Effects of visuospatial tasks on desensitization to emotive memories

Objectives. Intrusive memories of extreme trauma can disrupt a stepwise approach to imaginal exposure. Concurrent tasks that load the visuospatial sketchpad (VSSP) of working memory reduce the vividness of recalled images. This study tested whether relief of distress from competing VSSP tasks during imaginal exposure is at the cost of impaired desensitization. Design. This study examined repeated exposure to emotive memories using 18 unselected undergraduates and a within-subjects design with three exposure conditions (Eye Movement, Visual Noise, Exposure Alone) in random, counterbalanced order. Method. At baseline, participants recalled positive and negative experiences, and rated the vividness and emotiveness of each image. A different positive and negative recollection was then used for each condition. Vividness and emotiveness were rated after each of eight exposure trials. At a post-exposure session 1 week later, participants rated each image without any concurrent task. Results. Consistent with previous research, vividness and distress during imaging were lower during Eye Movements than in Exposure Alone, with passive visual interference giving intermediate results. A reduction in emotional responses from Baseline to Post was of similar size for the three conditions. Conclusion. Visuospatial tasks may offer a temporary response aid for imaginal exposure without affecting desensitization.

Paracetamol versus paracetamol-codeine in the treatment of post-operative dental pain: A randomized, double-blind, prospective trial

Background: Codeine is frequently added to paracetamol to treat post-operative dento-alveolar pain; studies have shown effectiveness in relief of post-operative pain at high doses but at the expense of central nervous and gastrointestinal side effects. There has been no trial to compare the efficacy and safety of paracetamol 1000mg with paracetamol 1000mg combined with codeine 30mg. Method. A randomized, single centre, double-blind prospective parallel group trial was performed to compare paracetamol 1000mg with paracetamol 1000mg with codeine 30mg for the relief of pain following surgical removal of impacted third molars, and analysed on an intention-to-treat (ITT) basis. Eighty-two patients were assigned randomly to receive either drug for a maximum of three doses. Patients recorded their pain intensity one hour after surgery and hourly thereafter for 12 hours. Results: The average increase in pain intensity over 12 hours was significantly less in patients receiving paracetamol plus codeine than in those receiving paracetamol alone (p=0.03) -1.81cm/h compared with 0.45cm/h - a difference of 1.13cm/h (95 per cent Cl: 0.18 to 2.08). Of the patients who received the paracetamol codeine combination, 62 per cent used escape medication compared with 75 per cent of those on paracetamol alone (p=0.20). There was no significant difference between the two groups in the proportion of patients experiencing adverse events (P=0.5). Conclusion: A combination of 1000mg paracetamol and 30mg codeine was significantly more effective in controlling pain for 12 hours following third molar removal, with no significant difference of side effects during the 12 hour period studied.

Pamidronate results in symptom control of hypertrophic pulmonary osteoarthropathy in cystic fibrosis

Hypertrophic pulmonary osteoarthropathy (HPOA) may complicate the advanced lung disease that is associated with cystic fibrosis, resulting in severe joint pain and early-morning stiffness. Symptoms are usually controlled with the administration of nonsteroidal anti-inflammatory drugs, physiotherapy, and, on occasions, oral corticosteroids. I This report describes a case of refractory HPOA with complete remission following the administration of IV pamidronate, which is a potent inhibitor of osteoclastic bone resorption. Symptom relief resulted for up to 3 months, but repeated courses of pamidronate have been required to maintain symptom control.

Barriers to effective cancer pain management: A survey of hospitalized cancer patients in Australia

The purpose of this study was to examine attitudinal barriers to effective pain management in a consecutively recruited cohort of 114 cancer patients from four Australian hospitals. When surveyed, 48% of this sample reported experiencing pain within the previous 24 hours. Of these, 56% reported this pain to be distressing, horrible or excruciating, with large proportions indicating that this pain had affected their movement, sleep and emotional well-being. Three factors were identified as potentially impacting on patients responses to pain-poor levels of patient knowledge about pain, low perceived control over pain, and a deficit in communication about pain. A trend for older patients to experience more severe pain was also identified. These older patients reported being more willing to tolerate pain and perceive less control over their pain. Suggestions are made for developing patient education programs and farther research using concepts drawn from broader social and behavioral models. J Pain Symptom Manage 2002:23:393-405. (C) U.S. Cancer Pain Relief Committee, 2002.

Modification of induced ischaemic pain by placebo electrotherapy

Quantifying the analgesic effect of placebo electrotherapy is an important part of understanding the placebo response in physiotherapy. This repeated measures study of induced ischaemic pain compared reports of pain threshold, pain tolerance, and pain endurance under three conditions: control, placebo interferential, and placebo TENS. Both of the placebo conditions significantly delayed the report of pain threshold. Placebo interferential also delayed pain tolerance. Each placebo condition reduced pain intensity in the 6th minute. Only placebo TENS reduced pain at the 9th minute of ischaemic pain. The nature of pain reduction in the placebo conditions suggests that analgesia was due to learned expectancies and endogenous opioid release. Further research into the impact of positive expectancies of pain relief in our patients could clarify the efficacy of physiotherapy outcomes for pain.

Chemotherapy and radiotherapy: When to call it quits

Abstract: Background: Patients diagnosed with cancer are often treated with chemotherapy and radiotherapy with curative intent. The transition from curative to palliative intent involves re-evaluation of treatment, and has to take into account the attitudes, beliefs and life aims of the patient. Objective: To discuss the difficulties in determining when to cease chemotherapy and radiotherapy in patients with advanced cancer. Discussion: The concept of treatment evaluation using a ‘burden versus benefit’ paradigm is discussed. Treatment aims must be in concordance with those of the patient, which are often couched in functional terms or linked to future significant life events. Chemotherapy and radiotherapy can offer patients in the palliative phase of cancer illness, benefits in terms of relief of symptoms and meaningful prolongation of life, and should be considered in appropriate circumstances. (author abstract)

How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Lateral epicondylalgia: a musculoskeletal physiotherapy perspective

Tennis elbow or lateral epicondylalgia (LE) is a challenging musculoskeletal condition to treat. This is largely due to the lack of research-based evidence of the clinical efficacy of the myriad of treatment approaches espoused in the literature. In view of this, successful rehabilitation of LE is based on choosing treatments that address the physical impairments found during clinical examination. The primary physical impairment in LE is a deficit in grip strength predominately due to pain and its consequences on motor function. Hence the mainstay of successful management of this condition is therapeutic exercise, providing it is not pain provocative. Adjunctive procedures such as manipulative therapy and sports taping techniques have recently been shown to provide substantial initial pain relief. Early relief of pain in the rehabilitation program helps accelerate recovery and most importantly motivates the client to persist with the therapeutic exercise program. The manipulative therapy and taping treatments presented in this masterclass warrant consideration in the clinical best practice management of LE, and serve as a model for other similar musculoskeletal conditions. (C) 2003 Elsevier Science Ltd. All rights reserved.

Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance

Previous studies have demonstrated that the initial hypoalgesic effect of spinal manipulative therapy was not antagonized by naloxone and did not exhibit tolerance with repeated applications. The implication is that endogenous opioid mechanisms of pain relief are probably not at play in spinal manipulative therapy. The role of endogenous opioid peptides in manipulation of the peripheral joints has not been investigated. The aim of this study was to evaluate whether the initial hypoalgesic effect of a peripheral manipulative technique (mobilization-with-movement treatment for the elbow) demonstrated a tolerance to repeated applications (ie, reduction in magnitude of effect over repeated applications). Twenty-four participants with unilateral chronic lateral epicondylalgia participated in the study. A repeated measures study was conducted to examine the effect of repeated applications of the mobilization-with-movement treatment for the elbow on 6 separate treatment occasions at least 2 days apart. Pain-free grip strength and pressure pain threshold were chosen as the pain-related outcome measures. Changes in the percent maximum possible effect scores of measures of hypoalgesia were evaluated across the 6 treatment sessions by using linear trend analysis. The results showed no significant difference for the hypoalgesic effect of the treatment technique between sessions (P >.05). This peripheral manipulative therapy treatment technique appeared to have a similar effect profile to previously studied spinal manipulative therapy techniques, thereby contributing to the body of knowledge that indicates that manipulative therapy most likely induces a predominant non-opioid form of analgesia.

Cervicogenic headache: Locus of control and success of treatment

Background.-A number of extraneous factors have been implicated in the effectiveness of treatment of headache, including patient beliefs about aspects of the treatment or persons delivering the treatment. Objective.-The concept of external locus of control for headaches refers to patients with a high level of belief that headache and relief are influenced primarily by health care professionals. The aim of this study was to examine whether external locus of control is associated with a reduction in frequency of cervicogenic headaches among patients treated by a physiotherapist. Design.-A recent randomized controlled trial of the effectiveness of physiotherapy among 200 patients with headache enabled a test of this relationship. Treatment consisted of manipulative therapy, therapeutic exercise, or a combination of the 2. Analysis of relative change in headache frequency was conducted after 6 weeks of treatment and at 3- and 12-month follow-up appointments. Results.-Results of the analysis indicated that participants with relatively high external Headache-Specific Locus of Control scores were more likely to achieve a reduction in headache frequency if they received the combined manipulative therapy and exercise therapy, compared with those who received no treatment. This was not determined for the group who received manipulative therapy, which is a treatment received passively by the patient. Conclusions.-The interpretation of these findings is considered in the context of nongeneralization to the other physiotherapy treatment groups and sustained reduction in headache frequency following withdrawal of treatment. The pattern of findings suggests that characteristics of the therapy were more pertinent than characteristics of the therapist.

Improving the ionic conductivity of yttria-stabilised zirconia electrolyte materials

Low-temperature anneals (1200 degreesC for 40 h) of 8 mol% yttria-stabilised zirconia, prior to the samples being sintered at 1500 degreesC, had the effect of improving the ionic conductivity of the specimens. The presence Of SiO2 in the specimens was shown to be detrimental, however. Irrespective of the SiO2 content, this type of heat treatment also leads to improvements in conductivity. Extensive microstructural analysis provided indication of the mechanism of this phenomenon. This included selective formation of zircon, relief of sintering strain leading to the formation of coherent grain boundaries and segregation effects. (C) 2002 Elsevier Science B.V All rights reserved.

For Your Freedom and Ours: The Polish Question in Wilson's Peace Initiatives, 1916 - 1917

The first eighteen months of the Great War witnessed an unprecedented awakening of interest in the Polish Question, when worldwide attention was drawn to the prolonged devastation of the Polish territories. Thereafter, a steady increase in media comment and criticism, highlighting Poland's plight, fostered public indignation at the continual stalling of humanitarian relief efforts for Polish refugees. Such burgeoning popular sentiment focused wider political attention upon a growing movement for recognition of Polish claims to independence. This particularly proved to be the case for Woodrow Wilson and his administration's budding interest in Poland. Subsequently, nowhere did the Polish Question assume a greater role in diplomatic efforts to mediate for peace than in America, and at no time more than during the year preceding the President's hesitant decision to intervene in hostilities.

Does participation in a pain course based on the international association for the study of pain's curricula guidelines change student knowledge about pain?

The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the "People in Pain" course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement. OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students' knowledge about pain. METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R-PKAQ) pre- and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study. RESULTS: Examination of the correlation matrix indicated substantial correlations between all R-PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students' knowledge on five of the six subscales of the R-PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive-behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance. CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.

Campo térmico e higrométrico da Regional Praia do Canto no município de Vitória (ES)

Nesta pesquisa foi analisado o comportamento térmico e higrométrico em diferentes locais da Regional Praia do Canto no município de Vitória (ES) tanto no período chuvoso quanto no seco por meio da técnica de transecto móvel. A análise confirmou que as mudanças de uso e cobertura da terra associado com as características do relevo influenciam diretamente as variáveis meteorológicas, neste caso a temperatura do ar e umidade relativa do ar. A análise das condições médias de temperatura do ar e umidade relativa do ar permitiu observar dois núcleos aquecidos um ao norte e outro ao sul na área em estudo. Às 15h, tanto no verão como no inverno, a temperatura do ar atingiu o valor máximo e as taxas de umidade relativa, o seu valor mínimo. No verão e inverno, as áreas mais aquecidas ficaram bem definidas, áreas correspondentes aos núcleos aquecidos. As maiores influências do tecido urbano nas variáveis meteorológicas foram verificadas sob atuação da Alta Subtropical do Atlântico Sul. A maritimidade têm um peso importante no comportamento topoclimático urbano, sobre tudo na parte da manhã e da tarde. Na porção centro-leste da área em estudo observou-se até 3ºC a menos nos períodos vespertinos em relação aos pontos localizados na porção norte e sul. Os pontos à centroleste sofrem influência direta dos efeitos da maritimidade e dos arranjos dos prédios que formam sombreamento (Cânions Urbanos), fato que dificulta a formação de núcleos aquecidos durante o dia sobre esta porção. Foram observadas nos dois períodos, tanto no período chuvoso (verão) como também, no período seco (inverno), elevado gradiente térmico, estes localizadas onde há intenso fluxo de veículos, e também nas áreas de construção mais verticalizadas. A intensidade do gradiente térmico é maior sobre a atuação da Alta Subtropical do Atlântico Sul. Às 09 horas, são registrados os maiores gradientes térmicos para os dois períodos analisados. A umidade relativa do ar mantevese elevada durante os dois campos, tanto no verão quanto inverno. Os menores valores de umidade foram registrados em pontos que compõem o núcleo aquecido verificado na parte norte da área em estudo. Em virtude do comportamento das variáveis observadas foram identificadas três unidades Topoclimáticas Urbanas na Regional Praia do Canto.

Estudo da camada limite atmosférica em regiões metropolitanas costeiras com simulações de brisa marítima

O principal objetivo deste trabalho foi identificar e caracterizar a evolução diária da Camada Limite Atmosférica (CLA) na Região da Grande Vitória (RGV), Estado do Espírito Santo, Brasil e na Região de Dunkerque (RD), Departamento Nord Pas-de-Calais, França, avaliando a acurácia de parametrizações usadas no modelo meteorológico Weather Research and Forecasting (WRF) em detectar a formação e atributos da Camada Limite Interna (CLI) que é formada pelas brisas marítimas. A RGV tem relevo complexo, em uma região costeira de topografia acidentada e uma cadeia de montanhas paralela à costa. A RD tem relevo simples, em uma região costeira com pequenas ondulações que não chegam a ultrapassar 150 metros, ao longo do domínio de estudos. Para avaliar os resultados dos prognósticos feitos pelo modelo, foram utilizados os resultados de duas campanhas: uma realizada na cidade de Dunkerque, no norte da França, em Julho de 2009, utilizando um sistema light detection and ranging (LIDAR), um sonic detection and ranging (SODAR) e dados de uma estação meteorológica de superfície (EMS); outra realizada na cidade de Vitória – Espírito Santo, no mês de julho de 2012, também usando um LIDAR, um SODAR e dados de uma EMS. Foram realizadas simulações usando três esquemas de parametrizações para a CLA, dois de fechamento não local, Yonsei University (YSU) e Asymmetric Convective Model 2 (ACM2) e um de fechamento local, Mellor Yamada Janjic (MYJ) e dois esquemas de camada superficial do solo (CLS), Rapid Update Cycle (RUC) e Noah. Tanto para a RGV quanto para a RD, foram feitas simulações com as seis possíveis combinações das três parametrizações de CLA e as duas de CLS, para os períodos em que foram feitas as campanhas, usando quatro domínios aninhados, sendo os três maiores quadrados com dimensões laterais de 1863 km, 891 km e 297 km, grades de 27 km, 9 km e 3 km, respectivamente, e o domínio de estudo, com dimensões de 81 km na direção Norte-Sul e 63 km na Leste-Oeste, grade de 1 km, com 55 níveis verticais, até um máximo de, aproximadamente, 13.400 m, mais concentrados próximos ao solo. Os resultados deste trabalho mostraram que: a) dependendo da configuração adotada, o esforço computacional pode aumentar demasiadamente, sem que ocorra um grande aumento na acurácia dos resultados; b) para a RD, a simulação usando o conjunto de parametrizações MYJ para a CLA com a parametrização Noah produziu a melhor estimativa captando os fenômenos da CLI. As simulações usando as parametrizações ACM2 e YSU inferiram a entrada da brisa com atraso de até três horas; c) para a RGV, a simulação que usou as parametrizações YSU para a CLA em conjunto com a parametrização Noah para CLS foi a que conseguiu fazer melhores inferências sobre a CLI. Esses resultados sugerem a necessidade de avaliações prévias do esforço computacional necessário para determinadas configurações, e sobre a acurácia de conjuntos de parametrizações específicos para cada região pesquisada. As diferenças estão associadas com a capacidade das diferentes parametrizações em captar as informações superficiais provenientes das informações globais, essenciais para determinar a intensidade de mistura turbulenta vertical e temperatura superficial do solo, sugerindo que uma melhor representação do uso de solo é fundamental para melhorar as estimativas sobre a CLI e demais parâmetros usados por modelos de dispersão de poluentes atmosféricos.