Oro-mucosal midazolam maleate: Use and effectiveness in adults with epilepsy in the UK.

BACKGROUND: Oro-mucosal midazolam maleate (OMM) with suitable training to family and carers is being increasingly recognized as the treatment of choice to mitigate the development of status epilepticus in non-hospital community settings. There are no studies to describe the use, effectiveness, and suitable dosing of OMM in adults with epilepsy in community settings. PURPOSE: To describe the use, effectiveness, and dosing of OMM in the emergency treatment of epileptic seizures in community settings. METHODS: A retrospective observational study (2016-17) design was used with participant recruitment from four UK NHS secondary care outpatient clinics providing epilepsy management. Study sample was of adult people with epilepsy (PWE) having had a recent seizure requiring OMM. Data on patient demographics, patient care plans, details of a recent seizure requiring emergency medication, and dose of OMM were collected from medical records. RESULTS: Study data from 146 PWE were included. The mean age of PWE was 41.0 years (SD 15.2) and mean weight was 64.8Kg (SD 18.2). Fifty-three percent of PWE were recorded as having intellectual disability. The most frequently used concomitant medications were lamotrigine (43%). The majority of seizures occurred at people's homes (n = 92, 63%). OMM was most often administered by family/professional care-givers (n = 75, 48.4%). Generalized (tonic/clonic) seizures were recorded in most people (n = 106, 72.6%). The most common initial dose of OMM was 10 mg (n = 124, 84.9%). The mean time to seizure cessation after administration of this initial dose was 5.5 minutes (SD = 4.5, Median 5.0, IQR 2.1-5.0). Only a minority of seizures led to ambulance callouts (n = 18, 12.3%) or hospital admissions (n = 13, 9%). CONCLUSION: This is the first observational study describing the use and effectiveness of OMM in adults in community settings. Minimal hospital admissions were reported in this cohort and the treatment was effective in ending seizures in adults in community settings.

Ultra-sensitive chip scale Sagnac gyroscope based on periodically modulated coupling of a coupled resonator optical waveguide.

We analyze the sensitivity to inertial rotations Ω of a micron scale integrated gyroscope consisting of a coupled resonator optical waveguide (CROW). We show here that by periodic modulation of the evanescent coupling between resonators, the sensitivity to rotations can be enhanced by a factor up to 10(9) in comparison to a conventional CROW with uniform coupling between resonators. Moreover, the overall shape of the transmission through this CROW superlattice is qualitatively changed resulting in a single sharp transmission resonance located at Ω = 0s-1 instead of a broad transmission band. The modulated coupling therefore allows the CROW gyroscope to operate without phase biasing and with sensitivities suitable for inertial navigation even with the inclusion of resonator losses.

Chirped area coupled resonator optical waveguide gyroscope.

We study the transmission of an optical field through a rotating coupled resonator optical waveguide (CROW) in which the size of the ring resonators changes from one ring to the next. We focus on symmetric integer wavelength chirps of the circumference of the rings relative to the central ring in the array. The transfer matrix method is used to obtain the transmission as a function of the inertial rotation rate Ω resulting from the Sagnac effect. Chirping increases the slope of the oscillations in the transmission as a function of Ω, which can be exploited to further enhance the rotation sensitivity beyond that of a CROW with uniform resonators.

Inclusion in primary care for people with intellectual disabilities: gaining the perspective of service user and supporting social care staff.

The aim of this study was to gain service user and social care staff perspectives on the barriers facing people with intellectual disabilities when accessing primary healthcare. A qualitative mixed methods semi-structured approach involved the use of focus groups and individual interviews within the service users' homes. A purposive sampling strategy identified people using primary healthcare in the last 6 months (N = 6) with support from social care staff (N = 19). Three emergent themes were common to service users and carer staff: ;accessing the surgery', ;communication issues' and ;waiting around'. Other themes were unique to each group. Social care staff identified the ;attitudes and behaviour of primary healthcare staff' as sometimes problematic, and the importance of ;knowing the service user'. Service users identified ;feelings about going to the doctor', ;health education' and ;making changes'. Gaining these views is an important first step in improving access to primary healthcare.