Syfte. Studiens syfte var att retrospektivt undersöka vilka kliniska variabler, bedömda under specialistundersökning av orofacial smärta, som kan förutsäga närvaro av en störd central smärtmodulering (DCPM). Material och metod. DC/TMD-data hämtades ur patientjournaler från 86 patienter som undersökts på Orofaciala smärtenheten på Malmö Universitet under perioden september 2012 till och med december 2013. Undersökta variabler omfattade smärtintensitet, smärtutbredning, smärtrelaterad nedsatthet, psykosociala variabler, refererad smärta samt kliniska fynd under somatosensoriska undersökningar. Baserat på denna data delades patienterna upp i en DCPM-grupp och en grupp utan DCPM. Allodyni, hyperalgesi, dysestesi, wind-up, regional/generell smärtutbredning samt eftersensation ansågs vara markörer för DCPM. Icke-parametriska statistiska analyser användes och en sannolikhetsnivå på P<0,05 ansågs vara signifikant. Resultat. Graden av ospecifika fysiska symptom och antalet refererande smärtor var signifikant högre i DCPM-gruppen. Den multivariata logistiska regressionen visade att ospecifika fysiska symptom, stress, smärtduration, smärtintensitet, smärtrelaterad nedsatthet, antalet refererande smärtpunkter, maximal gapning med och utan smärta, ångest samt antalet smärtinducerande käkrörelser var signifikanta marörer för DCPM (LR Chi2 = 26.89, p = 0.003, Pseudo R2 = 0.29). Slutsats. Denna studie indikerar att stress, ångest, smärtduration, smärtintensitet, smärtrelaterad nedsatthet, antalet refererande smärtpunkter, maximal gapning med och utan smärta samt antalet smärtinducerande käkrörelser är associerat med DCPM hos patienter med orofacial smärta. / Objective. To retrospectively investigate clinical variables that can predict the presence of disturbed central pain modulation (DCPM). Material and methods Medical records of 86 patients examined at the Orofacial Pain Unit at Malmö University from September 2012 to December 2013 were examined regarding pain intensity, pain distribution, pain-related disability, psychosocial variables, referred pain as well as somatosensory changes. Based on these variables, the patients were divided into a disturbed central pain modulation (DCPM) group and a non-DCPM group. Allodynia, hyperalgesia, dysesthesia, increased wind-up, regional/general pain distribution and aftersensation were considered as markers for DCPM. Non-parametric statistics were used and a probability level of P<0.05 was considered as significant. Results. The degree of unspecific physical symptoms and the number of sites eliciting pain referral were significantly higher in the DCPM group. In the multivariate regression model, the independent variables physical symptoms, stress, pain duration, characteristic pain intensity, pain-related disability, number of sites with referred pain, maximum mouth opening with and without pain, anxiety, and number of pain eliciting jaw movements significantly predicted DCPM (LR Chi2 = 26.89, p = 0.003, Pseudo R2 = 0.29). Conclusion. This study indicates that stress, anxiety, orofacial pain and its consequences, unspecific physical symptoms and jaw dysfunction are clinical signs of DCPM in patients with orofacial pain. Also, high number of palpations sites with referred pain over the masseter and temporal muscles and the TMJ indicate presence of DCPM.

Objectives: To explore the pain mechanism and the origin of the pain and to evaluate a short-term pain relief treatment in women suffering from CPP persisting after childbirth in order to enable physiotherapeutic intervention. Material and methods: Thirty-six parous women with chronic pelvic pain persisting after childbirth were recruited at the Department of Physiotherapy, SundsvallHospital and by advertisements in newspapers and 29 parous women without chronic pelvic pain were recruited from an organized gynaecological screening at a midwifery surgery. All women were provoked by intra-pelvic palpation of 13 predetermined intra-pelvic landmarks. The provoked pain distribution was expressed in pain drawings and the pain intensity verbally on a Likert scale.Also, in a randomised controlled trial the 36 women with chronic pelvic pain were allocated to bilateral injection treatment with either triamcinolone or saline solutions, given once on the ischial spine with follow-up after four weeks. Results: Referred pain provoked on intra-pelvic landmarks follows a specific pattern. In general, pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions. In women with chronic pelvic pain the provoked pain distribution area and pain intensity were magnified as compared to women without chronic pelvic pain. In the clinical trial decreased pain intensity, decreased distribution of pain and improved physical function was achieved among the triamcinolone treatment group as compared to the saline treatment group. Also, a positive correlation was shown between reduced pain intensity and improved function. Conclusions: Referred pain patterns provoked on intra-pelvic landmarks in women with chronic pelvic pain persisting after childbirth are consistent with sclerotomal sensory innervations and indicates allodynia and central sensitisation. This suggests that pain mapping can be used to evaluate and confirm the pain experience and contribute to diagnosis. Also, the pain intensity provoked by stimulation of the intra-pelvic landmarks is suggested to be useful to differentiate women with chronic pelvic pain from those without. Corticosteroid treatment to the ischial spine resulted in decreased pain and increased function.

En réponse à une stimulation sonore, la cellule ciliée interne libère du glutamate qui va activer des récepteurs distribués sur le bouton post-synaptique. Les courants post-synaptiques vont ensuite dépolariser la terminaison périphérique des neurones auditifs primaires, et initier le déclenchement d'un potentiel d'action. Tandis que la connaissance des mécanismes pré-synaptiques a considérablement progressé ces 10 dernières années, les mécanismes responsables de l'initiation des potentiels d'action sont encore méconnus. Dans cette étude, nous avons déterminé les conductances ioniques nécessaires au déclenchement des potentiels d'action.Les paramètres biophysiques des conductances (Na+ et K+) ont été identifiés (algorithme d'identification trace entière) à partir d'enregistrements de patch clamp acquis sur les corps cellulaires. Un modèle mathématique de nœud de Ranvier a ensuite été développé en faisant l'hypothèse que les canaux présents sur le corps cellulaire et sur un nœud de Ranvier étaient de même nature mais en densité différente. Les paramètres de ce modèle ont été identifiés pour reproduire les potentiels d'action extracellulaire au moyen d'un algorithme de descente du gradient.Nous avons identifié : i) un courant Na+ entrant rapide (GNa activation: V1/2=-33 mV, tau_act< 0.5 ms; inactivation: V1/2=-61 mV, tau_inact < 2 ms) et deux courants K+ sortants, un rectifiant retardé activé à haut seuil (GKH, activation: V1/2=-41 mV; tau_act < 2.5 ms) et un activé à bas seuil (GKL, activation: V1/2=-56 mV; tau_act < 5 ms). Le modèle de nœud de Ranvier génère des potentiels d'action extracellulaire similaires à ceux enregistrés in vivo. La différence de durée du potentiel d'action observée le long de l'axe tonotopique (i.e. 450 µs de durée pic à pic à 1 kHz contre 250 µs à 20 kHz) s'explique parfaitement par un gradient de densité en canaux ioniques le long de la cochlée (GNa ~78 nS, GKL ~9 nS, GKH ~3 nS à 1 kHz contre GNa ~90 nS, GKL ~12 nS, GKH ~6 nS à 20 kHz).Cette étude a permis d'identifier les conductances ioniques et les densités de canaux responsables de l'initiation des potentiels d'action dans les neurones auditifs primaires. Elle suggère que la coopération entre le courant Na+ et des 2 courants K+ est probablement à l'origine de la haute fréquence de décharge de ces neurones. Le modèle de nœud de Ranvier permet en outre de tester de nouvelles stratégies de stimulation électrique dans le contexte de l'implant cochléaire. / In response to sound stimulation, inner hair cell triggers glutamate release onto the dendrite-like processes of primary auditory neurons and drives action potentials, which are convey to the central nervous system. Whereas knowledge of the transfer function at the ribbon synapse has considerably progress, little is known about the voltage-gated ionic channels which shape the action potential. Here, we provide a comprehensive computational model bridging the gap between the voltage-dependent currents measured in vitro on fresh isolated primary auditory neurons and spikes (extracellular action potentials) recorded in vivo from guinea pig auditory nerve fibers.Voltage-dependent currents (Na+ and K+) of SGNs somata patch-clamp recordings were fitted by a Hodgkin-Huxley model with a full trace identification algorithm. Node of Ranvier model was designed from the hypothesis that channel expressed on soma were identical, but differ in density. Simulated spikes were adjusted in order to match in vivo single-unit recordings with gradient-descent algorithm. Computation of the data allows to the identification of: i) one fast inward Na current (GNa activation: V1/2=-33 mV, τact< 0.5 ms; inactivation: V1/2=-61 mV, τinact < 2 ms); and ii) two K conductances, a high voltage-activated delayed-rectifier component (GKH, activation: V1/2=-41 mV; τact < 2.5 ms) and a low voltage-activated component (GKL, activation: V1/2=-56 mV; τact < 5 ms). Node of Ranvier model generate spikes that fit with in vivo recordings. Interestingly, the different spike durations along the tonotopic axis measured in vivo (i.e. 450 µs peak-to-peak duration versus 250 µs for 1 to 20 kHz, respectively) was explain by a gradual change in Na and K channel densities along the cochlea (GNa ~78 nS, GKL ~9 nS, GKH ~3 nS at 1 kHz versus GNa ~90 nS, GKL ~12 nS, GKH ~6 nS at 20 kHz).This study identifies the ionic conductances and densities, which shape the action potential waveform of auditory nerve fibers and suggests that the interplay of fast inward Na+ current and the two K+ enables the auditory nerve fibers to sustain high firing rates. In addition, this node of Ranvier model provides a valuable tool to design new electrical stimulation strategies for cochlear implants.

A maioria dos pacientes que têm dor de origem dentária pulpar ou periapical tem dor referida, e algumas características da dor parecem influenciar este fenômeno. Por meio do preenchimento de fichas clínicas, com informações sobre as características da dor, investigamos, em 60 voluntários, a distribuição topográfica de áreas de dor referida de origem dentária. Por meio de métodos psicofísicos, comparamos a resolução espacial da dor com a resolução espacial de outras modalidades somestésicas (mecânica e térmica). Nossos resultados indicam que a intensidade da dor favorece o fenômeno da dor referida e interfere na sua dispersão topográfica. Dentes algógenos com polpa viva influenciam um maior espalhamento da dor. A organização hodológica do núcleo espinal do trigêmeo e mecanismos fisiológicos de integração neural podem explicar de maneira satisfatória várias características da dor referida. Além disso, observamos que a resolução espacial na localização da dor é maior que a resolução espacial da localização de outros estímulos somestésicos nos elementos dentários. / The majority of patients who suffer from toothache report referred pain to other sites in the head and neck. Thus, the aim of this study was to investigate the clinical and psychophysical characteristics of referred pain in the orofacial region and how factors such as intensity, duration and nature of odontogenic pain might modulate them. We employed psychophysical and clinical methods to correlate pain perception with the anatomy and physiology of the trigeminal system. Sixty patients reporting primary toothache were investigated as to the clinical and psychophysical aspects of their pains symptoms and signals (intensity, duration, location and state of the pulp inflammatory process). Pain intensity and state of irreversible pulp inflammation were found to significantly affect facilitate the incidence of referred pain and its spread across vertical laminations. Considering these results, we proposed a physiological model based on both neuronal integration (spatial and temporal summation) and the topographic organization of the trigeminal system, which is able to explain the observed characteristics of referred dental pain.

A maioria dos pacientes que têm dor de origem dentária pulpar ou periapical tem dor referida, e algumas características da dor parecem influenciar este fenômeno. Por meio do preenchimento de fichas clínicas, com informações sobre as características da dor, investigamos, em 60 voluntários, a distribuição topográfica de áreas de dor referida de origem dentária. Por meio de métodos psicofísicos, comparamos a resolução espacial da dor com a resolução espacial de outras modalidades somestésicas (mecânica e térmica). Nossos resultados indicam que a intensidade da dor favorece o fenômeno da dor referida e interfere na sua dispersão topográfica. Dentes algógenos com polpa viva influenciam um maior espalhamento da dor. A organização hodológica do núcleo espinal do trigêmeo e mecanismos fisiológicos de integração neural podem explicar de maneira satisfatória várias características da dor referida. Além disso, observamos que a resolução espacial na localização da dor é maior que a resolução espacial da localização de outros estímulos somestésicos nos elementos dentários. / The majority of patients who suffer from toothache report referred pain to other sites in the head and neck. Thus, the aim of this study was to investigate the clinical and psychophysical characteristics of referred pain in the orofacial region and how factors such as intensity, duration and nature of odontogenic pain might modulate them. We employed psychophysical and clinical methods to correlate pain perception with the anatomy and physiology of the trigeminal system. Sixty patients reporting primary toothache were investigated as to the clinical and psychophysical aspects of their pains symptoms and signals (intensity, duration, location and state of the pulp inflammatory process). Pain intensity and state of irreversible pulp inflammation were found to significantly affect facilitate the incidence of referred pain and its spread across vertical laminations. Considering these results, we proposed a physiological model based on both neuronal integration (spatial and temporal summation) and the topographic organization of the trigeminal system, which is able to explain the observed characteristics of referred dental pain.

Pain and movement are intimately connected and nearly universal human experiences. However, our understanding of the extent, significance, and mechanisms of pain-movement relationships is limited. While pain is a normal, protective response to injury and potentially harmful stimuli, prolonged or dysfunctional neuromuscular adaptions in response to pain can contribute to a variety of pain conditions. Alternatively, movement (in the form of global physical activity, individual exercise programs, and/or specific motor learning/functional tasks) is often prescribed to help decrease pain and improve function. While attempts have been made to show an effect of movement on pain or to better understand altered movement strategies in response to pain, much of the research has been limited to animal models or to those with specific persistent or chronic pain conditions limiting generalizability and interpretability. Therefore, this research sought to advance current understanding of the relationships between physical activity and normal variability in centrally- and peripherally-mediated pain in healthy adults. Additionally, we sought to characterize changes in reflexive motor responses in the upper extremity to an endogenous, naturally-occurring, long-lasting acute muscle pain. The results of these investigations indicate that greater, self-reported intense (i.e. vigorous) and leisure activity are more strongly associated with decreased pain sensitivity than is pain modulation or measured activity (via accelerometry). Future research is needed to determine directionality of these relationships. Further, reflexive motor responses to endogenous, acute muscle pain in the upper extremity were not significantly altered indicating that changes in pain-related, movement strategies may be more strongly influenced by supraspinal adaptations. These results may have value in improving understanding of pain-related, movement sequelae and directing future research in this area.

Syfte. Att retrospektivt undersöka relationen mellan central sensitisering i det orofacialaområdet och refererad smärta, som kliniskt fynd, samt psykosociala faktorer hos patienter medDC/TMD-muskeldiagnosen myofasciell smärta med refererad smärta (MPR). Studien syftadeäven till att undersöka skillnader gällande psykosociala faktorer mellan patienter somdiagnostiserats med DC/TMD muskeldiagnoserna myofasciell smärta med refererad smärta(MPR), lokal myalgi (LM) och patienter med orofacial smärta eller käkdysfunktion men ejkäkmuskeldiagnos (WMD) som kontrollgrupper.Material och metod. Information från 85 patienters DC/TMD-undersökning utförd påOrofaciala smärtenheten vid Malmö högskola mellan september 2012 till årsslutet 2013insamlades retrospektivt. Undersökta variabler inkluderade smärtintensitet, smärt-relateraddysfunktion, psykosociala faktorer (depression, ångest och stress) samt refererad smärta.Patienterna indelades i grupper baserade på muskeldiagnos enligt DC/TMD samt utbredning avsmärta. Non-parametrisk statistik användes och P < 0,05 betraktades som signifikant.Resultat. Patienter med MPR uppvisade en signifikant korrelation mellan totala antaletrefererade smärtlokalisationer och smärt-relaterad dysfunktion (rs = 0,43, n = 49, p = 0,002),depression (rs = 0,32, n = 49, p = 0,023) och stress (rs = 0,39, n = 49, p = 0,006). Patienter meden generell smärtutbredning uppvisade en signifikant högre grad av stress (p = 0,020) samt flerantal refererade smärtlokalisationer (p = 0,019) jämfört med patienter med lokal och/ellerregional orofacial smärta.Konklusion. Studien indikerar att grad av central sensitisering kan bedömas med hjälp avutbredningen av refererad smärta, undersökt enligt DC/TMD, hos patienter med diagnosenmyofasciell smärta med refererad smärta i det orofaciala området. Studien kunde inte påvisaskillnader gällande psykosociala faktorer mellan de undersökta grupperna. / Objective. The aim of this study was to retrospectively investigate the relation between referredpain, as a clinical finding, and psychosocial factors versus central sensitization in patients withmyofascial pain with referral (MPR) as assessed according to DC/TMD. The study also aimedto investigate differences regarding psychosocial factors between patients demonstratingmyofascial pain with referral (MPR) and patients diagnosed with the DC/TMD muscle diagnoselocal myalgia (LM) as well as OFP/TMD patients without masticatory muscular diagnose(WMD) as control patients.Material and methods. Patients’ medical records of 85 patients examined at the Orofacial PainUnit at Malmö University during September 2012 till the end of 2013 were retrospectivelyexamined for DC/TMD data. Examined variables included pain intensity, pain-related disability,psychosocial factors (depression, anxiety and stress) and referred pain. The patients weredivided into groups based on DC/TMD muscle diagnosis as well as extension of pain. Nonparametricstatistics were used and a probability level of P < 0.05 was considered as significant.Results. Patients with MPR demonstrated significant correlations between the total number ofreferred pain sites and disability score (rs = 0.43, n = 49, p = 0.002), depression (rs = 0.32, n =49, p = 0.023) as well as stress (rs = 0.39, n = 49, p = 0.006). Patients with generalized paindistribution demonstrated a significantly higher degree of stress (p = 0.020) as well as highernumber of referred pain sites (p = 0.019) than patients with local and/or regional orofacial pain.Conclusion. This study indicates that the degree of central sensitization can be estimated bythe extent of referred pain, as assessed according to DC/TMD, in patients with myofascial painwith referred pain in the orofacial region. This study could not detect a difference inpsychosocial factors between the three groups, myofascial pain with referral (MPR), localmyalgia (LM) and no masticatory muscle diagnosis (WMD).

Secularist views are a challenge to the field of religious education. Their worldview and influence in society will be discussed. This study evaluates the theocratic model under the apartheid regime, the co–operative model and the religion policy under the new democratic government. The areas that the researcher investigated in this study are centred on the effectiveness of the mission calling of the School of Tomorrow, Accelerated Christian Education. In order to achieve this outcome, the history of ACE Schools in America and South Africa will be discussed, as well as the role of the school, the parent and the teacher in missio Dei. An analysis and evaluation will be done on Christian educators such as Martin Luther, John Calvin and John Knox, as well as educational deform under Hitler. A study will be done on how Biblical doctrine was formed in children’s lives in the Old and New Testament. / Thesis (M.A. (Missiology))--North-West University, Potchefstroom Campus, 2012.

Secularist views are a challenge to the field of religious education. Their worldview and influence in society will be discussed. This study evaluates the theocratic model under the apartheid regime, the co–operative model and the religion policy under the new democratic government. The areas that the researcher investigated in this study are centred on the effectiveness of the mission calling of the School of Tomorrow, Accelerated Christian Education. In order to achieve this outcome, the history of ACE Schools in America and South Africa will be discussed, as well as the role of the school, the parent and the teacher in missio Dei. An analysis and evaluation will be done on Christian educators such as Martin Luther, John Calvin and John Knox, as well as educational deform under Hitler. A study will be done on how Biblical doctrine was formed in children’s lives in the Old and New Testament. / Thesis (M.A. (Missiology))--North-West University, Potchefstroom Campus, 2012.

The survival rate for a suddent cardiac arrest (SCA) is incredibly low, with less than one in ten surviving; most SCAs occur outside of a hospital setting. There is a need to develop an effective and efficient system that can sense, communicate and remediate potential SCA situations on a near real-time basis. This research presents a novel Zeolite-PDMS-based optically unobtrusive flexible dry electrodes for biosignal acquisition from various subjects while at rest and in motion. Two zeolite crystals (4A and 13X) are used to fabricate the electrodes. Three different sizes and two different filler concentrations are compared to identify the better performing electrode suited for electrocardiogram (ECG) data acquisition. A low-power, low-noise amplifier with chopper modulation is designed and implemented using the standard 180nm CMOS process. A commercial off-the-shelf (COTS) based wireless system is designed for transmitting ECG signals. Further, this dissertation provides a framework for Machine Learning Classification algorithms on large, open-source Arrhythmia and SCA datasets. Supervised models with features as the input data and deep learning models with raw ECG as input are compared using different methods. The machine learning tool classifies the datasets within a few minutes, saving time and effort for the physicians. The experimental results show promising progress towards advancing the development of a wireless ECG recording system combined with efficient machine learning models that can positively impact SCA outcomes.