Neuromodulation in neurogenic bladder.

While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction

Using formative research to develop a hospital-based perinatal public health intervention in the US: The Thirty Million Words Initiative Newborn Parent Education Curriculum

Parents and caregivers do not exist in a vacuum, and with regard to crafting impactful interventions, it is increasingly being recognized that there are no one-size-fits-all approaches to behavior change. Implementing research to practice is a complex endeavor and requires the adaptation of basic research findings to different cultural and environmental contexts of intended beneficiaries (Sepinwall, 2002; Weisner & Hay, 2014). The practice of formative research allows for the systematic assessment of diverse implementation contexts and provides insights into responsive adaptations of content and delivery. In this study, we detail the use of formative testing to inform the development of a curriculum designed to support the Universal Newborn Hearing Screening (UNHS): the Thirty Million Words Initiative Newborn (TMW-Newborn) Parent Education Curriculum provides caregivers of newborns with information on the UNHS and illustrates the importance of identifying if a newborn is deaf or hard of hearing (D/HH) to ensure that caregivers learn how to promote early language development. The information provided could potentially reduce lost-to-follow up (LFU) rates for newborns who may be D/HH. Using qualitative methods, we collected and responded to feedback obtained from caregivers of newborns and were able to gear content, messaging and delivery of the intervention to stakeholder needs. A subsample of participants also completed a knowledge survey testing their understanding of intervention content prior to receiving the intervention, as well as the day after. The results showed that participant scores increased significantly post-intervention

Ambulatory Surgery Centers and Their Intended Effects on Outpatient Surgery

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113726/1/hesr12278.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/113726/2/hesr12278-sup-0001-AppendixSA1.pd

Dynamic MRI evaluation of urethral hypermobility post‐radical prostatectomy

Aims One postulated cause of post‐prostatectomy incontinence is urethral and bladder neck hypermobility. The objective of this study was to determine the magnitude of anatomical differences of urethral and bladder neck position at rest and with valsalva in continent and incontinent men post‐prostatectomy based on dynamic MRI. Methods All subjects underwent a dynamic MRI protocol with valsalva and non‐valsalva images and a standard urodynamic evaluation. MRI measurements were taken at rest and with valsalva, including (1) bladder neck to sacrococcygeal inferior pubic point line (SCIPP), (2) urethra to pubis, and (3) bulbar urethra to SCIPP. Data were analyzed in SAS using two‐tailed t tests. Results A total of 21 subjects (13 incontinent and 8 continent) had complete data and were included in the final analysis. The two groups had similar demographic characteristics. On MRI, there were no statistically significant differences in anatomic position of the bladder neck or urethra either at rest or with valsalva. The amount of hypermobility ranged from 0.8 to 2 mm in all measures. There were also no differences in the amount of hypermobility (position at rest minus position at valsalva) between groups. Conclusions We found no statistically significant differences in bladder neck and urethral position or mobility on dynamic MRI evaluation between continent and incontinent men status post‐radical prostatectomy. A more complex mechanism for post‐prostatectomy incontinence needs to be modeled in order to better understand the continence mechanism in this select group of men. Neurourol. Urodynam. 33:312–315, 2014 . © 2013 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106760/1/nau22408.pd

A screening tool for clinically relevant urinary incontinence

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111206/1/nau22564.pd

Functional and anatomical differences between continent and incontinent men post radical prostatectomy on urodynamics and 3T MRI: A pilot study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112204/1/nau22616.pd

Casimir Energy of the Universe and New Regularization of Higher Dimensional Quantum Field Theories

Casimir energy is calculated for the 5D electromagnetism and 5D scalar theory in the {\it warped} geometry. It is compared with the flat case. A new regularization, called {\it sphere lattice regularization}, is taken. In the integration over the 5D space, we introduce two boundary curves (IR-surface and UV-surface) based on the {\it minimal area principle}. It is a {\it direct} realization of the geometrical approach to the {\it renormalization group}. The regularized configuration is {\it closed-string like}. We do {\it not} take the KK-expansion approach. Instead, the position/momentum propagator is exploited, combined with the {\it heat-kernel method}. All expressions are closed-form (not KK-expanded form). The {\it generalized} P/M propagators are introduced. We numerically evaluate \La(4D UV-cutoff), \om(5D bulk curvature, warp parameter) and $T$(extra space IR parameter) dependence of the Casimir energy. We present two {\it new ideas} in order to define the 5D QFT: 1) the summation (integral) region over the 5D space is {\it restricted} by two minimal surfaces (IR-surface, UV-surface) ; or 2) we introduce a {\it weight function} and require the dominant contribution, in the summation, is given by the {\it minimal surface}. Based on these, 5D Casimir energy is {\it finitely} obtained after the {\it proper renormalization procedure.} The {\it warp parameter} \om suffers from the {\it renormalization effect}. The IR parameter $T$ does not. We examine the meaning of the weight function and finally reach a {\it new definition} of the Casimir energy where {\it the 4D momenta(or coordinates) are quantized} with the extra coordinate as the Euclidean time (inverse temperature). We examine the cosmological constant problem and present an answer at the end. Dirac's large number naturally appears.Comment: 13 paes, 8 figures, proceedings of 1st Mediterranean Conf. on CQ

Conformal Tightness of Holographic Scaling in Black Hole Thermodynamics

The near-horizon conformal symmetry of nonextremal black holes is shown to be a mandatory ingredient for the holographic scaling of the scalar-field contribution to the black hole entropy. This conformal tightness is revealed by semiclassical first-principle scaling arguments through an analysis of the multiplicative factors in the entropy due to the radial and angular degrees of freedom associated with a scalar field. Specifically, the conformal SO(2,1) invariance of the radial degree of freedom conspires with the area proportionality of the angular momentum sums to yield a robust holographic outcome.Comment: 23 pages, 1 figure. v2 & v3: expanded explanations and proofs, references added, typos corrected; v3: published versio

How older men live with stress urinary incontinence: Patient experience and navigation to treatment

ObjectivesTo explore the context in which older men navigate treatment for stress urinary incontinence (SUI) following prostate surgery by characterizing lived experience of men with symptomatic SUI.Subjects/patients and methodsMixed method study using surveys and semistructured interviews to examine a cohort of men who underwent evaluation for treatment of postprostatectomy SUI.ResultsThirty-six men were interviewed after consultation for SUI and 31 had complete quantitative clinical data. Twenty-six underwent surgery and 10 chose no surgical intervention. In qualitative interviews, respondents experienced substantial decline in quality of life due to incontinence citing concerns associated with use of pads and worrying about incontinence. Most patients reported "workarounds"-efforts to mitigate or manage incontinence including Kegels, physical therapy, and garments. Participants also reported lifestyle changes including less strenuous physical activity, less sexual activity, and/or fewer social gatherings. Patients then described a "breaking point" where incontinence workarounds were no longer sufficient. After seeking evaluation, men described challenges in exploring treatment for SUI, including access to care and provider knowledge of treatment options.ConclusionIn a novel study of patients living with SUI a predictable lived experience was observed that culminated in a desire for change or "breaking point." In all men, this led to treatment-seeking behaviors and for many it led to SUI intervention. Despite effective treatments, patients continue to meet barriers gaining access to SUI evaluation and treatment