaser, Margot S

    2008-08-01

    Female pelvic floor dysfunction (FPFD) is a complex group of conditions that include urinary incontinence and pelvic organ prolapse (POP). In humans, elastin homeostasis has been implicated in the pathophysiology of FPFD. Lysyl oxidase-like 1 knockout (LOXL1-KO) mice demonstrate abnormal elastic fiber homeostasis and develop FPFD after parturition. We compared the lower urogenital tract (LUT) anatomy and function in LOXL1-KO mice with and without POP. LUT anatomy was assessed in LOXL1-KO mice over 28 wk. Pelvic visceral anatomy in LOXL1-KO was evaluated with a 7-Tesla magnetic resonance imaging (MRI) scanner. LUT function was assessed using conscious cystometry and leak point pressure (LPP) testing. Quantitative histological analysis of elastic fibers was performed on external urethral sphincter (EUS) cross sections. By 25 wk of age, 50% of parous LOXL1-KO mice developed POP. LOXL1-KO mice with POP had greater variability in the size and location of the bladder on MRI compared with mice without POP. Parity and POP were associated with lower LPP. Elastin clusters were significantly increased in the EUS of LOXL1-KO mice with POP. Because parity triggers POP in LOXL1-KO mice, LOXL1-KO mice with POP have variable internal pelvic anatomy, and both parity and POP are associated with a decrease in LPP, we conclude that LOXL1 LUT anatomical and functional phenotype resembles FPFD in humans. The increase in elastin clusters in the urethra of LOXL1-KO mice with POP suggests that elastin disorganization may lead to functional abnormalities. We conclude that LOXL1 warrants further investigation in the pathphysiology of FPFD.

  5. Dynamic Assessment of the Vaginal High Pressure Zone using High Definition Manometery, 3D -Ultrasound and Magnetic Resonance Imaging of the Pelvic Floor Muscles

    PubMed Central

    Raizada, Varuna; Bhargava, Valmik; Jung, Sung-Ae; Karstens, Anna; Pretorius, Dolores; Krysl, Petr; Mittal, Ravinder K

    2010-01-01

    Aims We used a novel technique, high definition manometry (HDM) that utilizes 256 tactile sensitive micro-transducers to define the characteristics of vaginal high-pressure zone. Methods 16 nullipara asymptomatic women were studied using HDM, transperineal 2D dynamic ultrasound and dynamic magnetic resonance (MR) imaging. Results Vaginal high-pressure zone revealed higher contact pressures in anterior and posterior compared to lateral directions, both at rest and squeeze. At rest, anterior pressure cluster is located 10 mm cephalad to posterior pressure cluster; with squeeze the latter moves in the cranial direction by 7 mm. Ultrasound and MR images reveal that the anorectal angle moves cephalad and ventrally during squeeze. Cephalad movement of posterior pressure cluster during squeeze is similar to the cranial movement of anorectal angle. Conclusions We propose that the vaginal high-pressure zone represents the constrictor function and cranial movement of the posterior pressure cluster represents the elevator function of pelvic floor. PMID:20462564

  6. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study

    PubMed Central

    Scaldazza, Carlo Vecchioli; Morosetti, Carolina; Giampieretti, Rosita; Lorenzetti, Rossana; Baroni, Marinella

    2017-01-01

    ABSTRACT Introduction This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). Materials and Methods 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. Results A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. Conclusion This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS. PMID:28124534

  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. Influence of Geometry and Mechanical Properties on the Accuracy of Patient-Specific Simulation of Women Pelvic Floor.

    PubMed

    Mayeur, Olivier; Witz, Jean-François; Lecomte, Pauline; Brieu, Mathias; Cosson, Michel; Miller, Karol

    2016-01-01

    The woman pelvic system involves multiple organs, muscles, ligaments, and fasciae where different pathologies may occur. Here we are most interested in abnormal mobility, often caused by complex and not fully understood mechanisms. Computer simulation and modeling using the finite element (FE) method are the tools helping to better understand the pathological mobility, but of course patient-specific models are required to make contribution to patient care. These models require a good representation of the pelvic system geometry, information on the material properties, boundary conditions and loading. In this contribution we focus on the relative influence of the inaccuracies in geometry description and of uncertainty of patient-specific material properties of soft connective tissues. We conducted a comparative study using several constitutive behavior laws and variations in geometry description resulting from the imprecision of clinical imaging and image analysis. We find that geometry seems to have the dominant effect on the pelvic organ mobility simulation results. Provided that proper finite deformation non-linear FE solution procedures are used, the influence of the functional form of the constitutive law might be for practical purposes negligible. These last findings confirm similar results from the fields of modeling neurosurgery and abdominal aortic aneurysms.

  9. The effect of ascorbic acid and fluid flow stimulation on the mechanical properties of a tissue engineered pelvic floor repair material.

    PubMed

    Osman, Nadir I; Roman, Sabiniano; Bullock, Anthony J; Chapple, Christopher R; MacNeil, Sheila

    2014-09-01

    Synthetic non-degradable meshes used in pelvic floor surgery can cause serious complications such as tissue erosion. A repair material composed of an autologous oral fibroblast seeded degradable polylactic acid scaffold may be a viable alternative. The aims of this study were to investigate the effects of media supplementation with additives (ascorbic acid-2-phosphate, glycolic acid and 17-β-oestradiol) on the mechanical properties of these scaffolds. Oral fibroblasts were isolated from buccal mucosa. The effects of the three additives were initially compared in two-dimensional culture to select the most promising collagen stimulating additive. Sterile electrospun scaffolds were seeded with 500,000 oral fibroblasts and fixed in 6-well plates and subjected to ascorbic acid-2-phosphate (the best performing additive) and/or mechanical stimulation. Mechanical stimulation by fluid shear stress was induced by rocking scaffolds on a platform shaker for 1 h/day for 10 of 14 days of culture. In two-dimensional culture, ascorbic acid-2-phosphate (concentrations from 0.02 mM to 0.04 M) and glycolic acid (10 µM) led to significantly greater total collagen production, but ascorbic acid-2-phosphate at 0.03 mM produced the greatest stimulation (of the order of >100%). In three-dimensional culture, mechanical stimulation alone gave non-significant increases in stiffness and strength. Ascorbic acid-2-phosphate (0.03 mM) significantly increased collagen production in the order 280% in both static and mechanically stimulated scaffolds (p < 0.0001). There was no additional effect of mechanical stimulation. Dense collagen I fibres were observed with ascorbic acid-2-phosphate supplementation. Uniaxial tensiometry showed that strength (p < 0.01) and stiffness (p <0.05) both improved significantly. A combination of ascorbic acid-2-phosphate and mechanical stimulation led to further non-signficant increases in strength and stiffness. In conclusion, a pelvic floor

  10. Steepest Descent

    SciTech Connect

    Meza, Juan C.

    2010-02-12

    The steepest descent method has a rich history and is one of the simplest and best known methods for minimizing a function. While the method is not commonly used in practice due to its slow convergence rate, understanding the convergence properties of this method can lead to a better understanding of many of the more sophisticated optimization methods. Here, we give a short introduction and discuss some of the advantages and disadvantages of this method. Some recent results on modified versions of the steepest descent method are also discussed.

  11. Pelvic Floor Disorders 6 Months after Attempted Operative Vaginal Delivery According to the Fetal Head Station: A Prospective Cohort Study

    PubMed Central

    Ducarme, Guillaume; Hamel, Jean-François; Brun, Stéphanie; Madar, Hugo; Merlot, Benjamin; Sentilhes, Loïc

    2016-01-01

    Objective To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD), and specifically midpelvic or low aOVD, on urinary incontinence (UI), anal incontinence (AI), and perineal pain at 6 months. Design Prospective cohort study. Setting 1941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital. Methods Symptoms of urinary incontinence (UI) using the Bristol Female Lower Urinary Tract Symptoms questionnaire, and symptoms of anal incontinence (AI) severity using Fecal Incontinence Severity Index (FISI) were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of UI, AI, and perineal pain at 6 months using multiple regression and adjusting for demographics, and risk factors of UI and AI, with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Results The study included 907 women (46.7%) who responded to the questionnaire; 18.4% (167/907) had midpelvic aOVD, and 81.6% (740/907) low; and none of women with symptoms of UI (26.6%, and 22.4%, respectively; p = 0.31), AI (15.9%, and 21.8%; p = 0.09), the FISI score, and perineal pain (17.2%, and 12.7%; p = 0.14) differed significantly between groups. The same was true for stress, urge, and mixed-type UI, severe UI and difficulty voiding. Compared with low pelvic aOVD, the aORs for symptoms of UI in midpelvic aOVD were 0.70 (0.46–1.05) and AI 1.42 (0.85–2.39). Third- and fourth-degree tears were a major risk factor of symptoms of UI (aOR 3.08, 95% CI 1.35–7.00) and AI (aOR 3.47, 95% CI 1.43–8.39). Conclusion Neither symptoms of urinary nor anal incontinence differed at 6 months among women who had midpelvic and low pelvic aOVD. These findings are reassuring and need further studies at long-term to confirm these short-term data. PMID:27992558

  12. Evaluation of the levator ani and pelvic wall muscles in levator ani syndrome.

    PubMed

    Hull, Margaret; Corton, Marlene M

    2009-01-01

    Chronic pelvic pain is a difficult problem to evaluate and treat. Knowledge of the pelvic floor and pelvic wall muscles may enable the provider to identify levator ani spasm syndrome, a possible cause of chronic pelvic pain.

  13. Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.

    PubMed

    Gyang, Anthony N; Feranec, Jessica B; Patel, Rakesh C; Lamvu, Georgine M

    2014-03-01

    In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0 % and 30 % of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions.

  14. 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.

  15. 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

  16. 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.

  17. Myofascial pelvic pain.

    PubMed

    Spitznagle, Theresa Monaco; Robinson, Caitlin McCurdy

    2014-09-01

    Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination.

  18. AB289. SPR-16 A preliminary evaluation of vaginal alignment following a transvaginal procedure using MatriStem™ pelvic floor matrix in the rhesus macaque

    PubMed Central

    Easley, Deanna C.; Barone, William R.; Moalli, Pamela A.; Abramowitch, Steven D.

    2016-01-01

    Objective Implantation of biological or synthetic mesh is the most common method of surgical intervention for pelvic organ prolapse, however, complications ensuing from these surgical repairs occur in 15.5% of cases. MatristemTM (ACell, Inc., USA) Pelvic Floor Matrix is a urinary bladder matrix (UBM) device indicated for transvaginal repair. This device is remodeled and replaced by host tissue following implantation, which raises the concern that the process may result in a loss of support to the vagina. Thus, the goal of this study was to quantify measurable changes in vaginal alignment via magnetic resonance imaging (MRI) before (pre) and after (10 days and 3 months) a transvaginal procedure with this device in a rhesus macaque model. Methods Two rhesus macaques underwent a transvaginal procedure in accordance with the IACUC at the University of Pittsburgh (protocol #13081928). Level 1 & 2 support to the vagina was transected to simulate compromised support. Two sheets of 6-ply MatriStemTM were implanted to support the anterior and posterior vagina. Vaginal alignment was derived from MRIs taken pre, 10 days, and 3 months after surgery. The border of the vagina was manually traced, and used to calculate the centroid of each tracing. These centroids represent the path of the vagina through the pelvis. Further, a 3D coordinate system was mapped to the pelvis, and lines fit to the proximal and distal vagina were used to measure the angle of each line with respect to a cephalic oriented axis in the mid-sagittal plane, which is referred to as the angle of elevation. Results At 10 days, the angle of elevation became more acute by 8.6% and 17%, respectively. These changes reflect expectations of a tensioned transvaginal fixation of the vagina. At 3 months post-surgery, angles of elevation approached pre surgery conditions, indicating that MatriStemTM was providing a comparable level of support to native tissue, even following remodeling. Conclusions This preliminary

  19. The surged faradic stimulation to the pelvic floor muscles as an adjunct to the medical management in children with rectal prolapse

    PubMed Central

    Ratan, Simmi K; Rattan, Kamal Nain; Jhajhria, Poonam; Mathur, Yogesh Parshad; Jhanwar, Atul; Kondal, Dimple

    2009-01-01

    Background To assess the role of the surged faradic stimulation to the pelvic floor muscles as an adjunct to the conservative management in the children of idiopathic rectal prolapse Methods Study design: Prospective Setting: Pediatric Surgery Department, Pt BD Sharma, Post Graduate Institute of Medical Sciences, Rohtak Subjects: 47 consecutive children with idiopathic rectal prolapse attending the Pediatric Surgery out patient department from July 2005 to June 2006 Methodology: The information pertaining to duration and the extent of rectal prolapse, predisposing or associated medical conditions, results of local clinical examination were noted. Surged faradic stimulation using modified intraluminal rectal probe, was given on the alternate days. The conventional conservative medical management was also continued. The extent of relief and the number of the sittings of faradic stimulation required were noted at various stages of follow-ups Statistical Methods: Mean values between those completely cured and others; poor responders and others were compared with t-test and proportions were compared with Chi square test. The p-value < 0.05 was considered statistically significant. Results The mean number of sittings in the completely cured group (n = 28(64%)) was (12.4 ± 7.8) and was comparable with very poor responder (n = 6(13%). There was higher percentage of relief (76%) at the first follow up (at 15 days) in completely cured Vs other (37%) and also the poor responders showed (20%) Vs other (68%) and was statistically significant. Conclusion With use of faradic stimulation, even the long-standing rectal prolapse can be fully cured. The follow up visit at 2 weeks is very important to gauge the likely success of this modality in treatment of the patients with rectal prolapse. Those showing poor response at this stage may require alternative treatment or take a long time to get cured PMID:19602234

  20. Musculoskeletal etiologies of pelvic pain.

    PubMed

    Prather, Heidi; Camacho-Soto, Alejandra

    2014-09-01

    Several musculoskeletal diagnoses are frequently concomitant with pelvic floor pathology and pain. The definition of pelvic pain itself often depends on the medical specialist evaluating the patient. Because there is variability among disorders associated with pelvic pain, patients may seek treatment for extended periods as various treatment options are attempted. Further, health care providers should recognize that there may not be a single source of dysfunction. This article discusses the musculoskeletal disorders of the pelvic girdle (structures within the bony pelvis) and their association with lumbar spine and hip disorders.

  1. 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

  2. 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 - ...

  3. 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

  4. Multimodal nociceptive mechanisms underlying chronic pelvic pain

    PubMed Central

    HELLMAN, Kevin M.; PATANWALA, Insiyyah Y.; POZOLO, Kristen E.; TU, Frank F.

    2015-01-01

    Objective To evaluate candidate mechanisms underlying the pelvic floor dysfunction in women with chronic pelvic pain and/or painful bladder syndrome/interstitial cystitis. Notably, prior studies have not consistently controlled for potential confounding by psychological or anatomical factors. Study Design As part of a larger study on pelvic floor pain dysfunction and bladder pain sensitivity, we compared a measure of mechanical pain sensitivity, pressure pain thresholds, between women with pelvic pain and pain-free controls. We also assessed a novel pain measure using degree and duration of post-exam pain aftersensation, and conducted structural and functional assessments of the pelvic floor to account for any potential confounding. Phenotypic specificity of pelvic floor measures was assessed with receiver-operator characteristic curves adjusted for prevalence. Results A total of 23 women with chronic pelvic pain, 23 painful bladder syndrome, and 42 pain-free controls completed the study. Women with chronic pelvic pain or painful bladder syndrome exhibited enhanced pain sensitivity with lower pressure pain thresholds (1.18 [interquartile range: 0.87–1.41] kg/cm2) than pain-free participants (1.48 [1.11–1.76] kg/cm2; p<0.001) and prolonged pain aftersensation (3.5 [0–9] vs 0 [0–1] minutes; p< 0.001). Although genital hiatus (p<0.01) was wider in women with chronic pelvic pain there were no consistently observed group differences in pelvic floor anatomy, muscle tone or strength. The combination of pressure pain thresholds and aftersensation duration correlated with severity of pelvic floor tenderness (R2 =41–51, p’s< 0.01). Even after adjustment for prevalence, the combined metrics discriminated pain-free controls from women with chronic pelvic pain or painful bladder syndrome (area under the curve=0.87). Conclusion Both experimental assessment of pelvic floor pain thresholds and measurement of sustained pain are independently associated with pelvic pain

  5. Transformable descent vehicles

    NASA Astrophysics Data System (ADS)

    Pichkhadze, K. M.; Finchenko, V. S.; Aleksashkin, S. N.; Ostreshko, B. A.

    2016-12-01

    This article presents some types of planetary descent vehicles, the shape of which varies in different flight phases. The advantages of such vehicles over those with unchangeable form (from launch to landing) are discussed. It is shown that the use of transformable descent vehicles widens the scope of possible tasks to solve.

  6. 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.

  7. Pelvic incidentalomas

    PubMed Central

    Newmark, G.M.; Thakrar, K.H.; Mehta, U.K.; Berlin, J.W.

    2010-01-01

    Abstract Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and non-oncology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented. PMID:20880789

  8. Emergency descent device

    NASA Technical Reports Server (NTRS)

    Belew, R. R.

    1974-01-01

    Device includes cable wound on reel; special assembly enclosed in fluid medium controls unwinding speed of cable during descent. Device is compact and reliable. It can be rewound quickly because reel disengages from latches when it is turned in opposite direction.

  9. Chronic Pelvic Pain

    MedlinePlus

    ... Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  10. Magnetic resonance-based female pelvic anatomy as relevant for maternal childbirth injury simulations.

    PubMed

    Hoyte, Lennox; Damaser, Margot S

    2007-04-01

    The objectives of the study are to review the female pelvic floor anatomy relevant to childbirth simulations, to discuss available methods for clinical evaluation of female pelvic floor function, and to review the variation in pelvic floor changes after vaginal childbirth. A high-resolution magnetic resonance (MR) data set from an asymptomatic nullipara was used to illustrate the MR anatomy of the female pelvic floor. Manual segmentation was performed and three-dimensional reconstructions of the pelvic floor structures were generated, which were used to illustrate the 3D anatomy of the pelvic floor. Variation in the post partum appearance of the levator ani muscles is illustrated using other 2D MR data sets, which depict unilateral and bilateral disruptions in the puborectalis portion of levator ani, as well as shape variations, which may be seen in the post partum levator. The clinical evaluation of the pelvic floor is then reviewed. The female pelvis is composed of a bony scaffold, from which the pelvic floor muscles (obturator internus, levator ani) are suspended. The rectum fits in a midline groove in the levator ani. The vagina is suspended across the midline, attaching bilaterally to the obturator and levator ani. The vagina supports the bladder and urethra. MR studies have demonstrated disruptions in levator ani attachments after vaginal childbirth. Such disruptions are rare in women who have not given birth vaginally. Changes to the neuromuscular apparatus of the pelvic floor can also be demonstrated after vaginal delivery. The combination of childbirth-related anatomic and neurological injury to the pelvic floor may be associated with pelvic floor dysfunction (PFD). These changes are difficult to study in vivo but may be studied through simulations. Appropriate consideration of clinical anatomy is important in these simulations.

  11. Advances in managing pelvic floor disorders

    PubMed Central

    2009-01-01

    The last 10-12 years have seen an avalanche of changes in both the management of incontinence and genital prolapse. So many new procedures continue to appear that often the clinician is confused as to which approach to adopt. Complications are now being reported, creating a need to reappraise the situation. PMID:20948691

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

    MedlinePlus

    ... noninvasive test that uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of ... scans, MRI does not utilize ionizing radiation. Instead, radio waves redirect alignment of hydrogen atoms that naturally exist ...

  13. How Are Pelvic Floor Disorders Commonly Treated?

    MedlinePlus

    ... opportunities Other Training, Education, & Career Development Programs Continuing education courses, training institutes & admin supplements News & Media ... Multimedia Audio briefings, videos & podcasts related ...

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

    MedlinePlus

    ... the technologist if you have any devices or metal in your body. Guidelines about eating and drinking ... if it is loose-fitting and has no metal fasteners. Guidelines about eating and drinking before an ...

  15. 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.

  16. 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 ...

  17. Complementary Curves of Descent

    DTIC Science & Technology

    2012-11-16

    provision of law , no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid...curves of descent 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT...NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) US Naval Academy,Physics Department,Annapolis,MD,21402-1363 8. PERFORMING ORGANIZATION

  18. 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.

  19. 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

  20. First and Second Floor Window Sills; First Floor, Second Floor, ...

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

    First and Second Floor Window Sills; First Floor, Second Floor, and Third Floor Door Jambs; Stair and Second Floor Baseboards; First Floor Window Jamb - National Home for Disabled Volunteer Soldiers - Battle Mountain Sanitarium, Treasurer's Quarters, 500 North Fifth Street, Hot Springs, Fall River County, SD

  1. 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.

  2. Entry, Descent, Landing Animation (Animation)

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Click on the image for Entry, Descent, Landing animation

    This animation illustrates the path the Stardust return capsule will follow once it enters Earth's atmosphere.

  3. Pelvic congestion syndrome and pelvic varicosities.

    PubMed

    Koo, Sonya; Fan, Chieh-Min

    2014-06-01

    Pelvic venous insufficiency (PVI), defined as retrograde flow in the gonadal and internal iliac veins, is the underlying cause of pelvic congestion syndrome (PCS), a common cause of disabling chronic pelvic pain in women of child-bearing age. PCS is a chronic pain syndrome characterized by positional pelvic pain that is worse in the upright position and is associated with pelvic and vulvar varicosities as well as symptoms of dyspareunia and postcoital pain. Through collaterals to the lower extremity venous system, PVI may also contribute to varicose vein formation and recurrence in the lower extremities. Endovascular embolization of the ovarian and internal iliac veins has become the treatment of choice for PVI and PCS. This article reviews the pelvic retroperitoneal venous anatomy, pathophysiology of PCS, treatment options and techniques, and clinical outcomes of embolotherapy for PCS.

  4. Mars Science Laboratory's Descent Stage

    NASA Technical Reports Server (NTRS)

    2008-01-01

    This portion of NASA's Mars Science Laboratory, called the descent stage, does its main work during the final few minutes before touchdown on Mars.

    The descent stage will provide rocket-powered deceleration for a phase of the arrival at Mars after the phases using the heat shield and parachute. When it nears the surface, the descent stage will lower the rover on a bridle the rest of the way to the ground.

    The Mars Science Laboratory spacecraft is being assembled and tested for launch in 2011.

    This image was taken at NASA's Jet Propulsion Laboratory, Pasadena, Calif., which manages the Mars Science Laboratory Mission for NASA's Science Mission Directorate, Washington. JPL is a division of the California Institute of Technology.

  5. Pelvic Inflammatory Disease (PID)

    MedlinePlus

    Pelvic Inflammatory Disease (PID) - CDC Fact Sheet Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a ... tubal blockage; •• Ectopic pregnancy (pregnancy outside the womb); •• Infertility (inability to get pregnant); •• Long-term pelvic/abdominal ...

  6. Reinforcement Learning Through Gradient Descent

    DTIC Science & Technology

    1999-05-14

    Reinforcement learning is often done using parameterized function approximators to store value functions. Algorithms are typically developed for...practice of existing types of algorithms, the gradient descent approach makes it possible to create entirely new classes of reinforcement learning algorithms

  7. 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.

  8. 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,…

  9. Chronic Pelvic Pain in Women

    MedlinePlus

    Chronic pelvic pain in women Overview By Mayo Clinic Staff Chronic pelvic pain is pain in the area below your bellybutton ... your hips that lasts six months or longer. Chronic pelvic pain can have multiple causes. It can be a ...

  10. Pelvic Inflammatory Disease

    MedlinePlus

    ... Weström, L., Joesoef, R., Reynolds, G., Hagdu, A., Thompson, S.E. (1992). Pelvic inflammatory disease and fertility. A ... Weström, L., Joesoef, R., Reynolds, G., Hagdu, A., Thompson, S.E. (1992). Pelvic inflammatory disease and fertility. A ...

  11. Numerical analysis of the orthogonal descent method

    SciTech Connect

    Shokov, V.A.; Shchepakin, M.B.

    1994-11-01

    The author of the orthogonal descent method has been testing it since 1977. The results of these tests have only strengthened the need for further analysis and development of orthogonal descent algorithms for various classes of convex programming problems. Systematic testing of orthogonal descent algorithms and comparison of test results with other nondifferentiable optimization methods was conducted at TsEMI RAN in 1991-1992 using the results.

  12. Readability of Common Health-Related Quality-of-Life Instruments in Female Pelvic Medicine

    PubMed Central

    Alas, Alexandriah N.; Bergman, Jonathan; Dunivan, Gena C.; Rashid, Rezoana; Morrisroe, Shelby N.; Rogers, Rebecca G.; Anger, Jennifer T.

    2016-01-01

    Objectives The average American adult reads below the eighth-grade level. To determine whether self-reported health-related quality-of-life questionnaires used for pelvic floor disorders are appropriate for American women, we measured reading levels of questionnaires for urinary incontinence(UI), pelvic organ prolapse(POP), and fecalin continence (FI). Methods An online literature search identified questionnaires addressing UI, POP, and FI. Readability was assessed using Flesch-Kincaid reading level and ease formulas. Flesch-Kincaid grade level indicates the average grade one is expected to completely and lucidly comprehend the written text. Flesch-Kincaid reading ease score, from 0 to 100, indicates how easy the written text can be read. Results Questionnaires were categorized by UI, POP, FI, and combined pelvic floor symptoms. The median Flesch-Kincaid reading level was 7.2, 10.1, 7.6, and 9.7, for UI, POP, FI, and combined pelvic floor symptoms, respectively. Reading levels varied greatly between questionnaires, with only 54% of questionnaires written below the eighth-grade level. Conclusions We identified significant variation in reading levels among the questionnaires and found the 2 most commonly used questionnaires per survey in 2008 at Society of Urodynamics and Female Pelvic Medicine and Urogenital Reconstruction were above the recommended eighth-grade reading level. As specialty societies focus on standardizing questionnaires for research, reading levels should be considered so they are generalizable to larger populations of women with pelvic floor disorders. PMID:23982579

  13. Haemodynamically Unstable Pelvic Fractures

    DTIC Science & Technology

    2009-01-01

    patients with pelvic fractures. Ann Surg 2001;233:843–50. 12. Blackmore CC, Cummings P, Jurkovich GJ , et al. Predicting major hemorrhage in patients...with pelvic fracture. J Trauma 2006;61:346–52. 13. Blackmore CC, Jurkovich GJ , Linnau KF, et al. Assessment of volume of hemorrhage and outcome from...outcome of blunt trauma patients sustaining pelvic fractures. Injury 2000;31:677–82. 55. Haidukewych GJ , Kumar S, Prpa B. Placement of half-pins for

  14. Myofascial pelvic pain.

    PubMed

    Kotarinos, Rhonda

    2012-10-01

    Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings.

  15. 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…

  16. 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 ...

  17. Pelvic laparoscopy - slideshow

    MedlinePlus

    ... ency/presentations/100131.htm Pelvic laparoscopy - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  18. 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.

  19. Case report: pelvic actinomycosis.

    PubMed

    Maxová, K; Menzlová, E; Kolařík, D; Dundr, P; Halaška, M

    2012-01-01

    A case of pelvic actinomycosis is presented. The patient is 42-year-old female with a 5 weeks history of pelvic pain. An intrauterine device (IUD) was taken out 3 weeks ago. There is a lump length 9 cm between rectus muscles. Ultrasound, magnetic resonance imaging (MRI) and histology are used to make the diagnosis. Actinomycosis can mimic the tumour disease. The definitive diagnosis requires positive anaerobic culture or histological identification of actinomyces granulas. A long lasting antibiotic therapy is performed.

  20. 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

  1. Prevention of falls during stairway descent in older adults.

    PubMed

    Kim, B J

    2009-05-01

    A prospective design was applied to examine how older adults would adapt stairway intervention stimuli to gait patterns during stairway descent to prevent falls. Ambient lighting and an auditory signal were used as stairway intervention stimuli. The gait pattern changes with and without stimuli were compared. No significant change of angular displacement was found between normal condition and intervention conditions under daylight and nightlight. The lighting intervention tended to increase the knee's angular velocity for both daylight and nightlight conditions, but not the ankle's angular velocity. However, adding the auditory signal to the lighting intervention under nightlight condition increased the ankle's angular velocity. Under the daylight condition, every intervention was significantly helpful to make people step on the floor more confidently compared to the condition without interventions. However, the intervention of lighting had an opposite effect on the confidence of stepping under the nightlight condition. The intervention of lighting may contribute to increase of confidence during stair descent while compromising the declined stride length in older adults and the potential "rush" factor for falls on stairs.

  2. Pelvic floor tenderness in the etiology of superficial dyspareunia.

    PubMed

    Yong, Paul J; Mui, Justin; Allaire, Catherine; Williams, Christina

    2014-11-01

    Objectif : Calculer la prévalence de la sensibilité du plancher pelvien au sein de la population des femmes qui connaissent des douleurs pelviennes et déterminer ses implications pour ce qui est des symptômes de la douleur pelvienne. Méthodes : Nous avons mené une analyse rétrospective auprès de patientes connaissant des douleurs pelviennes au sein d’un centre spécialisé tertiaire. La sensibilité du plancher pelvien a été définie comme étant une sensibilité du muscle releveur de l’anus ressentie au moins d’un côté au cours d’un examen pelvien mené au moyen d’un seul doigt. La prévalence de la sensibilité du plancher pelvien au sein de cette cohorte de femmes connaissant des douleurs pelviennes a été comparée à la même prévalence au sein d’une cohorte de femmes exemptes de douleurs fréquentant une clinique de gynécologie. Chez les femmes connaissant des douleurs pelviennes, une régression multiple a été menée en vue d’identifier les variables qui étaient associées de façon indépendante à la sensibilité du plancher pelvien. Résultats : La prévalence de la sensibilité du plancher pelvien était de 40 % (75/189) au sein de la cohorte « douleurs pelviennes »; elle était donc considérablement supérieure à la prévalence de 13 % (4/32) qui a été constatée au sein de la cohorte « absence de douleur » (RC, 4,61; IC à 95 %, 1,55 - 13,7, P = 0,005). Dans le cadre de la régression logistique multiple, la dyspareunie superficielle (RC, 4,45; IC à 95 %, 1,86 - 10,7, P = 0,001), la douleur ressentie au niveau de la paroi abdominale (RC, 4,04; IC à 95 %, 1,44 - 11,3, P = 0,005) et la sensibilité de la base de la vessie (RC, 4,65; IC à 95 %, 1,87 - 11,6, P = 0,001) étaient associées de façon indépendante à la sensibilité du plancher pelvien. Cette dernière était tout aussi présente chez les femmes qui connaissaient une endométriose sous-jacente que chez les femmes qui ne connaissaient pas une telle pathologie. Conclusion : La sensibilité du plancher pelvien est courante chez les femmes qui connaissent des douleurs pelviennes, en présence ou non d’une endométriose, et contribue à la dyspareunie superficielle. Elle a également été associée à la douleur ressentie au niveau de la paroi abdominale et à la sensibilité de la base de la vessie, ce qui semble indiquer que la sensibilisation du système nerveux est impliquée dans son étiologie.

  3. 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.

  4. Current concepts of female pelvic anatomy and physiology.

    PubMed

    Mostwin, J L

    1991-05-01

    The female urinary bladder and urethra are situated on the intrapelvic surface of the anterior vaginal wall, firmly anchored to the distal vagina by the urogenital diaphragm and to the superior vagina at the vesicocervicouterine junction. The anterior surface of the proximal urethra is firmly anchored to the posterior aspect of the symphysis pubis by the pubourethral ligaments and to the remaining distal vagina by the lower two thirds of the urogenital diaphragm. The lateral bladder wall derives its support from the anterior vaginal wall attachments to the pelvic sidewall. The anterior vaginal wall is strongly supported by pubococcygeus muscle fibers inserting on the vaginal wall and the genital hiatus and by the cardinal and uterosacral ligaments. Vaginal detachment from the lateral pelvic sidewall can result in herniation, with accompanying secondary posterior bladder descent. Levator ani weakness or injury may be a contributing etiologic factor in the genesis of vaginal wall detachment and the development of stress incontinence.

  5. 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.

  6. Human factors by descent energy management

    NASA Technical Reports Server (NTRS)

    Curry, R. E.

    1979-01-01

    This paper describes some of the results of a human factors study of energy management during descent using standard aircraft displays. Discussions with pilots highlighted the practical constraints involved and the techniques (algorithms) used to accomplish the descent. The advantages and disadvantages of these algorithms are examined with respect to workload and their sensitivity to disturbances. Vertical navigation and flight performance computers are discussed in terms of the information needed for effective pilot monitoring and takeover

  7. Mixed-Up Floors.

    ERIC Educational Resources Information Center

    Shaw, Richard

    2001-01-01

    Examines the maintenance management problems inherent in cleaning multiple flooring materials revealing the need for school officials to keep it simple when choosing flooring types. Also highlighted is a carpet recycling program used by Wright State University (Ohio). (GR)

  8. 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)

  9. 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

  10. Persistent pelvic pain and pelvic joint instability.

    PubMed

    Saugstad, L F

    1991-10-08

    As accepted as the condition of pelvic pain and pelvic joint instability (PPPJI) is in pregnancy, as controversial and doubted is the same diagnosis in non-pregnant women. Women suffering severe incapacitating PPPJI for years following parturition have recently founded an association. This offers a unique opportunity to investigate their characteristics. 153 of the 215 members answered a questionnaire. The majority (110) suffered PPPJI in first pregnancy with onset preceding 20 weeks gestation in 84 women. Onset was significantly earlier in users of oral contraceptives than in non-users (16.3 weeks and 20.5 weeks, respectively). The 153 women did not differ from the controls with regard to life-style, diseases prior to reproduction or reproduction. Their 358 deliveries were characterized by a marked excess of post-term deliveries, a raised proportion of infants of 4000 g or more, an extremely low sex-ratio of offspring (0.84) with 54.5% female births, and a significantly raised congenital hip dysplasia rate, consistent with elevated oestrogen and relaxin levels.

  11. Pelvic inflammatory disease

    PubMed Central

    2013-01-01

    Introduction Pelvic inflammatory disease is caused by infection of the upper female genital tract and is often asymptomatic. Pelvic inflammatory disease is the most common gynaecological reason for admission to hospital in the US, and is diagnosed in approximately 1% of women aged 16 to 45 years consulting their GP in England and Wales. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: How do different antimicrobial regimens compare when treating women with confirmed pelvic inflammatory disease? What are the effects of routine antibiotic prophylaxis to prevent pelvic inflammatory disease before intrauterine contraceptive device (IUD) insertion? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up to date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 13 RCTs or systematic reviews of RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antibiotics (oral, parenteral, different durations, different regimens) and routine antibiotic prophylaxis (before intrauterine device insertion in women at high risk or low risk). PMID:24330771

  12. Pelvic ultrasound - abdominal

    MedlinePlus

    ... pelvic ultrasound. In: Lumb P, Karakitsos D, eds. Critical Care Ultrasound. Philadelphia, PA: Elsevier Saunders; 2015:chap 43. Review Date 3/4/2016 Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, ...

  13. Pelvic Pain: Other FAQs

    MedlinePlus

    ... Publications Pelvic Pain: Other FAQs Skip sharing on social media links Share this: Page Content Basic information for topics, such as “What is it?” and “How many people are affected?” is available in the Condition Information ...

  14. 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

  15. 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.

  16. 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.

  17. Pelvic inflammatory disease

    PubMed Central

    2008-01-01

    Introduction Pelvic inflammatory disease is caused by infection of the upper female genital tract and is often asymptomatic. Pelvic inflammatory disease is the most common gynaecological reason for admission to hospital in the USA and is diagnosed in almost 2% of women aged 16 to 45 years consulting their GP in England and Wales. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical treatment compared with treatment delayed until the results of microbiological investigations are known? How do different antimicrobial regimens compare? What are the effects of routine antibiotic prophylaxis to prevent pelvic inflammatory disease before intrauterine contraceptive device (IUD) insertion? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antibiotics (oral, parenteral, empirical treatment, treatment guided by test results, different durations, outpatient, inpatient), and routine antibiotic prophylaxis (before intrauterine device insertion in women at high risk or low risk). PMID:19450319

  18. 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…

  19. 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

  20. 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.

  1. 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…

  2. 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.

  3. 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…

  4. 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…

  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-6 - Kid-Physick House, 325 Walnut Street, Philadelphia, Philadelphia County, PA

  6. 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

  7. 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

  8. Utilization of surgical procedures for pelvic organ prolapse: a population-based study in Olmsted County, Minnesota, 1965-2002.

    PubMed

    Babalola, Ebenezer O; Bharucha, Adil E; Melton, L Joseph; Schleck, Cathy D; Zinsmeister, Alan R; Klingele, Christopher J; Gebhart, John B

    2008-09-01

    To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN, we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic floor repair (PFR) procedures and 687 had PFR alone. The age-adjusted utilization of hysterectomy plus PFR and of PFR alone decreased by 62% (P < 0.001) and 32% (P = 0.02), respectively. In both groups, utilization decreased in all age groups over time except in women aged 80 years and older undergoing hysterectomy plus PFR and women aged 70 years and older undergoing PFR only. The most common indication for PFR was uterovaginal prolapse. Among women in the community, the rate of utilization and age distribution of pelvic organ prolapse surgery changed substantially between 1965 and 2002.

  9. Phenotyping Clinical Disorders: Lessons Learned From Pelvic Organ Prolapse

    PubMed Central

    Wu, Jennifer M.; Ward, Renée M.; Allen-Brady, Kristina L.; Edwards, Todd L.; Norton, Peggy A.; Hartmann, Katherine E.; Hauser, Elizabeth R.; Velez Edwards, Digna R.

    2012-01-01

    Genetic epidemiology, the study of genetic contributions to risk for disease, is an innovative area in medicine. While research in this arena has advanced in other disciplines, few genetic epidemiologic studies have been conducted in obstetrics and gynecology. It is crucial that we study the genetic susceptibility for issues in women’s health, as this information will shape the new frontier of “personalized medicine.” To date, preterm birth may be one of the best examples of genetic susceptibility in obstetrics and gynecology, but many areas are being evaluated including endometriosis, fibroids, polycystic ovarian syndrome and pelvic floor disorders. An essential component to genetic epidemiologic studies is to characterize, or “phenotype,” the disorder in order to identify genetic effects. Given the growing importance of genomics and genetic epidemiology, we discuss the importance of accurate phenotyping of clinical disorders and highlight critical considerations and opportunities in phenotyping, using pelvic organ prolapse as a clinical example. PMID:23200709

  10. Analysis of Online Composite Mirror Descent Algorithm.

    PubMed

    Lei, Yunwen; Zhou, Ding-Xuan

    2017-03-01

    We study the convergence of the online composite mirror descent algorithm, which involves a mirror map to reflect the geometry of the data and a convex objective function consisting of a loss and a regularizer possibly inducing sparsity. Our error analysis provides convergence rates in terms of properties of the strongly convex differentiable mirror map and the objective function. For a class of objective functions with Hölder continuous gradients, the convergence rates of the excess (regularized) risk under polynomially decaying step sizes have the order [Formula: see text] after [Formula: see text] iterates. Our results improve the existing error analysis for the online composite mirror descent algorithm by avoiding averaging and removing boundedness assumptions, and they sharpen the existing convergence rates of the last iterate for online gradient descent without any boundedness assumptions. Our methodology mainly depends on a novel error decomposition in terms of an excess Bregman distance, refined analysis of self-bounding properties of the objective function, and the resulting one-step progress bounds.

  11. A Sea Floor Penetrometer.

    DTIC Science & Technology

    processed through an analog-to-digital (A/D) converter, and stored in the memory of a mini-computer. Computer algorithms are applied to the deceleration data to provide real-time sea floor classification.

  12. Effects of examination technique modifications on pelvic organ prolapse quantification (POP-Q) results.

    PubMed

    Visco, Anthony G; Wei, John T; McClure, Leslie Ain; Handa, Victoria L; Nygaard, Ingrid E

    2003-06-01

    The pelvic organ prolapse quantification system (POP-Q) is currently the most quantitative, site-specific system for describing pelvic organ prolapse. To ensure that anatomic outcomes can be optimally assessed, investigators in the Pelvic Floor Disorders Network evaluated the impact of specific technique variations on POP-Q measurements performed on 133 patients by 16 examiners at seven sites. Values for genital hiatus and perineal body were higher when measured with maximal strain than on resting. With the exception of TVL, internal points did not differ significantly when measured with or without a speculum. The maximum extent of prolapse was best seen with the patient standing. These results suggest that genital hiatus and perineal body should be measured at rest and during straining, as the measurements may assess different aspects of pelvic floor function, and that internal points can be measured with or without a speculum. They also emphasize the value of the standing examination to observe the maximum extent of pelvic organ prolapse.

  13. Establishing the biomechanical properties of the pelvic soft tissues through an inverse finite element analysis using magnetic resonance imaging.

    PubMed

    Silva, M E T; Brandão, S; Parente, M P L; Mascarenhas, T; Natal Jorge, R M

    2016-04-01

    The mechanical characteristics of the female pelvic floor are relevant when explaining pelvic dysfunction. The decreased elasticity of the tissue often causes inability to maintain urethral position, also leading to vaginal and rectal descend when coughing or defecating as a response to an increase in the internal abdominal pressure. These conditions can be associated with changes in the mechanical properties of the supportive structures-namely, the pelvic floor muscles-including impairment. In this work, we used an inverse finite element analysis to calculate the material constants for the passive mechanical behavior of the pelvic floor muscles. The numerical model of the pelvic floor muscles and bones was built from magnetic resonance axial images acquired at rest. Muscle deformation, simulating the Valsalva maneuver with a pressure of 4 KPa, was compared with the muscle displacement obtained through additional dynamic magnetic resonance imaging. The difference in displacement was of 0.15 mm in the antero-posterior direction and 3.69 mm in the supero-inferior direction, equating to a percentage error of 7.0% and 16.9%, respectively. We obtained the shortest difference in the displacements using an iterative process that reached the material constants for the Mooney-Rivlin constitutive model (c10=11.8 KPa and c20=5.53 E-02 KPa). For each iteration, the orthogonal distance between each node from the group of nodes which defined the puborectal muscle in the numerical model versus dynamic magnetic resonance imaging was computed. With the methodology used in this work, it was possible to obtain in vivo biomechanical properties of the pelvic floor muscles for a specific subject using input information acquired non-invasively.

  14. 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

  15. Free descent and on bottom ADCM measurements in the Puerto Rico Trench, 19.77°N, 67.40°W

    NASA Astrophysics Data System (ADS)

    Schmidt, Wilford E.; Siegel, Eric

    2011-09-01

    On bottom ( ≈2m) current velocities in the Puerto Rico Trench ( ≈8350m depth) were measured at 1 Hz for 75 min by acoustic-Doppler current meter at 19.75°N, 66.40°W, via untethered free-descent/ascent vehicle. The April 2008 deployment also recorded 3-axis velocity, temperature, pressure, and instrument heading, pitch, roll, and signal strength during the 153 min free-descent, and while on bottom. No data for the ascent was recorded. Signal strength was above the noise floor for the entire data set, and SNR and velocity STD were within known acceptable bounds above 7000 m. Instrument heading showed a continuous anti-clockwise rotation during descent. Doppler vertical velocity during descent is compared to the pressure time derivative and observed to exhibit extended periods of under-bias, correlated not to low SNR, but to Doppler horizontal velocity fluctuations. Doppler horizontal velocity during descent is interpreted to be tangential to rotation and includes lateral translations. Integration of horizontal velocity during descent suggests a lateral displacement of less than 30 m over the 8.35 km free-fall. Measurements made at impact indicate full functionality of the instrument at depth. Maximum horizontal velocities while on bottom varied between 1 and 5 cm/s and were directed roughly along trench axis to the W.

  16. Kinetic analysis of stair descent: Part 1. Forwards step-over-step descent.

    PubMed

    Cluff, Tyler; Robertson, D Gordon E

    2011-03-01

    This study examined lower extremity biomechanics during the initiation of stair descent from an upright, static posture. Seventeen healthy subjects (aged 23±2.4 years) descended a five-step, steel-reinforced, wooden laboratory staircase (34° decline). Ten trials of stair descent were separated into two blocks of five trials. Beginning from an upright posture, subjects descended the staircase at their preferred velocity (0.53±0.082 m/s) and continued the length of the laboratory walkway (∼4 m). Joint mechanics were contrasted between gait cycles. Relative to the initiation cycle at the top of the staircase, the dissipative knee extensor (K3) and hip flexor (H2) moments and powers were independent of progression velocity and approximated steady-state (i.e., constant) values after the first cycle of the trail limb (Step 5 to Step 3). In contrast, a salient relationship was observed between progression velocity and ankle joint mechanics at initial-contact. The plantiflexor moment, power and work at initial-contact (A1) increased with centre of mass velocity. Our results demonstrate that while the knee extensor moment is the primary dissipater of mechanical energy in stair descent, the ankle plantiflexors are the primary dissipaters associated with increased progression velocity. In addition, the results show that steady-state stair descent may not be attained during the first gait cycle of the trail limb. These data shed light on locomotive strategies used in stair descent and can be applied in biomechanical models of human stair gait. Researchers and practitioners should take into consideration the influence of gait cycle and progression velocity when evaluating lower extremity function in stair descent.

  17. Patterns of intraneural ganglion cyst descent.

    PubMed

    Spinner, Robert J; Carmichael, Stephen W; Wang, Huan; Parisi, Thomas J; Skinner, John A; Amrami, Kimberly K

    2008-04-01

    On the basis of the principles of the unifying articular theory, predictable patterns of proximal ascent have been described for fibular (peroneal) and tibial intraneural ganglion cysts in the knee region. The mechanism underlying distal descent into the terminal branches of the fibular and tibial nerves has not been previously elucidated. The purpose of this study was to demonstrate if and when cyst descent distal to the articular branch-joint connection occurs in intraneural ganglion cysts to understand directionality of intraneural cyst propagation. In Part I, the clinical records and MRIs of 20 consecutive patients treated at our institution for intraneural ganglion cysts (18 fibular and two tibial) arising from the superior tibiofibular joint were retrospectively analyzed. These patients underwent cyst decompression and disconnection of the articular branch. Five of these patients developed symptomatic cyst recurrence after cyst decompression without articular branch disconnection which was done elsewhere prior to our intervention. In Part II, five additional patients with intraneural ganglion cysts (three fibular and two tibial) treated at other institutions without disconnection of the articular branch were compared. These patients in Parts I and II demonstrated ascent of intraneural cyst to differing degrees (12 had evidence of sciatic nerve cross-over). In addition, all of these patients demonstrated previously unrecognized MRI evidence of intraneural cyst extending distally below the level of the articular branch to the joint of origin: cyst within the proximal most portions of the deep fibular and superficial fibular branches in fibular intraneural ganglion cysts and descending tibial branches in tibial intraneural ganglion cysts. The patients in Part I had complete resolution of their cysts at follow-up MRI examination 1 year postoperatively. The patients in Part II had intraneural recurrences postoperatively within the articular branch, the parent

  18. Female pelvic congenital malformations. Part I: embryology, anatomy and surgical treatment.

    PubMed

    Laterza, Rosa M; De Gennaro, Mario; Tubaro, Andrea; Koelbl, Heinz

    2011-11-01

    This review covers the most important female congenital pelvic malformations. The first part focuses on the embryological development of the urogenital and anorectal apparatus, morphological features, and the diagnostic and surgical approach to abnormalities. Comprehension of the embryological development of the urogenital and anorectal apparatus is essential to understand the morphology of congenital pelvic abnormalities and their surgical treatment. Congenital pelvic malformations are characterized by specific common features; the severity of which often subverts the pelvic morphology completely and makes it difficult to comprehend before surgery. The development of imaging, mainly magnetic resonance imaging and ultrasound, in the investigation of pelvic floor disorders has recently become a fundamental tool for surgeons to achieve better understanding of the anatomy. Forty years ago, the primary aim of clinicians was to save the lives of such patients and to achieve anatomical normality. However, nowadays, functional reconstruction and recovery are essential parts of surgical management. Introduction of minimally invasive surgery has allowed the improvement of cosmetic results that is so important in paediatric or adolescent patients after reconstructive surgery. The option of sharing the complexity of pelvic congenital diseases by entrusting specific competencies to subspecialists (paediatric urologists, urogynaecologists, neurourologists, paediatric endocrinologists and neonatologists) has improved the quality of care for patients. However, at the same time, active interaction between various specialists remains fundamental. The exchange of knowledge and expertise, not only during the diagnostic-therapeutic process but also during follow-up, is crucial to obtain the best anatomical and functional results throughout the life of the patient.

  19. Chronic proctalgia and chronic pelvic pain syndromes: New etiologic insights and treatment options

    PubMed Central

    Chiarioni, Giuseppe; Asteria, Corrado; Whitehead, William E

    2011-01-01

    This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: A recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders. PMID:22110274

  20. 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.

  1. 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

  2. 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.

  3. African Descent and Glaucoma Evaluation Study (ADAGES)

    PubMed Central

    Girkin, Christopher A.; Sample, Pamela A.; Liebmann, Jeffrey M.; Jain, Sonia; Bowd, Christopher; Becerra, Lida M.; Medeiros, Felipe A.; Racette, Lyne; Dirkes, Keri A.; Weinreb, Robert N.; Zangwill, Linda M.

    2010-01-01

    Objective To define differences in optic disc, retinal nerve fiber layer, and macular structure between healthy participants of African (AD) and European descent (ED) using quantitative imaging techniques in the African Descent and Glaucoma Evaluation Study (ADAGES). Methods Reliable images were obtained using stereoscopic photography, confocal scanning laser ophthalmoscopy (Heidelberg retina tomography [HRT]), and optical coherence tomography (OCT) for 648 healthy subjects in ADAGES. Findings were compared and adjusted for age, optic disc area, and reference plane height where appropriate. Results The AD participants had significantly greater optic disc area on HRT (2.06 mm2; P<.001) and OCT (2.47 mm2; P<.001) and a deeper HRT cup depth than the ED group (P<.001). Retinal nerve fiber layer thickness was greater in the AD group except within the temporal region, where it was significantly thinner. Central macular thickness and volume were less in the AD group. Conclusions Most of the variations in optic nerve morphologic characteristics between the AD and ED groups are due to differences in disc area. However, differences remain in HRT cup depth, OCT macular thickness and volume, and OCT retinal nerve fiber layer thickness independent of these variables. These differences should be considered in the determination of disease status. PMID:20457974

  4. 16. STATIC TEST TOWER REMOVABLE FLOOR LEVEL VIEW OF FLOOR ...

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

    16. STATIC TEST TOWER REMOVABLE FLOOR LEVEL VIEW OF FLOOR THAT FOLDS BACK TO ALLOW ROCKET PLACEMENT. - Marshall Space Flight Center, Saturn Propulsion & Structural Test Facility, East Test Area, Huntsville, Madison County, AL

  5. 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

  6. 45. SECOND FLOOR WAREHOUSE, WITH CRANE AND WOODEN BLOCK FLOORING. ...

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

    45. SECOND FLOOR WAREHOUSE, WITH CRANE AND WOODEN BLOCK FLOORING. VIEW TO NORTH. - Ford Motor Company Long Beach Assembly Plant, Assembly Building, 700 Henry Ford Avenue, Long Beach, Los Angeles County, CA

  7. 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

  8. Traction vertical shear pelvic ring fracture: a marker for severe arterial injury? A case report.

    PubMed

    Manson, Theodore T; Nascone, Jason W; O'Toole, Robert V

    2010-10-01

    Vertical shear pelvic ring fractures have been described as being produced only by a force directed cephalad, typically from falls or motor vehicle collisions. We report a seemingly similar vertical injury with the displacement of the hemipelvis being caudad rather than cephalad. Caudad displacement of the hemipelvis might disrupt the pelvic floor and vasculature far more than a standard vertical shear injury would and might be more prone to vascular injury. The clinical examination of the pelvic wound in our patient was not impressive and the magnitude of displacement seen on the admission radiograph was not different from that seen with a typical vertical shear injury. It is the caudal direction of the displacement that we think should alert the surgeon to the possibility of massive vascular injury and potential for limb loss.

  9. 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

  10. 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

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

    2016-06-01

    [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.

  11. Pelvic Inflammatory Disease (PID) Treatment and Care

    MedlinePlus

    ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ...

  12. Pelvic Inflammatory Disease (PID) Fact Sheet

    MedlinePlus

    ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ...

  13. 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.

  14. Probability of identity by descent in metapopulations.

    PubMed Central

    Kaj, I; Lascoux, M

    1999-01-01

    Equilibrium probabilities of identity by descent (IBD), for pairs of genes within individuals, for genes between individuals within subpopulations, and for genes between subpopulations are calculated in metapopulation models with fixed or varying colony sizes. A continuous-time analog to the Moran model was used in either case. For fixed-colony size both propagule and migrant pool models were considered. The varying population size model is based on a birth-death-immigration (BDI) process, to which migration between colonies is added. Wright's F statistics are calculated and compared to previous results. Adding between-island migration to the BDI model can have an important effect on the equilibrium probabilities of IBD and on Wright's index. PMID:10388835

  15. 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.

  16. Error Analysis of Stochastic Gradient Descent Ranking.

    PubMed

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

    2012-12-31

    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.

  17. 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.

  18. Planetary entry, descent, and landing technologies

    NASA Astrophysics Data System (ADS)

    Pichkhadze, K.; Vorontsov, V.; Polyakov, A.; Ivankov, A.; Taalas, P.; Pellinen, R.; Harri, A.-M.; Linkin, V.

    2003-04-01

    Martian meteorological lander (MML) is intended for landing on the Martian surface in order to monitor the atmosphere at landing point for one Martian year. MMLs shall become the basic elements of a global network of meteorological mini-landers, observing the dynamics of changes of the atmospheric parameters on the Red Planet. The MML main scientific tasks are as follows: (1) Study of vertical structure of the Martian atmosphere throughout the MML descent; (2) On-surface meteorological observations for one Martian year. One of the essential factors influencing the lander's design is its entry, descent, and landing (EDL) sequence. During Phase A of the MML development, five different options for the lander's design were carefully analyzed. All of these options ensure the accomplishment of the above-mentioned scientific tasks with high effectiveness. CONCEPT A (conventional approach): Two lander options (with a parachute system + airbag and an inflatable airbrake + airbag) were analyzed. They are similar in terms of fulfilling braking phases and completely analogous in landing by means of airbags. CONCEPT B (innovative approach): Three lander options were analyzed. The distinguishing feature is the presence of inflatable braking units (IBU) in their configurations. SELECTED OPTION (innovative approach): Incorporating a unique design approach and modern technologies, the selected option of the lander represents a combination of the options analyzed in the framework of Concept B study. Currently, the selected lander option undergoes systems testing (Phase D1). Several MMLs can be delivered to Mars in frameworks of various missions as primary or piggybacking payload: (1) USA-led "Mars Scout" (2007); (2) France-led "NetLander" (2007/2009); (3) Russia-led "Mars-Deimos-Phobos sample return" (2007); (4) Independent mission (currently under preliminary study); etc.

  19. Gynecological pelvic pain as emergency pathology.

    PubMed

    Rivera Domínguez, A; Mora Jurado, A; García de la Oliva, A; de Araujo Martins-Romeo, D; Cueto Álvarez, L

    Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management.

  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. Floor of Hellas Basin

    NASA Technical Reports Server (NTRS)

    2002-01-01

    [figure removed for brevity, see original site]

    With a diameter of roughly 2000 km and a depth of over 7 km, the Hellas Basin is the largest impact feature on Mars. Because of its great depth, there is significantly more atmosphere to peer through in order to see its floor, reducing the quality of the images taken from orbit. This THEMIS image straddles a scarp between the Hellas floor and an accumulation of material at least a half kilometer thick that covers much of the floor. The southern half of the image contains some of this material. Strange ovoid landforms are present here that give the appearance of flow. It is possible that water ice or even liquid water was present in the deposits and somehow responsible for the observed landscape. The floor of Hellas remains a poorly understood portion of the planet that should benefit from the analysis of new THEMIS data.

    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 conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in

  2. 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

  3. Bone Health and Pelvic Radiotherapy.

    PubMed

    Higham, C E; Faithfull, S

    2015-11-01

    Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice.

  4. [Complex pelvic injury in childhood].

    PubMed

    Schmal, H; Klemt, C; Haag, C; Bonnaire, F

    2002-08-01

    Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. Combination of a rare injury and the capability of children to compensate blood loss for a long time may implicate a wrong security and prolong diagnostic and therapeutic procedures--a problem that definitely should be avoided. Three cases were analyzed and established algorithms for treatment of patients matching these special injury-features demonstrated. A good outcome may only be achieved when all components of injury pattern get recognized and treatment is organized following the hierarchy of necessity. Therefore in the time table first life-saving steps have to be taken and then accompanying injuries can be treated that often decisively influence life quality. As seen in our cases unstable and dislocated fractures require open reduction and internal fixation ensuring nerval decompression, stop of hemorrhage and realizing the prerequisite for effective treatment of soft tissue damage. The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center.

  5. Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) Trial: Design and Methods

    PubMed Central

    Barber, Matthew D.; Brubaker, Linda; Menefee, Shawn; Norton, Peggy; Borello-France, Diane; Varner, Edward; Schaffer, Joseph; Weidner, Alison; Xu, Xiao; Spino, Cathie; Weber, Anne

    2008-01-01

    The primary aims of this trial are: 1) to compare surgical outcomes following sacrospinous ligament fixation to uterosacral vaginal vault suspension in women undergoing vaginal surgery for apical or uterine pelvic organ prolapse and stress urinary incontinence and 2) to examine the effects of a structured perioperative program consisting of behavioral techniques and pelvic floor muscle training compared to usual care. This trial is performed through the Pelvic Floor Disorders Network (PFDN), which is funded by National Institute of Child Health and Human Development. Subjects will be enrolled from hospitals associated with seven PFDN clinical centers across the United States. A centralized biostatistical coordinating center will oversee data collection and analysis. Two approaches will be investigated simultaneously using a 2×2 randomized factorial design: a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (behavioral and pelvic floor muscle training versus usual care). Surgeons have standardized essential components of each surgical procedure and have met specific standards of expertise. Providers of the behavioral intervention have undergone standardized training. Anatomic, functional, and health-related quality of life outcomes will be assessed using validated measures by researchers blinded to all randomization assignments. Cost-effectiveness analysis will be performed using prospectively collected data on health care costs and resource utilization. The primary surgical endpoint is a composite outcome defined by anatomic recurrence, recurrence of bothersome vaginal prolapse symptoms and/or retreatment and will be assessed 2 years after the index surgery. Endpoints for the behavioral intervention include both short-term (6-month) improvement in urinary symptoms and long-term (2-year) improvement in anatomic outcomes and prolapse symptoms. This article describes the

  6. 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.

  7. Descent guidance and mission planning for space shuttle

    NASA Technical Reports Server (NTRS)

    Joosten, B. K.

    1985-01-01

    The Space Shuttle descent mission planning, mission design, deorbit targeting, and entry guidance have necessarily become interrelated because of the nature of the Orbiter's design and mission requirements. The desired descent trajectory has been formulated in a drag acceleration/relative velocity state space since nearly all of the vehicle's highly constraining flight limitations can be uniquely represented in this plane. Constraints and flight requirements that affect the descent are described. The guidance logic which allows the Orbiter to follow the designed trajectory, the impacts of contingency aborts and flightcrew interaction are discussed. The mission planning and guidance techniques remain essentially unchanged through the Shuttle flight test program and subsequent operational flights.

  8. 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.

  9. Crater Wall and Floor

    NASA Technical Reports Server (NTRS)

    2003-01-01

    [figure removed for brevity, see original site]

    3D Projection onto MOLA data [figure removed for brevity, see original site]

    The impact crater observed in this THEMIS image taken in Terra Cimmeria suggests sediments have filled the crater due to the flat and smooth nature of the floor compared to rougher surfaces at higher elevations. The abundance of several smaller impact craters on the floor of the larger crater indicate however that the flat surface has been exposed for an extended period of time. The smooth surface of the crater floor and rougher surfaces at higher elevations are observed in the 3-D THEMIS image that is draped over MOLA topography (2X vertical exaggeration).

    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 conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

    Image information: VIS instrument. Latitude -22.9, Longitude 155.7 East (204.3 West). 19 meter/pixel resolution.

  10. 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.

  11. Candor Chasma Floor

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Context image for PIA03080 Candor Chasma Floor

    This VIS image shows part of the layered and wind sculpted deposit that occurs on the floor of Candor Chasma.

    Image information: VIS instrument. Latitude 6.6S, Longitude 284.4E. 17 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 conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  12. Canyon Floor Deposits

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Context image for PIA03598 Canyon Floor Deposits

    The layered and wind eroded deposits seen in this VIS image occur on the floor of Chandor Chasma.

    Image information: VIS instrument. Latitude 5.2S, Longitude 283.4E. 17 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 conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  13. Spallanzani Cr. Floor

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Context image for PIA03632 Spallanzani Cr. Floor

    This image was taken by one of the Mars Student Imaging Project (MSIP) teams. Their target is the unusual floor deposits in Spallanzani Crater. The wind may have affected the surface of the layered deposit. Small dunes have formed near the southern margin.

    Image information: VIS instrument. Latitude 57.9S, Longitude 86.5E. 17 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 conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  14. 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.

  15. Pelvic muscles during rest: responses to pelvic muscle exercise.

    PubMed

    Griffin, C; Dougherty, M C; Yarandi, H

    1994-01-01

    The purpose of the research was to study pelvic muscle changes in the resting phase between voluntary contractions (during pelvic muscle assessment) and in response to pelvic muscle exercise (PME) through secondary analysis of data. The sample consisted of healthy women (N = 38) aged 35 to 54. Analysis of variance showed a significant difference in resting pressure within each assessment (F = 2.92, p < .04). A significant difference in resting pressures within subjects was found (F = 3.54, p < .02). Within-subject variance suggests exercises performed without a warmup may result in incomplete relaxation prior to contraction. Significant change between baseline and Level 1 of the graded PME program suggests slow relaxation of untrained muscles. Increases in resting pressure at Levels 3 and 4 may be a more accurate reflection of muscle hypertrophy. The results of this research indicate that care should be taken in establishing the point from which changes during contractions are measured. It is recommended that the resting pressure be used. Exercise continued for more than 3 or 4 weeks accounts for nearly all strength gains and explains the increases in resting pressure at PME Levels 3 and 4.

  16. 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.

  17. 25 CFR 11.711 - Descent and distribution.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ORDER CODE Probate Proceedings § 11.711 Descent and distribution. (a) The court shall distribute the estate according to the terms of the will of the decedent which has been admitted to probate. (b) If...

  18. 25 CFR 11.711 - Descent and distribution.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ORDER CODE Probate Proceedings § 11.711 Descent and distribution. (a) The court shall distribute the estate according to the terms of the will of the decedent which has been admitted to probate. (b) If...

  19. 25 CFR 11.711 - Descent and distribution.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... ORDER CODE Probate Proceedings § 11.711 Descent and distribution. (a) The court shall distribute the estate according to the terms of the will of the decedent which has been admitted to probate. (b) If...

  20. 25 CFR 11.711 - Descent and distribution.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ORDER CODE Probate Proceedings § 11.711 Descent and distribution. (a) The court shall distribute the estate according to the terms of the will of the decedent which has been admitted to probate. (b) If...

  1. 25 CFR 11.711 - Descent and distribution.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ORDER CODE Probate Proceedings § 11.711 Descent and distribution. (a) The court shall distribute the estate according to the terms of the will of the decedent which has been admitted to probate. (b) If...

  2. 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.

  3. Descent Stage of Mars Science Laboratory During Assembly

    NASA Technical Reports Server (NTRS)

    2008-01-01

    This image from early October 2008 shows personnel working on the descent stage of NASA's Mars Science Laboratory inside the Spacecraft Assembly Facility at NASA's Jet Propulsion Laboratory, Pasadena, Calif.

    The descent stage will provide rocket-powered deceleration for a phase of the arrival at Mars after the phases using the heat shield and parachute. When it nears the surface, the descent stage will lower the rover on a bridle the rest of the way to the ground. The larger three of the orange spheres in the descent stage are fuel tanks. The smaller two are tanks for pressurant gas used for pushing the fuel to the rocket engines.

    JPL, a division of the California Institute of Technology, manages the Mars Science Laboratory Project for the NASA Science Mission Directorate, Washington.

  4. Instantaneous, predictable balloon system descent from high altitude

    NASA Astrophysics Data System (ADS)

    Hazlewood, K.

    The 13 inch diameter helium valve has long been the only method for initiating and controlling balloon system descent. As greater altitudes have become standard, the 13 inch valves have become less and less effective. It takes as long as a half hour or more to effect a noticeable descent, even with two or three valves, at altitudes in excess of 120,000 ft. The project that prompted this study called for a descent rate of >1000 ft/min from 131,000 ft to 60,000 ft. The method by which this was accomplished is presented along with recommendations for future work to provide closer control of rapid descents such as this. The National Center for Atmospheric Research is sponsored by the National Science Foundation. Any opinions, findings, and conclusions or recommendations expressed in this publication are those of the author and do not necessarily reflect the views of the National Science Foundation

  5. [Epidemiology and treatment for urinary incontinence and pelvic organ prolapse in women].

    PubMed

    Starczewski, Andrzej; Brodowska, Agnieszka; Brodowski, Jacek

    2008-07-01

    Urinary incontinence (UI) is defined as uncontrolled urine leakage through an urethra. At present, the following types of UI can be specified: stress incontinence (SI), urge incontinence (UI), mixed incontinence (MI), overflow incontinence (OI) in which the bladder becomes too full because it cannot be fully emptied, and functional incontinence (FI). Incontinence is one of the most common chronic diseases in women and is found in 17-60% of the whole population. In most patients, SI is combined with pelvic organ prolapse. The basic risk factors mentioned as contributing to these two conditions are obstetrical past and gynaecological history and atrophic changes in the urogenital area. There are also a number of diseases related to the increase in intra-abdominal pressure, such as obesity chronic constipation and diseases associated with persistent cough. Other factors leading to pelvic organ prolapse include hard physical work, some professional sports, connective tissue disorders, neuropathy and disturbed innervation of the pelvic floor. To deal with stress incontinence (SI), conservative and surgical treatment is employed. In the first degree intensity, it is mainly physiotherapy, electrical stimulation of the pelvic floor muscles, lifestyle modification and reduction of body mass. When the SI symptoms are more severe, surgical treatment is usually preferred. From among many methods, these presently used are Burch and sling operations. On the other hand, surgical treatment for pelvic organ prolapse involves colpoperineoplasty with the use of polypropylene mesh (Prolift), colporrhaphy by double TOT approach method, median colporrhaphy, Cooper's ligament or sacrospinous ligament colpopexy, and attachment of the uterus to the sacrum. The results of surgical treatment depend on co-occurrence of risk factors, the surgical method chosen, the lapse of time from the surgery and the type of the applied biomedical material.

  6. Porcine Small Intestinal Submucosa Mesh for Treatment of Pelvic Organ Prolapsed

    PubMed Central

    Cao, Ting-Ting; Sun, Xiu-Li; Wang, Shi-Yan; Yang, Xin; Wang, Jian-Liu

    2016-01-01

    Background: Pelvic organ prolapse (POP) is a major health concern that affects women. Surgeons have increasingly used prosthetic meshes to correct POP. However, the most common used is synthetic mesh, and absorbable mesh is less reported. This research aimed to evaluate the clinical effectiveness of porcine small intestinal submucosa (SIS). Methods: Consecutive forty POP patients who met the inclusion criteria underwent pelvic reconstruction surgery with SIS between March 2012 and December 2013. The patients’ clinical characteristics were recorded preoperatively. Surgical outcomes, measured by objective and subjective success rates, were investigated. We evaluated the quality of life (QOL) using the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). Sexual QOL was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12). Results: At postoperative 12 months, the subjective recurrence rate (7.5%) was much lower than the objective recurrence rate (40.0%). Postoperatively, no erosion was identified. One underwent a graft release procedure because of urinary retention, and one had anus sphincter reconstruction surgery due to defecation urgency. Another experienced posterior vaginal wall infection where the mesh was implanted, accompanied by severe vaginal pain. Estrogen cream relieved the pain. One patient with recurrence underwent a secondary surgery with Bard Mesh because of stage 3 anterior vaginal wall prolapse. Scoring system of PFDI-20 was from 59.150 ± 13.143 preoperatively to 8.400 ± 4.749 postoperatively and PFIQ-7 was from 73.350 ± 32.281 to 7.150 ± 3.110, while PISQ-12 was from 15.825 ± 4.050 to 12.725 ± 3.471. Conclusions: QOL and the degree of subjective satisfaction were significantly improved postoperatively. Anterior repair deserves more attention because of the higher recurrence rate. The long-term follow-up of the patient is warranted to draw firm

  7. Pain and Psychological Outcomes After Rehabilitative Treatment for a Woman With Chronic Pelvic Pain With Stage III Cervical Cancer: A Case Report

    PubMed Central

    Alappattu, Meryl J.

    2016-01-01

    Background Chronic pelvic pain and sexual dysfunction are adverse effects of treatment of cervical cancer. Surgery and radiation therapies may result in soft tissue pain and dysfunction, including spasms and trigger points of the pelvic floor muscles that result in pain. In addition to physical restrictions, negative mood associated with pain is believed to intensify and prolong the pain experience. Study Design The purpose of this case report was to describe outcomes of pelvic physical therapy in a 58-year-old woman with chronic pelvic pain after medical treatments for cervical cancer. Case Description The patient reported dyspareunia, hip pain, and lower abdominal, pelvic pain, and fatigue with activities lasting greater than 30 minutes. Interventions included pelvic floor massage, dilator use, and patient education. Symptoms were assessed at baseline and completion of physical therapy, using the Female Sexual Function Index, Fear of Pain Questionnaire–III, Pain Catastrophizing Scale, and Numerical Pain Rating Scale. Outcomes The Female Sexual Function Index score decreased from 7.8 to 2.8, the Fear of Pain Questionnaire– III score decreased from 85 to 73, the Pain Catastrophizing Scale score decreased from 18 to 8, and lower abdominal and pelvic pain decreased from 4 of 10 to 0 of 10, while bilateral hip pain remained at 4 of 10. In addition, she exhibited increased tolerance to mechanical pressure, evidenced by progression in size of a vaginal dilator. Discussion These results suggest that pelvic physical therapy may be useful in treating chronic pelvic pain after cervical cancer treatments and may also help decrease the magnitude of negative mood aspects such as pain-related fear and catastrophizing. PMID:27134605

  8. Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture?

    PubMed

    Brown, Carlos V R; Kasotakis, George; Wilcox, Alison; Rhee, Peter; Salim, Ali; Demetriades, Demetrios

    2005-09-01

    Pelvic angiography plays an increasing role in the management of pelvic fractures (PFs). Little has been written regarding the size of pelvic hematoma on admission computed tomography (CT) and how it relates to angiography results after PF. This is a retrospective review of trauma patients with PF who underwent an admission abdominal/pelvic CT scan and pelvic angiography from 2001 to 2003. CT pelvic hematoma was measured and classified as minimal or significant based on hematoma dimensions. Presence of a contrast blush on CT scan was also documented. Thirty-seven patients underwent an admission CT scan and went on to pelvic angiography. Of the 22 patients with significant pelvic hematoma, 73 per cent (n = 16) had bleeding at angiography. Fifteen patients had minimal pelvic hematoma, with 67 per cent (n = 10) showing active bleeding at angiography. In addition, five of six patients (83%) with no pelvic hematoma had active bleeding at angiography. Six patients had a blush on CT scan, with five of these (83%) having a positive angiogram. But, 22 of 31 (71%) patients with no blush on CT scan had bleeding at angiography. The absence of a pelvic hematoma or contrast blush should not alter indications for pelvic angiography, as they do not reliably exclude active pelvic bleeding.

  9. 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.'

  10. Laparoscopically guided bilateral pelvic lymphadenectomy

    NASA Astrophysics Data System (ADS)

    Gershman, Alex; Danoff, Dudley; Chandra, Mudjianto; Grundfest, Warren S.

    1991-07-01

    Pelvic node dissection has gained widespread acceptance as the final staging procedure in patients with normal acid phospatase and bone scan free of metastatic disease prior to definitive therapy for cure. However, the procedure has had a high morbidity (20-34%) and a major economic impact on the patient due to lengthy hospitalization and recuperative time. The development of laparoscopic biopsy techniques suggests that the need for open surgical lymphadenectomy may be reduced by a laparoscopically performed lymphadenectomy. The goal of this report is to investigate the possibility of laparoscopic pelvic lymphadenectomy in an animal model. Our interest in laparoscopy is based on the ability of this technique to permit tissue removal without the need for major incisions. In laparoscopic cholecystectomy and laparoscopic appendectomy, the surgical procedure is essentially unaltered. The diseased organ is removed and there is no need for a large abdominal incision.

  11. 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

  12. 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

  13. 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

  14. VIEW OF WIDE STAIR TO SECOND FLOOR FROM GROUND FLOOR. ...

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

    VIEW OF WIDE STAIR TO SECOND FLOOR FROM GROUND FLOOR. VIEW FACING SOUTH - U.S. Naval Base, Pearl Harbor, Ford Island Polaris Missile Lab & U.S. Fleet Ballistic Missile Submarine Training Center, Between Lexington Boulvevard and the sea plane ramps on the southwest side of Ford Island, Pearl City, Honolulu County, HI

  15. 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

  16. 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

  17. [Stereotactic radiotherapy for pelvic tumors].

    PubMed

    Mazeron, R; Fumagalli, I

    2014-01-01

    Extracranial stereotactic radiotherapy is booming. The development and spread of dedicated accelerators coupled with efficient methods of repositioning can now allow treatments of mobile lesions with moderate size, with high doses per fraction. Intuitively, except for the prostate, pelvic tumours, often requiring irradiation of regional lymph node drainage, lend little to this type of treatment. However, in some difficult circumstances, such as boost or re-radiation, stereotactic irradiation condition is promising and clinical experiences have already been reported.

  18. Pelvic trauma: WSES classification and guidelines.

    PubMed

    Coccolini, Federico; Stahel, Philip F; Montori, Giulia; Biffl, Walter; Horer, Tal M; Catena, Fausto; Kluger, Yoram; Moore, Ernest E; Peitzman, Andrew B; Ivatury, Rao; Coimbra, Raul; Fraga, Gustavo Pereira; Pereira, Bruno; Rizoli, Sandro; Kirkpatrick, Andrew; Leppaniemi, Ari; Manfredi, Roberto; Magnone, Stefano; Chiara, Osvaldo; Solaini, Leonardo; Ceresoli, Marco; Allievi, Niccolò; Arvieux, Catherine; Velmahos, George; Balogh, Zsolt; Naidoo, Noel; Weber, Dieter; Abu-Zidan, Fikri; Sartelli, Massimo; Ansaloni, Luca

    2017-01-01

    Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

  19. Ocean floor boundaries.

    PubMed

    Hedberg, H D

    1979-04-13

    The base of the continental slope, combined with the concepts of a boudary zone, a technical advisory boundary commission, and special treatment for restricted seas, offers a readily attainable, natural, practicable, and equitable boundary between national and international jurisdiction over the ocean floor. There is no point in bringing into the boundary formula the unnecessary added complication of thickness of sediments, as recently proposed. Review of the U.S. offshore brings out the critical importance with respect to energy resources of proper choice of boundary principles and proper determination of the base-of-continent line about our shores. The advice of the pertinent science and technology community should urgently be sought and contributed to decisions on offshore boundaries.

  20. 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.

  1. Sexual Function Before and After Sacrocolpopexy for Pelvic Organ Prolapse

    PubMed Central

    Handa, Victoria L.; Zyczynski, Halina M.; Brubaker, Linda; Nygaard, Ingrid; Janz, Nancy K.; Richter, Holly E.; Wren, Patricia A.; Brown, Morton B.; Weber, Anne M.

    2008-01-01

    Objective To describe sexual function before and after sacrocolpopexy. Study design In the Colpopexy and Urinary Reduction Efforts trial, sexual function was assessed in 224 women with sexual partners before and 1 year after surgery using validated questionnaires. Results After surgery, significantly fewer women reported sexual interference from “pelvic or vaginal symptoms” (32.5% one year after surgery versus 7.8% prior to surgery), fear of incontinence (10.7% versus 3.3%), vaginal bulging (47.3% versus 4.6%), or pain (39.9% versus 21.6%). The proportion of women with infrequent sexual desire (32%) did not change. More women were sexually active 1 year after surgery (171, 76.3%) than before surgery (148, 66.1%). The 11 women (7.4%) who became sexually inactive were more likely than sexually active women to report infrequent sexual desire (70.05% versus 22.1%, p<0.001). The addition of Burch colposuspension did not impact postoperative sexual function. Conclusions After sacrocolpopexy, most women reported improvements in pelvic floor symptoms that previously interfered with sexual function. These improvements were not impacted by concomitant Burch colposuspension. PMID:18060957

  2. Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse.

    PubMed

    Iglesia, Cheryl B; Hale, Douglass S; Lucente, Vincent R

    2013-03-01

    Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon's audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.

  3. Flow Along Valley Floors

    NASA Technical Reports Server (NTRS)

    2003-01-01

    [figure removed for brevity, see original site]

    Released 9 May 2003

    Lines indicative of flow in a valley floor (east to west) cut across similar lines in a slightly smaller valley (southeast to northwest), indicating both that material flowed along the valley floor (as opposed to across it) and that relative flow ages may be determined from crosscutting relationships.

    Image information: VIS instrument. Latitude 39.6, Longitude 31.1East (328.9). 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 conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  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. What's New in Floor Care.

    ERIC Educational Resources Information Center

    Griffin, William R.

    1999-01-01

    Examines some of the new equipment, chemicals, and procedures in floor care to help educational facility managers develop floor care programs and improve performance. Trends include more mechanization, higher concentrations and environmentally preferable products for cleaning, and the use of written cleaning procedures. (GR)

  6. Osteopathy for Endometriosis and Chronic Pelvic Pain – a Pilot Study

    PubMed Central

    Sillem, M.; Juhasz-Böss, I.; Klausmeier, I.; Mechsner, S.; Siedentopf, F.; Solomayer, E.

    2016-01-01

    Introduction: Pelvic pain is a common problem in gynaecological practice. It is often unclear whether definite causality exists between reported symptoms and objective clinical findings of the female genital tract, and medical or operative treatments do not always achieve long-term resolution of symptoms. Methods: This pilot study investigated 28 patients (age 20–65, median 36.5 years) from a gynaecology practice whose only clinical finding was painful pelvic floor muscle tightness. Following standardised gynaecological and physiotherapist examination, all patients received osteopathic treatment. Pain had been present for a median of 3 years (range 1 month to 20 years). 14 patients had previously confirmed endometriosis. Treatment success was evaluated on consultation with patients in person or in writing. Results: 22 of the 28 participants completed the treatment according to plan. Overall, 17 reported symptom improvement, while 10 of the 14 patients with endometriosis did. Conclusion: Osteopathy is well received by women with painful pelvic floor muscle tightness and appears to be an effective treatment option. PMID:27681520

  7. 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.

  8. 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

  9. Delayed Diagnosis of Pelvic Hematoma without Fracture Due to Military Parachuting.

    PubMed

    Cunningham, Cord W; Kotwal, Russ S; Kragh, John F

    2013-01-01

    The U.S. military has been conducting static-line parachute jumps for nearly a century. Beginning with World War II, military forces have also employed full-scale airborne operations as a method for insertion into combat. Through the years, injuries from blunt trauma as a result of static-line parachute jumps have evolved little with the refinement of equipment, training, and tactics. Parachute jumps continue to invoke primarily musculoskeletal injuries, especially to the lower extremities, back, neck, and head. These injuries are usually straightforward in their presentation and diagnosis. We describe the delayed diagnosis of a pelvic hematoma due to an uncommon blunt trauma jump injury. The purpose of this case report is to increase awareness of injury patterns during paratrooper operations, as well as to review the diagnosis and management of occult hemorrhage. Specific objectives for the readers are to (1) know the common injury types and patterns for airborne operations, (2) know the descent rate of T-10C/D parachutes and factors influencing the rate, (3) recognize signs and symptoms associated with a pelvic hematoma, and (4) recognize common complications resulting from a pelvic hematoma.

  10. Spino-pelvic-rhythm with forward trunk bending in normal subjects without low back pain.

    PubMed

    Hasebe, Kiyotaka; Sairyo, Koichi; Hada, Yasushi; Dezawa, Akira; Okubo, Yu; Kaneoka, Koji; Nakamura, Yoshio

    2014-07-01

    A strong correlation between low back pain and tight hamstrings has been reported. However, the effect of tight hamstrings on spinal biomechanics remains unclear. The purpose of the study was to investigate spino-pelvic-rhythm during forward bending of the trunk and to clarify the rhythm features with regard to hamstrings tightness. Eighteen healthy male adults with no history of low back pain volunteered to participate. First, we measured the finger-to-floor distance (FFD) in the upright position and set this parameter to 100 %. Using a spinal mouse, spinal alignment was measured in the following four positions: (1) upright posture—100 % FFD; (2) forward bending—50 % FFD; (3) forward bending—25 % FFD; and (4) forward bending—0 % FFD (fingers in contact with the floor). Changes of the angle of the thoracic and lumbar spine as well as the pelvis were calculated. As an indicator of tight hamstrings, we measured straight leg raising (SLR) angle. From positions 1–2 (phase I), the entire spino-pelvic angle moved in 104°. During this phase, the lumbar spine mainly moved. In the second phase (positions 2–3), it moved in 16°. Interestingly, all but 2 subjects showed a negative angle in the thoracic motion, meaning that the thoracic spine extended 4° during trunk flexion, thus exhibiting paradoxical motion. During this phase, lumbopelvic rhythm showed 2 patterns. In 7 subjects, pelvic motion was greater than lumbar motion, while the remaining subjects showed the opposite. In subjects without tight hamstrings, 83 % showed a pelvis-dominant pattern. Only 7 subjects were capable of position 4. During this phase, only slight motion was noted in the spine, and the majority of the motion occurred in the pelvis. Lumbar and pelvic motion correlated negatively in all phases. SLR angle and pelvic motion correlated strongly during phase III, indicating dominant pelvic movement in flexible subjects. The lumbo-pelvic-rhythm comprises 2 patterns—lumbar dominant and

  11. Spino-pelvic-rhythm with forward trunk bending in normal subjects without low back pain.

    PubMed

    Hasebe, Kiyotaka; Sairyo, Koichi; Hada, Yasushi; Dezawa, Akira; Okubo, Yu; Kaneoka, Koji; Nakamura, Yoshio

    2014-07-01

    A strong correlation between low back pain and tight hamstrings has been reported. However, the effect of tight hamstrings on spinal biomechanics remains unclear. The purpose of the study was to investigate spino-pelvic-rhythm during forward bending of the trunk and to clarify the rhythm features with regard to hamstrings tightness. Eighteen healthy male adults with no history of low back pain volunteered to participate. First, we measured the finger-to-floor distance (FFD) in the upright position and set this parameter to 100 %. Using a spinal mouse, spinal alignment was measured in the following four positions: (1) upright posture-100 % FFD; (2) forward bending-50 % FFD; (3) forward bending-25 % FFD; and (4) forward bending-0 % FFD (fingers in contact with the floor). Changes of the angle of the thoracic and lumbar spine as well as the pelvis were calculated. As an indicator of tight hamstrings, we measured straight leg raising (SLR) angle. From positions 1-2 (phase I), the entire spino-pelvic angle moved in 104°. During this phase, the lumbar spine mainly moved. In the second phase (positions 2-3), it moved in 16°. Interestingly, all but 2 subjects showed a negative angle in the thoracic motion, meaning that the thoracic spine extended 4° during trunk flexion, thus exhibiting paradoxical motion. During this phase, lumbopelvic rhythm showed 2 patterns. In 7 subjects, pelvic motion was greater than lumbar motion, while the remaining subjects showed the opposite. In subjects without tight hamstrings, 83 % showed a pelvis-dominant pattern. Only 7 subjects were capable of position 4. During this phase, only slight motion was noted in the spine, and the majority of the motion occurred in the pelvis. Lumbar and pelvic motion correlated negatively in all phases. SLR angle and pelvic motion correlated strongly during phase III, indicating dominant pelvic movement in flexible subjects. The lumbo-pelvic-rhythm comprises 2 patterns-lumbar dominant and pelvis

  12. Inherited pelvic organ prolapse in the mouse: preliminary evaluation of a new murine model

    PubMed Central

    MCNANLEY, Anna R.; JOHNSON, Aimee M.; FLYNN, Michael K.; WOOD, Ronald W.; KENNEDY, Scott D.; REEDER, Jay E.

    2013-01-01

    Objectives/Introduction To report the initial anatomic, radiographic, and genetic evaluations of a novel form of spontaneous pelvic organ prolapse (S-POP) in mice. Methods We observed S-POP in a colony of UPII-SV40T transgenic mice developed for studies on bladder cancer. We utilized magnetic resonance imaging and necropsy to characterize this finding. We have established a breeding colony to identify inheritance patterns and for future studies. Results Selective breeding isolated the S-POP phenotype from the transgene. In contrast to other animal models, the S-POP mouse does not require an obligatory antecedent event to manifest pelvic organ prolapse. Necropsy and imaging demonstrate significant displacement of the pelvic organs distal to the pelvic floor in both sexes. The appearance of the POP is similar to that seen in the human female phenotype. Preliminary breeding studies indicate an autosomal dominant inheritance pattern. Conclusions This mouse may be an effective animal model for the study of POP in humans. PMID:18802654

  13. Pelvic architectural distortion is associated with pelvic organ prolapse.

    PubMed

    Huebner, Markus; Margulies, Rebecca U; DeLancey, John O L

    2008-06-01

    The aim of this study was to determine whether there is an association between architectural distortion seen on magnetic resonance (MR) scans (lateral "spill" of the vagina and posterior extension of the space of Retzius) and pelvic organ prolapse. Secondary analysis of MR imaging scans from a case-control study of women with prolapse (maximum point > or = + 1 cm; N = 144) and normal controls (maximum point < or = -1 cm; N= 126) was done. Two independent investigators, blinded to prolapse status and previously established levator-defect scores, determined the presence of architectural distortion on axial MR scans. Women were categorized into three groups based on levator defects and architectural distortion. Among the three groups, women with levator defects and architectural distortion have the highest proportion of prolapse (78%; p < 0.001). Among women with levator defects, those with prolapse had an odds ratio of 2.2 for the presence of architectural distortion (95% CI = 1.1-4.6). Pelvic organ prolapse is associated with the presence of visible architectural distortion on MR scans.

  14. Pelvic sepsis after stapled hemorrhoidopexy

    PubMed Central

    van Wensen, Remco JA; van Leuken, Maarten H; Bosscha, Koop

    2008-01-01

    Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade III and IV hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons. PMID:18855996

  15. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 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. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 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...

  17. 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...

  18. 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...

  19. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 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...

  20. Primary pelvic hydatid cyst: a case report.

    PubMed

    Parray, Fazl Q; Wani, Shadab Nabi; Bazaz, Sajid; Khan, Shakeel-Ur Rehman; Malik, Nighat Shaffi

    2011-01-01

    This is a case report of a young man who presented to us as a case of hypogastric pain and frequency of micturation. General physical examination and radiological evaluation confirmed a multiloculated pelvic swelling. Patient was subjected to laparotomy which confirmed the diagnosis of a primary pelvic hydatid disease. Patient was put on chemotherapy after surgery and is doing well on follow up.

  1. 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.

  2. 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.

  3. Flooring choices for newborn ICUs.

    PubMed

    White, R D

    2007-12-01

    Floors are a major element of newborn intensive care unit (NICU) construction. They provide visual cues, sound control, and with certain materials, some degree of physical comfort for workers. Flooring materials may entail a significant cost for installation and upkeep and can have substantial ecological impact, both in the choice of the flooring itself, as well as the substances used to clean it. In this article the important aspects to consider for each factor are explored and recommendations are offered for appropriate choices in various NICU areas.

  4. 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

  5. 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

  6. 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

  7. 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).

  8. 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.

  9. [Current echography diagnosis of pelvic congestion syndrome].

    PubMed

    Malinova, M; Shopov, A

    2012-01-01

    Chronic pelvic pain is a common condition. The sources of pelvic pain are multifactorial, and their causes are difficult to determine. Pelvic congestion syndrome (PCS) is associated with varicose ovarian veins and/or varicose veins in the pelvis. The syndrome is associated with constant dull pelvic pain, abnormal menstrual bleeding, tenderness to touch in lower abdomen, pain during intercourse, painful menstrual periods, vaginal discharge, PCOS. The specific diagnosis of Pelvic Congestion Syndrome is made using several tests which include ultrasound, CAT, MIR, MDCT (multidetector) and venogram. The ultrasound is the first test of choice. It can assess the uterus and other organs in the pelvis. Doppler ultrasound can also help visualize the blood flow and asses the presence of varicosities in the pelvis.

  10. Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management.

    PubMed

    Machin, Sarah Elizabeth; Mukhopadhyay, Sambit

    2011-12-01

    Pelvic organ prolapse is a common condition affecting a large number of women. Incidence increases after the menopause. Age, parity and obesity are the most consistently reported risk factors. Many women can be asymptomatic of prolapse but common symptoms include a sensation of a bulge or fullness in the vagina or urinary, bowel or sexual dysfunction. Management depends upon symptoms and the type and grade of the prolapse as well as any associated medical co-morbidities. Management options include expectant, conservative or surgical approaches. Up to 10% of women having a surgical procedure for prolapse will require a second procedure. It is, therefore, important to consider lifestyle modifications such as weight loss and conservative measures including pelvic floor muscle training, topical estrogens and pessaries as initial management options.

  11. The gubernaculum during testicular descent in the human fetus.

    PubMed Central

    Heyns, C F

    1987-01-01

    This study of 178 male human fetuses and infants demonstrates that descent of the testis through the inguinal canal is a rapid process, with 75% of testes descending between 24 and 28 weeks of gestation. The gubernaculum is a cylindrical, gelatinous structure attached cranially to the testis and epididymis. While the testis is in the abdomen, the caudal tip of the gubernaculum is firmly attached to the region of the inguinal canal. In a few fetuses prior to descent the globular tip of the gubernaculum can be seen bulging through the external inguinal ring, covered by superficial fascia, with no macroscopically discernible extensions to the scrotum or any other area. Once the testis has passed through the inguinal canal, the bulbous lower tip of the gubernaculum is no longer firmly attached to any structure, nor does it extend to the bottom of the scrotum. Histologically the gubernaculum consists of undifferentiated mesenchymatous tissue. Prior to descent of the testis, there is an increase in the length of the intra-abdominal gubernaculum. The wet mass of the gubernaculum relative to the fetal mass increases rapidly prior to descent, while the relative wet mass of the testis remains constant during this period. There is also an increase in the wet/dry mass ratio of the gubernaculum, denoting an increase in its water content prior to descent. This indicates that a combination of growth processes is responsible for testicular descent, with the increase in the size of the gubernaculum playing the most important role in passage of the testis through the inguinal canal. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 PMID:2892824

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. Powered-descent trajectory optimization scheme for Mars landing

    NASA Astrophysics Data System (ADS)

    Liu, Rongjie; Li, Shihua; Chen, Xisong; Guo, Lei

    2013-12-01

    This paper presents a trajectory optimization scheme for powered-descent phase of Mars landing with considerations of disturbance. Firstly, θ-D method is applied to design a suboptimal control law with descent model in the absence of disturbance. Secondly, disturbance is estimated by disturbance observer, and the disturbance estimation is as feedforward compensation. Then, semi-global stability analysis of the composite controller consisting of the nonlinear suboptimal controller and the disturbance feedforward compensation is proposed. Finally, to verify the effectiveness of proposed control scheme, an application including relevant simulations on a Mars landing mission is demonstrated.

  17. 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.

  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. 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,…

  20. Aortoiliac aneurysm with congenital right pelvic kidney.

    PubMed

    Date, Kazuma; Okada, Shuuichi; Ezure, Masahiko; Takihara, Hitomi; Okonogi, Shuuichi; Hasegawa, Yutaka; Sato, Yasushi; Kaneko, Tatsuo

    2015-05-01

    The association of congenital pelvic kidney with abdominal aortoiliac aneurysm is an extremely rare clinical finding. Previous reports have described various methods of aneurysm repair with successful preservation of the function of pelvic kidney. However, to our knowledge, reconstruction of more than two renal arteries has not been established. We report a case of abdominal aortic aneurysm complicated by congenital right pelvic kidney in a 72-year-old man. Computed tomography (CT) revealed an abdominal aortic aneurysm with a maximum diameter of 54 mm and a right common iliac aneurysm of 45 mm. In addition, he had a congenital right pelvic kidney and CT angiography identified three right pelvic renal arteries. The upper artery originated from the bifurcation of the terminal aorta and the lower two originated from the right common iliac artery. Three-dimensional CT was helpful for the accurate planning of the operation. Open surgical repair of the aortoiliac aneurysm with a Dacron bifurcated graft replacement was decided and reimplantation of all three right pelvic kidney arteries to the right limb of the graft was also performed. For renal preservation, the right pelvic kidney arteries were perfused with cold Ringer's lactate using a rapid infusion pump and coronary perfusion cannula. The patient's postoperative course was uneventful, and worsening of renal function was not observed. The perfusion of renal arteries with cold Ringer's solution was thought to be a simple and appropriate procedure for renal protection.

  1. Whole-body angular momentum during stair ascent and descent.

    PubMed

    Silverman, Anne K; Neptune, Richard R; Sinitski, Emily H; Wilken, Jason M

    2014-04-01

    The generation of whole-body angular momentum is essential in many locomotor tasks and must be regulated in order to maintain dynamic balance. However, angular momentum has not been investigated during stair walking, which is an activity that presents a biomechanical challenge for balance-impaired populations. We investigated three-dimensional whole-body angular momentum during stair ascent and descent and compared it to level walking. Three-dimensional body-segment kinematic and ground reaction force (GRF) data were collected from 30 healthy subjects. Angular momentum was calculated using a 13-segment whole-body model. GRFs, external moment arms and net joint moments were used to interpret the angular momentum results. The range of frontal plane angular momentum was greater for stair ascent relative to level walking. In the transverse and sagittal planes, the range of angular momentum was smaller in stair ascent and descent relative to level walking. Significant differences were also found in the ground reaction forces, external moment arms and net joint moments. The sagittal plane angular momentum results suggest that individuals alter angular momentum to effectively counteract potential trips during stair ascent, and reduce the range of angular momentum to avoid falling forward during stair descent. Further, significant differences in joint moments suggest potential neuromuscular mechanisms that account for the differences in angular momentum between walking conditions. These results provide a baseline for comparison to impaired populations that have difficulty maintaining dynamic balance, particularly during stair ascent and descent.

  2. 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.…

  3. Self-Hatred in Americans of African Descent.

    ERIC Educational Resources Information Center

    Vontress, Clemmont E.

    In spite of attempts to destigmatize themselves with the "black is beautiful" rhetoric, efforts by Americans of African descent to disavow their imputed inferiority have not been successful. The black is reacted to as a handicapped person by the white American. Whites look with disdain on black-white sexual relationships, black language, and…

  4. 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.

  5. APOLLO 16 TECHNICIAN ATTACHES PLAQUE TO LUNAR MODULE'S DESCENT STAGE

    NASA Technical Reports Server (NTRS)

    1972-01-01

    Working inside the Apollo 16 Saturn V space vehicle at the launch pad, technician Ken Crow attaches a stainless steel plaque bearing the names of Apollo 16 astronauts John W. Young, Thomas K. Mattingly II and Charles M. Duke, Jr., to the Lunar Module's descent stage, which will remain on the Moon's surface.

  6. 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,…

  7. "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…

  8. 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.

  9. 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.

  10. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a... from any single tear in the balloon envelope between tear stoppers: (1) The maximum vertical velocity..., with the balloon descending at the maximum vertical velocity determined in paragraph (a)(1) of...

  11. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a... from any single tear in the balloon envelope between tear stoppers: (1) The maximum vertical velocity..., with the balloon descending at the maximum vertical velocity determined in paragraph (a)(1) of...

  12. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a... from any single tear in the balloon envelope between tear stoppers: (1) The maximum vertical velocity..., with the balloon descending at the maximum vertical velocity determined in paragraph (a)(1) of...

  13. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a... from any single tear in the balloon envelope between tear stoppers: (1) The maximum vertical velocity..., with the balloon descending at the maximum vertical velocity determined in paragraph (a)(1) of...

  14. 14 CFR 31.19 - Performance: Uncontrolled descent.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AIRWORTHINESS STANDARDS: MANNED FREE BALLOONS Flight Requirements § 31.19 Performance: Uncontrolled descent. (a... from any single tear in the balloon envelope between tear stoppers: (1) The maximum vertical velocity..., with the balloon descending at the maximum vertical velocity determined in paragraph (a)(1) of...

  15. 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…

  16. 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

  17. 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

  18. [Patients with hemodynamic unstable pelvic fractures in extremis: pelvic packing or angiography?].

    PubMed

    Liñán-Padilla, A; Giráldez-Sánchez, M Á; Serrano-Toledano, D; Lázaro-Gonzálvez, A; Cano-Luís, P

    2013-01-01

    The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing. We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis? From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability.

  19. Locally vascularized pelvic accessory spleen.

    PubMed

    Iorio, F; Frantellizzi, V; Drudi, Francesco M; Maghella, F; Liberatore, M

    2016-01-01

    Polysplenism and accessory spleen are congenital, usually asymptomatic anomalies. A rare case of polysplenism with ectopic spleen in pelvis of a 67-year-old, Caucasian female is reported here. A transvaginal ultrasound found a soft well-defined homogeneous and vascularized mass in the left pelvis. Patient underwent MRI evaluation and contrast-CT abdominal scan: images with parenchymal aspect, similar to spleen were obtained. Abdominal scintigraphy with 99mTc-albumin nanocolloid was performed and pelvic region was studied with planar scans and SPECT. The results showed the presence of an uptake area of the radiopharmaceutical in the pelvis, while the spleen was normally visualized. These findings confirmed the presence of an accessory spleen with an artery originated from the aorta and a vein that joined with the superior mesenteric vein. To our knowledge, in the literature, there is just only one case of a true ectopic, locally vascularized spleen in the pelvis.

  20. 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.

  1. 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

  2. Spinal Posture of Thoracic and Lumbar Spine and Pelvic Tilt in Highly Trained Cyclists

    PubMed Central

    Muyor, José M.; López-Miñarro, Pedro A.; Alacid, Fernando

    2011-01-01

    The aim of this study was to evaluate sagittal thoracic and lumbar spinal curvatures and pelvic tilt in elite and master cyclists when standing on the floor, and sitting on a bicycle at three different handlebar-hand positions. A total of 60 elite male cyclists (mean age: 22.95 ± 3.38 years) and 60 master male cyclists (mean age: 34.27 ± 3.05 years) were evaluated. The Spinal Mouse system was used to measure sagittal thoracic and lumbar curvature in standing on the floor and sitting positions on the bicycle at three different handlebar-hand positions (high, medium, and low). The mean values for thoracic and lumbar curvatures and pelvic tilt in the standing position on the floor were 48.17 ± 8.05°, -27.32 ± 7.23°, and 13.65 ± 5.54°, respectively, for elite cyclists and 47.02 ± 9.24°, -25.30 ± 6.29°, and 11.25 ± 5.17° for master cyclists. A high frequency of thoracic hyperkyphosis in the standing position was observed (58.3% in elite cyclists and 53.3% in master cyclists), whereas predominately neutral values were found in the lumbar spine (88.3% and 76.7% in elite and master cyclists, respectively). When sitting on the bicycle, the thoracic curve was at a lower angle in the three handlebar-hand positions with respect to the standing position on the floor in both groups (p < 0.01). The lumbar curve adopted a kyphotic posture. In conclusion, cyclists present a high percentage of thoracic hyperkyphotic postures in standing positions on the floor. However, thoracic hyperkyphosis is not directly related to positions adopted on the bicycle. Key points This study evaluated thoracic and lumbar spinal curvatures and pelvic tilt in elite and master cyclists while standing and sitting on the bicycle. Elite and master cyclists showed a high frequency of thoracic hyperkyphosis and neutral lumbar lordosis in standing. Cyclists adopted a significantly lower thoracic kyphosis on the bicycle at the three handlebar positions analysed (upper, middle and lower handlebars

  3. Pelvic Surgical Site Infections in Gynecologic Surgery

    PubMed Central

    Lachiewicz, Mark P.; Moulton, Laura J.; Jaiyeoba, Oluwatosin

    2015-01-01

    The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery. PMID:25788822

  4. Postoperative pelvic pain: An imaging approach.

    PubMed

    Farah, H; Laurent, N; Phalippou, J; Bazot, M; Giraudet, G; Serb, T; Poncelet, E

    2015-10-01

    Postoperative pelvic pain after gynecological surgery is a readily detected but unspecific sign of complication. Imaging as a complement to physical examination helps establish the etiological diagnosis. In the context of emergency surgery, vascular, urinary and digestive injuries constitute the most frequent intraoperative complications. During the follow-up of patients who had undergone pelvic surgery, imaging should be performed to detect recurrent disease, postoperative fibrosis, adhesions and more specific complications related to prosthetic material. Current guidelines recommend using pelvic ultrasonography as the first line imaging modality whereas the use of pelvic computed tomography and/or magnetic resonance imaging should be restricted to specific situations, depending on local availability of equipment and suspected disease.

  5. Pelvic actinomycosis associated with intrauterine devices.

    PubMed

    O'Connor, K F; Bagg, M N; Croley, M R; Schabel, S I

    1989-02-01

    The authors describe two women with pelvic pain, long-term use of an intrauterine device, and a pelvic mass due to Actinomyces israelii. The diagnostic imaging findings were nonspecific but included mass effect and mucosal irregularity of the rectosigmoid colon at barium enema examination and complex masses and inflammatory changes at computed tomography and magnetic resonance imaging. Radiologists should be aware of the imaging findings of this potentially lethal but curable condition.

  6. Primary Pelvic Hydatid Cyst: A Case Report

    PubMed Central

    Parray, Fazl Q.; Wani, Shadab Nabi; Bazaz, Sajid; Khan, Shakeel-ur Rehman; Malik, Nighat Shaffi

    2011-01-01

    This is a case report of a young man who presented to us as a case of hypogastric pain and frequency of micturation. General physical examination and radiological evaluation confirmed a multiloculated pelvic swelling. Patient was subjected to laparotomy which confirmed the diagnosis of a primary pelvic hydatid disease. Patient was put on chemotherapy after surgery and is doing well on follow up. PMID:22606594

  7. 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.

  8. The Functional Anatomy of the Female Pelvic Floor and Stress Continence Control System

    PubMed Central

    Ashton-Miller, James A.; Howard, Denise; DeLancey, John O. L.

    2005-01-01

    This paper provides an overview of the functional anatomy of the structures responsible for controlling urinary continence under stress. The stress continence control system can be divided into two parts: the system responsible for bladder neck support, and the system responsible for sphincteric closure. Age- and injury-related changes in each of these systems are discussed. Understanding the pathophysiology of incontinence on the anatomical level will help to lead to identification of specific defects, thereby allowing better individualized treatment for the incontinent patient. PMID:11409608

  9. The functional anatomy of the female pelvic floor and stress continence control system.

    PubMed

    Ashton-Miller, J A; Howard, D; DeLancey, J O

    2001-01-01

    This paper provides an overview of the functional anatomy of the structures responsible for controlling urinary continence under stress. The stress continence control system can be divided into two parts: the system responsible for bladder neck support, and the system responsible for sphincteric closure. Age- and injury-related changes in each of these systems are discussed. Understanding the pathophysiology of incontinence on the anatomical level will help to lead to identification of specific defects, thereby allowing better individualized treatment for the incontinent patient.

  10. Role of the pelvic floor in bladder neck opening and closure I: muscle forces.

    PubMed

    Petros, P E; Ulmsten, U

    1997-01-01

    The aim of the study was to identify the striated muscle forces hypothesized to assist bladder neck opening and closure in females. Cadaveric dissection was used to identify the levator plate (LP), the anterior portion of pubococcygeus muscle (PCM), the longitudinal muscle of the anus (LMA), and their relation to the bladder, vagina and rectum. X-ray video recordings were made during coughing, straining, squeezing and micturition in a group of 20 incontinent patients and 4 controls, along with surface EMG, urethral pressure and digital palpation studies. During effort, urethral closure appeared to be activated by a forward muscle force corresponding to PCM, and bladder neck closure by backward muscle forces corresponding to LP and LMA. During micturition the PCM force appeared to relax, allowing LP and LMA to pull open the outflow tract. The data appear to support the hypothesis of specific directional muscle forces stretching the vagina to assist bladder neck opening and closure.

  11. 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

  12. 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.

  13. A conjugate gradient method with descent direction for unconstrained optimization

    NASA Astrophysics Data System (ADS)

    Yuan, Gonglin; Lu, Xiwen; Wei, Zengxin

    2009-11-01

    A modified conjugate gradient method is presented for solving unconstrained optimization problems, which possesses the following properties: (i) The sufficient descent property is satisfied without any line search; (ii) The search direction will be in a trust region automatically; (iii) The Zoutendijk condition holds for the Wolfe-Powell line search technique; (iv) This method inherits an important property of the well-known Polak-Ribière-Polyak (PRP) method: the tendency to turn towards the steepest descent direction if a small step is generated away from the solution, preventing a sequence of tiny steps from happening. The global convergence and the linearly convergent rate of the given method are established. Numerical results show that this method is interesting.

  14. 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.

  15. Peak knee flexion angles during stair descent in TKA patients.

    PubMed

    Bjerke, Joakim; Öhberg, Fredrik; Nilsson, Kjell G; Foss, Olav A; Stensdotter, Ann K

    2014-04-01

    Reduced peak knee flexion during stair descent (PKSD) is demonstrated in subjects with total knee arthroplasty (TKA), but the underlying factors are not well studied. 3D gait patterns during stair descent, peak passive knee flexion (PPKF), quadriceps strength, pain, proprioception, demographics, and anthropometrics were assessed in 23 unilateral TKA-subjects ~19 months post-operatively, and in 23 controls. PKSD, PPKF and quadriceps strength were reduced in the TKA-side, but also in the contralateral side. A multiple regression analysis identified PPKF as the only predictor (57%) to explain the relationship with PKSD. PPKF was, however sufficient for normal PKSD. Deficits in quadriceps strength in TKA-group suggest that strength is also contributing to smaller PKSD. Increased hip adduction at PKSD may indicate both compensatory strategy and reduced hip strength.

  16. 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.

  17. 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.

  18. 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.

  19. 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…

  20. 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.

  1. 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…

  2. Aerodynamics of the EXPERT Reentry Capsule Along the Descent Trajectory

    NASA Astrophysics Data System (ADS)

    Vashchenkov, P.; Kashkovsky, A.; Ivanov, M.

    2009-01-01

    Results of numerical simulations of high-altitude aero thermodynamics of the EXPERT reentry capsule along its descent trajectory are presented. Aerodynamic characteristics for different angles of attack and rolling of the capsule at altitude of 150 down to 20 km are studied. An engineering local bridging method is used in computations. The uncertainty of the engineering method in the transitional regime is determined by comparisons with results obtained by DSMC simulations.

  3. 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.

  4. [Retroperitoneal hematoma in pelvic fractures].

    PubMed

    Purghel, F; Jemna, C; Ciuvică, R

    2011-01-01

    Retroperitoneal trauma implies a wide variety of organs in multiple systems (digestive, urinary, circulatory, musculoskeletal); although their common result is the retroperitoneal hematoma, their management is completely different, an intervention indicated for a particular lesion being able to completely decompensate other lesions in case of insufficient diagnostic. The present material highlights the recent diagnostic and therapeutic particularities in retroperitoneal hematoma from pelvic fractures. We noted a recent trend in diminishing the role of the fracture pattern on standard pelvis X-ray in assessing the risk of hemodinamic instability, new markers being indicated as more predictive. CT scan with contrast substance, when applies, remains the gold standard in identifying the source of the vascular bleeding and in guiding the subsequent therapeutic maneuvers. The angiographic embolisation in arterial lesions remains the main therapeutic procedure in hemodinamical unstable patients, with the possibility of repeating it when needed; the C-clamp external fixator application is associated. The pre-peritoneal packing constantly gains support as an emergency hemostasis maneuver. The treatment should be adapted in each case, the hemodinamic instability being the trigger in initiation and repetition of the emergency therapeutic interventions mentioned above.

  5. 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.

  6. Effect of feet hyperpronation on pelvic alignment in a standing position.

    PubMed

    Khamis, Sam; Yizhar, Ziva

    2007-01-01

    Hyperpronation may cause malalignment of the lower extremity, frequently leading to structural and functional deficits both in standing and walking. Our aim was to study the effect of induced foot hyperpronation on pelvic and lower limb alignment while standing. Thirty-five healthy subjects were requested to remain in a natural standing position for 20s in four different modes: feet flat on the floor, and on wedges angled at 10 degrees, 15 degrees and 20 degrees, designed to induce hyperpronation. Sequencing was random, repeated three times and captured by eight computerized cameras using the VICON three-dimensional motion analysis system. We found that standing on the wedges at various angles, induced hyperpronation, with 41% to 90% of the changes attributable to the intervention. In addition, a statistically significant increase (paired t-test) in internal shank rotation (p<0.0001), internal hip rotation (p<0.0001) and anterior pelvic tilt (p<0.0001) was identified. A strong correlation was found between segmental alignment in every two consecutive modes at all levels (r=0.612-0.985; p<0.0001). These findings suggest that alignment of the lower extremity up to the pelvic girdle, can be altered, due to forces acting on the foot. Interaction between the foot and pelvis occurs in a kinematic chain reaction manner. Although this study was limited to healthy subjects, clinicians should be aware that when addressing pelvis and lower back dysfunction, foot alignment should be examined as a contributing factor.

  7. [Robotic assisted laparoscopic colposacropexy in the treatment of pelvic organ prolapse].

    PubMed

    Moreno Sierra, Jesús; Galante Romo, Isabel; Ortiz Oshiro, Elena; Núñez Mora, Carlos; Silmi Moyano, Angel

    2007-05-01

    Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair.

  8. 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

  9. 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)

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  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. Raise the Floor When Remodeling Science Labs

    ERIC Educational Resources Information Center

    Nation's Schools, 1972

    1972-01-01

    A new remodeling idea adopts the concept of raised floor covering gas, water, electrical, and drain lines. The accessible floor has removable panels set into an adjustable support frame 24 inches above a concrete subfloor. (Author)

  18. Hospital Room Floors May Harbor 'Superbugs'

    MedlinePlus

    ... fullstory_163886.html Hospital Room Floors May Harbor 'Superbugs' But that area often overlooked when it comes ... Hospital room floors may be more of a "superbug" threat than many hospital staffers realize, new research ...

  19. 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)

  20. African descents are more sensitive than European descents to the antitumor compounds α-hederin and kalopanaxsaponin I.

    PubMed

    Feller, Geva; Kugel, Aleksandra; Moonshine, Dana; Chalifa-Caspi, Vered; Scholz, Martin; Prüfer, Dirk; Rabinski, Tatiana; Müller, Kai J; Ofir, Rivka

    2010-11-01

    α-Hederin, a natural triterpene saponin and its derivative kalopanaxsaponin I (ksI) exhibit cytotoxicity against various cancer cell lines and IN VIVO tumors. We studied the genetic variants contributing to the activity of these two anticancer compounds. Cell lines derived from 30 trios of European descent (Centre d'Etude du Polymorphisme Human, CEPH; CEU) and 30 trios of African descent (Yoruban, YRI) were used. Cytotoxicity was determined as inhibition of cell growth at increasing concentrations of α-hederin or ksI for 24 h. In comparison to the European, the Yoruban populations revealed a higher sensitivity to α-hederin and to ksI that can be attributed to several unique SNPs. These SNPs are located near 111 and 130 genes in the European and the Yoruban populations, respectively, raising the possibility that some of these genes contribute to the differential sensitivity to these compounds.

  1. Pelvic organ prolapse is associated with alteration of sphingosine-1-phosphate/Rho-kinase signalling pathway in human vaginal wall.

    PubMed

    Rhee, S H; Zhang, P; Hunter, K; Mama, S T; Caraballo, R; Holzberg, A S; Seftel, R H; Seftel, A D; Echols, K T; DiSanto, M E

    2015-01-01

    Pelvic organ prolapse (POP) is a debilitating condition of unknown aetiology affecting > 50% of women over 40 years of age. In POP patients, the vaginal walls are weakened allowing descent of pelvic organs through the vagina. We sought to determine if sphingosine-1-phosphate (S1P) signalling, which regulates smooth muscle contractility and apoptosis via the RhoA/Rho-kinase (ROK) pathway, is altered in the vagina of women with POP. Utilising anterior vaginal wall specimens, we provide novel demonstration of the S1P pathway in this organ. Additionally, comparing specimens from women having pelvic reconstructive surgery for POP and control subjects, we reveal increases in mRNA expression of the three major mammalian S1P receptors (S1P1-S1P3), and RhoA and the ROK isoforms: ROKα and ROKβ in POP patients, which correlates with a decrease in elastic fibre assembly pathway constituents. Taken together, our data suggest the S1P/ROK pathway as a novel area for future POP research and potential therapeutic development.

  2. 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

  3. 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

  4. 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

  5. Pelvic girdle and fin of Tiktaalik roseae.

    PubMed

    Shubin, Neil H; Daeschler, Edward B; Jenkins, Farish A

    2014-01-21

    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.

  6. 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

  7. 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

  8. 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.

  9. 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...

  10. 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...

  11. 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,...

  12. The Secrets of Effective Floor Care.

    ERIC Educational Resources Information Center

    Michels, Ed

    2002-01-01

    Discusses the importance of staff training and a maintenance program to the care of hard floors. Describes four key features to look for in a computer-based training program and types of floor pads and matting used to keep flooring clean. (EV)

  13. TINY FEET NO TREAT TO FLOORS.

    ERIC Educational Resources Information Center

    SMALLEY, DAVE E.

    A DISCUSSION OF FLOOR MAINTENANCE AND CARE INTERMS OF BROKEN, WARPED, AND OTHERWISE DAMAGED CONDITIONS WHICH OFTEN REQUIRE REPLACEMENTS GIVES SUGGESTIONS FOR VARIOUS TYPES OF FLOORING MATERIAL. WOOD FLOOR CONDITIONS MAY INCLUDE--(1) CUPPED BOARDS, (2) BUCKLING BOARDS, AND (3) BROKEN BOARDS. A DETAILED DISCUSSION IS GIVEN OF METHODS FOR REMOVING…

  14. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome

    PubMed Central

    Siqueira, Flavio Meirelles; Monsignore, Lucas Moretti; Rosa-e-Silva, Julio Cesar; Poli-Neto, Omero Benedicto; de Castro-Afonso, Luis Henrique; Nakiri, Guilherme Seizem; Muglia, Valdair Francisco; Abud, Daniel Giansante

    2016-01-01

    OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique. PMID:28076514

  15. [Surgical dilemmas. Sinus floor elevation].

    PubMed

    ten Bruggenkate, C M; Schulten, E A J M; Zijderveld, S A

    2008-12-01

    Limited alveolar bone height prevents the placement of dental implants. Sinus floor elevation is an internal augmentation of the maxillary sinus that allows implants to be placed. The principle of this surgical procedure is the preparation of a 'top hinge door', that is raised together with the Schneiderian membrane in the cranial direction. The space which created under this lid is filled with a bone transplant. Autogenous bone is the standard transplant material, despite the fact that a second surgery site is necessary. Under certain circumstances bone substitutes can be used, with a longer healing phase. If sufficient alveolar bone height is available to secure implant stability, simultaneous implantation and sinus floor elevation are possible. Considering the significant anatomical variation in the region of the maxillary sinus, a sound knowledge of the anatomy is of great importance.

  16. 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

  17. Role of female pelvic anatomy in infertility.

    PubMed

    Harris-Glocker, Miranda; McLaren, Janet F

    2013-01-01

    Infertility is defined as a couple's failure to achieve pregnancy after one year of regular, unprotected intercourse. The etiology of infertility can be due to female factors, male factors, combined male and female factors, or have an unknown etiology. This review focuses on the role of female pelvic anatomy in infertility. Normal anatomy and the physiology of reproduction will be discussed, as well as the anatomic and pathophysiologic processes that cause infertility including ovulatory disorders, endometriosis, pelvic adhesions, tubal blockage, mullerian anomalies, and abnormalities affecting the uterine cavity such as leiomyomata and endometrial polyps.

  18. Diagnosis and therapy of pelvic actinomycosis.

    PubMed

    Taga, Shigeki

    2007-12-01

    Pelvic actinomycosis is difficult to diagnose. In most cases, it is not diagnosed until after surgery. If this condition is diagnosed preoperatively, it can be treated in many cases. Three cases of actinomycosis are reported here. Three women with intrauterine devices (IUD) each presented with lower abdominal pain and pelvic mass, and elevated white blood cell count and C-reactive protein. Left salpingo-oophorectomy was performed for one the women. The pathological diagnosis was actinomycosis. For the other two women, a Gram or Papanicolaou stain of the IUD sample showed actinomycetes. They were discharged after intravenous administration of penicillin without surgery.

  19. Open Pelvic Fractures: Review of 30 Cases

    PubMed Central

    Giordano, Vincenzo; Koch, Hilton Augusto; Gasparini, Savino; Serrão de Souza, Felipe; Labronici, Pedro José; do Amaral, Ney Pecegueiro

    2016-01-01

    Background: Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval. Patients and Methods: In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient’s age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%. Results: Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the

  20. 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.

  1. Measuring foot placement and clearance during stair descent.

    PubMed

    Muhaidat, Jennifer; Kerr, Andrew; Rafferty, Danny; Skelton, Dawn A; Evans, Jonathan J

    2011-03-01

    Falls during stair descent are a serious problem and can lead to accidental death. Inappropriate foot placement on, and clearance over, steps have been identified as causes for falls on stairs. This study investigated a new method for measuring placement and clearance during stair descent in 10 healthy young subjects. The effect of foot length was accounted for during the measurement of foot placement by calculating the percentage length of the foot overhanging the step. Foot clearance was measured as the resultant of the minimum vertical and horizontal distances from the heel of the foot to the edge of the step. Clearance was divided into landing and passing clearance depending on the planned placement of the foot in relation to the step edge being cleared. Each subject performed seven trials of stairs descent. Mean (SD) and CV (SD) were 16% (6), 0.28 (0.15) for placement; 45.88 (10.05), 0.21 (0.07) for landing clearance; 107.25 (5.59), 0.25 (0.08) for passing clearance. There was no statistically significant effect of trial on placement and clearance (p>0.05). There was a significant effect of step number on landing and passing clearance (p=0.01, p<0.001 respectively). Landing and passing clearances were greater for the third step compared to the second step. Passing clearance was also significantly greater than landing clearance (p<0.001). The repeatable methods and findings from this study might be useful in providing a technical background and normal values for the design of future gait studies on stairs.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. [Pelvic hydatid yst: apropos of 8 cases].

    PubMed

    Laghzaoui Boukaidi, M; Bouhya, S; Soummani, A; Hermas, S; Bennan, O; Sefrioui, O; Aderdour, M

    2001-05-01

    The hydatidosis fisues in the endemic state in Morocco, its pelvigenital localization is rare and doubtful. The objective of this study is to examine the epidemio-clinic appearance, the diagnosis means and the therapeutic flow of the pelvigenital hydatid cyst in Morocco. This retrospective study is about eight patients hospitalized and cured for pelvigenital hydatid cyst in lalla Meryem maternity of Casablanca during a period of six years (1992-1997). The hydatid cyst diagnosis was confirmed by anatomopathology. This affection represented 0.80% of the pelvic mass operated during the same periode. The majority of our patients was from rural origin, their age varies between 22 and 70 years old. The discovery circumstances were dominated by abdomino-pelvic mass. The diagnosis was nearly certain prior to the surgery for half of the cases. The genital organs were the most reached by the pelvic hydatidosis (75%). The treatment was purely surgical, adapted to each case in according to the localization, the volume and the contribution of the cyst. The medical treatment has been prescribed in one case in post surgery. The evolution was good in all the cases. The hydatidos cyst must always be present in mind when dealing with cyst pelvic formation in an endemic country like Morocco. The prophylaxia preserves its important value and must constitute a hinder against this disease in endemic countries.

  10. Pelvic lymphangioleiomyomatosis treated successfully with everolimus

    PubMed Central

    Wahid, Sharjil; Chiang, Ping Chia; Luo, Hao Lun; Huang, Shun-Chen; Tsai, Eing-Mei; Chiang, Po Hui

    2017-01-01

    Abstract Background: Lymphangioleiomyomatosis (LAM) is a rare disease affecting young women caused by abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs and extrapulmonary sites (extrapulmonary LAM). The objective of this case series is to demonstrate marked regression in 2 cases of retroperitoneal LAM after treatment with everolimus, an mTOR inhibitor. Methods: We enrolled 2 cases with large volume, extrapulmonary pelvic LAM, and evaluated them with contrast-enhanced abdominal computed tomographic (CT) scans at presentation and serially during treatment with everolimus. Results were objectively quantified using the Response Evaluation Criteria in Solid Tumors, RECIST, Version 1.1. Results: After 12 to 18 months of treatment with everolimus, both patients showed substantial reduction in the volume of their tumors. The first had about 50% regression of the pelvic LAM and renal angiomyolipoma (AML). The second patient had extensive abdomino-pelvic LAM which after treatment showed complete remission. Both patients have not demonstrated disease progression after nearly 4 and 2 years of follow-up, respectively. Conclusions: This case series demonstrates the enormous value of mTOR inhibitors (specifically everolimus) in the management of extrapulmonary pelvic LAM, of which there is no effective treatment currently available. PMID:28272193

  11. 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.

  12. Magnetic resonance imaging of fetal pelvic cysts.

    PubMed

    Archontaki, Styliani; Vial, Yvan; Hanquinet, Sylviane; Meuli, Reto; Alamo, Leonor

    2016-12-01

    The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI.

  13. Iatrogenic water intoxication after pelvic ultrasonography imaging.

    PubMed

    Camkurt, Meltem Akkaş; Coşkun, Figen; Aksu, Nalan Metin; Akpinar, Erhan; Ay, Didem

    2010-03-01

    Ultrasound (US) is a simple, easily accessible, and noninvasive method. Thus, it is commonly used. The bladder should be sufficiently filled to acquire pelvic images by US. This report describes water poisoning in 3 patients with no hepatic, cardiac, or renal disease. Both patients had a history of excessive fluid intake.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. Arachnid aloft: directed aerial descent in neotropical canopy spiders

    PubMed Central

    Yanoviak, Stephen P.; Munk, Yonatan; Dudley, Robert

    2015-01-01

    The behaviour of directed aerial descent has been described for numerous taxa of wingless hexapods as they fall from the tropical rainforest canopy, but is not known in other terrestrial arthropods. Here, we describe similar controlled aerial behaviours for large arboreal spiders in the genus Selenops (Selenopidae). We dropped 59 such spiders from either canopy platforms or tree crowns in Panama and Peru; the majority (93%) directed their aerial trajectories towards and then landed upon nearby tree trunks. Following initial dorsoventral righting when necessary, falling spiders oriented themselves and then translated head-first towards targets; directional changes were correlated with bilaterally asymmetric motions of the anterolaterally extended forelegs. Aerial performance (i.e. the glide index) decreased with increasing body mass and wing loading, but not with projected surface area of the spider. Along with the occurrence of directed aerial descent in ants, jumping bristletails, and other wingless hexapods, this discovery of targeted gliding in selenopid spiders further indicates strong selective pressures against uncontrolled falls into the understory for arboreal taxa. PMID:26289654

  19. Viking Mars hydrazine terminal descent engine thermal design considerations

    NASA Technical Reports Server (NTRS)

    Cunningham, C. R.; Morrisey, D. C.

    1977-01-01

    A description is given of some of the more significant thermal design considerations employed in the development and qualification of the monopropellant hydrazine terminal descent engines on the Viking Mars lander spacecraft. The terminal descent engine operates in a blowdown and throttling mode, which results in an operating thrust range of 638 to 90 lbf. Martian entry thermal design boundary conditions are described, along with resulting radiative and conductive engine thermal isolation hardware. Test results are presented, showing engine thermal design performance as compared with specified requirements. General engine materials of construction are described, along with Hastelloy B shell structural characteristics, which were extended to 2000 F by test and are compared with limited existing MIL-HDBK-5 data. Subscale test results are presented, showing the maximum catalyst bed cylinder design temperature of 1970 F. Test results also are presented, showing local reactor internal convective heat-transfer coefficients. Such data are unique, since the engine employs a completely radial flow catalyst bed design. This design approach is the first of its kind in the monopropellant hydrazine gas generator field to be flight qualified.

  20. 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.

  1. 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.

  2. Steepest descent moment method for three-dimensional magnetohydrodynamic equilibria

    SciTech Connect

    Hirshman, S.P.; Whitson, J.C.

    1983-11-01

    An energy principle is used to obtain the solution of the magnetohydrodynamic (MHD) equilibrium equation J Vector x B Vector - del p = 0 for nested magnetic flux surfaces that are expressed in the inverse coordinate representation x Vector = x Vector(rho, theta, zeta). Here, theta and zeta are poloidal and toroidal flux coordinate angles, respectively, and p = p(rho) labels a magnetic surface. Ordinary differential equations in rho are obtained for the Fourier amplitudes (moments) in the doubly periodic spectral decomposition of x Vector. A steepest descent iteration is developed for efficiently solving these nonlinear, coupled moment equations. The existence of a positive-definite energy functional guarantees the monotonic convergence of this iteration toward an equilibrium solution (in the absence of magnetic island formation). A renormalization parameter lambda is introduced to ensure the rapid convergence of the Fourier series for x Vector, while simultaneously satisfying the MHD requirement that magnetic field lines are straight in flux coordinates. A descent iteration is also developed for determining the self-consistent value for lambda.

  3. 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

  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.

  6. 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

  7. [Recommendations for Releasing the Pelvic Binder After a Non-Invasive Pelvic Stabilisation Procedure Under Emergency Room Conditions].

    PubMed

    Schweigkofler, U; Wohlrath, B; Paffrath, T; Flohé, S; Wincheringer, D; Hoffmann, R; Trentzsch, H

    2016-10-01

    Severe brain, thoracic and intrapelvic injuries, as well as heavy bleeding, are the main causes of death in patients with major trauma. Unstable pelvic ring fractures can cause this bleeding and the so-called "C problem". This is usually due to haemorrhagic shock caused by the loss of large volumes of blood from the presacral venous plexus, iliac vessels and the fracture surfaces. Many clinical studies have shown that, in the preclinical setting, unstable pelvic ring injuries are often underestimated. The application of a non-invasive external pelvic ring stabilisation (pelvic binder) is therefore recommended if a pelvic fracture is possible. Several circumferential pelvic binders have been developed and their prehospital use is increasing. Clinical and biomechanical studies have demonstrated that there is a favourable haemodynamic effect in unstable fractures, due to rapid closure of the pelvic ring. It is unclear whether the pelvic binder can be safely removed in a presumably haemodynamically stable patient. A correctly placed pelvic binder leads to anatomical closure of the pelvic ring. Therefore unstable pelvic ring fractures may be clinically and radiologically overlooked. This is a particular problem in unconscious patients. Furthermore, the real severity of the injury may then be underestimated in the diagnostic evaluation. Unconsidered opening of the pelvic binder can thus provoke renewed deterioration of the circulatory situation, especially if the injury was adequately treated by the binder and the C problem was controlled. The aim of this article is to describe procedures for handling pelvic binders, particularly as to how to deal with an already applied pelvic binder and how to "clear the pelvic region" while reducing the risk of haemodynamic instability. A detailed analysis of the literature and a Delphi-like discussion among several experts were performed. The following points were raised: 1) Assessment of the clinical situation, including trauma

  8. 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.

  9. 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

  10. Functional pelvic orientation measured from lateral standing and sitting radiographs.

    PubMed

    DiGioia, Anthony M; Hafez, Mahmoud A; Jaramaz, Branislav; Levison, Timothy J; Moody, James E

    2006-12-01

    We prospectively obtained preoperative and 3-month postoperative lateral pelvic radiographs in the standing and sitting positions from 84 patients who underwent total hip arthroplasty. We measured pelvic orientation (flexion extension) using the anterior pelvic plane as defined by the anterior superior iliac spines and pubic tubercles as references. There was a trend towards upright pelvic alignment when standing, with a mean anterior pelvic plane angle of 1.2 degrees (range, -22 degrees - +27 degrees). In the sitting position the pelvis tended to extend posteriorly, with a mean anterior pelvic plane angle of -36.2 degrees (range, -64 degrees - +4 degrees). There was a wide variation in the arc of pelvic flexion extension as patients moved from standing to sitting, with are of pelvic motion in some patients as mobile as 70 degrees and in others as stiff as 5 degrees. There was no significant variation between males and females or between preoperative and postoperative pelvic flexion extension. There were substantial variations in pelvic orientation when comparing standing and sitting for an individual patient and between different patients. This variation can be unpredictable, and may influence implant alignment and stability after total hip arthroplasty.

  11. 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

  12. 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…

  13. Introduction to the special issue on lesbians of African descent: contemporary perspectives.

    PubMed

    Wilson, Bianca D M; Johnson, Verlena L

    2011-01-01

    This article serves as an introduction to the special issue entitled, "Lesbians of African Descent: Contemporary Perspectives." We briefly discuss our framing of this collection as a contemporary contribution to the canon of Black lesbian writing and art, and identify themes that appear to transcend both earlier and current works of lesbians of African descent.

  14. 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…

  15. 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.

  16. 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

  17. The descent of words: evolutionary thinking 1780-1880.

    PubMed

    van Wyhe, John

    2005-09-01

    Histories of evolutionary thought are dominated by organic evolution. The colossus in our midst that is evolutionary biology casts its shadow over history, making it appear that what is so widespread and important today was always the primary subject of evolutionary speculation. Thus many histories assume that the core meaning of evolution is the change of organic life and that other forms of evolutionary thinking, such as linguistic, social or cultural evolution, are only analogies or offshoots of the main biological evolutionary trunk. Ironically this is an ahistorical understanding. Long before the work of Charles Darwin, scholars were independently developing evolutionary concepts such as descent with modification and divergence from a common stock in order to understand cultural change.

  18. 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

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

    NASA Technical Reports Server (NTRS)

    Prakash, Ravi; Burkhart, P. Dan; Chen, Allen; Comeaux, Keith A.; Guernsey, Carl S.; Devin, M. Kipp; Mendeck, Gavin F.; Powell, Richard W.; Rivellini, Tommaso P.; San Martin, A. Miguel; Sell, Steven W.; Steltzner, Adam D.; Way, David W.

    2008-01-01

    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. In addition to landing more mass than prior missions to Mars, MSL will offer access to regions of Mars that have been previously unreachable. The MSL EDL sequence is a result of a more stringent requirement set than any of its predecessors. Notable among these requirements is landing a 900 kg rover in a landing ellipse much smaller than that of any previous Mars lander. In meeting these requirements, MSL is extending the limits of the EDL technologies qualified by the Mars Viking, Mars Pathfinder, and Mars Exploration Rover missions.

  20. 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