Pragmatic physiologically-based pharmacokinetic modeling to support clinical implementation of optimized gentamicin dosing in term neonates and infants: proof-of-concept

IntroductionModeling and simulation can support dosing recommendations for clinical practice, but a simple framework is missing. In this proof-of-concept study, we aimed to develop neonatal and infant gentamicin dosing guidelines, supported by a pragmatic physiologically-based pharmacokinetic (PBPK) modeling approach and a decision framework for implementation.MethodsAn already existing PBPK model was verified with data of 87 adults, 485 children and 912 neonates, based on visual predictive checks and predicted-to-observed pharmacokinetic (PK) parameter ratios. After acceptance of the model, dosages now recommended by the Dutch Pediatric Formulary (DPF) were simulated, along with several alternative dosing scenarios, aiming for recommended peak (i.e., 8–12 mg/L for neonates and 15–20 mg/L for infants) and trough (i.e., <1 mg/L) levels. We then used a decision framework to weigh benefits and risks for implementation.ResultsThe PBPK model adequately described gentamicin PK. Simulations of current DPF dosages showed that the dosing interval for term neonates up to 6 weeks of age should be extended to 36–48 h to reach trough levels <1 mg/L. For infants, a 7.5 mg/kg/24 h dose will reach adequate peak levels. The benefits of these dose adaptations outweigh remaining uncertainties which can be minimized by routine drug monitoring.ConclusionWe used a PBPK model to show that current DPF dosages for gentamicin in term neonates and infants needed to be optimized. In the context of potential uncertainties, the risk-benefit analysis proved positive; the model-informed dose is ready for clinical implementation

Four Work-Ins by Australian Journalists, 1944-80

During industrial disputes with employers between 1944 and 1980 the Australian Journalist's Association occasionally turned to the tactic of the work-in, producing wild cat newspapers during strikes in Sydney. These newspapers (The News, and The Clarion) exemplified problematic elements of the work-in as a working-class strategy. While single incident studies of the work-in have been conducted in Australia, the Australian Journalist Association work-ins present a time series of struggle. This time series allows for a broader evaluation of the radical content of the work-in and indicates that the tactic can become systematised, less radical, and less participatory when not connected to a broader generation of workplace radical behaviour by workers. In short: the work-in, much like the strike or go slow, can become a tame cat tactic – it is not inherently transgressive or opposed to capitalist production. Expectedly, the first work-ins were more radical in scope, presenting a newspaper which fully duplicated the commodity produced under capitalist control and in some ways exceeded the scope presented by capitalist organised journalism in both a material and a cultural sense. However, this radical economic potential dissipated by the end of the time series of work-ins. Instead of providing an alternative commodity fit for market, the tactic produced propaganda pieces aimed primarily at the members of the community who would be predisposed to favour the journalist's case. The 1980s Clarion was not a daily newspaper of news, sport, racing, women's interest, classifieds, and general opinion. This change will be explained in terms of human causes such as skills loss, production process causes such as computerisation and wire services, and broader social causes such as the changing role of the newspaper in Australian society.The symposium is organised on behalf of AAHANZBS by the Business and Labour History Group, The University of Sydney, with the financial support of the University’s Faculty of Economics and Business

Physiologically Based Pharmacokinetic (PBPK) Model-Informed Dosing Guidelines for Pediatric Clinical Care: A Pragmatic Approach for a Special Population

Physiologically based pharmacokinetic (PBPK) modeling can be an attractive tool to increase the evidence base of pediatric drug dosing recommendations by making optimal use of existing pharmacokinetic (PK) data. A pragmatic approach of combining available compound models with a virtual pediatric physiology model can be a rational solution to predict PK and hence support dosing guidelines for children in real-life clinical care, when it can also be employed by individuals with little experience in PBPK modeling. This comes within reach as user-friendly PBPK modeling platforms exist and, for many drugs and populations, models are ready for use. We have identified a list of drugs that can serve as a starting point for pragmatic PBPK modeling to address current clinical dosing needs