Effetto dell'analgesia epidurale sulla progressione della testa fetale valutata mediante ecografia 3D

Introduzione: L'analgesia epidurale è stata messa in correlazione con l'aumento della durata del secondo stadio del travaglio e del tasso di utilizzo della ventosa ostetrica. Diversi meccanismi sono stati ipotizzati, tra cui la riduzione di percezione della discesa fetale, della forza di spinta e dei riflessi che promuovono la progressione e rotazione della testa fetale nel canale del parto. Tali parametri sono solitamente valutati mediante esame clinico digitale, costantemente riportato essere poco accurato e riproducibile. Su queste basi l'uso dell'ecografia in travaglio, con introduzione di diversi parametri ecografici di valutazione della discesa della testa fetale, sono stati proposti per supportare la diagnosi clinica nel secondo stadio del travaglio. Scopi dello studio: studiare effetto dell’analgesia epidurale sulla progressione della testa fetale durante il II stadio del travaglio valutata mediante ecografia intrapartum. Materiali e metodi: una serie di pazienti nullipare a basso rischio a termine (37+0-42+0) sono state reclutate in modo prospettico nella sala parto del nostro Policlinico Universitario. In ciascuna di esse abbiamo acquisito un volume ecografico ogni 20 minuti dall’inizio della fase attiva del secondo stadio fino al parto ed una serie di parametri ecografici sono stati ricavati in un secondo tempo (angolo di progressione, distanza di progressione distanza testa sinfisi pubica e midline angle). Tutti questi parametri sono stati confrontati ad ogni intervallo di tempo nei due gruppi. Risultati: 71 pazienti totali, di cui 41 (57.7%) con analgesia epidurale. In 58 (81.7%) casi il parto è stato spontaneo, mentre in 8 (11.3%) e 5 (7.0%) casi rispettivamente si è ricorsi a ventosa ostetrica o taglio cesareo. I valori di tutti i parametri ecografici misurati sono risultati sovrapponibili nei due gruppi in tutti gli intervalli di misurazione. Conclusioni: la progressione della testa fetale valutata longitudinalmente mediante ecografia 3D non sembra differire significativamente nelle pazienti con o senza analgesia epidurale.

Multimodal (EEG-fMRI) functional connectivity study of levodopa effect in Parkinson’s disease

Aim: To assess if the intake of levodopa in patients with Parkinson’s Disease (PD) changes cerebral connectivity, as revealed by simultaneous recording of hemodynamic (functional MRI, or fMRI) and electric (electroencephalogram, EEG) signals. Particularly, we hypothesize that the strongest changes in FC will involve the motor network, which is the most impaired in PD. Methods: Eight patients with diagnosis of PD “probable”, therapy with levodopa exclusively, normal cognitive and affective status, were included. Exclusion criteria were: moderate-severe rest tremor, levodopa induced dyskinesia, evidence of gray or white matter abnormalities on structural MRI. Scalp EEG (64 channels) were acquired inside the scanner (1.5 Tesla) before and after the intake of levodopa. fMRI functional connectivity was computed from four regions of interest: right and left supplementary motor area (SMA) and right and left precentral gyrus (primary motor cortex). Weighted partial directed coherence (w-PDC) was computed in the inverse space after the removal of EEG gradient and cardioballistic artifacts. Results and discussion: fMRI group analysis shows that the intake of levodopa increases hemodynamic functional connectivity among the SMAs / primary motor cortex and: sensory-motor network itself, attention network and default mode network. w-PDC analysis shows that EEG connectivity among regions of the motor network has the tendency to decrease after the intake the levodopa; furthermore, regions belonging to the DMN have the tendency to increase their outflow toward the rest of the brain. These findings, even if in a small sample of patients, suggest that other resting state physiological functional networks, beyond the motor one, are affected in patients with PD. The behavioral and cognitive tasks corresponding to the affected networks could benefit from the intake of levodopa.

Language, action, and sensoriality: a multimodal analysis of interactions in inclusive sport climbing with visually impaired athletes

In sport climbing, athletes with vision impairments are constantly accompanied by their guides – usually trainers – both during the preparatory inspection of the routes and whilst climbing. Trainers are, so to speak, the climbers’ eyes, in the sense that they systematically put their vision in the service of the climbers’ mobility and sporting performance. The synergy between trainers and athletes is based on peculiar, strictly multimodal interactive practices that are focused on the body and on its constantly evolving sensory engagement with the materiality of routes. In this context, sensory perception and embodied actions required to plan and execute the climb are configured as genuinely interactive accomplishments. Drawing on the theoretical framework of Embodied and Situated Cognition and on the methodology of Conversation Analysis, this thesis engages in the multimodal analysis of trainer-athlete interactions in paraclimbing. The analysis is based on a corpus of video recorded climbing sessions. The major findings of the study can be summarized as follows. 1) Intercorporeality is key to interactions between trainers and athletes with visual impairments. The participants orient to perceiving the climbing space and acting in it as a ‘We’. 2) The grammar, lexicon, prosody, and timing of the trainers’ instructions are finely tuned to the ongoing corporeal experience of the climbers. 3) Climbers with visual impairments build their actions by using sensory resources that are provided by their trainers. This result is of particular importance as it shows that resources and constraints for action are in a fundamental way constituted in interaction with Others and with specific socio-material ecologies, rather than being defined a priori by the organs and functions of individuals’ body and mind. Individual capabilities are thus enhanced and extended in interaction, which encourages a more ecological view of (dis)ability.

Investigating interpreter-mediated interaction in the Chinese bilingual courtroom: Analysis based on a multimodal corpus

This research project is based on the Multimodal Corpus of Chinese Court Interpreting (MUCCCI [mutʃɪ]), a small-scale multimodal corpus on the basis of eight authentic court hearings with Chinese-English interpreting in Mainland China. The corpus has approximately 92,500 word tokens in total. Besides the transcription of linguistic and para-linguistic features, utilizing the facial expression classification rules suggested by Black and Yacoob (1995), MUCCCI also includes approximately 1,200 annotations of facial expressions linked to the six basic types of human emotions, namely, anger, disgust, happiness, surprise, sadness, and fear (Black & Yacoob, 1995). This thesis is an example of conducting qualitative analysis on interpreter-mediated courtroom interactions through a multimodal corpus. In particular, miscommunication events (MEs) and the reasons behind them were investigated in detail. During the analysis, although queries were conducted based on non-verbal annotations when searching for MEs, both verbal and non-verbal features were considered indispensable parts contributing to the entire context. This thesis also includes a detailed description of the compilation process of MUCCCI utilizing ELAN, from data collection to transcription, POS tagging and non-verbal annotation. The research aims at assessing the possibility and feasibility of conducting qualitative analysis through a multimodal corpus of court interpreting. The concept of integrating both verbal and non-verbal features to contribute to the entire context is emphasized. The qualitative analysis focusing on MEs can provide an inspiration for improving court interpreters’ performances. All the constraints and difficulties presented can be regarded as a reference for similar research in the future.