Conscious Sedation in Dentistry.

Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.

A brief illustration of the official national standards for the safe use of cupping therapy (Hijama) in Saudi Arabia.

Cupping therapy (Hijama in Arabic) is a popular traditional treatment especially in Asia, the Middle East and Central Europe. Traditionally, cupping therapy has been one of the most used practices in Saudi Arabia. Standardization of the practice of cupping therapy is a very important step to eliminate or reduce any adverse events related to cupping. This article gives a brief illustration and highlights the important points of the first accredited Saudi Arabian standards for the safe use of cupping equipment and its applications.

What are the most common domains of the core competencies of disaster nursing? A scoping review.

AIM: Scoping review was conducted to identify the most common domains of the core competencies of disaster nursing. BACKGROUND: Nurses play an essential role in all phases of disaster management. For nurses to respond competently, they must be equipped with the skills to provide comprehensive and holistic care to the populations affected by or at risk of disasters. METHODS: A scoping review was conducted using the Joanna Briggs Institute methodology. The review used information from six databases: the Cumulative Index to Nursing and Allied Health Literature, Ovid MEDLINE, ScienceDirect, ProQuest, Scopus and the Education Resources Information Center. Keywords and inclusion and exclusion criteria were identified as strategies to use in this review. RESULTS: Twelve studies were eligible for result extraction, as they listed domains of the core competencies. These domains varied among studies. However, the most common domains were related to communication, planning, decontamination and safety, the Incident Command System and ethics. CONCLUSION: Knowledge of the domains of the core competencies, such as understanding the content and location of the disaster plan, communication during disaster and ethical issues is fundamental for nurses. Including these domains in the planning and provision of training for nurses, such as disaster drills, will strengthen their preparedness to respond competently to disaster cases. Nurses must be involved in future research in this area to explore and describe their fundamental competencies in each domain.

Recalibration of nonclinical safety pharmacology assessment to anticipate evolving regulatory expectations.

Safety pharmacology (SP) has evolved in terms of architecture and content since the inception of the SP Society (SPS). SP was initially focused on the issue of drug-induced QT prolongation, but has now become a broad spectrum discipline with expanding expectations for evaluation of drug adverse effect liability in all organ systems, not merely the narrow consideration of torsades de pointes (TdP) liability testing. An important part of the evolution of SP has been the elaboration of architecture for interrogation of non-clinical models in terms of model development, model validation and model implementation. While SP has been defined by mandatory cardiovascular, central nervous system (CNS) and respiratory system studies ever since the core battery was elaborated, it also involves evaluation of drug effects on other physiological systems. The current state of SP evolution is the incorporation of emerging new technologies in a wide range of non-clinical drug safety testing models. This will refine the SP process, while potentially expanding the core battery. The continued refinement of automated technologies (e.g., automated patch clamp systems) is enhancing the scope for detection of adverse effect liability (i.e., for more than just IKr blockade), while introducing a potential for speed and accuracy in cardiovascular and CNS SP by providing rapid, high throughput ion channel screening methods for implementation in early drug development. A variety of CNS liability assays, which exploit isolated brain tissue, and in vitro electrophysiological techniques, have provided an additional level of complimentary preclinical safety screens aimed at establishing the seizurogenic potential and risk for memory dysfunction of new chemical entities (NCEs). As with previous editorials that preface the annual themed issue on SP methods published in the Journal of Pharmacological and Toxicological Methods (JPTM), we highlight here the content derived from the most recent (2015) SPS meeting held in Prague, Czech Republic. This issue of JPTM continues the tradition of providing a publication summary of articles primarily presented at the SPS meeting with direct bearing on the discipline of SP. Novel method development and refinement in all areas of the discipline are reflected in the content.

Lifestyle and safety practices of firefighters and their relation to cardiovascular risk factors.

BACKGROUND: In the United States, over 50% of the deaths of on-duty firefighters are classified as sudden cardiac deaths. A holistic view of the multiple risk factors and their relation to the prevalence of cardiovascular disease (CVD) is necessary to determine a baseline for prevention. METHODS: This study surveyed 154 firefighters in a large Midwestern county about their individual exposure to particulates, noise, heat stress, skin contamination, and physical stress; lifestyle factors such as exercise, diet, smoking, and alcohol consumption; health status; and demographic factors. RESULTS: Consumption of whole grains and alcohol were associated with a reduction of the risk of heart disease, while higher Body Mass Index (BMI) scores and increasing age were associated with increased risk of heart disease. CONCLUSIONS: Although firefighters are exposed to substantial occupational risks, only lifestyle factors were found to significantly predict CVD and related health issues. BMI is a modifiable risk factor, which, if controlled, could appreciably improve health outcomes.

[Specificity of traditional Chinese medicine's clinical re-evaluation].

Clinical re-evaluation is to verify the drug's safety and effectiveness again,while the drug itself has not been improved. However, due to the complexity of traditional Chinese medicine, ingredients in bulk drugs, prescription, productive processes, quality standards and other aspects need to be enhanced. So improving the quality, safety and effectiveness of traditional Chinese medicine by clinical re-evaluation is also very necessary. Therefore, except for achieving those basic requirements of medicine, it should also be improved on itself and pay full attention to the particularity, then traditional Chinese medicine's clinical re-evaluation will play its due role.

Benchmarking road safety of U.S. states: a DEA-based Malmquist productivity index approach.

In this study, a DEA based Malmquist index model was developed to assess the relative efficiency and productivity of U.S. states in decreasing the number of road fatalities. Even though the national trend in fatal crashes has reached to the lowest level since 1949 (Traffic Safety Annual Assessment Highlights, 2010), a state-by-state analysis and comparison has not been studied considering other characteristics of the holistic national road safety assessment problem in any work in the literature or organizational reports. In this study, a DEA based Malmquist index model was developed to assess the relative efficiency and productivity of 50 U.S. states in reducing the number of fatal crashes. The single output, fatal crashes, and five inputs were aggregated into single road safety score and utilized in the DEA-based Malmquist index mathematical model. The period of 2002-2008 was considered due to data availability for the inputs and the output considered. According to the results, there is a slight negative productivity (an average of -0.2 percent productivity) observed in the U.S. on minimizing the number of fatal crashes along with an average of 2.1 percent efficiency decline and 1.8 percent technological improvement. The productivity in reducing the fatal crashes can only be attributed to the technological growth since there is a negative efficiency growth is occurred. It can be concluded that even though there is a declining trend observed in the fatality rates, the efficiency of states in utilizing societal and economical resources towards the goal of zero fatality is not still efficient. More effective policy making towards increasing safety belt usage and better utilization of safety expenditures to improve road condition are derived as the key areas to focus on for state highway safety agencies from the scope of current research.

Job demands, job resources and safety outcomes: The roles of emotional exhaustion and safety compliance.

The aim of this study was to assess the effectiveness of the job demands-resources (JD-R) model in explaining the relationship of job demands and resources with safety outcomes (i.e., workplace injuries and near-misses). We collected self-reported data from 670 crude oil production workers from three sub-companies of a major oilfield company in China. The results of a structural equation analysis indicated that job demands (psychological and physical demands) and job resources (decision latitude, supervisor support and coworker support) could affect emotional exhaustion and safety compliance, and thus influence the occurrence of injuries and near-misses. The implications of the present findings regarding both the JD-R model and occupational safety research were discussed.

Translating road safety into health outcomes using a quantitative impact assessment model.

INTRODUCTION: The majority of traffic safety policies are limited to preventing mortality. However, non-fatal injuries also impose a significant risk of adverse health. Therefore, both mortality and morbidity outcomes should be included in the evaluation of traffic safety policies. The authors propose a method to evaluate different policy options taking into account both fatalities and serious injuries. METHODS: A health impact model was developed and aligned with a transport and road safety model, calculating the health impact of fatalities and seriously injured traffic victims for two transport scenarios in Flanders and Brussels (Belgium): a base scenario and a fuel price increase of 20% as an alternative. Victim counts were expressed as disability adjusted life years, using a combination of police and medical data. Seriously injured victims were assigned an injury, using injury distributions derived from hospital data, to estimate the resulting health impact from each crash. Health impact of fatalities was taken as the remaining life expectancy at the moment of the fatal crash. RESULTS: The fuel price scenario resulted in a decrease of health impact due to fatalities of 5.53%--5.85% and 3.37%--3.88% for severe injuries. This decrease was however not equal among all road users. CONCLUSIONS: With this method, the impact of traffic polices can be evaluated on both mortality and morbidity, while taking into account the variability of different injuries following a road crash. This model however still underestimates the impact due to non-fatal injuries.

A holistic approach for assessing traffic safety in the United Arab Emirates.

Traffic accident and fatality rates can be utilized as indicators of traffic safety, but cannot reflect the overall status of traffic safety in a country. This paper uses a holistic perspective approach to investigate traffic safety in the United Arab Emirates (UAE). Initially, 12 potential items were selected to investigate the issue of traffic safety in the country. The investigation included data collection and analyses from official police reports, survey among road-users and interview of traffic safety experts. Based on data analysis and interpretation, the main factors affecting traffic safety in the UAE along with their level of deficiency were identified. The study revealed that the main factors contributing to traffic safety in the UAE are driving behaviour, awareness, education and training, infrastructure, vehicle, law enforcement, coordination and quality of resources. Among these factors, a major deficiency was found in the "driving behaviour", a minor deficiency in "vehicle safety", and a moderate deficiency in the others. Based on the deficiency level of the factors recommendations were proposed to improve the status of traffic safety in the country.

Eficacia y seguridad de abatacept en pacientes con artritis reumatoide sin tratamiento biológico previo / Efficacy and safety of abatacept in patients with rheumatoid arthritis and no prior treatment with biologics

El abatacept (ABA) es una proteína de fusión recombinante humana que permite el bloqueo de la señal co-estimuladora del linfocito T, evitando su activación. Se han realizado estudios aleatorizados y controlados de eficacia y seguridad del ABA combinado con metotrexato (MTX), frente a MTX en monoterapia y frente a infliximab (IFB) combinado con MTX en pacientes con artritis reumatoide naive a terapia biológica. ABA ha demostrado ser más eficaz que el MTX y al menos igual que IFB+MTX, en términos de actividad y remisión clínica, funcionalidad física y disminución de la progresión radiológica. Los datos de seguridad a 7 años han demostrado que el fármaco es equiparable al MTX en monoterapia y más seguro que la combinación IFB+MTX, aunque las infecciones continúan siendo el principal riesgo del uso de ABA. En esta revisión se resumen los datos de seguridad y eficacia de los estudios AIM, ATTEST, fase IIb IM101-100 y AGREE (AU)

Abatacept (ABA) is a recombinant human fusion protein that blocks co-stimulation signals on T lymphocytes, impeding their activation. Randomized and controlled trials examining efficacy and safety have been performed with ABA combined with methotrexate (MTX), vs MTX monotherapy and vs infliximab (IFB) combined with MTX in patients with Rheumatoid Arthritis and who are naïve to biologic therapy. ABA has shown to be more effective than MTX and at least as effective as IFB+MTX, in terms of activity and clinical remission, physical function and reduction in radiological progression. Safety data at 7 years have shown that the drug is comparable to MTX in monotherapy and safer than the IFB+MTX combination, although infections still constitute the main risk when using ABA. This review summarizes the safety and efficacy data of the AIM, ATTEST, Phase IIb IM101-100 and AGREE trials (AU)

WNA's worldwide overview on front-end nuclear fuel cycle growth and health, safety and environmental issues.

This paper presents the WNA's worldwide nuclear industry overview on the anticipated growth of the front-end nuclear fuel cycle from uranium mining to conversion and enrichment, and on the related key health, safety, and environmental (HSE) issues and challenges. It also puts an emphasis on uranium mining in new producing countries with insufficiently developed regulatory regimes that pose greater HSE concerns. It introduces the new WNA policy on uranium mining: Sustaining Global Best Practices in Uranium Mining and Processing-Principles for Managing Radiation, Health and Safety and the Environment, which is an outgrowth of an International Atomic Energy Agency (IAEA) cooperation project that closely involved industry and governmental experts in uranium mining from around the world.

Adaptación del «Cuestionario de Experiencias de Recuperación» a una muestra española / Adaptation of the «Recovery Experience Questionnaire» in a Spanish sample

El objetivo de este estudio consistió en examinar las propiedades psicométricas de la versión española del «Cuestionario de Experiencias de Recuperación» desarrollado por Sonnentag y Fritz. La muestra estaba compuesta por 941 trabajadores del sector de seguridad. Los resultados del análisis factorial exploratorio sugirieron la posibilidad de considerar una estructura de cuatro factores. En el análisis factorial confirmatorio se mantuvo dicha estructura, siendo el modelo que mejor ajustaba a los datos el que presentaba cuatro factores con tres ítems cada uno correlacionados entre sí (CFI= 0,97, GFI= 0,96, NNFI= 0,96, RMSEA= 0,05 y AIC= 171,76). Por tanto, el cuestionario mantiene la distinción de cuatro experiencias de recuperación -distanciamiento psicológico del trabajo, relajación, búsqueda de retos y control sobre el tiempo libre- aunque con 12 ítems frente a los 16 de la escala original. El análisis de fiabilidad del cuestionario mostró que la escala posee una adecuada consistencia interna, con valores situados entre 0,75 y 0,88. Se encontraron correlaciones significativas entre las experiencias de recuperación y diversas variables externas, lo que proporciona apoyo sobre su validez de constructo. Así pues, se considera que esta versión española posee adecuadas propiedades psicométricas y puede contribuir a ampliar el conocimiento sobre esta temática (AU)

The aim of this work was to examine the psychometric properties of the Spanish version of the «Recovery Experience Questionnaire» developed by Sonnentag and Fritz. The sample was made up of 941 professionals from the security sector. Results from the exploratory factor analysis suggested the possibility of considering a four-factor structure. Confirmatory factor analysis showed that the four-factor model with three correlated items each provided the best fi t to the data (CFI= 0.97, GFI= 0.96, NNFI= 0.96, RMSEA= 0.05 y AIC= 171.76). Therefore, the questionnaire maintains the four recovery experiences -psychological detachment from work, relaxation, mastery experiences and control over leisure time- but with 12 items instead of 16 items as in the original scale. Reliability analysis showed good internal consistency for this scale with Cronbach alpha coefficients for the factors ranging from .75 to .88. Significant correlations were found between the recovery experiences and various external variables, providing evidence of construct validity. Thus, this Spanish version shows adequate psychometric properties and may help to achieve a better understanding of this topic (AU)

Concentrations of 238U, 234U, 235U, 232Th, 230Th, 228Th, 226Ra, 228Ra, 224Ra, 210Po, 210Pb and 212Pb in drinking water in Italy: reconciling safety standards based on measurements of gross alpha and beta.

Some important naturally occurring alpha- and beta-radionuclides in drinking water samples collected in Italy were determined and the radiological quality evaluated. The mean activity concentrations (mBqL(-1)) of the radionuclides in the water samples were almost in the order: 26+/-36 ((234)U)>21+/-30 ((238)U)>8.9+/-15 ((226)Ra)>4.8+/-6.3 ((228)Ra)>4.0+/-4.1 ((210)Pb)>3.2+/-3.7 ((210)Po)>2.7+/-1.2 ((212)Pb)>1.4+/-1.8 ((224)Ra)> 1.1+/-1.3 ((235)U)>0.26+/-0.39 ((228)Th)>0.0023+/-0.0009 ((230)Th)>0.0013+/-0.0006 ((232)Th). The mean estimated dose (microSvyr(-1)) to an adult from the water intake was in this order: 2.8+/-3.3 ((210)Po)>2.4+/-3.2 ((228)Ra)>2.1+/-2.1 ((210)Pb)>1.8+/-3.1 ((226)Ra)>0.94+/-1.30 ((234)U)>0.70+/-0.98 ((238)U)>0.069+/-0.087 ((224)Ra)>0.036+/-0.044 ((235)U)>0.014+/-0.021 ((228)Th)>0.012+/-0.005 ((212)Pb)>0.00035+/-0.00029 ((230)Th)>0.00022+/-0.00009 ((232)Th). It is obvious that (210)Po, (228)Ra, (210)Pb and (226)Ra are the most important dose contributors in the drinking water intake. As far as the seventeen brands of analysed drinking water were concerned, the committed effective doses were in the range of 2.81-38.5 microSvyr(-1), all well below the reference level of the committed effective dose (100 microSvyr(-1)) recommended by the WHO. These data throw some light on the scale of the radiological impact on the public from some naturally occurring radionuclides in drinking water, and can also serve as a comparison for the dose contribution from artificial radionuclides released to the environment as a result of human practices. Based on the radionuclide composition in the analysed waters, comment was made on the new screening level for gross alpha activity in guidelines for drinking-water quality recommended by the WHO, 2004.

Determination of total content and isotopic compositions of plutonium and uranium in environmental samples for safeguards purposes by ICP-QMS.

The aim of this work was to determine the concentrations and isotopic compositions of plutonium and uranium in environmental samples for safeguards purposes. An analytical method was developed with a plutonium and uranium separation procedure based on extraction chromatography (using 2mL TEVA and UTEVA columns) and detection with a quadrupole ICP-MS applying an ultra-sonic nebulizer coupled with a membrane desolvation system. Starting from blank swipes, the background equivalent concentration (BEC) was 8fg for (239)Pu and 1ng (238)U. The method was successfully applied to certified reference materials as well as to round robin samples obtained in the framework of the inter-laboratory exercise program, promoted by the Brazilian-Argentine Agency for Accounting and Control of Nuclear Materials (ABACC), together with the US Department of Energy (USDOE). After the introduction of an additional ion-exchange separation step, the methodology was applied to the IAEA-384 sediment reference sample with precise and accurate total plutonium and uranium, (240)Pu/(239)Pu, (241)Pu/(239)Pu, (234)U/(238)U and (235)U/(238)U atomic ratio results.

Using the Framework for Health Promotion Action to address staff perceptions of occupational health and safety at a fly-in/fly-out mine in north-west Queensland.

ISSUE ADDRESSED: An exploratory descriptive study was undertaken to identify staff perceptions of the types and sources of occupational health and safety hazards at a remote fly-in-fly-out minerals extraction and processing plant in northwest Queensland. METHODS: Ongoing focus groups with all sectors of the operation were conducted concurrently with quantitative research studies from 2001 to 2005. Action research processes were used with management and staff to develop responses to identified issues. RESULTS: Staff identified and generated solutions to the core themes of: health and safety policies and procedures; chemical exposures; hydration and fatigue. The Framework for Health Promotion Action was applied to ensure a comprehensive and holistic response to identified issues. CONCLUSIONS: Participatory processes using an action research framework enabled a deep understanding of staff perceptions of occupational health and safety hazards in this setting. The Framework for Health Promotion provided a relevant and useful tool to engage with staff and develop solutions to perceived occupational health and safety issues in the workplace.

Safe depth of abdominal acupoints in pediatric patients.

OBJECTIVES: To evaluate the depths to which acupuncture needles can be inserted safely (safe depth) in 12 abdominal acupoints in pediatric patients. This study also evaluates the variations in safe depth according to sex, age, body weight, and waist girth. DESIGN: We retrospectively studied computerized tomography (CT) images of pediatric patients aged 7-15 years who had undergone abdominal CT scans at our hospital from January 1997 to March 2006. The safe depth of 12 acupoints along the conception vessel (CV) meridian (Renmai), CV-2 to CV-7 and CV-9 to CV-14, were measured directly on the CT images. The relationship between the safe depth of these acupoints and sex, age, body weight and waist girth was analyzed by one-way ANOVA and multiple linear regression analysis. RESULTS: A total of 219 patients were included in this study. Except for CV-2, there was no significant difference in safe depth of the other 11 acupoints between sexes. The safe depth of all 12 CV acupoints increased significantly (P<0.001) with age, body weight and waist girth. There were large variations in the safe depth of the 12 points among different age and body weight groups. The safe depths were 1.3-2.1 times deeper in the 12-15-year-old group than in the 7-9-year-old group, and 1.7-3 times deeper in overweight children than in underweight children. CONCLUSION: The safe depth to which the 12 abdominal CV meridian acupoints can be needled significantly increases with age, body weight and waist girth in pediatric patients aged 7-15 years. Physicians who perform acupuncture in pediatric patients should be aware of the large variations in safe depth of acupoints to prevent possible complications.

Investigating the safety of electroacupuncture with a Picoscope.

Our wish to know more about the paths taken by electrical currents in electroacupuncture (EA) with special reference to the heart, particularly in patients with an implanted pacemaker, prompted us to undertake this study. Using ourselves as subjects, we have developed a safe oscillographic method to detect, visualise and record the EA currents that avoids the use of equipment requiring mains electricity. After two trials with unsatisfactory equipment, we found that the newly developed model 3425 PicoScopeTM (Pico Technology Ltd), with a four channel differential amplifier input connected to a laptop PC operating in battery mode, satisfied our criteria. With this recording system, we carried out two sets of experiments in which EA was provided by a Cefar acus4TM stimulator. The results confirm that the placement of a pair of acupuncture needles for EA can be used to predict the paths taken by the stimulating currents, and thus their areas of likely influence. When the needles are placed in closely adjacent acupuncture points in a limb, there is little or no detectable spread of the currents along the limb or into the chest. By contrast, when the needles are placed far apart, the electrical currents spread widely. Thus, when each of a pair of needles is placed in a point on opposite arms, the electrical currents recorded in the area of the pectoral muscles is of an order that might trigger an abnormal cardiac rhythm in a susceptible heart or activate a cardiac pacemaker incorporating an intracardiac defibrillator (ICD). Our results confirm the guidelines for EA safe practice recommended by the British Medical Acupuncture Society (BMAS) to avoid adverse events, ie EA should not be applied such that the current is likely to traverse the heart. We can now be confident that electric fields generated by pairs of needles below the knee or elbow do not create detectable currents in the chest. It is likely that similar results would be obtained with the use of transcutaneous electrical nerve stimulation (TENS) but this remains to be established by additional experiments.