Informed consent for epidural analgesia in labour

Consent for epidural analgesia for labour is unique. The issues of patient autonomy and competence are controversial because of the limited antenatal education that most South African patients receive, and the absence of a culture of structured birth planning. Frequently, such patients are first encountered by the anaesthetist when in advanced labour and limited time is available for explanation. Overall, this represents the most extreme example of obtaining consent in compromised circumstances

The use of ultrasound-guided transversus abdominis plane blocks for total abdominal hysterectomy: A double-blind, controlled trial

Objectives: This study investigated the postoperative analgesic efficacy of bilateral ultrasound-guided transversus abdominis plane (TAP) blocks, in patients undergoing total abdominal hysterectomy.Design, setting and subjects: This was a prospective, randomised, double-blind, controlled study. Thirty patients were allocated to two groups; a TAP block group (n = 15) and a placebo group (n = 15). The TAP blocks were performed with 0.25% bupivacaine. The placebo group received sham blocks with normal saline, post induction of anaesthesia. Postoperatively,patients received patient-controlled intravenous morphine for analgesia.Outcome measures: The primary outcome was morphine consumption during the first 24 hours postoperatively. Secondary outcomes were  adequacy of pain relief, as assessed by pain scores at 0, 6 and 24 hours postoperatively, and side-effects.Results: Our study showed a significant between-group difference in morphine requirements (5.2 ± 3.9 vs. 9.7 ± 4.3 mg, p = 0.007, and 12.9 ± 8.9 mg vs. 25 ± 12.1 mg, p = 0.006) for the TAP group, compared with the placebo group at six and 24 hours, respectively. There were no significant between-group differences in pain scores. There were no complicationswith any of the blocks.Conclusion: Bilateral ultrasound-guided TAP blocks significantly reduced postoperative morphine consumption in a multimodal postoperative analgesia regimen for abdominal hysterectomy

Species Richness and Host Associations of Lepidoptera-Attacking Tachinidae in the Northeast Ecuadorian Andes

Most of the unknown biological diversity of macro-organisms remaining to be discovered and described lies in the tropical regions of the world and consists primarily of insects. Those insects with parasitoid lifestyles constitute a significant portion of insect diversity, yet parasitoids are among the most poorly known of major insect guilds in the humid tropics. Here we describe and analyze the richness of one diverse taxon of parasitoids, flies in the family Tachinidae, reared from Lepidoptera as part of a biological survey of Lepidoptera and their parasitoids in one mid-elevation (2000 m) area in the northeast Ecuadorian Andes. One hundred fifty-seven separable tachinid “morpho-species” were reared from approximately 160 species of Lepidoptera in 16 families. These tachinid flies were recovered from a sample of over 12,800 successful caterpillar rearing events that resulted in either adult Lepidoptera or parasitoids. Tachinid species accumulation and rarefaction curves exhibit no sign of reaching an asymptote and richness estimators indicate that the community likely consists of nearly twice this number of species (at minimum). Most tachinid species were reared infrequently, with 50% being represented by a single individual. The majority of species appeared to be relatively specialized on one or a few related hosts, but sampling was insufficient to make strong inferences regarding host range. The tribes Blondeliini and Goniini were the best represented, but some tribes that were expected to be common such as Tachinini and Winthemiini were poorly represented. The estimates of tachinid species richness derived here are suggestive of a far more diverse tachinid community than in temperate localities in North America. Additional rearing of Lepidoptera, as well as other herbivorous insect taxa, along with the use of additional collecting methods will be necessary to achieve a more accurate understanding of the richness of tropical Tachinidae and their contribution to broader patterns of tropical biodiversity

Effectiveness of the coping power program in a Mexican-American sample: distinctive cultural considerations

This study responds to the challenges associated with delivering culturally sensitive and evidence-based treatment (EBT) to at-risk children. Current research supports group interventions based on the Coping Power Program (CPP) curriculum as EBT for improving the frequency of positive behaviors in children and adolescents. However, the effectiveness of the CPP in a Mexican-American sample has not been explored to date. This study investigated the effectiveness of the CPP delivered as a preventative intervention to Mexican-American adoles- cents in a rural school setting. A major emphasis is put on cultural sensitivity when working with this population. Cultural sensitivity is expressed by minor adaptations of the CPP. The adaptations consisted of modifying treatment content, providing culturally relevant examples, contextualizing content and so forth, while maintaining program value. Our hypothesis was that when using the adapted EBT curriculum on the Mexican-American subsample, both groups would have similar scores and retention rates. As hypothesized, no significant differences were found between the two treatment groups (non-adapted EBT European-American and adapted EBT Mexican-American). Overall, the results suggest that EBT interventions for at-risk Mexican-American youth might require cultural adaptation in order to maximize its effectiveness

The Arp2/3 complex, UNC-115/abLIM, and UNC-34/Enabled regulate axon guidance and growth cone filopodia formation in Caenorhabditis elegans

<p>Abstract</p> <p>Background</p> <p>While many molecules involved in axon guidance have been identified, the cellular and molecular mechanisms by which these molecules regulate growth cone morphology during axon outgrowth remain to be elucidated. The actin cytoskeleton of the growth cone underlies the formation of lamellipodia and filopodia that control growth cone outgrowth and guidance. The role of the Arp2/3 complex in growth cone filopodia formation has been controversial, and other mechanisms of growth cone filopodia formation remain to be described.</p> <p>Results</p> <p>Here we show that mutations in genes encoding the Arp2/3 complex (<it>arx </it>genes) caused defects in axon guidance. Analysis of developing growth cones <it>in vivo </it>showed that <it>arx </it>mutants displayed defects in filopodia and reduced growth cone size. Time-lapse analysis of growth cones in living animals indicated that <it>arx </it>mutants affected the rate of growth cone filopodia formation but not filopodia stability or length. Two other actin modulatory proteins, UNC-115/abLIM and UNC-34/Enabled, that had been shown previously to affect axon guidance had overlapping roles with Arp2/3 in axon guidance and also affected the rate of filopodia initiation but not stability or length.</p> <p>Conclusion</p> <p>Our results indicate that the Arp2/3 complex is required cell-autonomously for axon guidance and growth cone filopodia initiation. Furthermore, they show that two other actin-binding proteins, UNC-115/abLIM and UNC-34/Enabled, also control growth cone filopodia formation, possibly in parallel to Arp2/3. These studies indicate that, <it>in vivo</it>, multiple actin modulatory pathways including the Arp2/3 complex contribute to growth cone filopodia formation during growth cone outgrowth.</p

Two-divisibility of the coefficients of certain weakly holomorphic modular forms

We study a canonical basis for spaces of weakly holomorphic modular forms of weights 12, 16, 18, 20, 22, and 26 on the full modular group. We prove a relation between the Fourier coefficients of modular forms in this canonical basis and a generalized Ramanujan tau-function, and use this to prove that these Fourier coefficients are often highly divisible by 2.Comment: Corrected typos. To appear in the Ramanujan Journa

Multi-Modal Courtship in the Peacock Spider, Maratus volans (O.P.-Cambridge, 1874)

The peacock spider, Maratus volans, has one of the most elaborate courtship displays in arthropods. Using regular and high-speed video segments captured in the lab, we provide detailed descriptions of complete male courtship dances. As research on jumping spiders has demonstrated that males of some species produce vibrations concurrently with visual displays, we also used laser vibrometry to uncover such elements for this species. Our recordings reveal and describe for the first time, that M. volans males use vibratory signals in addition to complex body ornaments and motion displays. The peacock spider and other closely related species are outstanding study organisms for testing hypotheses about the evolution and functional significance of complex displays, thus, this descriptive study establishes a new model system for behavioral ecology, one that certainly stands to make important contributions to the field

Vehicle Systems Panel deliberations

The Vehicle Systems Panel addressed materials and structures technology issues related to launch and space vehicle systems not directly associated with the propulsion or entry systems. The Vehicle Systems Panel was comprised of two subpanels - Expendable Launch Vehicles & Cryotanks (ELVC) and Reusable Vehicles (RV). Tom Bales, LaRC, and Tom Modlin, JSC, chaired the expendable and reusable vehicles subpanels, respectively, and co-chaired the Vehicle Systems Panel. The following four papers are discussed in this section: (1) Net Section components for Weldalite Cryogenic Tanks, by Don Bolstad; (2) Build-up Structures for Cryogenic Tanks and Dry Bay Structural Applications, by Barry Lisagor; (3) Composite Materials Program, by Robert Van Siclen; (4) Shuttle Technology (and M&S Lessons Learned), by Stan Greenberg

Telepsychiatric assessment of a mariner expressing suicidal ideation.

This case report highlights the successful use of telepsychiatric consultation by secure video chat to remotely assess a mariner expressing suicidal ideation. As a result of this intervention, telemedicine providers initiated psychiatric stabilisation while the mariner was still aboard the vessel, determined that he was safe for repatriation under the care of qualified medical escorts, and facilitated admission to a psychiatric facility near his home in the United States. Mental health emergencies are a significant cause of morbidity and mortality among mariners. Telepsychiatry is a validated method of establishing a psychiatric diagnosis and disposition as well as assessing risk of suicidality and the potential for violent decompensation. It has the potential to be a valuable adjunct to any traditional maritime telemedicine service