The role of membranous urethral afferent autonomic innervation in the continence mechanism after nerve sparing radical prostatectomy: a clinical and prospective study

Purpose: We evaluated the somatic and autonomic innervation of the pelvic floor and rhabdosphincter before and after nerve sparing radical retropubic prostatectomy using neurophysiological tests and correlated findings with clinical parameters and urinary continence. Materials and Methods: From February 2003 to October 2005, 46 patients with prostate cancer were enrolled in a controlled, prospective study. Patients were evaluated before and 6 months after nerve sparing radical retropubic prostatectomy using the UCLA-PCI urinary function domain and neurophysiological tests, including somatosensory evoked potential, and the pudendo-urethral, pudendo-anal and urethro-anal reflexes. Clinical parameters and urinary continence were correlated with afferent and efferent innervation of the membranous urethra and pelvic floor. We used strict criteria to define urinary continence as complete dryness with no leakage at all, not requiring any pads or diapers and with a UCLA-PCI score of 500. Patients with a sporadic drop of leakage, requiring up to 1 pad daily, were defined as having occasional urinary leakage. Results: Two patients were excluded from study due to urethral stricture postoperatively. We evaluated 44 patients within 6 months after surgery. The pudendo-anal and pudendo-urethral reflexes were unchanged postoperatively (p = 0.93 and 0.09, respectively), demonstrating that afferent and efferent pudendal innervation to this pelvic region was not affected by the surgery. Autonomic afferent denervation of the membranous urethral mucosa was found in 34 patients (77.3%), as demonstrated by a postoperative increase in the urethro-anal reflex sensory threshold and urethro-anal reflex latency (p <0.001 and 0.0007, respectively). Six of the 44 patients used pads. One patient with more severe leakage required 3 pads daily and 23 showed urinary leakage, including 5 who needed 1 pad per day and 18 who did not wear pads. Afferent autonomic denervation at the membranous urethral mucosa was found in 91.7% of patients with urinary leakage. Of 10 patients with preserved urethro-anal reflex latency 80% were continent. Conclusions: Sensory and motor pudendal innervation to this specific pelvic region did not change after nerve sparing radical retropubic prostatectomy. Significant autonomic afferent denervation of the membranous urethral mucosa was present in most patients postoperatively. Impaired membranous urethral sensitivity seemed to be associated with urinary incontinence, particularly in patients with occasional urinary leakage. Damage to the afferent autonomic innervation may have a role in the continence mechanism after nerve sparing radical retropubic prostatectomy.

Effects of mandibular fixed implant-supported prostheses on masticatory and swallowing functions in completely edentulous elderly individuals

Purpose: To evaluate the effect of oral rehabilitation with immediately loaded fixed implant-supported mandibular prostheses on chewing and swallowing in elderly individuals. Materials and Methods: Fifteen completely edentulous patients aged more than 60 years (10 women and rive men), wearing removable dentures in both arches, had a mandibular denture replaced by an implant-supported prosthesis. All individuals were evaluated before surgery and again 3, 6, and 18 months later with regard to mastication and swallowing conditions. Examinations entailed an interview, evaluation of tactile sensitivity of the face, and observation of food intake, masticatory type, formations of bolus, and pain during mastication. The swallowing evaluation comprised observation of clinical signs related to the oral and pharyngeal stages of swallowing, as well as the presence of oral residue. The findings of different evaluations before and 3, 6, and 18 months after the surgical-prosthetic procedure were statistically compared by analysis of variance for repeated measurements at a significance level of 5%. Results: The questionnaire revealed a reduction in complaints of masticatory and swallowing disturbances, a decreased need for liquid ingestion, and reduced choking and coughing. Clinical evaluations showed improved oral function and bolus propulsion for both solid and paste-consistency foods; pain during mastication was also resolved. Conclusion: Treatment with mandibular implant-supported dentures had positive effects on the clinical aspects of mastication and swallowing in elderly individuals.

A novel nonrepudiable threshold multi-proxy multi-signature scheme with shared verification

Tzeng et al. proposed a new threshold multi-proxy multi-signature scheme with threshold verification. In their scheme, a subset of original signers authenticates a designated proxy group to sign on behalf of the original group. A message m has to be signed by a subset of proxy signers who can represent the proxy group. Then, the proxy signature is sent to the verifier group. A subset of verifiers in the verifier group can also represent the group to authenticate the proxy signature. Subsequently, there are two improved schemes to eliminate the security leak of Tzeng et al.’s scheme. In this paper, we have pointed out the security leakage of the three schemes and further proposed a novel threshold multi-proxy multi-signature scheme with threshold verification.

Threshold

In this video, the words of a translated poem fade in and out above an abstract, moving horizon line. The animated words are set to an emotive stock music track. This work examines processes of signification. It emphasizes abstraction and disconnection as fundamental and generative operations in making meaning. Extending on post-structural and deconstructionist ideas, this work questions the signifying processes of translation and metaphor. By emphasizing the abstract qualities of a translated love poem, it questions the sites and mechanisms of signification.

Threshold concepts in property education : a case study

First year Property Economics students enrolled in the Bachelor of Urban Development at QUT are required to undertake a number of compulsory subjects, alongside students undertaking studies in other disciplines. One such common unit is ‘Stewardship of Land’, an interdisciplinary unit that introduces students to the characteristics of land and land tenure with a focus on land use and property rights. It covers a range of issues including: native title, land contamination, heritage values, alternative uses, the property development process, impact of environmental and social factors, and the management of land, both urban and regional. Teaching such a diverse content to a diverse audience has in previous years proved difficult, from the perspectives of relevance, engagement and content overload. In 2011 a project was undertake to redevelop this unit to reflect ‘threshold concepts’, concepts that are “transformative, probably irreversible, integrative, often troublesome and probably bounded” (Meyer & Land, 2003) . This project involved the development of a new set of underlying concepts students should draw from the unit, application of these to the unit curriculum, and a survey of the student response to these changes. This paper reports on the threshold concepts developed for this unit, the changes this made to the unit curriculum, and a preliminary report on survey responses. Recommendations for other educators seeking to incorporate threshold concepts into their curricula are provided.

The other side of the threshold : Strindberg's experiments in creative dissection

A 1500-word review of Strindberg: A Life by Sue Prideaux (Yale UP, 2012). One way of classifying biographies is to divide them into those that apply their own interpretative framework – be it psychoanalytic, gender-based, socio-historical, and so on – to a given subject and those that aim to meet the subject, on their own terms, or at least in terms that the subject would recognise...

Implementing the self-management threshold learning outcome in Australian legal curricula : insights from self-determination theory

In 2010, six Threshold Learning Outcomes (TLOs) for law were developed by the Australian Learning and Teaching Council's Discipline Scholars: Law. The final of these outcomes, TLO 6, concerns self-management. This thesis examines strategies for implementing self-management in Australian legal education by first contextualising the development of TLO 6 in light of other relevant national and international developments in higher education, and secondly, analysing this learning outcome through the lens of Self-Determination Theory (SDT), an influential branch of educational psychology. It is argued that the central concept of autonomous self-regulation in SDT provides insights into factors that are relevant to law students’ capacities for long-term self-management, which is reinforced by analysis of the literature on law students’ distress. Accordingly, curriculum design that supports students’ autonomy may simultaneously promote students’ self-management capacities. The discussion of theoretical and practical perspectives on autonomy supportive curriculum design in this thesis thus illuminates potential pedagogical approaches for the implementation of TLO 6 in Australian legal curricula.

Outcomes of the Chemistry Discipline Network Mapping Exercises: Are the Threshold Learning Outcomes met?

The Chemistry Discipline Network has recently completed two distinct mapping exercises. The first is a snapshot of chemistry taught at 12 institutions around Australia in 2011. There were many similarities but also important differences in the content taught and assessed at different institutions. There were also significant differences in delivery, particularly laboratory contact hours, as well as forms and weightings of assessment. The second mapping exercise mapped the chemistry degrees at three institutions to the Threshold Learning Outcomes for chemistry. Importantly, some of the TLOs were addressed by multiple units at all institutions, while others were not met, or were met at an introductory level only. The exercise also exposed some challenges in using the TLOs as currently written.

Acquiring search expertise : learning experiences and threshold concepts

Expert searchers engage with information as information brokers, researchers, reference librarians, information architects, faculty who teach advanced search, and in a variety of other information-intensive professions. Their experiences are characterized by a profound understanding of information concepts and skills and they have an agile ability to apply this knowledge to interacting with and having an impact on the information environment. This study explored the learning experiences of searchers to understand the acquisition of search expertise. The research question was: What can be learned about becoming an expert searcher from the learning experiences of proficient novice searchers and highly experienced searchers? The key objectives were: (1) to explore the existence of threshold concepts in search expertise; (2) to improve our understanding of how search expertise is acquired and how novice searchers, intent on becoming experts, can learn to search in more expertlike ways. The participant sample drew from two population groups: (1) highly experienced searchers with a minimum of 20 years of relevant professional experience, including LIS faculty who teach advanced search, information brokers, and search engine developers (11 subjects); and (2) MLIS students who had completed coursework in information retrieval and online searching and demonstrated exceptional ability (9 subjects). Using these two groups allowed a nuanced understanding of the experience of learning to search in expertlike ways, with data from those who search at a very high level as well as those who may be actively developing expertise. The study used semi-structured interviews, search tasks with think-aloud narratives, and talk-after protocols. Searches were screen-captured with simultaneous audio-recording of the think-aloud narrative. Data were coded and analyzed using NVivo9 and manually. Grounded theory allowed categories and themes to emerge from the data. Categories represented conceptual knowledge and attributes of expert searchers. In accord with grounded theory method, once theoretical saturation was achieved, during the final stage of analysis the data were viewed through lenses of existing theoretical frameworks. For this study, threshold concept theory (Meyer & Land, 2003) was used to explore which concepts might be threshold concepts. Threshold concepts have been used to explore transformative learning portals in subjects ranging from economics to mathematics. A threshold concept has five defining characteristics: transformative (causing a shift in perception), irreversible (unlikely to be forgotten), integrative (unifying separate concepts), troublesome (initially counter-intuitive), and may be bounded. Themes that emerged provided evidence of four concepts which had the characteristics of threshold concepts. These were: information environment: the total information environment is perceived and understood; information structures: content, index structures, and retrieval algorithms are understood; information vocabularies: fluency in search behaviors related to language, including natural language, controlled vocabulary, and finesse using proximity, truncation, and other language-based tools. The fourth threshold concept was concept fusion, the integration of the other three threshold concepts and further defined by three properties: visioning (anticipating next moves), being light on one's 'search feet' (dancing property), and profound ontological shift (identity as searcher). In addition to the threshold concepts, findings were reported that were not concept-based, including praxes and traits of expert searchers. A model of search expertise is proposed with the four threshold concepts at its core that also integrates the traits and praxes elicited from the study, attributes which are likewise long recognized in LIS research as present in professional searchers. The research provides a deeper understanding of the transformative learning experiences involved in the acquisition of search expertise. It adds to our understanding of search expertise in the context of today's information environment and has implications for teaching advanced search, for research more broadly within library and information science, and for methodologies used to explore threshold concepts.

Learning portals : analyzing threshold concept theory for LIS education

This paper explores the theoretical framework of threshold concepts and its potential for LIS education. Threshold concepts are key ideas, often troublesome and counter-intuitive, that are critical to profound understanding of a domain. Once understood, they allow mastery of significant aspects of the domain, opening up new, previously inaccessible ways of thinking. The paper is developed in three parts. First, threshold concept theory is introduced and studies of its use in higher education are described, including emergent work related to LIS. Second, results of a recent study on learning experiences integral to learning to search are presented along with their implications for search expertise and search education, forming a case illustration of what threshold concept theory may contribute to this and other areas of LIS education. Third, the potential of threshold concept theory for LIS education is discussed. The paper concludes that threshold concept theory has much to offer LIS education, particularly for researching critical concepts and competencies, and considerations for a research agenda are put forth.