Mid-urethral slings for treatment of stress urinary incontinence : long- and mid-term follow-up

Urinary incontinence is a common problem, affecting one third of the women at least at some time during their lives. The prevalence of urinary incontinence increases with advancing age, and the everyday impact of incontinence on women and on health services is enormous. Urinary incontinence is usually divided into three different subtypes, of which stress urinary incontinence (SUI) is the most common. Surgical treatment is often needed to cure SUI, and modern mid-urethral sling procedures give the possibility to cure this condition with a low risk of adverse events, a problem often associated with the so-called traditional incontinence operations. Life expectancy among women in Western countries has grown beyond 80 years of age. Long-term efficacy of treatment options for urinary incontinence therefore becomes an important issue in a world with limited eco-nomic resources. The purpose of the present study was to prospectively evaluate the long-term efficacy and safety of the first minimally invasive mid-urethral tape procedure, the Tension-free Vaginal Tape (TVT) procedure. The long-term (5-year) follow-up results of the TVT procedure as a repeat operation af-ter an unsuccessful mid-urethral tape operation were studied and the reasons for failure of the first operation were analyzed. Another purpose was to compare the original TVT procedure with a newer modification, the Tension-free Vaginal Tape Obturator (TVT-O) procedure within a multi-centre, randomized context in order to find out possible differences between these procedures re-garding efficacy and complications and the effects on symptoms of urgency. The first study of the present thesis is a prospective, Nordic, three-centre follow-up study of 90 women suffering from SUI, who were treated by means of the TVT procedure. The mean follow-up time was more than eleven years, and the study is the first to be published in connection with more than ten years of follow-up. The second study is a retrospective analysis of 26 women who were treated with a repeat TVT procedure after an unsuccessful primary mid-urethral tape procedure. The third and fourth studies concern 273 women in seven centres in Finland who were ran-domly assigned to the TVT and TVT-O procedures, the 3-year follow-up results of which are pre-sented in this thesis. After eleven years of follow-up, 90% of the women had a negative cough stress test result and a negative 24-h pad test result. The subjective cure rate measured as the women s global impression of cure was 77%, the rate of improvement 20%, and only 3% thought that the treatment had failed. No late-onset adverse effects were found. The repeat TVT procedure was successful in 75% of the cases when women who were cured and women who were significantly improved were included. The reasons for failure of the first operation could be separated into four different groups: tape material-related, operation technique-related, concomitant illness-related and a group with no identifiable reason. There were no intra-operative complications during the repeat operation. In the randomized trial comparing the TVT with the TVT-O procedure a cough stress test results were negative in 94.6% and 89.5% of the women in the two groups, respectively, after a 3-year follow-up period. There were no statistical differences in the cure rate or the rate of complications be-tween the two procedures. Symptoms of urgency were analyzed more closely and the main finding was that the prevalence of urgency symptoms decreased significantly after both mid-urethral sling procedures. The TVT operation was found to be an effective and safe procedure even after eleven years of follow-up. Long-term follow-up after a repeat TVT procedure revealed that the TVT procedure can well be considered after an unsuccessful mid-urethra tape procedure, because 75% of the patients showed significantly improvement of their incontinence. The TVT and TVT-O procedures showed no statistically significant differences in efficacy and rate of complications after three years of follow-up. In most cases these procedures alleviate preoperative symptoms of urgency and the risk of developing de novo urgency is low.

Finlandismer och språkvård från 1800-talet till i dag

The aim of the study is to investigate the use of finlandisms in an historical perspective, how they have been viewed from the mid-19th century to this day, and the effect of language planning on their use. A finlandism is a word, a phrase, or a structure that is used only in the Swedish varieties used in Finland (i.e. in Finland Swedish), or used in these varieties in a different meaning than in the Swedish used in Sweden. Various aspects of Finland-Swedish language planning are discussed in relation to language planning generally; in addition, the relation of Finland Swedish to Standard Swedish and standard regional varieties is discussed, and various types of finlandisms are analysed in detail. A comprehensive picture is provided of the emergence and evolution of the ideology of language planning from the mid-19th century up until today. A theoretical model of corpus planning is presented and its effect on linguistic praxis described. One result of the study is that the belief among Finland-Swedish language planners that the Swedish language in Finland must not be allowed to become distanced from Standard Swedish, has been widely adopted by the average Finland Swede, particularly during the interwar period, following the publication of Hugo Bergroth s work Finlandssvenska in 1917. Criticism of this language-planning ideology started to appear in the 1950s, and intensified in the 1970s. However, language planning and the basis for this conception of language continue to enjoy strong support among Swedish-speaking Finns. I show that the editing of Finnish literary texts written in Swedish has often been somewhat amateurish and the results not always linguistically appropriate, and that Swedish publishers have in fact adopted a rather liberal attitude towards finlandisms. My conclusion is that language planning has achieved rather modest results in its resistance to finlandisms. Most of the finlandisms used in 1915 were still in use in 2005. Finlandisms occur among speakers of all ages, and even among academically educated people despite their more elevated style. The most common finlandisms were used by informants of all ages. The ones that are firmly rooted are the most established, in other words those that are stylistically neutral, seemingly genuinely Swedish, but which are nevertheless strongly supported by Finnish, and display a shift in meaning as compared with Standard Swedish.

Investigation of unusual mortalities of bottlenose dolphins along the mid-Texas coastal bay ecosystem during 1992

An investigation was conducted into the deaths of more than 220 bottlenose dolphins (Tursiops truncatus) that occurred within the coastal bay ecosystem of mid-Texas between January and May 1992. The high mortality rate was unusual in that it was limited to a relatively small geographical area, occurred primarily within an inshore bay system separated from the Gulf of Mexico by barrier islands, and coincided with deaths of other taxa including birds and fish. Factors examined to determine the potential causes of the dolphin mortalities included microbial pathogens, natural biotoxins, industrial pollutants, other environmental contaminants, and direct human interactions. Emphasis was placed on nonpoint source pesticide runoff from agricultural areas, which had resulted from record rainfall that occurred during the period of increased mortality. Analytical results from sediment, water, and biota indicated that biotoxins, trace metals, and industrial chemical contamination were not likely causative factors in this mortality event. Elevated concentrations of pesticides (atrazine and aldicarb) were detected in surface water samples from bays within the region, and bay salinities were reduced to <10 ppt from December 1991 through April 1992 due to record rainfall and freshwater runoff exceeding any levels since 1939. Prolonged exposure to low salinity could have played a significant role in the unusual mortalities because low salinity exposure may cause disruption of the permeability barrier in dolphin skin. The lack of established toxicity data for marine mammals, particularly dermal absorption and bioaccumulation, precludes accurate toxicological interpretation of results beyond a simple comparison to terrestrial mammalian models. Results clearly indicated that significant periods of agricultural runoff and accompanying low salinities co-occurred with the unusual mortality event in Texas, but no definitive cause of the mortalities was determined. (PDF file contains 25 pages.)

Species Profiles: Life Histories and Environmental Requirements of Coastal Fishes and Invertebrates (Mid-Atlantic): Alewife/Blueback Herring

This profile covers life history and environmental requirements of both alewife (Alosa pseudoharengus) and blueback herring (Alosa aestivalis), since their distribution is overlapping and their morphology, ecological role, and environmental requirements are similar. The alewife is an anadromous species found in riverine, estuarine, and Atlantic coastal habitats, depending on life cycle stage, from Newfoundland (Winters et al. 1973) to Soutn Carolina (Berry 1964). Landlocked populations are i n the Great Lakes, Finger Lakes, and many other freshwater lakes (Bigelow and Sch roeder 1953; Scott and Crossman 1973). The blueback herring is an anadromous species found in riverine, estuarine, and Atlantic coastal habitats, depending on life stage cycle, from Nova Scotia to the St. Johns River, Florida (Hildebrand 1963)

Geological evolution of two crustal scale shear zones. Part I. The Rand thrust complex, northwestern Mojave Desert, California. Part II. The Magdalena metamorphic core complex, north central Sonora, Mexico

The geology and structure of two crustal scale shear zones were studied to understand the partitioning of strain within intracontinental orogenic belts. Movement histories and regional tectonic implications are deduced from observational data. The two widely separated study areas bear the imprint of intense Late Mesozoic through Middle Cenozoic tectonic activity. A regional transition from Late Cretaceous-Early Tertiary plutonism, metamorphism, and shortening strain to Middle Tertiary extension and magmatism is preserved in each area, with contrasting environments and mechanisms. Compressional phases of this tectonic history are better displayed in the Rand Mountains, whereas younger extensional structures dominate rock fabrics in the Magdalena area.

In the northwestern Mojave desert, the Rand Thrust Complex reveals a stack of four distinctive tectonic plates offset along the Garlock Fault. The lowermost plate, Rand Schist, is composed of greenschist facies metagraywacke, metachert, and metabasalt. Rand Schist is structurally overlain by Johannesburg Gneiss (= garnet-amphibolite grade orthogneisses, marbles and quartzites), which in turn is overlain by a Late Cretaceous hornblende-biotite granodiorite. Biotite granite forms the fourth and highest plate. Initial assembly of the tectonic stack involved a Late Cretaceous? south or southwest vergent overthrusting event in which Johannesburg Gneiss was imbricated and attenuated between Rand Schist and hornblende-biotite granodiorite. Thrusting postdated metamorphism and deformation of the lower two plates in separate environments. A post-kinematic stock, the Late Cretaceous Randsburg Granodiorite, intrudes deep levels of the complex and contains xenoliths of both Rand Schist and mylonitized Johannesburg? gneiss. Minimum shortening implied by the map patterns is 20 kilometers.

Some low angle faults of the Rand Thrust Complex formed or were reactivated between Late Cretaceous and Early Miocene time. South-southwest directed mylonites derived from Johannesburg Gneiss are commonly overprinted by less penetrative north-northeast vergent structures. Available kinematic information at shallower structural levels indicates that late disturbance(s) culminated in northward transport of the uppermost plate. Persistence of brittle fabrics along certain structural horizons suggests a possible association of late movement(s) with regionally known detachment faults. The four plates were juxtaposed and significant intraplate movements had ceased prior to Early Miocene emplacement of rhyolite porphyry dikes.

In the Magdalena region of north central Sonora, components of a pre-Middle Cretaceous stratigraphy are used as strain markers in tracking the evolution of a long lived orogenic belt. Important elements of the tectonic history include: (1) Compression during the Late Cretaceous and Early Tertiary, accompanied by plutonism, metamorphism, and ductile strain at depth, and thrust driven? syntectonic sedimentation at the surface. (2) Middle Tertiary transition to crustal extension, initially recorded by intrusion of leucogranites, inflation of the previously shortened middle and upper crustal section, and surface volcanism. (3) Gravity induced development of a normal sense ductile shear zone at mid crustal levels, with eventual detachment and southwestward displacement of the upper crustal stratigraphy by Early Miocene time.

Elucidation of the metamorphic core complex evolution just described was facilitated by fortuitous preservation of a unique assemblage of rocks and structures. The "type" stratigraphy utilized for regional correlation and strain analysis includes a Jurassic volcanic arc assemblage overlain by an Upper Jurassic-Lower Cretaceous quartz pebble conglomerate, in turn overlain by marine strata with fossiliferous Aptian-Albian limestones. The Jurassic strata, comprised of (a) rhyolite porphyries interstratified with quartz arenites, (b) rhyolite cobble conglomerate, and (c) intrusive granite porphyries, are known to rest on Precambrian basement north and east of the study area. The quartz pebble conglomerate is correlated with the Glance Conglomerate of southeastern Arizona and northeastern Sonora. The marine sequence represents part of an isolated arm? of the Bisbee Basin.

Crosscutting structural relationships between the pre-Middle Cretaceous supracrustal section, younger plutons, and deformational fabrics allow the tectonic sequence to be determined. Earliest phases of a Late Cretaceous-Early Tertiary orogeny are marked by emplacement of the 78 ± 3 Ma Guacomea Granodiorite (U/Pb zircon, Anderson et al., 1980) as a sill into deep levels of the layered Jurassic series. Subsequent regional metamorphism and ductile strain is recorded by a penetrative schistosity and lineation, and east-west trending folds. These fabrics are intruded by post-kinematic Early Tertiary? two mica granites. At shallower crustal levels, the orogeny is represented by north directed thrust faulting, formation of a large intermontane basin, and development of a pronounced unconformity. A second important phase of ductile strain followed Middle Tertiary? emplacement of leucogranites as sills and northwest trending dikes into intermediate levels of the deformed section (surficial volcanism was also active during this transitional period to regional extension). Gravitational instabilities resulting from crustal swelling via intrusion and thermal expansion led to development of a ductile shear zone within the stratigraphic horizon occupied by a laterally extensive leucogranite sill. With continued extension, upper crustal brittle normal faults (detachment faults) enhanced the uplift and tectonic denudation of this mylonite zone, ultimately resulting in southwestward displacement of the upper crustal stratigraphy.

Strains associated with the two ductile deformation events have been successfully partitioned through a multifaceted analysis. R_f/Ø measurements on various markers from the "type" stratigraphy allow a gradient representing cumulative strain since Middle Cretaceous time to be determined. From this gradient, noncoaxial strains accrued since emplacement of the leucogranites may be removed. Irrotational components of the postleucogranite strain are measured from quartz grain shapes in deformed granites; rotational components (shear strains) are determined from S-C fabrics and from restoration of rotated dike and vein networks. Structural observations and strain data are compatable with a deformation path of: (1) coaxial strain (pure shear?), followed by (2) injection of leucogranites as dikes (perpendicular to the minimum principle stress) and sills (parallel to the minimum principle stress), then (3) southwest directed simple shear. Modeling the late strain gradient as a simple shear zone permits a minimum displacement of 10 kilometers on the Magdalena mylonite zone/detachment fault system. Removal of the Middle Tertiary noncoaxial strains yields a residual (or pre-existing) strain gradient representative of the Late Cretaceous-Early Tertiary deformation. Several partially destrained cross sections, restored to the time of leucogranite emplacement, illustrate the idea that the upper plate of the core complex bas been detached from a region of significant topographic relief. 50% to 100% bulk extension across a 50 kilometer wide corridor is demonstrated.

Late Cenozoic tectonics of the Magdalena region are dominated by Basin and Range style faulting. Northeast and north-northwest trending high angle normal faults have interacted to extend the crust in an east-west direction. Net extension for this period is minor (10% to 15%) in comparison to the Middle Tertiary detachment related extensional episode.

Part I. A study of the velocity structure of the earth by the use of core phases. Part II. The 1971 San Fernando earthquake series focal mechanisms and tectonics

The initial objective of Part I was to determine the nature of upper mantle discontinuities, the average velocities through the mantle, and differences between mantle structure under continents and oceans by the use of P'dP', the seismic core phase P'P' (PKPPKP) that reflects at depth d in the mantle. In order to accomplish this, it was found necessary to also investigate core phases themselves and their inferences on core structure. P'dP' at both single stations and at the LASA array in Montana indicates that the following zones are candidates for discontinuities with varying degrees of confidence: 800-950 km, weak; 630-670 km, strongest; 500-600 km, strong but interpretation in doubt; 350-415 km, fair; 280-300 km, strong, varying in depth; 100-200 km, strong, varying in depth, may be the bottom of the low-velocity zone. It is estimated that a single station cannot easily discriminate between asymmetric P'P' and P'dP' for lead times of about 30 sec from the main P'P' phase, but the LASA array reduces this uncertainty range to less than 10 sec. The problems of scatter of P'P' main-phase times, mainly due to asymmetric P'P', incorrect identification of the branch, and lack of the proper velocity structure at the velocity point, are avoided and the analysis shows that one-way travel of P waves through oceanic mantle is delayed by 0.65 to 0.95 sec relative to United States mid-continental mantle.

A new P-wave velocity core model is constructed from observed times, dt/dΔ's, and relative amplitudes of P'; the observed times of SKS, SKKS, and PKiKP; and a new mantle-velocity determination by Jordan and Anderson. The new core model is smooth except for a discontinuity at the inner-core boundary determined to be at a radius of 1215 km. Short-period amplitude data do not require the inner core Q to be significantly lower than that of the outer core. Several lines of evidence show that most, if not all, of the arrivals preceding the DF branch of P' at distances shorter than 143° are due to scattering as proposed by Haddon and not due to spherically symmetric discontinuities just above the inner core as previously believed. Calculation of the travel-time distribution of scattered phases and comparison with published data show that the strongest scattering takes place at or near the core-mantle boundary close to the seismic station.

In Part II, the largest events in the San Fernando earthquake series, initiated by the main shock at 14 00 41.8 GMT on February 9, 1971, were chosen for analysis from the first three months of activity, 87 events in all. The initial rupture location coincides with the lower, northernmost edge of the main north-dipping thrust fault and the aftershock distribution. The best focal mechanism fit to the main shock P-wave first motions constrains the fault plane parameters to: strike, N 67° (± 6°) W; dip, 52° (± 3°) NE; rake, 72° (67°-95°) left lateral. Focal mechanisms of the aftershocks clearly outline a downstep of the western edge of the main thrust fault surface along a northeast-trending flexure. Faulting on this downstep is left-lateral strike-slip and dominates the strain release of the aftershock series, which indicates that the downstep limited the main event rupture on the west. The main thrust fault surface dips at about 35° to the northeast at shallow depths and probably steepens to 50° below a depth of 8 km. This steep dip at depth is a characteristic of other thrust faults in the Transverse Ranges and indicates the presence at depth of laterally-varying vertical forces that are probably due to buckling or overriding that causes some upward redirection of a dominant north-south horizontal compression. Two sets of events exhibit normal dip-slip motion with shallow hypocenters and correlate with areas of ground subsidence deduced from gravity data. Several lines of evidence indicate that a horizontal compressional stress in a north or north-northwest direction was added to the stresses in the aftershock area 12 days after the main shock. After this change, events were contained in bursts along the downstep and sequencing within the bursts provides evidence for an earthquake-triggering phenomenon that propagates with speeds of 5 to 15 km/day. Seismicity before the San Fernando series and the mapped structure of the area suggest that the downstep of the main fault surface is not a localized discontinuity but is part of a zone of weakness extending from Point Dume, near Malibu, to Palmdale on the San Andreas fault. This zone is interpreted as a decoupling boundary between crustal blocks that permits them to deform separately in the prevalent crustal-shortening mode of the Transverse Ranges region.

Migratory and within-estuary behaviors of adult Summer Flounder (Paralichthys dentatus) in a lagoon system of the southern mid-Atlantic Bight

We monitored the movements of 45 adult Summer Flounder (Paralichthys dentatus) between June 2007 and July 2008 through the use of passive acoustic telemetry to elucidate migratory and within-estuary behaviors in a lagoon system of the southern mid-Atlantic Bight. Between 8 June and 10 October 2007, fish resided primarily in the deeper (>3 m) regions of the system and exhibited low levels of large-scale (100s of meters) activity. Mean residence time within this estuarine lagoon system was conservatively estimated to be 130 days (range: 18–223 days), which is 1.5 times longer than the residence time previously reported for Summer Flounder in a similar estuarine habitat ~250 km to the north. The majority of fish remained within the lagoon system until mid-October, although some fish dispersed earlier and some of them appeared to disperse temporarily (i.e., exited the system for at least 14 consecutive days before returning). Larger fish were more likely to disperse before mid-October than smaller fish and may have moved to other estuaries or the inner continental shelf. Fish that dispersed after mid-October were more likely to return to the lagoon system the following spring than were fish that dispersed before mid-October. In 2008, fish returned to the system between 7 February and 7 April. Dispersals and returns most closely followed seasonal changes in mean water temperature, but photoperiod and other factors also may have played a role in large-scale movements of Summer Flounder.

Columnar aerosol optical properties at AERONET sites in central eastern Asia and aerosol transport to the tropical mid-Pacific

IEECAS SKLLQG

Records of the East Asian winter monsoon from the mud area on the inner shelf of the East China Sea since the mid-Holocene

AMS(14)C dating and analysis of grain size, major elements and clay minerals were applied to Core MZ01 from the mud area on the inner shelf of the East China Sea. Based on the environmentally sensitive grain size, clay mineral and major element assemblages, the history of the East Asia winter monsoon since the mid-Holocene could be reconstructed. These three proxies, mean grain size (>9.71 mu m), chemical index of alteration (CIA) and ratio of smectite to kaolinite in particular, show similar fluctuation patterns. Furthermore, 10 extreme values corresponding to the contemporary cooling events could be recognized since the mid-Holocene; these extreme values are likely to have been caused by the strengthening of the East Asia winter monsoon. The cooling events correlated well with the results of the delta O-18 curves of the Dunde ice core and GISP2, which therefore revealed a regional response to global climate change. Four stages of the East Asia winter monsoon were identified, i.e. 8300-6300 a BP, strong and unstable; 6300-3800 a BP, strong but stable; 3800-1400 a BP, weak and unstable; after 1400 a BP, weak but stable.

Mid-Level Vision and Recognition of Non-Rigid Objects

We address mid-level vision for the recognition of non-rigid objects. We align model and image using frame curves - which are object or "figure/ground" skeletons. Frame curves are computed, without discontinuities, using Curved Inertia Frames, a provably global scheme implemented on the Connection Machine, based on: non-cartisean networks; a definition of curved axis of inertia; and a ridge detector. I present evidence against frame alignment in human perception. This suggests: frame curves have a role in figure/ground segregation and in fuzzy boundaries; their outside/near/top/ incoming regions are more salient; and that perception begins by setting a reference frame (prior to early vision), and proceeds by processing convex structures.

FLUTE MUSIC FROM THE MID-TWENTIETH CENTURY BY THREE FRENCH COMPOSERS: JEAN-MICHEL DAMASE, ANDRE JOLIVET, AND HENRI TOMASI

Jean-Michel Damase (b.1928), Andre Jolivet (1905-1974), and Henri Tomasi (1901-1971) are three prominent French composers ofthe twentieth century. Tomasi won the Prix de Rome in 1927, and Damase won the Prix de Rome in 1947. All three composers were educated and lived in Paris around the same period; however, their musical styles are quite distinct. Most of Jolivet's compositions for flute are well known and are often selected as international competition repertoire. The compositions for flute by Damase and Tomasi are not as recognized as those of Jolivet, and most of their works for flute still have not been commercially recorded. The purpose of this dissertation is to provide a more comprehensive guide to the compositions for flute by Damase, Jolivet and Tomasi, and, in addition, to make the works ofDamase and Tomasi familiar to flutists. This dissertation will focus on the compositions ofDamase, Jolivet, and Tomasi for flute alone and those for flute and piano, written between 1928 and 1971 (1928 is the year Damase was born, and 1971 is the year that Tomasi died). Damase continues French romanticism, and his music is always playful, elegant, and accessible with rhythmic and harmonic surprises, but with an underlying complexity. His compositions for flute include three concertos, two double concertos, one flute solo work, and nine works for flute and piano. Jolivet's compositions make use of ancient rituals, incantations, and spirituality, as well as repeated phrases and single notes, irregular rhythmic patterns, dissonant effects, and rhythmic drive. He composed one flute concerto, three works for flute solo, and four works for flute and piano. Tomasi's compositions also continue French romanticism and contain melodies which often seem to tell a story, and which are not only full of flourishes and vitality, but are also delicate, colorful, and romantic. Virtuosic technical demand is another characteristic of his style. Tomasi composed three flute concertos, three works for solo flute, and one work for flute and piano. Appendix I is a list of the compositions for flute by Damase, Jolivet, and Tomasi, and Appendix II is a discography of their works.