BACKGROUND: This double-blind, randomized trial compared dural puncture epidural analgesia (DPEA) for labor using 25-gauge and 27-gauge pencil point spinal needles. We hypothesized that both needle sizes would result in similar onset time (equivalence margin=2.5 min) and therefore designed the study as an equivalence trial. METHODS: One hundred and forty patients undergoing labor were randomized to DPEA with 25-gauge (n=70) or 27-gauge (n=70) pencil point spinal needles. After the placement of the epidural catheter, a bolus of 20 mL of bupivacaine 0.125% and fentanyl 2 µg/mL was administered to all subjects. Thereafter, patients received boluses of 12 mL of bupivacaine 0.125% every 2 hours as needed.A blinded investigator recorded the onset time (defined as the temporal interval required to achieve a pain score ≤1 on a 0-10 scale), S2 block, sensory block height (30 min after the initial bolus of local anesthetic), presence of motor block (30 min after the initial bolus of local anesthetic), number of top-up doses required during labor and incidence of postural headache. RESULTS: Out of the 140 recruited patients, 135 were retained for analysis. Compared with their 27-gauge counterparts, 25-gauge pencil point spinal needles provided a 1.6 min shorter DPEA onset (95% CI of the difference of the means: -3.2 to -0.1 min). However, there were no intergroup differences in terms of S2 block, sensory block height, motor block, number of top-up doses and incidence of postural headache. CONCLUSION: Dural puncture epidural analgesia with 25-gauge pencil point spinal needles provides a 1.6 min shorter onset time than DPEA with 27-gauge spinal needles. Although statistically significant, such a difference may not be clinically relevant. Further investigation is required to compare 25-gauge and 27-gauge spinal needles for DPEA in the setting of different local anesthetic infusion strategies. TRIAL REGISTRATION NUMBER: NCT03389945.
When people see a life-sized virtual body (VB) from first person perspective in virtual reality they are likely to have the perceptual illusion that it is their body. Additionally such virtual embodiment can lead to changes in perception, implicit attitudes and behaviour based on attributes of the VB. To date the changes that have been studied are as a result of being embodied in a body representative of particular social groups (e.g., children and other race). In our experiment participants alternately switched between a VB closely resembling themselves where they described a personal problem, and a VB representing Dr Sigmund Freud, from which they offered themselves counselling. Here we show that when the counsellor resembles Freud participants improve their mood, compared to the counsellor being a self-representation. The improvement was greater when the Freud VB moved synchronously with the participant, compared to asynchronously. Synchronous VB movement was associated with a much stronger illusion of ownership over the Freud body. This suggests that this form of embodied perspective taking can lead to sufficient detachment from habitual ways of thinking about personal problems, so as to improve the outcome, and demonstrates the power of virtual body ownership to effect cognitive changes.
Counseling , Freudian Theory , Self Psychology , Female , Humans , Male
We introduce a new method, based on immersive virtual reality (IVR), to give people the illusion of having traveled backwards through time to relive a sequence of events in which they can intervene and change history. The participant had played an important part in events with a tragic outcome-deaths of strangers-by having to choose between saving 5 people or 1. We consider whether the ability to go back through time, and intervene, to possibly avoid all deaths, has an impact on how the participant views such moral dilemmas, and also whether this experience leads to a re-evaluation of past unfortunate events in their own lives. We carried out an exploratory study where in the "Time Travel" condition 16 participants relived these events three times, seeing incarnations of their past selves carrying out the actions that they had previously carried out. In a "Repetition" condition another 16 participants replayed the same situation three times, without any notion of time travel. Our results suggest that those in the Time Travel condition did achieve an illusion of "time travel" provided that they also experienced an illusion of presence in the virtual environment, body ownership, and agency over the virtual body that substituted their own. Time travel produced an increase in guilt feelings about the events that had occurred, and an increase in support of utilitarian behavior as the solution to the moral dilemma. Time travel also produced an increase in implicit morality as judged by an implicit association test. The time travel illusion was associated with a reduction of regret associated with bad decisions in their own lives. The results show that when participants have a third action that they can take to solve the moral dilemma (that does not immediately involve choosing between the 1 and the 5) then they tend to take this option, even though it is useless in solving the dilemma, and actually results in the deaths of a greater number.
Chronic unipolar depression is being increasingly recognized in general psychiatry as a particularly severe form of depressive illness that leads to significant symptomatology, prolonged suffering, and prolonged functional impairment in a variety of domains, including educational/vocational dysfunction as well as interpersonal impairment. Recent research on treatment interventions for adult patients with chronic depressions suggests that standard treatments for depressive illness may need modification to benefit patients with chronic illness. Little attention at this point has been given to the problem of chronic depression in children and adolescents. Many adults with chronic depressive disorders had onset of depression in their childhood or adolescence, making early identification of this form of illness a priority. The authors present a comprehensive review of emerging literature in the assessment, clinical course, and treatment of chronic forms of unipolar depression in youth. They then develop summary recommendations for the assessment and treatment of this type of mood disorder in youth, based on the currently available research and common sense clinical experience.
Adoption/legislation & jurisprudence , Child Abuse/legislation & jurisprudence , Child Welfare/legislation & jurisprudence , Parent-Child Relations , Social Justice , Child , Child Abuse/classification , Child Abuse/prevention & control , Female , Humans , Male , Mandatory Reporting , Safety/legislation & jurisprudence , United States
Se efectuó examen serológico mediante RHAI y RIFI para Enfermedad de Chagas a 35 pacientes hemofílicos bajo control en el Banco de Sangre del Hospital Barros Luco Trudeau, de Santiago, comparando los resultados con los obtenidos con igual estudio en 748 donantes de sangre del mismo banco. Entre los hemofílicos la frecuencia de seropositivos fue de 45,7% (16 casos), mientras que en los donantes sólo hubo 1,9% de positivos (14 casos). De los 16 hemofílicos seropositivos 12 (75%) habían recibido más de 1.000 unidades transfusionales. La correlación de los resultados serológicos positivos a T. cruzi entre los hemofílicos y los donantes permite establecer con coeficiente de riesgo relativo estimado (RRE) de infección chagásica transfusional de 44,15 veces mayor en los hemofílicos que entre personas no transfundidas. Tanto la cifra general de infección chagásica en hemofílicos como el RRE de infección por Enfermedad de Chagas en estos pacientes es mayor que en otros estudios similares efectuados en el país
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Chagas Disease/transmission , Hemophilia A/complications , Blood Transfusion/adverse effects , Chagas Disease/diagnosis , Serologic Tests
