Long-term consequences of pain in human neonates

The low tactile threshold in preterm infants when they are in the neonatal intensive care unit (NICU), while their physiological systems are unstable and immature, potentially renders them more vulnerable to the effects of repeated invasive procedures. There is a small but growing literature on pain and tactile responsivity following procedural pain in the NICU, or early surgery. Long-term effects of repeated pain in the neonatal period on neurodevelopment await further research. However, there are multiple sources of stress in the NICU, which contribute to inducing high overall 'allostatic load', therefore determining specific effects of neonatal pain in human infants is challenging.

Early pain in preterm infants. A model of long-term effects

There are multiple lines of evidence suggesting that in vulnerable prematurely born infants, repeated and prolonged pain exposure may affect the subsequent development of pain systems, as well as potentially contribute to alterations in long-term development and behavior. Multiple factors cumulatively contribute to altered developmental trajectories in such infants. These include characteristics of the developing organism (low tactile threshold, sensitization, rapid brain development), characteristics intrinsic to the infant (gestation, illness severity), characteristics of the experience in the neonatal intensive care unit (pain exposure and cumulative stress), and characteristics of the caregivers within their family and social context. This article provides a model for examining long-term effects of pain in the newborn period embedded in a developmental context framework.

Islands of pain in a sea of change: Behaviour analysis and bereavement,

The paper Bereavement: A behavioural process (Dillenburger & Keenan, 1994) was first published within a vacuum of behaviour analytic thinking or research in this field. The paper was meant to be a first step in stimulating others to contribute to the understanding of one of the most complex, yet most universal, human behavioural processes. The only behaviour analyst addressing the issues directly was Calkin (1990). Recently, after reading our original 1994 paper, Beth Sulzer-Azaroff suggested that we should solicit comments directly from the behaviour analytic community. This we did with the help of Erik Arntzen and now the reprint and the commentaries in this edition of the European Journal of Behaviour Analysis (EJBA) fully embrace and extend the contribution of behaviour analysis to the understanding of the behavioural process that is bereavement.

Randomized controlled trial of interferential therapy and manipulative therapy for acute low back pain.

Study Design. A multi-center assessor-blinded randomized clinical trial was conducted. Objectives. To investigate the relative effectiveness of interferential therapy and manipulative therapy for patients with acute low back pain when used as sole treatments and in combination. Summary of Background Data. Both manipulative therapy and interferential therapy are commonly used treatments for low back pain. Evidence for the effectiveness of manipulative therapy is available only for the short term. There is no evidence for interferential therapy and no study has investigated the effectiveness of interferential therapy combined with manipulative therapy. Methods. Consenting subjects (n=240) were randomly assigned to receive a copy of the Back Book and either manipulative therapy (MT; n=80), interferential therapy (IFT; n=80) or combined manipulative therapy and interferential therapy (CT; n=80). Follow-up outcome questionnaires were posted at discharge, 6 and 12 months. Results. The groups were balanced at baseline for low back pain and demographic characteristics. All interventions were found to significantly reduce functional disability and pain and increase quality of life at discharge and to maintain these improvements at 6 and 12 months. No significant differences were found between groups for reported LBP recurrence, work absenteeism, medication consumption, exercise participation and healthcare use at 12 months. Conclusions. For acute low back pain, interferential therapy whether used in isolation or in combination with manipulative therapy was as effective as manipulative therapy alone (in addition to the Back Book).

A descriptive study of the usage of spinal manipulative therapy techniques within a randomised clinical trial in acute low back pain

The majority of randomized clinical trials (RCTs) of spinal manipulative therapy have not adequately de?ned the terms ‘mobilization’ and ‘manipulation’, nor distinguished between these terms in reporting the trial interventions. The purpose of this study was to describe the spinal manipulative therapy techniques utilized within a RCT of manipulative therapy (MT; n=80), interferential therapy (IFT; n=80), and a combination of both (CT; n=80) for people with acute low back pain (LBP). Spinal manipulative therapy was de?ned as any ‘mobilization’ (low velocity manual force without a thrust) or ‘manipulation’ (high velocity
thrust) techniques of the spine described by Maitland and Cyriax.
The 16 physiotherapists, all members of the Society of Orthopaedic Medicine, utilized three spinal manipulative therapy patterns in the RCT: Maitland Mobilization (40.4%, n=59), Maitland Mobilization/Cyriax Manipulation (40.4%, n=59) and Cyriax Manipulation (19.1%, n=28). There was a signi?cant difference between the MT and CT groups in their usage of spinal manipulative therapy techniques (w2=9.178; df=2;P=0.01); subjects randomized to the CT group received three times more Cyriax Manipulation (29.2%, n=21/72) than those randomized to the MT group (9.5%, n=7/74; df=1; P=0.003).
The use of mobilization techniques within the trial was comparable with their usage by the general population of physiotherapists in Britain and Ireland for LBP management. However, the usage of manipulation techniques was considerably higher than reported in physiotherapy surveys and may re?ect the postgraduate training of trial therapists.

Double-electron above threshold ionization of helium

We present calculations of intense-field multiphoton ionization processes in helium at XUV wavelengths. The calculations are obtained from a full-dimensional integration of the two-electron time-dependent Schrödinger equation. A momentum-space analysis of the ionizing two-electron wavepacket reveals the existence of double-electron above threshold ionization (DATI). In momentum-space two distinct forms of DATI are resolved, namely non-sequential and sequential. In non-sequential DATI correlated electrons resonantly absorb and share energy in integer units of Ïlaser.

Secondary threshold laws for multiple ionization of atoms

We propose a physical mechanism that leads to the emergence of secondary threshold laws in processes of multiple ionization of atoms. We argue that the removal of n electrons (n>2) from a many-electron atom may proceed via intermediate resonant states of the corresponding doubly charged ion. For atoms such as rare gases, the density of such resonances in the vicinity of subsequent ionization thresholds is high. As a result, the appearance energies for multiply charged ions are close to these thresholds, while the effective power indices mu in the near-threshold energy dependence of the cross section, sigmaproportional toE(mu), are lower compared to those from the Wannier theory. This provides a possible explanation of the recent experimental results of B. Gstir [Nucl. Instrum. Methods Phys. Res. B 205, 413 (2003)].

Electron-impact ionization of atomic hydrogen close to threshold

A systematic study of the ionization of atomic hydrogen by electron impact from 0.3 eV to a few eV above the ionization threshold has been carried out using a semiclassical-quantal calculation. Differential and integrated cross sections are presented at 0.3 eV above the energy threshold. Triple- differential cross sections (TDCS) are presented at constant theta(12) geometry where theta(12)=180degrees and 150degrees. Good agreement is achieved with the measurement [Roder, Phys. Rev. Lett. 79, 1666 (1997)] and calculations based on exterior complex scaling at 2 eV and 4 eV above threshold. Results of triple-differential cross sections are also presented at 0.3, 0.5, and 1.0 eV above threshold at both theta(12)=180degrees and 150degrees. At theta(12)=180degrees the small local maximum in the TDCS around theta(1)=90degrees reported by Pan and Starace [Phys. Rev. A 45, 4588 (1992)] at 0.5 eV above threshold is not observed in our calculation at energies down to 0.3 eV above threshold. The shape of our double differential cross sections seems to disagree qualitatively with the available calculations as we found two local maxima around 15degrees and 165degrees in our calculation. Single differential cross sections in our formulation appear naturally as a function of total excess energy E and, therefore, constant for all combinations of individual electron energies E-1 and E- 2 with E=E-1+E-2. Total ionization cross sections are also compared with measurement and available theoretical calculations and found to be in reasonably good agreement up to 10 eV above ionization threshold.