BACKGROUND Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared to electroconvulsive therapy (ECT), the most effective therapy for depression. METHODS Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT, in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery Åsberg Depression Rating Scale [MADRS] score ≤10). Secondary outcomes included adverse events (AEs), time to remission and relapse. Treatment sessions (maximum of twelve) were administered until remission or maximal effect was achieved. Remitters were followed for twelve months after the final treatment session. RESULTS 186 inpatients were included and received treatment. Among patients receiving ECT 63% remitted, compared to 46% receiving ketamine infusions (p=0.026; difference 95% CI 2%, 30%). Both ketamine and ECT required a median of six treatment sessions to induce remission. Distinct adverse events (2015) were associated with each treatment. Serious and long-lasting AE, including cases of persisting amnesia, were more common with ECT, while treatment emergent AE led to more dropouts in the ketamine group. Among remitters, 70% and 63%, with 57 and 61 median days in remission, relapsed within twelve months in the ketamine and ECT group respectively (p=0.52). CONCLUSION Remission and cumulative symptom reduction following multiple racemic ketamine infusions in severely ill patients (age 18-85) in an authentic clinical setting suggest that ketamine, despite being inferior to ECT, can be a safe and valuable tool in treating unipolar depression.

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In light of how the knowledge society may give rise to new forms of inequity in schools, the purpose of this article is to examine the stratification of Swedish schoolteachers' access to and use of ICT. The empirical data consist of a nationwide survey conducted in 2010, involving 6000 Swedish teachers in all grades (except preschool and university). Accounting for teachers' age, gender, grade, and principal organization, bivariate analyses were conducted. The study finds significant differences between teacher's age and principal organization, indicating a growing gap between teachers in public versus independent schools. The finding is discussed in relation to the current research and its potential consequences for equitable learning activities.

The purpose of the study is to explore how Swedish lower secondary school teachers manage blended learning environments, established through using a specific learning management system (LMS) application. In the study, four teachers were followed during a four-month (n)ethnographic fieldwork. Based on analyses of data from video-recordings and observations in physical and virtual classrooms, the study examines teachers' practices of integrating and segmenting the two classroom domains. In order to unpack the realms of these practices, the study employs affordance and boundary theories. Through the analysis of participants' boundary practices and their use of communicative affordances in and across space and time, four teacher roles, enacted and emerging through teaching practices, are presented. The paper concludes with a discussion of how participants' engagement with virtual and physical learning environment compels teachers to reflect upon their preferred teacher role in the new multidimensional classrooms.