A randomised non-inferiority controlled trial of a single versus a four intradermal sterile water injection technique for relief of continuous lower back pain during labour

Background: Almost one third of women suffer continuous lower back pain during labour. Evidence from three systematic reviews demonstrates that sterile water injections (SWI) provide statistically and clinically significant pain relief in women experiencing continuous lower back pain during labour. The most effective technique to administer SWI is yet to be determined. Therefore, the aim of this study is to determine if the single injection SWI technique is no less effective than the routinely used four injection SWI method in reducing continuous lower back pain during labour.Methods/design: The trial protocol was developed in consultation with an interdisciplinary team of clinical researchers. We aim to recruit 319 women presenting at term, seeking analgesia for continuous severe lower back pain during labour. Participants will be recruited from two major maternity hospitals in Australia. Randomised participants are allocated to receive a four or single intradermal needle SWI technique. The primary outcome is the change in self-reported pain measured by visual analogue scale at baseline and thirty minutes post intervention. Secondary outcomes include VAS change scores at 10, 60, 90 and 120 min, analgesia use, mode of birth and maternal satisfaction.Statistical analysis: Sample size was calculated to achieve 90% power at an alpha of 0.025 to detect a non-inferiority margin of ≤ 1 cm on the VAS, using a one-sided, two-sample t-test. Baseline demographic and clinical characteristics will be analysed for comparability between groups. Differences in primary (VAS pain score) and secondary outcomes between groups will be analysed by intention to treat and per protocol analysis using Student's t-test and ANOVA.Conclusion: This study will determine if a single intradermal SWI technique is no less effective than the routinely used four injection technique for lower back pain during labour. The findings will allow midwives to offer women requesting SWI during labour an evidence-based alternative technique more easily administered by staff and accepted by labouring women. Trial Registration: ACTRN12609000964213

Late Quaternary sea-level change and early human societies in the central and eastern Mediterranean Basin : an interdisciplinary review

This article reviews key data and debates focused on relative sea-level changes since the Last Interglacial (approximately the last 132,000 years) in the Mediterranean Basin, and their implications for past human populations. Geological and geomorphological landscape studies are critical to archaeology. Coastal regions provide a wide range of resources to the populations that inhabit them. Coastal landscapes are increasingly the focus of scholarly discussions from the earliest exploitation of littoral resources and early hominin cognition, to the inundation of the earliest permanently settled fishing villages and eventually, formative centres of urbanisation. In the Mediterranean, these would become hubs of maritime transportation that gave rise to the roots of modern seaborne trade. As such, this article represents an original review of both the geo-scientific and archaeological data that specifically relate to sea-level changes and resulting impacts on both physical and cultural landscapes from the Palaeolithic until the emergence of the Classical periods. Our review highlights that the interdisciplinary links between coastal archaeology, geomorphology and sea-level changes are important to explain environmental impacts on coastal human societies and human migration. We review geological indicators of sea level and outline how archaeological features are commonly used as proxies for measuring past sea levels, both gradual changes and catastrophic events. We argue that coastal archaeologists should, as a part of their analyses, incorporate important sea-level concepts, such as indicative meaning. The interpretation of the indicative meaning of Roman fishtanks, for example, plays a critical role in reconstructions of late Holocene Mediterranean sea levels. We identify avenues for future work, which include the consideration of glacial isostatic adjustment (GIA) in addition to coastal tectonics to explain vertical movements of coastlines, more research on Palaeolithic island colonisation, broadening of Palaeolithic studies to include materials from the entire coastal landscape and not just coastal resources, a focus on rescue of archaeological sites under threat by coastal change, and expansion of underwater archaeological explorations in combination with submarine geomorphology. This article presents a collaborative synthesis of data, some of which have been collected and analysed by the authors, as the MEDFLOOD (MEDiterranean sea-level change and projection for future FLOODing) community, and highlights key sites, data, concepts and ongoing debates

Frequency and triggering of small-scale submarine landslides on decadal timescales: Analysis of 4D bathymetric data from the continental slope offshore Nice (France),

International audienceTime-series bathymetric data acquired from 1967 to 2011 are used to evaluate the morphological evolution of the continental shelf and upper continental slope off the city of Nice (SE France, Ligurian Sea). Mapping in water depths of 0–300 m was undertaken to identify the changing morphology of landslide scars and their erosive chutes. Quantitative Digital Terrain Model (DTM) comparisons reveal areas of erosion and deposition over intervals of 5–8 years. Sediment remobilization events on the upper slope (above depths of 200 m) are frequent and significant; landslide scars with volumes > 25,000 m3 can occur with frequencies of 200 m). Periods of quiescence (1980–1990 and 2006–2011) are seen to alternate with periods when rapid retrogressive failure increase sediment volumes eroded from the upper slope-shelf transition by an order of magnitude (1999–2006). Temporal variations in landslide activity were correlated to several potential triggering factors that individually would not induce failures, including earthquake activity, rapid deposition of fine-grained sediments on a steep slope, and rainfall leading to fresh groundwater circulation below the shelf. This 4D bathymetric study suggests that over the last 50 years the most important factor triggering landslides offshore Nice is overpressure due to freshwater outflows

Temporal evolution of weathered cataclastic material in gravitational faults of the La Clapiere deep-seated landslide by mechanical approach

International audienceAfter a few years of research, the observation and the analysis of the deep-seated landslides suggest that these are mainly controlled by tectonic structures, which play a dominant role in the deformation of massif slopes. The La Clapière deep-seated landslide (Argentera Mercantour massif) is embedded in a deep-seated gravitational slope deformation affecting the entire slope, and characterized by specific landforms (trenches, scarps...). Onsite, the tangential displacement direction of the trenches and the scarps are controlled by the tectonic structures. The reactivation of the inherited fault in gravitational faults create a gouge material exposed to an additional mechanical and chemical weathering as well as an increased of leaching. The displacement of these reactivated faults gets increasingly important around the area of the La Clapière landslide and this since 3.6 ka BP. In this study, mechanical analysis and grain size distributions were performed and these data were analysed according to their proximity the La Clapiere landslide and times of initiation of the landslide by 10Be dating. Triaxial test results show that the effective cohesion decreases and the effective angle of internal friction increases from the unweathered area to the weathered area. The whole distribution of the grain size indicates that the further the shear zone is open or developed, the further the residual material loses its finest particles. This paper suggests that the mechanical evolution along the reactivated fault is influenced by the leaching processes. For the first time, we can extract from these data temporal behaviour of the two main mechanical parameters (cohesion and angle of internal friction) from the beginning of the La Clapiere landslide initiation (3.6 ka BP) to now

Paraglacial gravitational deformations in the SW Alps: a review of field investigations, 10Be cosmogenic dating and physical modeling,

International audienceCatastrophic deep-seated landslides (DSL) are generally considered to be the result of large slope deformations also known as deep-seated gravitational slope deformation (DSGSD). This paper aims to build a synthesis of multiple studies made in the Tinée Valley (southern French Alps) to assess the geometrical, kinematical, mechanical and chronological relationships between these two gravitational processes. At the scale of the valley, data issued from geological, geomorphological and 10Be dating indicate a clear geometrical link between DSGSD and DSL occurring at the base of the slope and suggest that gravitational slope evolution began after the glacial retreat (13 ka BP). This is supported by the example of the well-documented La Clapière slope. A continuous evolution process is characterized geometrically and temporally from geomorphic observations and analogue modelling. Coupling structural, geomorphological, physical and chronological studies allowed us to propose a four-dimensional (4D) deformation model mechanically correlated with progressive failure concept. The validity and variability of this reference site are discussed at the valley scale (taking Isola and Le Pra slope deformation as examples). It allows a rough estimation of the state of slope deformation at the valley scale to be constructed and the slope evolution with time to be considered. This 4D model could then be considered as a reference for other deep-seated gravitational slope deformations in comparable Alpine valleys