Midazolam use for dental conscious sedation: how safe are we?

Aim: To explore the safety awareness of midazolam use amongst dentist in the UK. Materials and methods: A cross-sectional study on 203 dentists was undertaken, 146 of whom currently practice conscious sedation using intravenous midazolam. Use of high strength midazolam; awareness of the Rapid Response Report (RRR) and the National Reporting and Learning System (NRLS); and midazolam related incidents were explored. Results: Formal training in conscious sedation was variable with 35.6% holding a postgraduate sedation qualification. Flumazenil administration was common practice (63%) although used very selectively. Use to reverse respiratory depression was minimal (4%). Awareness of the RRR and the NRLS was generally low but higher among those working in general dental practice (p<0.05). Comparative analysis showed that high dose midazolam was administered more frequently in gastroenterology than in dentistry (p<0.001) with higher incidences of overdose (12.4% Vs 4.8%) and death (8.3% Vs 0%) within a 3 year period. Conclusions: High strength midazolam administration remains prevalent in dentistry, despite recommendations by the DoH. Use of flumazenil for reasons other than respiratory depression in dentistry should warrant little concern. The low incidence of reported harm is positive but may be due to a lack of uptake of national reporting systems

Stochastic Chemical Reactions in Micro-domains

Traditional chemical kinetics may be inappropriate to describe chemical reactions in micro-domains involving only a small number of substrate and reactant molecules. Starting with the stochastic dynamics of the molecules, we derive a master-diffusion equation for the joint probability density of a mobile reactant and the number of bound substrate in a confined domain. We use the equation to calculate the fluctuations in the number of bound substrate molecules as a function of initial reactant distribution. A second model is presented based on a Markov description of the binding and unbinding and on the mean first passage time of a molecule to a small portion of the boundary. These models can be used for the description of noise due to gating of ionic channels by random binding and unbinding of ligands in biological sensor cells, such as olfactory cilia, photo-receptors, hair cells in the cochlea.Comment: 33 pages, Journal Chemical Physic

The bloodstream differentiation - division of Trypanosoma brucei studied using mitochondrial markers

In the bloodstream of its mammalian host, the African trypanosome Trypanosoma brucei undergoes a life cycle stage differentiation from a long, slender form to a short, stumpy form. This involves three known major events: exit from a proliferative cell cycle, morphological change and mitochondrial biogenesis. Previously, models have been proposed accounting for these events (Matthews & Gull 1994a). Refinement of, and discrimination between, these models has been hindered by a lack of stage-regulated antigens useful as markers at the single-cell level. We have now evaluated a variety of cytological markers and applied them to investigate the coordination of phenotypic differentiation and cell cycle arrest. Our studies have focused on the differential expression of the mitochondrial enzyme dihydrolipoamide dehydrogenase relative to the differentiation-division of bloodstream trypanosomes. The results implicate a temporal order of events: commitment, division, phenotypic differentiation

Testing Magnetic Field Models for the Class 0 Protostar L1527

For the Class 0 protostar, L1527, we compare 131 polarization vectors from SCUPOL/JCMT, SHARP/CSO and TADPOL/CARMA observations with the corresponding model polarization vectors of four ideal-MHD, non-turbulent, cloud core collapse models. These four models differ by their initial magnetic fields before collapse; two initially have aligned fields (strong and weak) and two initially have orthogonal fields (strong and weak) with respect to the rotation axis of the L1527 core. Only the initial weak orthogonal field model produces the observed circumstellar disk within L1527. This is a characteristic of nearly all ideal-MHD, non-turbulent, core collapse models. In this paper we test whether this weak orthogonal model also has the best agreement between its magnetic field structure and that inferred from the polarimetry observations of L1527. We found that this is not the case; based on the polarimetry observations the most favored model of the four is the weak aligned model. However, this model does not produce a circumstellar disk, so our result implies that a non-turbulent, ideal-MHD global collapse model probably does not represent the core collapse that has occurred in L1527. Our study also illustrates the importance of using polarization vectors covering a large area of a cloud core to determine the initial magnetic field orientation before collapse; the inner core magnetic field structure can be highly altered by a collapse and so measurements from this region alone can give unreliable estimates of the initial field configuration before collapse.Comment: 43 pages, 9 figures, 4 tables. Accepted by the Astrophysical Journa

The 'Dream Team' for sexual, reproductive, maternal, newborn and adolescent health: An adjusted service target model to estimate the ideal mix of health care professionals to cover population need

© 2017 The Author(s). Background: A competent, enabled and efficiently deployed health workforce is crucial to the achievement of the health-related sustainable development goals (SDGs). Methods for workforce planning have tended to focus on 'one size fits all' benchmarks, but because populations vary in terms of their demography (e.g. fertility rates) and epidemiology (e.g. HIV prevalence), the level of need for sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workers also varies, as does the ideal composition of the workforce. In this paper, we aim to provide proof of concept for a new method of workforce planning which takes into account these variations, and allocates tasks to SRMNAH workers according to their competencies, so countries can assess not only the needed size of the SRMNAH workforce, but also its ideal composition (the 'Dream Team'). Methods: An adjusted service target model was developed, to estimate (i) the amount of health worker time needed to deliver essential SRMNAH care, and (ii) how many workers from different cadres would be required to meet this need if tasks were allocated according to competencies. The model was applied to six low- and middle-income countries, which varied in terms of current levels of need for health workers, geographical location and stage of economic development: Azerbaijan, Malawi, Myanmar, Peru, Uzbekistan and Zambia. Results: Countries with high rates of fertility and/or HIV need more SRMNAH workers (e.g. Malawi and Zambia each need 44 per 10,000 women of reproductive age, compared with 20-27 in the other four countries). All six countries need between 1.7 and 1.9 midwives per 175 births, i.e. more than the established 1 per 175 births benchmark. Conclusions: There is a need to move beyond universal benchmarks for SRMNAH workforce planning, by taking into account demography and epidemiology. The number and range of workers needed varies according to context. Allocation of tasks according to health worker competencies represents an efficient way to allocate resources and maximise quality of care, and therefore will be useful for countries working towards SDG targets. Midwives/nurse-midwives who are educated according to established global standards can meet 90% or more of the need, if they are part of a wider team operating within an enabled environment

Development of FRET-Based Assays in the Far-Red Using CdTe Quantum Dots

Colloidal quantum dots (QDs) are now commercially available in a biofunctionalized form, and Förster resonance energy transfer (FRET) between bioconjugated dots and fluorophores within the visible range has been observed. We are particularly interested in the far-red region, as from a biological perspective there are benefits in pushing to ∼700 nm to minimize optical absorption (ABS) within tissue and to avoid cell autofluorescence. We report on FRET between streptavidin- (STV-) conjugated CdTe quantum dots, Qdot705-STV, with biotinylated DY731-Bio fluorophores in a donor-acceptor assay. We also highlight the changes in DY731-Bio absorptivity during the streptavidin-biotin binding process which can be attributed to the structural reorientation. For fluorescence beyond 700 nm, different alloy compositions are required for the QD core and these changes directly affect the fluorescence decay dynamics producing a marked biexponential decay with a long-lifetime component in excess of 100 nanoseconds. We compare the influence of the two QD relaxation routes upon FRET dynamics in the presence of DY731-Bio

Cryptographic requirements for chaotic secure communications

In recent years, a great amount of secure communications systems based on chaotic synchronization have been published. Most of the proposed schemes fail to explain a number of features of fundamental importance to all cryptosystems, such as key definition, characterization, and generation. As a consequence, the proposed ciphers are difficult to realize in practice with a reasonable degree of security. Likewise, they are seldom accompanied by a security analysis. Thus, it is hard for the reader to have a hint about their security. In this work we provide a set of guidelines that every new cryptosystems would benefit from adhering to. The proposed guidelines address these two main gaps, i.e., correct key management and security analysis, to help new cryptosystems be presented in a more rigorous cryptographic way. Also some recommendations are offered regarding some practical aspects of communications, such as channel noise, limited bandwith, and attenuation.Comment: 13 pages, 3 figure

Optimized random phase approximations for arbitrary reference systems: extremum conditions and thermodynamic consistence

The optimized random phase approximation (ORPA) for classical liquids is re-examined in the framework of the generating functional approach to the integral equations. We show that the two main variants of the approximation correspond to the addition of the same correction to two different first order approximations of the homogeneous liquid free energy. Furthermore, we show that it is possible to consistently use the ORPA with arbitrary reference systems described by continuous potentials and that the same approximation is equivalent to a particular extremum condition for the corresponding generating functional. Finally, it is possible to enforce the thermodynamic consistence between the thermal and the virial route to the equation of state by requiring the global extremum condition on the generating functional.Comment: 8 pages, RevTe