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

The Oscillatory 2D Convective States of a Binary Fluid Confined in Small Cavity

2D accurate numerical experiments have been performed with a Boussinesq binary fluid subject to Soret effect and confined in a small (length/height = 2) cavity. The steady convective states observed close to the threshold from conduction to convection, for a separation ratio fixed at -0.2, are not made of standing waves. Rather, they can be seen as made of unbalanced and phase shifted counterpropagating traveling waves. The salient features of these flows are reported, their temporal characteristics in particular

Sensitivity of binary liquid thermal convection to confinement

Physics of fluids, v. 15, n. 10, p. 2791-2802, 2003. http://dx.doi.org/10.1063/1.1600439International audienc

Identification of the gravitational boundary in weathered gneiss by geophysical survey: La Clapiere Landslide (France)

Journal of Applied Geophysics, v. 62, n. 1, p. 47-57, 2007. http://dx.doi.org/10.1016/j.jappgeo.2006.07.003International audienc

Axisymmetric convective states of pure and binary liquids enclosed in a vertical cylinder and boundary conditions' influence thereupon

Physics of fluids, v. 17, n. 4, p. 44102-44121, 2005. http://dx.doi.org/10.1063/1.1863257International audienc

Mouvement de versant : un processus géomorphologique long terme

Du relief au bassi

Influence of inherited topography on gravitational slope failure: three-dimensional numerical modelling of the La Clapière slope, Alpes-Maritimes, France,

International audienceGravitational slope failure involves rock slopes at various scales. Nowadays, it is accepted that different factors influence slope destabilization, including topography. In many cases, slope failure occurs between tributary valleys cutting the slope. In this study, we ask what influence tributary valleys have on slope failure. To tackle this question, we developed a 3-D numerical model of the La Clapière Slope and then examined a series of simplified 3-D models with different geometries of tributary valleys (spacing and depth). Our results show that: (1) whatever considered in situ stresses are, including the third dimension reduces the destabilization threshold compared with 2-D models; and (2) the spacing and the depth of tributary valleys influence slope failure. For shallow incisions, increasing the lateral spacing between tributary valleys does not affect failure localization but does increase slope damage (to a stable value from 2000 m). However, deeper incision does not affect slope damage but does contribute to failure localization. When the spacing is less than 1500 m, the part of the slope between tributary valleys is not involved in the failure process, but for spacings above 1500 m slope failure occurs between tributary valleys