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.

Addition [Illustration]

Isidor Kaufmann

Improving Automaticity with Basic Addition Facts: Do Taped Problems Work Faster Than Cover, Copy, Compare?

This small pilot study compared the effectiveness of two interventions to improve automaticity with basic addition facts: Taped Problems (TP) and Cover, Copy, Compare (CCC), in students aged 6-10. Automaticity was measured using Mathematics Curriculum-Based Measurement (M-CBM) at pretest, after 10 days, and after 20 days of intervention. Our hypothesis was that the TP group will gain higher levels of automaticity more quickly than the CCC and control groups. However, when gain scores were compared, no significant differences were found between groups. Limitations to the study include low treatment integrity and a short duration of intervention.

Nitrogen Fertilizer Form and Associated Nitrate Leaching from Cool-Season Lawn Turf

Various N fertilizer sources are available for lawn turf. Few field studies, however, have determined the losses of nitrate (NO3-N) from lawns receiving different formulations of N fertilizers. The objectives of this study were to determine the differences in NO3-N leaching losses among various N fertilizer sources and to ascertain when losses were most likely to occur. The field experiment was set out in a completely random design on a turf typical of the lawns in southern New England. Treatments consisted of four fertilizer sources with fast- and slow-release N formulations: (i) ammonium nitrate (AN), (ii) polymer-coated sulfur-coated urea (PCSCU), (iii) organic product, and (iv) a nonfertilized control. The experiment was conducted across three years and fertilized to supply a total of 147 kg N ha-1 yr-1. Percolate was collected with zero-tension lysimeters. Flow-weighted NO3-N concentrations were 4.6, 0.57, 0.31, and 0.18 mg L-1 for AN, PCSCU, organic, and the control, respectively. After correcting for control losses, average annual NO3-N leaching losses as a percentage of N applied were 16.8% for AN, 1.7% for PCSCU, and 0.6% for organic. Results indicate that NO3-N leaching losses from lawn turf in southern New England occur primarily during the late fall through the early spring. To reduce the threat of NO3-N leaching losses, lawn turf fertilizers should be formulated with a larger percentage of slow-release N than soluble N.

Fertilizer and Swine Manure Management Systems Impacts on Phosphorus in Soil and Subsurface Tile Drainage

Swine manure and fertilizer can be used to supply the nitrogen (N) and phosphorus (P) needs of crops. Excess P application sometimes applied with N-based manure for corn increases the risk of P loss and water quality impairment. Poor water quality in Iowa streams and lakes due to excess P has prompted questions about the impact of cropping and nutrient management systems on P loss from fields.

Aplicación de nitratos y cloruros en Amaranthus tricolor L. : efecto sobre la producción de materia verde, materia seca, contenidos de nitratos y cloruros.

Se evaluó la incidencia del agregado de cloruros (Cl-) adicionado como NaCl, y de nitrógeno (N) como KNO3, sobre la producción de materia verde (MV), materia seca (MS) y contenido de nitratos (NO3 -) y Cl- en la parte aérea cosechada de Amaranthus tricolor L. El ensayo se realizó en el invernáculo de la Facultad de Agronomía, UNLPam., Santa Rosa, La Pampa, Argentina, en macetas que contenían 5 kg de suelo. Las dosis de fertilizante agregado en kg ha-1 fueron: 50 y 100 de N y 100, 200 y 300 de Cl-. Se realizaron todas las combinaciones posibles originando 12 tratamientos, incluido el testigo. Para el análisis estadístico se empleó ANOVA doble y los tests de Tukey y Tukey-Kramer. No se encontraron diferencias significativas para MS para ningún agregado. Tampoco se encontraron diferencias significativas en la producción de MV entre las dosis de N (N50 y N100) pero sí entre éstas y el testigo. No hubo diferencias entre las dosis de Cl- aplicadas para esta variable. Los NO3 - mostraron diferencias significativas frente a las distintas dosis de N, como así también entre las medias de los tratamientos con el agregado de Cl- y la no incorporación de éstos. Los valores promedio de NO3 - variaron entre 0,51 y 3,56% base seca (bs) y 445,4 y 2916,1 mg kg-1 fresco. Se encontraron diferencias significativas en el % Cl- (bs) frente a las diferentes dosis de NaCl adicionado. Bajo las condiciones del ensayo, los valores promedio de NO3 - se encuentran dentro de los límites establecidos por la Comunidad Económica Europea.

Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

Background: Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment. Methods: A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants. Results: Due to a much lower rate of PPH than expected (1.2%), only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or maternal deaths among study participants. The rate of transient shivering and fever was significantly higher among women receiving misoprostol Conclusion: A 600 mcg dose of misoprostol given sublingually shows promise as an adjunct treatment for PPH and its use should continue to be explored for its life-saving potential in the care of women experiencing PPH. Trial Registration: Clinical trials.gov, Registry No. NCT00116480

Phosphorylation levels of JAK2 after addition of increasing Epo-concentrations: model approach (Figure 5a)

The present dataset contain source data for Figure 5a from Schilling et al., 2009. Cell fate decisions are regulated by the coordinated activation of signalling pathways such as the extracellular signal-regulated kinase (ERK) cascade, but contributions of individual kinase isoforms are mostly unknown. The authors combined quantitative data from erythropoietin-induced pathway activation in primary erythroid progenitor (colony-forming unit erythroid stage, CFU-E) cells with mathematical modelling, in order to predict and experimentally confirmed a distributive ERK phosphorylation mechanism in CFU-E cells. The authors found evidences that double-phosphorylated ERK1 attenuates proliferation beyond a certain activation level, whereas activated ERK2 enhances proliferation with saturation kinetics. Phosphorylation levels of JAK2 at 7 min after stimulation for Epo concentrations ranging from 0.1 to 1000 U/ml were simulated.

Phosphorylation levels of JAK2 after addition of increasing Epo-concentrations: experimental data (Figure 5a)

The present dataset data contain source data for Figure 5a from Schilling et al., 2009. Cell fate decisions are regulated by the coordinated activation of signalling pathways such as the extracellular signal-regulated kinase (ERK) cascade, but contributions of individual kinase isoforms are mostly unknown. The authors combined quantitative data from erythropoietin-induced pathway activation in primary erythroid progenitor (colony-forming unit erythroid stage, CFU-E) cells with mathematical modelling, in order to predict and experimentally confirmed a distributive ERK phosphorylation mechanism in CFU-E cells. The authors found evidences that double-phosphorylated ERK1 attenuates proliferation beyond a certain activation level, whereas activated ERK2 enhances proliferation with saturation kinetics. CFU-E cells were stimulated with the indicated Epo concentrations for 7 min and phosphorylation levels were determined by quantitative immunoblotting.

Effect of increased pCO2 on bacterial assemblage shifts in response to glucose addition in Fram Strait seawater mesocosms

Ocean acidification may stimulate primary production through increased availability of inorganic carbon in the photic zone, which may in turn change the biogenic flux of dissolved organic carbon (DOC) and the growth potential of heterotrophic bacteria. To investigate the effects of ocean acidification on marine bacterial assemblages, a two-by-three factorial mescosom experiment was conducted using surface sea water from the East Greenland Current in Fram Strait. Pyrosequencing of the V1-V2 region of bacterial 16S ribosomal RNA genes was used to investigate differences in the endpoint (Day 9) composition of bacterial assemblages in mineral nutrient-replete mesocosms amended with glucose (0 µm, 5.3 µm and 15.9 µm) under ambient (250 µatm) or acidified (400 µatm) partial pressures of CO2 (pCO2). All mesocosms showed low richness and diversity by Chao1 estimator and Shannon index, respectively, with general dominance by Gammaproteobacteria and Flavobacteria. Nonmetric multidimensional scaling analysis and two-way analysis of variance of the Jaccard dissimilarity matrix (97% similarity cut-off) demonstrated that the significant community shift between 0 µm and 15.9 µm glucose addition at 250 µatm pCO2 was eliminated at 400 µatm pCO2. These results suggest that the response potential of marine bacteria to DOC input may be altered under acidified conditions.

Growth dynamics and yield of melon as influenced by nitrogen fertilizer

Nitrogen (N) is an important nutrient for melon (Cucumis melo L.) production. However there is scanty information about the amount necessary to maintain an appropriate balance between growth and yield. Melon vegetative organs must develop sufficiently to intercept light and accumulate water and nutrients but it is also important to obtain a large reproductive-vegetative dry weight ratio to maximize the fruit yield. We evaluated the influence of different N amounts on the growth, production of dry matter and fruit yield of a melon ‘Piel de sapo’ type. A three-year field experiment was carried out from May to September. Melons were subjected to an irrigation depth of 100% crop evapotranspiration and to 11 N fertilization rates, ranging 11 to 393 kg ha –1 in the three years. The dry matter production of leaves and stems increased as the N amount increased. The dry matter of the whole plant was affected similarly, while the fruit dry matter decreased as the N amount was increased above 112, 93 and 95 kg ha –1 , in 2005, 2006 and 2007, respectively. The maximum Leaf Area Index (LAI), 3.1, was obtained at 393 kg ha –1 of N. The lowest N supply reduced the fruit yield by 21%, while the highest increased the vegetative growth, LAI and Leaf Area Duration (LAD), but reduced yield by 24% relative to the N93 treatment. Excessive applications of N increase vegetative growth at the expense of reproductive growth. For this melon type, rates about 90-100 kg ha –1 of N are sufficient for adequate plant growth, development and maximum production. To obtain fruit yield close to the maximum, the leaf N concentration at the end of the crop cycle should be higher than 19.5 g kg –1

Response of Chrysantemum Plant to Addition of Broiler Manure as a Substitute for Commercial Substrate

Dos tipos diferentes de pollinaza mezclados con el material de cama (paja o serrín) añadidas en tasas de 0 y 10% más dos substratos comerciales de turba (turba negra y turba rubia) se usaron para estudiar el crecimiento de crisantemo en maceta. En todos los casos, la calidad y el tamaño de las plantas fue mejor con las mezclas de substratos de turba negra que con las mezclas de turba rubia. Con las mezclas de turba negra con pollinaza hubo un aumento significativo del número de flores sin que hubiese un aumento en el tamaño de las plantas. También se pudo observar que con la adición de pollinaza, el substrato de turba rubia mejoró significativamente los parámetros de crecimiento estudiados, esto fue debido a que el pH del substrato fue más adecuado para el cultivo. Por último, no hubo mortalidad de plantas con las mezclas experimentadas, pero cuando la cantidad de gallinaza aumentó en la mezcla fue más notable la mortalidad de plantas.

Thermal behaviour of bitumen modified by sulphur addition

The most frequent use of bitumen is as binder for pavement applications. The effect of sulphur addition on the properties of the bitumen has been extensively studied several decades ago. Recently, there is a renewed interest in researching the behaviour of sulphur-bitumen combination, because off 1.The future availability of bitumen may be limited and 2. The beneficial consumption of great amounts of sulphur compounds from petroleum refining is advisable. The addition of sulphur to bitumen provokes the beginning of chemical reactions depending on the sulphur content and heating temperature. At heating temperatures T< 140 ºC liquid sulphur reacts with naphthenic-aromatic fraction forming polysulphides. At temperatures above 150 ºC dehydrogenization reactions with emission of hydrogen sulfide take place and naphthenic-aromatic molecules are transformed into asphaltenes. Therefore, the addition of sulphur to bitumen provokes changes in the chemical structure of the bitumen. The objective of this work is to analyze, the thermal behaviour of sulphur-bitumen mixtures of different composition (0-35 %wt sulphur content) prepared at 130 and 140 ºC, by means of differential scanning calorimetry (DSC). Besides, the volatile emissions of the mixtures at high temperature have been estimated from loss weight measurements as a function of stored time

Texture perception determined by doy protein isolate and inulin addition in potato puree: links with mechanical and microstructural features

This study evaluated the effect of adding soy protein isolate (SPI) and long-chain perception, trained and untrained panel inulin (INL) blends with 10 different SPI : INL ratios on the textural, rheological and 17 microstructural properties of freshly made and frozen/thawed potato puree. All the potato puree samples were subjected to a sensory texture pro?le analysis and a 21 trained panel rated the intensity of six descriptors, while an untrained panel did the same on six selected frozen/thawed products. The main SPI : INL ratio effect remained signi?cant for all the descriptors evaluated, when the analysis of variance was applied considering the untrained assessors as random effects. However, only trained panel scores for creaminess corresponded well with untrained assessor. Rheological ?ow index values were linked with variations in perceived consistency, and geometric and surface textural attributes were explained by structural features such as the presence of INL crystallites and SPI coarse strands.