Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review.

INTRODUCTION Investigations of the dynamic function of female pelvic floor muscles (PFM) help us to understand the pathophysiology of stress urinary incontinence (SUI). Displacement measurements of PFM give insight into muscle activation and thus help to improve rehabilitation strategies. This systematic review (PROSPERO 2013: CRD42013006409) was performed to summarise the current evidence for PFM displacement during voluntary and involuntary activation in continent and incontinent women. METHODS MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were searched using selected terminology reflecting the PICO approach. Screening of Google Scholar and congress abstracts added to further information. Original articles investigating PFM displacement were included if they reported on at least one of the aims of the review, e.g., method, test position, test activity, direction and quantification of displacement, as well as the comparison between continent and incontinent women. Titles and abstracts were screened by two reviewers. The papers included were reviewed by two individuals to ascertain whether they fulfilled the inclusion criteria and data were extracted on outcome parameters. RESULTS Forty-two predominantly observational studies fulfilled the inclusion criteria. A variety of measurement methods and calculations of displacement was presented. The sample was heterogeneous concerning age, parity and continence status. Test positions and test activities varied among the studies. CONCLUSIONS The findings summarise the present knowledge of PFM displacement, but still lack deeper comprehension of the SUI pathomechanism of involuntary, reflexive activation during functional activities. We therefore propose that future investigations focus on PFM dynamics during fast and stressful impact tasks.

Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: study protocol for a randomized controlled trial

BACKGROUND Pelvic floor muscle training is effective and recommended as first-line therapy for female patients with stress urinary incontinence. However, standard pelvic floor physiotherapy concentrates on voluntary contractions even though the situations provoking stress urinary incontinence (for example, sneezing, coughing, running) require involuntary fast reflexive pelvic floor muscle contractions. Training procedures for involuntary reflexive muscle contractions are widely implemented in rehabilitation and sports but not yet in pelvic floor rehabilitation. Therefore, the research group developed a training protocol including standard physiotherapy and in addition focused on involuntary reflexive pelvic floor muscle contractions. METHODS/DESIGN The aim of the planned study is to compare this newly developed physiotherapy program (experimental group) and the standard physiotherapy program (control group) regarding their effect on stress urinary incontinence. The working hypothesis is that the experimental group focusing on involuntary reflexive muscle contractions will have a higher improvement of continence measured by the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence (short form), and - regarding secondary and tertiary outcomes - higher pelvic floor muscle activity during stress urinary incontinence provoking activities, better pad-test results, higher quality of life scores (International Consultation on Incontinence Modular Questionnaire) and higher intravaginal muscle strength (digitally tested) from before to after the intervention phase. This study is designed as a prospective, triple-blinded (participant, investigator, outcome assessor), randomized controlled trial with two physiotherapy intervention groups with a 6-month follow-up including 48 stress urinary incontinent women per group. For both groups the intervention will last 16 weeks and will include 9 personal physiotherapy consultations and 78 short home training sessions (weeks 1-5 3x/week, 3x/day; weeks 6-16 3x/week, 1x/day). Thereafter both groups will continue with home training sessions (3x/week, 1x/day) until the 6-month follow-up. To compare the primary outcome, International Consultation on Incontinence Modular Questionnaire (short form) between and within the two groups at ten time points (before intervention, physiotherapy sessions 2-9, after intervention) ANOVA models for longitudinal data will be applied. DISCUSSION This study closes a gap, as involuntary reflexive pelvic floor muscle training has not yet been included in stress urinary incontinence physiotherapy, and if shown successful could be implemented in clinical practice immediately. TRIAL REGISTRATION NCT02318251 ; 4 December 2014 First patient randomized: 11 March 2015.

Unit Commitment and Electricity Prices Forecasting for Market Strategy Preparation in Interconnected Systems

In this paper we present a solution for building a better strategy to take part in external electricity markets. For an optimal strategy development, both the internal system costs as well as the future values of the series of electricity prices in external markets need to be known. But in practice, the real problems that must be faced are that both future electricity prices and costs are unknown. Thus, the first ones must be modeled and forecasted and the costs must be calculated. Our methodology for building an optimal strategy consists of three steps: The first step is modeling and forecasting market prices in external systems. The second step is the cost calculation on internal system taking into account the expected prices in the first step. The third step is based on the results of the previous steps, and consists of preparing the bids for external markets. The main goal is to reduce consumers' costs unlike many others that are oriented to increase GenCo's profits.

Neuropeptides, by direct interaction with T cells, induce cytokine secretion and break the commitment to a distinct T helper phenotype

Searching for nervous system candidates that could directly induce T cell cytokine secretion, I tested four neuropeptides (NPs): somatostatin, calcitonin gene-related peptide, neuropeptide Y, and substance P. Comparing neuropeptide-driven versus classical antigen-driven cytokine secretion from T helper cells Th0, Th1, and Th2 autoimmune-related T cell populations, I show that the tested NPs, in the absence of any additional factors, directly induce a marked secretion of cytokines [interleukin 2 (IL-2), interferon-γ, IL-4, and IL-10) from T cells. Furthermore, NPs drive distinct Th1 and Th2 populations to a “forbidden” cytokine secretion: secretion of Th2 cytokines from a Th1 T cell line and vice versa. Such a phenomenon cannot be induced by classical antigenic stimulation. My study suggests that the nervous system, through NPs interacting with their specific T cell-expressed receptors, can lead to the secretion of both typical and atypical cytokines, to the breakdown of the commitment to a distinct Th phenotype, and a potentially altered function and destiny of T cells in vivo.

Lineage commitment in the progeny of murine hematopoietic preprogenitor cells: Influence of thrombopoietin and interleukin 5

Normal mouse marrow cells were stimulated by stem cell factor (SCF) to form dispersed or multicentric blast colonies containing progenitor cells committed to various hematopoietic lineages. Combination of the eosinophil-specific regulator interleukin 5 with SCF increased the frequency of colonies containing eosinophil-committed progenitor cells with multicentric but not dispersed blast colonies. Combination of thrombopoietin with SCF increased the frequency of colonies containing megakaryocyte-committed progenitor cells with both types of blast colony. Neither interleukin 5 nor thrombopoietin significantly altered the number or total cell content of blast colonies or progenitor cell numbers in blast colonies from those stimulated by SCF alone. No correlation was observed between total progenitor cell content and the presence or absence of either eosinophil or megakaryocyte progenitors in either type of blast colony. The data argue against a random process as being responsible for the formation of particular committed progenitor cells or the possibility that lineage-specific regulators merely enhance survival of such committed progenitor cells formed in developing blast colonies.

Commitment to natural killer cells requires the helix–loop–helix inhibitor Id2

We have previously described how T and natural killer (NK) lineage commitment proceeds from common T/NK progenitors (p-T/NK) in the murine fetal thymus (FT), with the use of a clonal assay system capable of discriminating p-T/NK from unipotent T or NK lineage-committed progenitors (p-T and p-NK, respectively). The molecular mechanisms controlling the commitment processes, however, are yet to be defined. In this study, we investigated the progenitor activity of FT cells from Id2−/− mice that exhibit defective NK cell development. In the Id2−/− FT, NK cells were greatly reduced, and a cell population that exclusively contains p-NK in the wild-type thymus was completely missing. Id2−/− FT progenitors were unable to differentiate into NK cells in IL-2-supplemented-FT organ culture. Single progenitor analysis demonstrated that all Id2−/− fetal thymic progenitors are destined for the T cell lineage, whereas progenitors for T/NK, T, and NK cell lineages were found in the control. Interestingly, the total progenitor number was similar between Id2−/− and Id2+/+ embryos analyzed. Expression of Id2 was correlated with p-NK activity. Our results suggest that Id2 is indispensable in thymic NK cell development, where it most probably restricts bipotent T/NK progenitors to the NK cell lineage.

Volunteer Engagement: Does Engagement Predict the Degree of Satisfaction among New Volunteers and the Commitment of Those who have been Active Longer?

This study examines the concept of engagement in samples of volunteers from different non-profit organisations. Study 1 analyzes the psychometric properties of the abbreviated version of the Utrecht Work Engagement Scale (UWES) (Schaufeli, Bakker, & Salanova, 2006a). Two factorial structures are examined: one-dimensional and three-dimensional structures. Based on the Three-Stage Model of Volunteers’ Duration of Service (Chacón, Vecina, & Dávila, 2007), Study 2 investigates the relationship between engagement, volunteer satisfaction, and intention to remain in a sample of new volunteers and the relationship between engagement, organisational commitment, and intention to remain in a sample of veteran volunteers. Moderated mediation analysis is provided using duration of service as a moderator in order to set a splitting point between new and veteran volunteers. The results of the confirmatory factor analysis suggest that the three-factor model fits better to the data. Regarding the structural models, the first one shows that engagement is crucial to volunteer satisfaction during the first stage, while volunteer satisfaction is the key variable in explaining intention to continue. The second structural model shows that engagement reinforces the participant’s commitment to the organisation, while organizational commitment predicts intention to continue. Both models demonstrate a notable decline when samples are changed.

Psychological and Social Perspectives on Malingering and Symptom Exaggeration: Conceptualization and Interventions Using Acceptance and Commitment Therapy

Malingering and the production of false symptoms seen in such disorders as Factitious Disorder are an ongoing mystery to medical and mental health professionals. Historically, these presentations have been difficult to identify and treat. As might be expected, individuals with such symptomology rarely agree to participate in research, possibly because of a reluctance to admit to the feigning or exaggerating behaviors and a fear of reprisals. Many different etiologies have been proposed, including the assumption of roles in order to manage impressions, taking control of symptoms in order to gain attention or other rewards or avoid aversive events, and even the production of symptoms that is largely out of awareness such as is seen in conversion or somatoform presentations. By examining historical and present-day beliefs about etiology and treatment interventions, professionals can explore what new types of effective treatment might look like. The behaviorist philosophy that underlies Acceptance and Commitment Therapy proposes a perspective emphasizing effective working in context. This philosophy also suggests individuals sometimes engage in behavior in order to escape from or avoid aversive experiences. Utilizing case examples and fresh behavioral perspectives provides insight and ideas for conceptualization of these behaviors of interest. Using the above conceptualizations, an ACT based treatment of those who produce false symptoms is introduced.

An Acceptance and Commitment Approach to Issues of Behavioral Health Care in Soldiers

For over a decade, the U.S. military has been engaged in two distinct, yet equally deadly conflicts: Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). There are many physical and psychological effects of war necessitating the activation and interventions of a myriad of behavioral health professionals. The purpose of the paper was to understand how and if contemporary military culture may work to support or hinder application of an Acceptance and Commitment Therapy (ACT) approach to issues of psychological health among Soldiers. While the empirical research on efficacy with Soldiers is limited, a review of military culture revealed the promotion of rigid rule following, although effective in combat, influences the emotional control agenda and stigma while in garrison. However, empirical research demonstrating the clinical benefits and flexibility of ACT is rapidly emerging with civilian and Veteran populations. Suggested as a prevention technique utilized early in Soldier's training to increase psychological flexibility, ACT appears to demonstrate much promise in ameliorating the psychological consequences of war.

Acceptance and Commitment Therapy with Forensic Inpatients

This paper provides a preliminary exploration of the application of Acceptance and Commitment Therapy (ACT) within the context of a forensic hospital. ACT has a reputation for being a clinically flexible and empirically sound therapeutic intervention, which appears uniquely suited for forensic hospital settings. However, no research has been published to date on the use of ACT as a treatment for forensic inpatients. The ACT approach directly aims to help people let go of the unwinnable struggles to control symptoms of mental illness, and instead focus on constructing a "life worth living." ACT interventions can equip forensic patients with the values and flexible behavioral repertoires necessary to lead lives that are personally meaningful and satisfying and do not involve inflicting harm to others. The ACT model also attempts to minimize the therapist-patient hierarchy through an emphasis on the ubiquitous nature of human suffering. This approach can be particularly useful when working with marginalized, treatment-resistant patients. Continued research on the application of ACT with forensic inpatients is recommended.

Acceptance and Commitment Therapy-Based Exposure Treatment of Choking Phobia: A Case Study

One might choke if they observed the lack of research on choking phobia. McNally's (1994) review of the literature on choking phobia found only 25 studies addressing the treatment of choking phobia. The vast majority of these were case studies and none were randomized controlled trials. A search of the literature since then yielded only a few more studies. Given the dearth of information available about choking phobia and its treatment, it is important to document cases treated successfully with novel approaches. My goal in this paper is therefore to illustrate the use of exposure therapy augmented by Acceptance and Commitment Therapy (ACT; e.g., see Hayes, Strosahl, & Wilson, 1999; Hayes and Strosahl, 2004) in the treatment of an adult male presenting with fear of choking and to offer suggestions for the optimal treatment of choking phobia. To my knowledge, there are no documented cases of elements of ACT being used in the treatment of choking phobia to be found in the literature.

Acceptance and Commitment Therapy: Increasing Psychologists' Willingness to Assess and Treat Substance-abusing Clients.

The high prevalence of substance abuse in the United States and the low rates of assessment and treatment of these disorders by mental health providers points to a growing need to understand the factors that prevent substance-abusing individuals from receiving adequate services. Psychologists are one group of mental health providers that show little interest in working with this population and receive little research attention on the topic. This paper explores the potential role that education, previous experience, and the impact that holding stigmatizing beliefs towards substance-abusing individuals has on psychologists' willingness to provide clinical services for clients struggling with addiction. Acceptance and Commitment Therapy (ACT) is explored as a potential intervention for psychologists.

Asperger's Disorder in College Students: Application of Acceptance and Commitment Therapy

College students with Asperger's Disorder (AD) are likely to face significant challenges as they encounter the unpredictable and socially demanding environment of their university setting. Acceptance and Commitment Therapy (ACT) can be a valuable approach to addressing many of these struggles. This paper will explore the application of ACT to problems that are commonly associated with individuals diagnosed with AD. Utilizing ACT and the Hexaflex Model as a guide for working with AD students can assist in establishing a greater understanding and acceptance of their unique internal experience, as well as their interaction with the external world. ACT can offer these students the ability to be more present in the moment, to recognize efforts to avoid negative experiences, and to move in directions in life that are personally meaningful.