Patient-maintained propofol sedation: the anaesthetists' point of view

Many operations within the UK do not require general anaesthesia, and are instead carried out under sedation. A doctor normally provides this, and as the patient is not in control, they may be either under or over-sedated due to a misjudgement of patient anxiety. One solution would be to allow the patients to directly control their own sedation level. This paper presents an invention for innovation (i4i) project developing such a Patient Maintained Propofol Sedation Device (PMPSD). Due to the health risks associated with under and over-sedation, the anaesthetists' interface takes on an added importance to ensure they can oversee the process and intervene when needed. Through the project, a unique opportunity has arisen where anaesthetists have been involved throughout the interface design process, contributing to the development and testing of a prototype. We present this prototype, highlight its key features and how it differs from existing sedation pump interface systems. As the project continues, the interface will be used as part of a clinical trial at Nottingham University Hospitals NHS Trust involving 80 orthopaedic patients throughout the rest of 2018 and into 2019

A prototype patient-maintained propofol sedation system using target controlled infusion for primary lower-limb arthroplasty

Each year, many operations in the UK are performed with the patient awake, without the use of general anaesthesia. These include joint replacement procedures, and in order to reduce patient anxiety, the supervising anaesthetist delivers the sedative propofol intravenously using a target-controlled infusion (TCI) device. However, it is clinically challenging to judge the required effect-site concentration of sedative for an individual patient, resulting in patient care issues related to over or under-sedation. To improve the process, patient-maintained propofol sedation (PMPS), where the patient can request an increase in concentration through a hand-held button, has been considered as an alternative. However, due to the proprietary nature of modern TCI pumps, the majority of PMPS research has been conducted using prototypes in research studies. In this work, a PMPS system is presented that effectively converts a standard infusion pump into a TCI device using a laptop with TCI software. Functionally, the system delivers sedation analogous to a modern TCI pump, with the differences in propofol consumption and dosage within the tolerance of clinically approved devices. Therefore, the Medicines and Healthcare products Regulatory Agency (MHRA) has approved the system as a safe alternative to anaesthetist-controlled TCI procedures. It represents a step forward in the consideration of PMPS as a sedation method as viable alternative, allowing further assessment in clinical trials

Search for the Rare Decays KL->pi0pi0mu+mu- and KL->pi0pi0X0->pi0pi0mu+mu-

The KTeV E799 experiment has conducted a search for the rare decays KL->pi0pi0mu+mu- and KL->pi0pi0X0->pi0pi0mu+mu-, where the X0 is a possible new neutral boson that was reported by the HyperCP experiment with a mass of (214.3 pm 0.5) MeV/c^{2}. We find no evidence for either decay. We obtain upper limits of Br(KL->pi0pi0X0->pi0pi0mu+mu-) pi0pi0mu+mu-) < 9.2 x 10^{-11} at the 90% confidence level. This result rules out the pseudoscalar X0 as an explanation of the HyperCP result under the scenario that the \bar{d}sX0 coupling is completely real

Search for the Rare Decay K_{L}\to\pi^{0}\pi^{0}\gamma

The KTeV E799 experiment has conducted a search for the rare decay $K_{L}\to\pi^{0}\pi^{0}\gamma$ via the topology $K_{L}\to\pi^{0}\pi^{0}_D\gamma$ (where $\pi^0_D\to\gamma e^+e^-$). Due to Bose statistics of the $\pi^0$ pair and the real nature of the photon, the $K_{L}\to\pi^{0}\pi^{0}\gamma$ decay is restricted to proceed at lowest order by the CP conserving direct emission (DE) of an E2 electric quadrupole photon. The rate of this decay is interesting theoretically since chiral perturbation theory predicts that this process vanishes at level $O(p^4)$. Therefore, this mode probes chiral perturbation theory at $O(p^6)$. In this paper we report a determination of an upper limit of $2.43\times 10^{-7}$ (90% CL) for $K_{L}\to\pi^{0}\pi^{0}\gamma$. This is approximately a factor of 20 lower than previous results.Comment: six pages and six figures in the submission. Reformatted for Physics Review

Anthropology and GIS: Temporal and Spatial Distribution of the Philippine Negrito Groups

The Philippine negrito groups comprise a diverse group of populations speaking over 30 different languages, who are spread all over the archipelago, mostly in marginal areas of Luzon Island in the north, the central Visayas islands, and Mindanao in the south. They exhibit physical characteristics that are different from more than 100 Philippine ethnolinguistic groups that are categorized as non-negritos. Given their numbers, it is not surprising that Philippine negritos make up a major category in a number of general ethnographic maps produced since the nineteenth century. Reports from various ethnological surveys during this period, however, have further enriched our understanding regarding the extent and distribution of negrito populations. Using the data contained in these reports, it is possible to plot and create a map showing the historical locations and distribution of negrito groups. Using geographic information systems (GIS), the location and distribution of negrito groups at any given time can be overlaid on historical or current maps. In the present study, a GIS layer was compiled and extracted from the 2000 Philippine Census of population at the village level and overlaid on existing maps of the Philippines. The maps that were generated from this project will complement ongoing anthropological and genetic studies of negrito groups that inhabit different locations within the Philippine archipelago

Measurement of the rare decay pi0 -> e+ e-

The branching ratio of the rare decay pi0 -> e+ e- has been measured precisely, using the complete data set from the KTeV E799-II experiment at Fermilab. We observe 794 candidate pi0 -> e+ e- events using K0_L -> 3pi0 as a source of tagged pi0's. The expected background is 52.7 +- 11.2 events, predominantly from high e+ e- mass pi0 -> e+ e- gamma decays. We have measured B[(pi0 -> e+ e-), (m_e+e-/m_pi0)^2 > 0.95] = 6.44 +- 0.25(stat) +- 0.22(syst) x10^(-8), which is above the unitary bound from pi0 -> gamma gamma and within the range of theoretical expectations from the standard model.Comment: 6 pages, 4 figure

Measurement of Direct Emission in the KL->pi+pi-gamma Decay Mode

In this paper the KTeV collaboration reports the analysis of 112.1*10^3 candidate KL->pi+pi-gamma decays including a background of 671+/-41 events with the objective of determining the photon production mechanisms intrinsic to the decay process. These decays have been analyzed to extract the relative contributions of the CP violating bremsstrahlung process and the CP conserving M1 and CP violating E1 direct photon emission processes. The M1 direct photon emission amplitude and its associated vector form factor parameterized as |g_M1|(1+ (a_1/a_2)/(M(rho)^2-M(K)^2+2M(K)*E(gamma)) have been measured to be |g_M1|=1.198 +/- 0.035(stat) +/- 0.086(syst) and a_1/a_2 = -0.738 +/- 0.007(stat) +/- 0.018 (syst) GeV^2/c^2 respectively. An upper limit for the CP violating E1 direct emission amplitude |g_E1| < 0.21 (90% CL) has been found. The overall ratio of direct photon emission (DE) to total photon emission including the bremsstrahlung process (IB) has been determined to be DE/(DE +IB) = 0.689 +/- 0.021 for E(gamma) > 20 MeV.Comment: REVTeX 3.1, 4 pages, 4 figures submitted to Physical Review Letter

Structure and Dynamics of Cholesterol-Containing Polyunsaturated Lipid Membranes Studied by Neutron Diffraction and NMR

A direct and quantitative analysis of the internal structure and dynamics of a polyunsaturated lipid bilayer composed of 1-stearoyl-2-docosahexaenoyl-sn-glycero-3-phosphocholine (18:0-22:6n3-PC) containing 29 mol% cholesterol was carried out by neutron diffraction, 2H-NMR and 13C-MAS NMR. Scattering length distribution functions of cholesterol segments as well as of the sn-1 and sn-2 hydrocarbon chains of 18:0-22:6n3-PC were obtained by conducting experiments with specifically deuterated cholesterol and lipids. Cholesterol orients parallel to the phospholipids, with the A-ring near the lipid glycerol and the terminal methyl groups 3 Å away from the bilayer center. Previously, we reported that the density of polyunsaturated docosahexaenoic acid (DHA, 22:6n3) chains was higher near the lipid–water interface. Addition of cholesterol partially redistributes DHA density from near the lipid–water interface to the center of the hydrocarbon region. Cholesterol raises chain-order parameters of both stearic acid and DHA chains. The fractional order increase for stearic acid methylene carbons C8–C18 is larger, reflecting the redistribution of DHA chain density toward the bilayer center. The correlation times of DHA chain isomerization are short and mostly unperturbed by the presence of cholesterol. The uneven distribution of saturated and polyunsaturated chain densities and the cholesterol-induced balancing of chain distributions may have important implications for the function and integrity of membrane receptors, such as rhodopsin

Ocean Bottom Seismometer Augmentation of the Philippine Sea Experiment (OBSAPS) cruise report

The Ocean Bottom Seismometer Augmentation to the Philippine Sea Experiment (OBSAPS, April-May, 2011, R/V Revelle) addresses the coherence and depth dependence of deep-water ambient noise and signals. During the 2004 NPAL Experiment in the North Pacific Ocean, in addition to predicted ocean acoustic arrivals and deep shadow zone arrivals, we observed "deep seafloor arrivals" that were dominant on the seafloor Ocean Bottom Seismometer (OBS) (at about 5000m depth) but were absent or very weak on the Distributed Vertical Line Array (DVLA) (above 4250m depth). These "deep seafloor arrivals" (DSFA) are a new class of arrivals in ocean acoustics possibly associated with seafloor interface waves. The OBSAPS cruise had three major research goals: a) identification and analysis of DSFAs occurring at short (1/2CZ) ranges in the 50 to 400Hz band, b) analysis of deep sea ambient noise in the band 0.03 to 80Hz, and c) analysis of the frequency dependence of BR and SRBR paths as a function of frequency. On OBSAPS we deployed a fifteen element VLA from 12 to 852m above the seafloor, four short-period OBSs and two long-period OBSs and carried out an 11.5day transmission program using a J15-3 acoustic source.Funding was provided by the Office of Naval Research under Contract Nos. N00014-10-1-0994 and N00014-10-1-0987