Urinary incontinence persisting after childbirth : extent, delivery history, and effects in a 12-year longitudinal cohort study

© 2015 Royal College of Obstetricians and Gynaecologists. Funded by •Wellbeing of Women/Royal College of Obstetricians and Gynaecologists •Health Research Council of New Zealand

Urinary incontinence persisting after childbirth : extent, delivery history, and effects in a 12-year longitudinal cohort study

© 2015 Royal College of Obstetricians and Gynaecologists. Funded by •Wellbeing of Women/Royal College of Obstetricians and Gynaecologists •Health Research Council of New Zealand

A theory-informed approach to developing visually mediated interventions to change behaviour using an asthma and physical activity intervention exemplar

Funding for this study was received from the Chief Scientist Office for Scotland. We would like to thank Asthma UK and Asthma UK Scotland for facilitating the advertisement of the study pilot and consultative user group. Thanks to Dr Mark Grindle for his helpful discussions concerning narrative. Thanks also to Mr Mark Haldane who designed the characters, backgrounds, and user interface used within the 3D computer animation. Particular thanks to the participants of the consultative user group for their enthusiasm, comments, and suggestions at all stages of the intervention design.

Two parallel, pragmatic, UK multicentre, randomised controlled trials comparing surgical options for upper compartment (vault or uterine) pelvic organ prolapse (the VUE Study) : study protocol for a randomised controlled trial

The VUE study is funded by the National Institute for Health Research Health Technology Assessment programme (project number 11/129/183).

Projeto de Desenvolvimento de um Sistema de Gestão de Destinos (SGD): O Caso das Entidades Regionais de Turismo em Portugal

Enquadramento: O presente projeto de investigação surge num contexto onde as tecnologias estão cada vez mais enraizadas nas sociedades e onde a web se tornou no canal preferido de distribuição para uma boa parte das Organizações de Gestão de Destinos (OGDs) e dos consumidores finais (Butler, 2002; Gretzel, Yuan, & Fesenmaier, 2000; Kramer, Modsching, ten Hagen, & Gretzel, 2007). As novas Tecnologias da Informação e Comunicação (TICs) afiguram-se, assim, como uma das áreas mais críticas para o sucesso do turismo, no presente e no futuro, sendo vitais para a forma como se promovem os destinos turísticos (Machado & Almeida, 2010). Descrição: Pretende-se apresentar uma proposta extensiva de desenvolvimento de um Sistema de Gestão de Destinos (SGD), de âmbito regional, devidamente orçada e economicamente viável, para ajudar as OGDs na gestão, promoção e distribuição holística do destino turístico Portugal. Objetivos: Desenvolvimento sustentável e integrado dos destinos turísticos portugueses, a nível regional; aposta nos canais digitais como forma de adaptação às novas tendências de mercado no setor do turismo; envolvimento de todos os stakeholders no projeto (entidades públicas e privadas), por forma a aumentar os índices de coesão nos destinos turísticos; satisfação das necessidades de planeamento e de reserva dos potenciais turistas/visitantes; e incremento da qualidade geral da experiência turística no destino Portugal. Investigação Empírica: Parte 1 – Realização de um estudo Delphi, com a participação de um painel de 12 especialistas nas áreas do turismo e das TICs, para aferição e hierarquização das principais barreiras à adoção de SGDs; Parte 2 – Estudo avaliativo da eficácia dos websites oficiais das 5 Entidades Regionais de Turismo (ERTs) portuguesas, por intermédio do modelo adaptado de ICTRT (na versão de Charoula et al., 2014), aplicado por um avaliador externo recrutado para o efeito. Resultados e Conclusões: Identificaram-se e hierarquizaram-se 55 barreiras à adoção de SGDs, para a realidade portuguesa; apresentaram-se e escrutinaram-se os índices de eficácia dos websites oficiais das 5 ERTs em Portugal; e apresentou-se uma proposta de desenvolvimento de um SGD devidamente orçada e economicamente viável. No final, discutiram-se os principais resultados, teceram-se considerações gerais sobre o projeto e enunciaram-se as principais limitações e possíveis futuras linhas de investigação.

Kies- / Sandkörper im Wesertal zwischen Rinteln und Porta Westfalica

In this article the sand-/gravelbodies from Hausberge-Veltheim and Krankenhagen- Möllenbeck in the Wesertal are described and compared considering their depositional and architectural regime. A scenario is developed to explain the genetic sequence of the deposits. The sand-/gravel-body exposed at Krankenhagen-Möllenbeck was deposited first in form of a marginal käme. Subsequently during the Drenthe-stade of the Saale ice age, the sedimentation of the sand- /gravelbody at Hausberge-Veltheim took place under the depositional environment of an end- moraine.

N=4 supersymmetric AdS(5) vacua and their moduli spaces

We classify the N = 4 supersymmetric AdS(5) backgrounds that arise as solutions of five-dimensional N = 4 gauged supergravity. We express our results in terms of the allowed embedding tensor components and identify the structure of the associated gauge groups. We show that the moduli space of these AdS vacua is of the form SU(1, m)/ (U(1) x SU(m)) and discuss our results regarding holographically dual N = 2 SCFTs and their conformal manifolds.

Das verflixte (?) siebte Jahr – Sieben Jahre Virtuelle Universität

Im Wintersemester 1996 wurde am Lehrgebiet Praktische Informatik I mit einigen wenigen Kursen und ebenso wenig Studierenden die Virtuelle Universität (VU) der FernUniversität in Hagen gestartet. Heute arbeiten mehr als 25.000 Nutzer aktiv mit dieser Plattform und können aus über 300 Kursen aller Fachbereiche ihr individuelles Studienprofil auswählen. Die Virtuelle Universität (VU) hat allerdings nicht nur enorme Veränderungen von Lehren und Lernen bewirkt, auch die Organisation als Ganzes erfährt inzwischen durch die VU einen Strukturwandel. Viele Publikationen beschäftigen sich mit den technologischen, didaktischen und auch juristischen Aspekten des Wandels; aber kaum jemand beschreibt die kompletten Auswirkungen durch den Einsatz eines solchen Systems und doch wird genau danach sehr häufig gefragt. Nicht nur Studierende, auch Lehrende, Verwaltungsangestellte und Techniker werden vor neue Herausforderungen gestellt. Im folgenden Papier werden die Erfahrungen aus dem Projekt Virtuelle Universität der FernUniversität in Hagen zusammengefasst. Am Beispiel des Projektes soll gezeigt werden, wie ein Initiativprojekt eine ganze Organisation in seinen Bann zog und vielfältige Veränderungen in allen Bereichen bewirkt hat. (DIPF/Orig.)

Investigation of multisensory processing and structural brain differences in Autism Spectrum Disorder

This thesis is an investigation of structural brain abnormalities, as well as multisensory and unisensory processing deficits in autistic traits and Autism Spectrum Disorder (ASD). To achieve this, structural and functional magnetic resonance imaging (fMRI) and psychophysical techniques were employed. ASD is a neurodevelopmental condition which is characterised by the social communication and interaction deficits, as well as repetitive patterns of behaviour, interests and activities. These traits are thought to be present in a typical population. The Autism Spectrum Quotient questionnaire (AQ) was developed to assess the prevalence of autistic traits in the general population. Von dem Hagen et al. (2011) revealed a link between AQ with white matter (WM) and grey matter (GM) volume (using voxel-based-morphometry). However, their findings revealed no difference in GM in areas associated with social cognition. Cortical thickness (CT) measurements are known to be a more direct measure of cortical morphology than GM volume. Therefore, Chapter 2 investigated the relationship between AQ scores and CT in the same sample of participants. This study showed that AQ scores correlated with CT in the left temporo-occipital junction, left posterior cingulate, right precentral gyrus and bilateral precentral sulcus, in a typical population. These areas were previously associated with structural and functional differences in ASD. Thus the findings suggest, to some extent, autistic traits are reflected in brain structure - in the general population. The ability to integrate auditory and visual information is crucial to everyday life, and results are mixed regarding how ASD influences audiovisual integration. To investigate this question, Chapter 3 examined the Temporal Integration Window (TIW), which indicates how precisely sight and sound need to be temporally aligned so that a unitary audiovisual event can be perceived. 26 adult males with ASD and 26 age and IQ-matched typically developed males were presented with flash-beep (BF), point-light drummer, and face-voice (FV) displays with varying degrees of asynchrony and asked to make Synchrony Judgements (SJ) and Temporal Order Judgements (TOJ). Analysis of the data included fitting Gaussian functions as well as using an Independent Channels Model (ICM) to fit the data (Garcia-Perez & Alcala-Quintana, 2012). Gaussian curve fitting for SJs showed that the ASD group had a wider TIW, but for TOJ no group effect was found. The ICM supported these results and model parameters indicated that the wider TIW for SJs in the ASD group was not due to sensory processing at the unisensory level, but rather due to decreased temporal resolution at a decisional level of combining sensory information. Furthermore, when performing TOJ, the ICM revealed a smaller Point of Subjective Simultaneity (PSS; closer to physical synchrony) in the ASD group than in the TD group. Finding that audiovisual temporal processing is different in ASD encouraged us to investigate the neural correlates of multisensory as well as unisensory processing using functional magnetic resonance imaging fMRI. Therefore, Chapter 4 investigated audiovisual, auditory and visual processing in ASD of simple BF displays and complex, social FV displays. During a block design experiment, we measured the BOLD signal when 13 adults with ASD and 13 typically developed (TD) age-sex- and IQ- matched adults were presented with audiovisual, audio and visual information of BF and FV displays. Our analyses revealed that processing of audiovisual as well as unisensory auditory and visual stimulus conditions in both the BF and FV displays was associated with reduced activation in ASD. Audiovisual, auditory and visual conditions of FV stimuli revealed reduced activation in ASD in regions of the frontal cortex, while BF stimuli revealed reduced activation the lingual gyri. The inferior parietal gyrus revealed an interaction between stimulus sensory condition of BF stimuli and group. Conjunction analyses revealed smaller regions of the superior temporal cortex (STC) in ASD to be audiovisual sensitive. Against our predictions, the STC did not reveal any activation differences, per se, between the two groups. However, a superior frontal area was shown to be sensitive to audiovisual face-voice stimuli in the TD group, but not in the ASD group. Overall this study indicated differences in brain activity for audiovisual, auditory and visual processing of social and non-social stimuli in individuals with ASD compared to TD individuals. These results contrast previous behavioural findings, suggesting different audiovisual integration, yet intact auditory and visual processing in ASD. Our behavioural findings revealed audiovisual temporal processing deficits in ASD during SJ tasks, therefore we investigated the neural correlates of SJ in ASD and TD controls. Similar to Chapter 4, we used fMRI in Chapter 5 to investigate audiovisual temporal processing in ASD in the same participants as recruited in Chapter 4. BOLD signals were measured while the ASD and TD participants were asked to make SJ on audiovisual displays of different levels of asynchrony: the participants’ PSS, audio leading visual information (audio first), visual leading audio information (visual first). Whereas no effect of group was found with BF displays, increased putamen activation was observed in ASD participants compared to TD participants when making SJs on FV displays. Investigating SJ on audiovisual displays in the bilateral superior temporal gyrus (STG), an area involved in audiovisual integration (see Chapter 4), we found no group differences or interaction between group and levels of audiovisual asynchrony. The investigation of different levels of asynchrony revealed a complex pattern of results indicating a network of areas more involved in processing PSS than audio first and visual first, as well as areas responding differently to audio first compared to video first. These activation differences between audio first and video first in different brain areas are constant with the view that audio leading and visual leading stimuli are processed differently.

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013 : summary of the 5th International Consultation on Incontinence

Aims The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Methods Revision and updates of the 4th ICI Report using systematic review covering years 2008–2012. Results Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a “grade of recommendation.” The paper concludes with areas identified as requiring further research. Conclusions For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation.

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013 : summary of the 5th International Consultation on Incontinence

Aims The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Methods Revision and updates of the 4th ICI Report using systematic review covering years 2008–2012. Results Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a “grade of recommendation.” The paper concludes with areas identified as requiring further research. Conclusions For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation.

Cordectomía por sustracción pedicular en la columna dorsal y lumbar en fracturas traumáticas: experiencia en el hospital universitario mayor Mederi y revisión sistemática de la literatura

Objetivo: Presentar la experiencia con la técnica de corpectomia por sustracción pedicular en fracturas traumática a nivel de la columna dorsal y Lumbar en el Hospital Universitario Mayor en Bogotá y hacer una revisión sistemática de la literatura de esta técnica quirúrgica. Material y métodos: Se realizó un análisis retrospectivo de las historias clínicas de pacientes que consultaron al servicio de neurocirugía entre los años 2013 y 2015 con fracturas traumáticas a nivel de la columna dorsal y lumbosacra. Se realizó un análisis de déficit neurológico pre y posoperatorio por medio de la Clasificación neurológica estándar de lesión medular (ASIA), al igual que tiempos de cirugía, sangrado intraoperatorio y complicaciones. A su vez se realiza una revisión sistemática de la literatura sobre esta técnica quirúrgica. Resultados: El total de pacientes que se sometieron a cirugía fue de 32, de los cuales el tiempo quirúrgico promedio fue de 396 min, se obtuvo un ASIA prequirúrgico B: 50% C: 47% y E: 3%. El ASIA post operatorio fue de B: 9% C: 47% D: 38% E: 6%. Se obtuvo una mejoría del déficit neurológico en el 75% los pacientes intervenidos. El promedio de sangrado fue de 1,223 cc. Se tuvieron 4 complicaciones, 2 hematomas en lecho quirúrgico que requirió re intervención y dos fistulas de líquido cefalorraquídeo las cuales se manejaron con vendaje compresivo y reposo absoluto. Conclusiones: La corpectomia por sustracción pedicular requiere de un adecuado entrenamiento y un grupo multidisciplinario dentro de los que se incluye neuroanestesiologo, a su vez de neurocirujanos entrenados en columna. Este abordaje presenta grandes beneficios como disminución de tiempos quirúrgicos, disminución de sangrado intraoperatorio y disminución de morbilidad entre otras.