The role of anticipatory and reflexive compensatory muscle activation in catching errors under load uncertainty.

This experiment investigated the role of anticipatory and reflexive compensatory neuromotor control in catching errors occurring under load uncertainty. Participants performed 64 trials of a one-handed ball catching task using visually identical balls of four different weights without knowing the weight of the ball on each trial. Anticipatory and reflexive compensatory muscle activation were recorded in five muscles (anterior deltoid, biceps brachii, wrist flexors group, triceps brachii, lumbar erector spinae) using the EMG integral. In each muscle, the anticipatory and reflexive compensatory muscle activation were compared between successful catches and catching errors for the lightest ball and the heaviest ball. Anticipatory muscle activation was not implicated in errors made with the lightest ball. However, reflexive compensatory muscle activation in the anterior deltoid, biceps brachii, and wrist flexors were implicated in errors made with the lightest ball. Specifically, catching errors with the lightest ball were characterized by elevated reflexive compensatory muscle activation. In the case of the heaviest ball, both anticipatory (anterior deltoid, wrist flexors) and reflexive compensatory muscle activation (anterior deltoid, biceps brachii, wrist flexors) were implicated in catching errors. That is, catching errors with the heaviest ball were characterized by lower anticipatory and reflexive compensatory muscle activation. Results are considered in the context of the likely influence of limb compliance in catching under load uncertainty.

Muscle activity prior to experiencing the rubber hand illusion is associated with alterations in perceived hand location.

The rubber hand illusion (RHI) is a perceptual illusion in which one is made to feel that a hand-shaped object is part of their body. This illusion is believed to be the result of the integration of afferent information. However, there has been an increasing amount of evidence that suggests efferent information plays a role in this illusion as well. Previous research has found that individuals who are afflicted by pathological lack of movement experience the RHI more vividly than control participants. Whereas individuals who move their hands more than the general population (i.e. professional pianists) experience the RHI less vividly than control participants. Based upon the available evidence it would seem that muscle activity prior to experiencing the RHI should be associated with how vividly one experiences different indices of the illusion. In the present study we tested this possibility by having participants perform a maximum voluntary muscle contraction task prior to experiencing three variants of the RHI (moving active, moving passive and classic). It was found that electromyographic features known to be indicative of muscle fatigue exhibited a positive association with proprioceptive drift when stimulation was synchronous or visual movement only (with the exception of the passive moving RHI synchronous condition). More work is needed to better characterize the muscular processes associated with experiencing the RHI.

Effect of non-contact boxing training on the frequency and timing of anticipatory postural adjustments in healthy adults.

BACKGROUND: The experiment tested the effect of non-contact boxing training on the frequency and timing of anticipatory postural adjustments (APAs) resulting from self-induced postural perturbations in healthy adults. METHODS: The 8-week non-contact boxing intervention study involved 33 healthy adults between 18 and 27 years of age who had no boxing experience (control group = 17 participants, boxing group = 16 participants). Pretests and post-tests utilized rapid bilateral arm raising as a focal movement to elicit APAs. EMG in the anterior deltoid, thoracic and lumbar erector spinae, semitendinosus, and soleus muscles was recorded. The boxing group completed twenty 90-min non-contact boxing training sessions over 8 weeks, whereas the control group kept physical activity consistent during the intervention period. RESULTS: Non-contact boxing training caused APAs to become more frequent during the focal movement, in comparison to the control group, in the soleus and in the semitendinosus after an outlier was removed. Non-contact boxing training caused earlier APA onset during the focal movement, in comparison to the control group, in the lumbar erector spinae after an outlier was removed. CONCLUSIONS: Non-contact boxing training had a modest positive effect on the frequency and timing of APAs resulting from self-induced postural perturbations in healthy adults.

Iatrogenic effects of radical cancer surgery on male fertility.

Iatrogenic causes of male infertility can include medications, chemotherapy, radiation, and surgery. In this review, we discuss commonly performed urologic cancer surgeries and nonurologic surgeries that harbor a high risk of iatrogenic infertility. These include radical prostatectomy, radical cystectomy, retroperitoneal lymph node dissection, pelvic colon surgery, and anterior spine surgery. In addition, we review the anatomy and surgical strategies that help to reduce the risks of infertility. With an increase in life expectancy and improvements in fertility preservation, it is important to properly counsel patients about the risks of infertility and provide options for fertility preservation before surgery.

Real-world Compliance With Percutaneous Tibial Nerve Stimulation Maintenance Therapy in an American Population.

OBJECTIVE: To evaluate percutaneous tibial nerve stimulation (PTNS) maintenance therapy dropout rates and identify factors associated with compliance in an American population. METHODS: We retrospectively queried our PTNS database for patients from 2014-2019. Demographic, relevant clinical, and visit data were collected. Maintenance therapy was patient-driven and frequency of sessions was tapered based on symptomology. Upon completion of 12 initial sessions, we assessed dropout from maintenance at 3, 6, 9, and 12 months. Multiple variables were tested for correlation with dropout in patients continuing maintenance therapy for 1 year vs those who dropped out. RESULTS: One hundred and sixty-three PTNS patients were identified, of which 104 completed initial therapy and 81 proceeded with maintenance therapy. At 3, 6, 9, and 12 months, maintenance continuation rates were 77.8% (63/81), 58.0% (47/81), 45.6% (37/81), and 39.5% (32/41), respectively. Primary reasons for dropout were worsening of urinary symptoms/lack of efficacy (n = 21), time commitment (n = 9), loss of insurance (n = 5), medical comorbidities (n = 4), request for alternative OAB treatment (n = 2), and unknown (n = 8). On both univariate and multivariate analysis, perceived symptom improvement (P<.01; HR = 0.02, P< .01) was associated with continuing maintenance therapy. On only univariate analysis, neurological history (P = .02) and multiple sclerosis history (0.02) were associated with continuing therapy. CONCLUSION: Only 39.5% of patients continue to undergo maintenance PTNS therapy after 1 year. Future studies are required to understand and ameliorate factors for low compliance in PTNS maintenance therapy.

A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?

AIMS: Third-line therapies are efficacious in improving overactive bladder (OAB) symptoms; however, OAB patients have poor follow-up and rarely progress to these therapies. Clinical care pathways (CCP) may improve OAB follow-up rates and third-line therapy use. We sought to determine how new OAB patients follow up and utilize third-line therapies with the implementation of an OAB CCP in a fellowship Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained urologist's academic practice. METHODS: We identified new OAB patients using ICD-9 and 10 codes. They were placed into two groups: pre- and post-CCP use. Basic demographic data were collected. Patients were evaluated in a retrospective longitudinal fashion over 12 months to determine follow-up and third-line therapy utilization. RESULTS: A total of 769 new OAB patients (261 pre-CCP and 508 post-CCP) were identified. The mean number of follow-up visits increased significantly at 6 months (0.94 vs. 1.64 visits, p = .001) and 12 months (1.26 vs. 2.46 visits, p < .003). Follow-up rates increased significantly at 3 months (38.7% vs. 50.2%, p = .002). Mean time to third-line therapy decreased significantly (280 days vs. 160 days, p = .016). Third-line therapy utilization therapy rates increased at 6 months (7.7% vs. 13.4%, p = .018) and at 12 months (11.1% vs. 16.5%, p = .044). CONCLUSIONS: New OAB patients follow-up and progress to third-line therapies faster and more frequently with the use of a CCP in an FPMRS-trained urologist practice. However, many OAB patients still fail to follow up and overall utilization of third-line therapies remains low. Future studies are warranted to identify factors to why overall OAB compliance remains low.

Clinical implications of telemedicine for providers and patients.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in paradigm shifts in the delivery of health care. Lockdowns, quarantines, and local mandates forced many physician practices around the United States to move to remote patient visits and adoption of telemedicine. This has several long-term implications in the future practice of medicine. In this review we outline different models of integrating telemedicine into both male and female fertility practices and recommendations on performing video physical examinations. Moving forward we foresee two general models of integration: one conservative, where initial intake and follow-up is performed remotely, and a second model where most visits are performed via video and patients are only seen preoperatively if necessary. We also discuss the impact THAT telemedicine has on coding and billing and our experience with patient satisfaction.

Hypogonadism and metabolic syndrome: review and update.

PURPOSE OF REVIEW: The prevalence of metabolic syndrome and hypogonadism continues to rise in the United States and around the world. These two conditions are inexorably linked, and understanding their relationship with each other is key to treating men with either of these conditions. RECENT FINDINGS: Testosterone has been shown to be a key regulator in the maintenance of metabolic homeostasis. A large volume of research has found that testosterone deficiency is closely linked to metabolic syndrome through complex physiologic mechanisms of endothelial dysfunction, inflammation, and glucose metabolism. SUMMARY: Interventions through lifestyle modification and testosterone replacement in hypogonadal men may reduce the morbidity and mortality risks associated with metabolic syndrome.

Information for anticipatory neuromotor control in catching under load uncertainty.

Humans employ anticipatory muscle activation when catching under conditions of load uncertainty. Questions addressed were (a) on what information referent do catchers base their anticipatory neuromotor control when catching balls of unknown weight?, and (b) how do catchers use this functional referent? Thirty-six participants caught visually identical balls dropped from 0.75 m. Participants performed 40 trials, half with knowledge of ball weight and half without. Group L caught balls with a large weight range, while group S caught balls with a smaller range of weights. EMG integrals were computed for the ball flight period in five muscles. Anticipatory EMG integrals in the unknown weight condition were normalized to anticipatory EMG integrals for the maximum, minimum and average ball weights in the known ball weight condition. We assumed participants would base anticipatory control in the unknown weight condition on similar information, regardless of group. Therefore, differences in normalized EMG integrals between groups L and S would suggest that the specific referent tested (e.g., minimum possible ball weight) was not used to scale anticipatory muscle activation under load uncertainty. Independent sample t tests ascertained differences in normalized EMG integrals between groups L and S. The results suggested that the information referent participants used to catch balls of an unknown weight was knowledge of the maximum ball weight. Participants used this referent to generate a submaximal level of anticipatory muscle activation, i.e., about 93.2% of that used to catch the heaviest ball when ball weight was known in advance.

What's in a name? Choosing a title for a female pelvic medicine and reconstructive surgery clinic: A prospective questionnaire.

AIMS: A new multidisciplinary clinic specializing in female pelvic medicine and reconstructive surgery (FPMRS) opened at our institution. We sought to assess patient preference in naming this new center, and how readability and word choice informs these preferences. METHODS: We prospectively surveyed patient preference in naming this new center, as well as patient knowledge and societal perception of pelvic floor disorders. This survey was distributed to female patients presenting to general urology and gynecology clinics. RESULTS: There were 300 respondents out of 1000 distributed surveys. Patients preferred titles with accessible readability scores and societally neutral vocabulary. Preferred titles for the clinic were at a 6th-grade readability level. Patients preferred neutral titles that included the word "health" and disliked titles that contained the words "pelvic floor" and "dysfunction." In general, survey participants believed that "incontinence" was associated with negative connotations. CONCLUSION: Readable and neutral vocabulary in the title of the clinic are key components of patient-preferred titles for an FPMRS clinic and affect patient comfort levels in scheduling an appointment.

The Effect of Load Uncertainty on Neuromotor Control in Catching: Gender Differences and Short Foreperiods.

To reveal how the CNS copes with load uncertainty in catching, electromyography (EMG) was recorded in 15 females and 14 males while catching visually identical balls of known and unknown weights under varied (1-10 s) and constant (1 s) foreperiods (warning time). EMG integrals, which represented total muscle activity, were computed for three time intervals prior to the catch (anticipatory), and one interval after (compensatory). Load uncertainty caused the CNS to utilize an anticipatory strategy in several muscles, primarily during the ball-flight interval, characterized by preparation to catch balls of unknown weight by utilizing an average of 99.7% of the muscle activation used to catch the heaviest ball under the known weight condition. The constant 1 s foreperiod, which permitted precise temporal anticipation of ball release, did not influence the anticipatory strategy adopted by the CNS to cope with load uncertainty. There were no observed differences in the neuromotor control used by men and women to manage load uncertainty in catching, although there was an interesting difference in the way men and women employed the triceps to prepare to catch balls of a known weight.

Phosphorus and potassium effects on taproot C and N reserve pools and long-term persistence of alfalfa (Medicago sativa L.).

Improved P and K nutrition can enhance yield and persistence of alfalfa (Medicago sativa L.) grown on low fertility soils, but it is unknown if the improved agronomic performance is associated with greater taproot N and C reserves. Our objective was to use cluster analysis to determine how alfalfa plant persistence is altered by P and K fertilization, and determine if changes in specific taproot C and/or N reserves were associated with alfalfa plant death. Taproots were dug and plants counted in May and December of each year and taproots analyzed for P, K, starch, sugar, amino-N, and soluble protein. K-means clustering was used to create six clusters that were subsequently compared using two-sample t-tests. Low K in herbage and taproots was associated with low yield and poor persistence of the Low and Very Low clusters and taproots of these plants generally had low starch, protein, and amino-N concentrations. Plants died primarily between May and December. Plant persistence of the low yielding, P-deficient Medium cluster was high and associated with high starch concentrations. Low amino-N concentrations in taproots may provide an early indication of potential plant death because these were evident in poor-persisting Low and Very Low clusters early in the study.

Medicaid Patients Experience Longer Wait Times at Academic Urology Clinics Compared to Patients with Medicare.

INTRODUCTION: It has been established that Medicaid patients face unequal access to health care. There is a paucity of literature comparing wait times for Medicaid patients to those of patients with other types of insurance. We determined whether Medicaid patients experience longer wait times at academic urology clinics compared to patients with Medicare. METHODS: A prospective cross-sectional telephone survey was conducted in October 2016. The study involved collection of data from multiple academic centers with telephone interviews conducted from a single institution. Calls were made to all accredited urology residency programs (131). Earliest appointment times were established for fictional patients with Medicaid and then Medicare. The main outcome was the difference in wait times for a new patient appointment in a urology clinic for Medicaid vs Medicare patients. The wait time in days was the difference between the date of the appointment and the date of the telephone call. RESULTS: There were 108 academic urology clinics that accepted Medicaid and Medicare patients in our final analysis (82.4% participation rate). A 2-tailed t-test was performed with unequal variances for the wait times between Medicaid and Medicare groups. There was a significant difference (p <0.001) between mean wait times for a patient with Medicare (23 days, SD 20.8; 95% CI 19.0, 26.9) vs Medicaid (35 days, SD 27.5; 95% CI 30.0, 40.3). CONCLUSIONS: Our data suggest that Medicaid patients experience longer wait times for their initial outpatient urological evaluation. These findings may be used for future health policy considerations.

Effect of the Alexander Technique on Muscle Activation, Movement Kinematics, and Performance Quality in Collegiate Violinists and Violists: A Pilot Feasibility Study.

Musicians are trained to attend to aural and visual senses, to the detriment of kinesthetic awareness, which often results in unnecessary muscle tension and narrowed attentional focus. The Alexander technique (AT) addresses these concerns by approaching action using a process of whole-body consciousness. Incorporation of AT concepts into skill practice may reduce static tension in playing and result in both prevention of injury and improved quality of performance, but objective evidence of these effects is lacking. This pilot feasibility study was designed to determine if muscle activation, movement kinematics, musical performance, and qualitative self-assessment over the course of a 10- week AT intervention are viable means to assess the efficacy of AT in violinists/ violists. Two groups of collegiate violinists and violists participated: Group A (n=4) participated in weekly 1-hour group AT lessons and kept a personal journal of their progress. Group B (n=3) received no AT lessons. Pre- and post tests included muscle activation recorded using electromyography (EMG) and movement kinematics recorded via motion tracking as musicians played a scale and a Kreutzer étude. Performance was also video-recorded and evaluated by an expert for quality and kinesthetic awareness. The results suggest that the measures and intervention employed could, with some adaptation, be a viable means of determining the potential benefits of AT training.

Complications of Renal Surgery.

The incidence of the small renal mass continues to increase owing to the aging population and the ubiquity imaging. Most of these tumors are stage I tumors. Management strategies include surveillance, ablation, and extirpation. There is a wide body of literature favoring nephron-sparing approaches. Although nephron-sparing surgery may yield decreased long-term morbidity, it is not without its drawbacks, including a higher rate of complications. Urologists must be attuned to the complications of surgery and develop strategies to minimize risk. This article reviews expected complications of surgery on renal masses and risk stratification schema.

The Effect of Load Uncertainty and Foreperiod Regularity on Anticipatory and Compensatory Neuromotor Control in Catching.

Muscle activation was measured using EMG in 28 males (n = 28) while participants caught visually identical balls of known and unknown weights (50, 1.32, 2.18, and 2.99 kg) under variable (1-10s) and constant (3s) foreperiods. EMG integrals were computed for three time intervals before the catch (anticipatory), and one after (compensatory). Load uncertainty caused the CNS to use an anticipatory strategy characterized by preparation to catch balls of an unknown weight by utilizing about 92% of the muscle activation used to catch the heaviest possible ball under the known weight condition. The CNS appeared to scale anticipatory muscle activation to afford an opportunity to catch a ball of an unknown weight between .50 and 2.99 kg. The constant 3s foreperiod, which permitted temporal anticipation, did not influence the anticipatory neuromotor strategy adopted by the CNS to cope with load uncertainty. Load uncertainty also altered compensatory neuromotor control in catching.

Does load uncertainty affect adaptation to catch training?

Catching relies on anticipatory and compensatory control processes. Load uncertainty increases anticipatory and compensatory neuromotor effort in catching. This experiment tested the effect of load uncertainty in plyometric catch/throw training on elbow flexion reaction time (RT), movement time (MT) and peak torque, as well as the distribution of anticipatory and compensatory neuromotor effort in catching. We expected load uncertainty training to be superior to traditional training for improving elbow flexion MT and peak torque, as well as for reallocating neuromotor effort from compensatory to anticipatory control in catching. Three groups of men (mean age = 21), load knowledge training (K) (n = 14), load uncertainty training (U) (n = 13) and control (C) (n = 14), participated. Groups K and U trained three times/week for 6 weeks using single-arm catch/throw exercises with 0.45-4.08 kg balls. Sets involved 16 repetitions of four different ball masses presented randomly. Group K had knowledge of ball mass on every repetition, whereas group U never did. Change scores were analyzed using Kruskal-Wallis tests and follow-up Wilcoxon rank-sum tests. Group K improved both RT and MT (by 6.2 and 12 %, respectively), whereas group U did not. Both groups K and U improved peak eccentric elbow flexion torque. Group K reallocated neuromotor effort from compensatory to anticipatory processes in the biceps, triceps and the all muscle average, whereas group U did so in the triceps only. In sum, plyometric catch/throw training caused a reallocation of neuromotor effort from compensatory to anticipatory control in catching. However, load uncertainty training did not amplify this effect and in fact appeared to inhibit the reallocation of neuromotor effort from compensatory to anticipatory control.

The impact of object weight, reach distance, discomfort and muscle activation on the location of preferred critical boundary during a seated reaching task.

Successful performance of a goal-directed action requires the prospective actor to perceive the environment relative to their action capabilities and tailor their movements accordingly. The current study examined the roles of reach distance, object (power drill) weight, gender, discomfort, and muscle activation (anterior deltoid, upper trapezius, biceps, ventral and dorsal forearm) in determining the location of the transition between an arm-only and an arm-and-torso reach (preferred critical boundary) during a seated reach task in which participants had to direct a power drill toward a target. Generalized Estimating Equations (GEE) used extrinsic (independent of the participant) and intrinsic measures (relative to the biodynamic properties of the participant) of reach distance and drill weight, discomfort judgments, and EMG integral recordings for the five muscles to identify factors that best predicted the type of reach used. GEE revealed that intrinsic measures of reach distance and drill weight were superior predictors compared to extrinsic measures. Discomfort judgment and upper trapezius activity were also significant predictors of the location of the preferred critical boundary.