Paracetamol, widely used hardly understood

__Abstract__ Paracetamol (APAP), in the USA known as acetaminophen, is widely used both in hospital settings and at home for antipyresis and mild (postoperative) pain. Although APAP is available over the counter and is ranked on the third place, following nystatin and cisapride, when looking at the most commonly prescribed drugs in our Pediatric Surgical Intensive Care Unit (PSICU), it is surprising that there are still little data available concerning the pharmacokinetics (i.e. absorption, distribution, metabolism and elimination) and pharmacodynamics (i.e. effects) of APAP in children. Off label prescription of APAP is common, since prescription is often outside the terms of the product license with regards to the age of the patient, the indication and the dose and frequency of administration. Product license does not account for children < 3 months of age and prolonged use in children < 4 years of age for more than 2 days is advised against, since studies investigating the effects of prolonged use in children ar

Efficacy of different routes of acetaminophen administration for postoperative pain in children:a systematic review and network meta-analysis

Purpose: Acetaminophen is the most common drug used to treat acute pain in the pediatric population, given its wide safety margin, low cost, and multiple routes for administration. We sought to determine the most efficacious route of acetaminophen administration for postoperative acute pain relief in the pediatric surgical population. Methods: We conducted a systematic review of randomized controlled trials (RCTs) that included children aged between 30 days and 17 yr who underwent any type of surgical procedure and that evaluated the analgesic efficacy of different routes of administration of acetaminophen for the treatment of postoperative pain. We searched MEDLINE, CENTRAL, Embase, CINAHL, LILACs, and Google Scholar databases for trials published from inception to 16 April 2023. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias 1.0 tool. We performed a frequentist network meta-analysis using a random-effects model. Our primary outcome was postoperative pain using validated pain scales. Results: We screened 2,344 studies and included 14 trials with 829 participants in the analysis. We conducted a network meta-analysis for the period from zero to two hours, including six trials with 496 participants. There was no evidence of differences between intravenous vs rectal routes of administration of acetaminophen (difference in means, −0.28; 95% confidence interval [CI], −0.62 to 0.06; very low certainty of the evidence) and intravenous vs oral acetaminophen (difference in means, −0.60; 95% CI, −1.20 to 0.01; low certainty of the evidence). For the comparison of oral vs rectal routes, we found evidence favouring the oral route (difference in means, −0.88; 95% CI, −1.44 to −0.31; low certainty of the evidence). Few trials reported secondary outcomes of interest; when comparing the oral and rectal routes in the incidence of nausea and vomiting, there was no evidence of differences (relative risk, 1.20; 95% CI, 0.81 to 1.78). Conclusion: The available evidence on the effect of the administration route of acetaminophen on postoperative pain in children is very uncertain. The outcomes of postoperative pain control and postoperative vomiting may differ very little between the oral and rectal route. Better designed and executed RCTs are required to address this important clinical question. Study registration: PROSPERO (CRD42021286495); first submitted 19 November 2021.</p

Efficacy of different routes of acetaminophen administration for postoperative pain in children:a systematic review and network meta-analysis

Purpose: Acetaminophen is the most common drug used to treat acute pain in the pediatric population, given its wide safety margin, low cost, and multiple routes for administration. We sought to determine the most efficacious route of acetaminophen administration for postoperative acute pain relief in the pediatric surgical population. Methods: We conducted a systematic review of randomized controlled trials (RCTs) that included children aged between 30 days and 17 yr who underwent any type of surgical procedure and that evaluated the analgesic efficacy of different routes of administration of acetaminophen for the treatment of postoperative pain. We searched MEDLINE, CENTRAL, Embase, CINAHL, LILACs, and Google Scholar databases for trials published from inception to 16 April 2023. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias 1.0 tool. We performed a frequentist network meta-analysis using a random-effects model. Our primary outcome was postoperative pain using validated pain scales. Results: We screened 2,344 studies and included 14 trials with 829 participants in the analysis. We conducted a network meta-analysis for the period from zero to two hours, including six trials with 496 participants. There was no evidence of differences between intravenous vs rectal routes of administration of acetaminophen (difference in means, −0.28; 95% confidence interval [CI], −0.62 to 0.06; very low certainty of the evidence) and intravenous vs oral acetaminophen (difference in means, −0.60; 95% CI, −1.20 to 0.01; low certainty of the evidence). For the comparison of oral vs rectal routes, we found evidence favouring the oral route (difference in means, −0.88; 95% CI, −1.44 to −0.31; low certainty of the evidence). Few trials reported secondary outcomes of interest; when comparing the oral and rectal routes in the incidence of nausea and vomiting, there was no evidence of differences (relative risk, 1.20; 95% CI, 0.81 to 1.78). Conclusion: The available evidence on the effect of the administration route of acetaminophen on postoperative pain in children is very uncertain. The outcomes of postoperative pain control and postoperative vomiting may differ very little between the oral and rectal route. Better designed and executed RCTs are required to address this important clinical question. Study registration: PROSPERO (CRD42021286495); first submitted 19 November 2021.</p

The SLUGGS Survey: kinematics for over 2500 globular clusters in twelve early-type galaxies

We present a spectrophotometric survey of 2522 extragalactic globular clusters (GCs) around 12 early-type galaxies, nine of which have not been published previously. Combining space-based and multicolour wide-field ground-based imaging, with spectra from the Keck/DEep Imaging Multi-Object Spectrograph (DEIMOS) instrument, we obtain an average of 160 GC radial velocities per galaxy, with a high-velocity precision of ∼15 km s−1 per GC. After studying the photometric properties of the GC systems, such as their spatial and colour distributions, we focus on the kinematics of metal-poor (blue) and metal-rich (red) GC subpopulations to an average distance of ∼8 effective radii from the galaxy centre. Our results show that for some systems the bimodality in GC colour is also present in GC kinematics. The kinematics of the red GC subpopulations are strongly coupled with the host galaxy stellar kinematics. The blue GC subpopulations are more dominated by random motions, especially in the outer regions, and decoupled from the red GCs. Peculiar GC kinematic profiles are seen in some galaxies: the blue GCs in NGC 821 rotate along the galaxy minor axis, whereas the GC system of the lenticular galaxy NGC 7457 appears to be strongly rotation supported in the outer region. We supplement our galaxy sample with data from the literature and carry out a number of tests to study the kinematic differences between the two GC subpopulations. We confirm that the GC kinematics are coupled with the host galaxy properties and find that the velocity kurtosis and the slope of their velocity dispersion profiles are different between the two GC subpopulations in more massive galaxies

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

The SAMI Galaxy Survey : data release one with emission-line physics value-added products

SAMI DR1 data products available from http://datacentral.aao.gov.au/asvo/surveys/sami/We present the first major release of data from the SAMI Galaxy Survey. This data release focuses on the emission-line physics of galaxies. Data Release One includes data for 772 galaxies, about 20% of the full survey. Galaxies included have the redshift range 0.004 <  z < 0.092, a large massrange (7.6 < log M∗/M⊙ < 11.6), and star-formation rates of ∼10−4 to ∼101 M⊙yr−1. For each galaxy, we include two spectral cubes and a set of spatially resolved 2D maps: single- and multi-component emission-line fits (with dust extinction corrections for strong lines), local dust extinction and star-formation rate. Calibration of the fibre throughputs, fluxes and differential-atmospheric-refraction has been improved over the Early Data Release. The data have average spatial resolution of 2.16 arcsec (FWHM) over the 15 arcsec diameter field of view and spectral (kinematic) resolution R= 4263 (σ= 30 km s−1) around Hα. The relative flux calibration is better than 5% and absolute flux calibration better than ±0.22 mag, with the latter estimate limited by galaxy photometry. The data are presented online through the Australian Astronomical Observatory’s Data Central.Publisher PDFPeer reviewe