Population Pharmacokinetics and Pharmacodynamics of Dobutamine in Neonates on the First Days of Life

Aims: To describe the pharmacokinetics (PK) and concentration‐related effects of dobutamine in critically ill neonates in the first days of life, using nonlinear mixed effects modelling. Methods: Dosing, plasma concentration and haemodynamic monitoring data from a dose‐escalation study were analysed with a simultaneous population PK and pharmacodynamic model. Neonates receiving continuous infusion of dobutamine 5–20 μg kg−1 min−1 were included. Left ventricular ejection fraction (LVEF) and cardiac output of right and left ventricle (RVO, LVO) were measured on echocardiography; heart rate (HR), mean arterial pressure (MAP), peripheral arterial oxygen saturation and cerebral regional oxygen saturation were recorded from patient monitors. Results: Twenty‐eight neonates with median (range) gestational age of 30.4 (22.7–41.0) weeks and birth weight (BW) of 1618 (465–4380) g were included. PK data were adequately described by 1‐compartmental linear structural model. Dobutamine clearance (CL) was described by allometric scaling on BW with sigmoidal maturation function of postmenstrual age (PMA). The final population PK model parameter mean typical value (standard error) estimates, standardised to median BW of 1618 g, were 41.2 (44.5) L h−1 for CL and 5.29 (0.821) L for volume of distribution, which shared a common between subject variability of 29% (17.2%). The relationship between dobutamine concentration and RVO/LVEF was described by linear model, between concentration and LVO/HR/MAP/cerebral fractional tissue oxygen extraction by sigmoidal Emax model. Conclusion: In the postnatal transitional period, PK of dobutamine was described by a 1‐compartmental linear model, CL related to BW and PMA. A concentration–response relationship with haemodynamic variables has been established

Long–term hay meadow management maintains the target community despite local-scale species turnover

Hay meadows, which are managed using a low intensity regime, are characterised by highly diverse vegetation but have declined significantly since the mid twentieth century. Remaining species-rich meadows are often protected by statutory designations and conservation management agreements. However, long-term studies of change in the composition of meadow vegetation, and investigations of the success of conservation over the long-term are rare. Fourteen sites, which had a long history of being managed for field dried hay, were resurveyed after 25 years and redundancy analysis was undertaken to investigate changes in community composition. Investigations of the effect of soil conditions, site size and spatial distribution of the meadow sites were carried out. Although overall community composition had changed significantly, the suite of species representative of the meadow community had been maintained, and species usually associated with more intensively managed grasslands had declined. However, there were losses of particular species of conservation importance such as Alchemilla glabra and Conopodium majus, and losses and gains of species varied from site to site. There was a significant increase in the homogeneity of the meadow vegetation between the two survey years. Comparisons of indicators of soil conditions suggested that there had been no significant change for the community as a whole but analyses of the species showing the most change indicated a decrease in soil fertility. Low intensity management has been successful in maintaining the meadow community but consideration of changes in key species and losses at the site level is needed. More research is needed to establish whether fragmentation is starting to have an impact on diversity

Molecular Descriptors from Two-Dimensional Chemical Structure

This chapter presents a review of whole-molecule descriptors obtained from two-dimensional chemical structure. The sections include a short overview of the mathematical foundation (graph theory) that is behind the calculation of topological descriptors. A concise overview, together with practical calculated examples, is provided for major classes of 2-D descriptors, including topological indices, information content descriptors, electrotopological descriptors, and autocorrelation descriptors. Numerous examples of their practical use in QSAR modelling are presented. The examples are dedicated to in silico toxicology modelling applications, including toxicities towards Pimephales promelas, Tetrahymena pyriformis, Daphnia magna, Vibrio fischeri, Chlorella vulgaris, rodents and humans. Also the role of 2-D descriptors in the modelling of soil sorption coefficients is presented. Emphasis is given to the interpretation of topological descriptors in QSAR models. Finally, a state-of-the art overview of available applications for the calculation of molecular descriptors is given together with an extensive bibliography of the relevant literature.</jats:p

Population Pharmacokinetics and Dosing of Milrinone After Patent Ductus Arteriosus Ligation in Preterm Infants

OBJECTIVES: The postoperative course of patent ductus arteriosus ligation is often complicated by postligation cardiac syndrome, occurring in 10-45% of operated infants. Milrinone might prevent profound hemodynamic instability and improve the recovery of cardiac function in this setting. The present study aimed to describe the population pharmacokinetics of milrinone in premature neonates at risk of postligation cardiac syndrome and give dosing recommendations. DESIGN: A prospective single group open-label pharmacokinetics study. SETTINGS: Two tertiary care neonatal ICUs: Tallinn Children's Hospital and Tartu University Hospital, Estonia. PATIENTS: Ten neonates with postmenstrual age of 24.6-30.1 weeks and postnatal age of 5-27 days undergoing patent ductus arteriosus ligation and at risk of postligation cardiac syndrome, based on echocardiographic assessment of left ventricular output of less than 200 mL/kg/min 1 hour after the surgery. INTERVENTIONS: Milrinone at a dose of 0.73 μg/kg/min for 3 hours followed by 0.16 μg/kg/min for 21 hours. Four blood samples from each patient for milrinone plasma concentration measurements were collected. MEASUREMENTS AND MAIN RESULTS: Concentration-time data of milrinone were analyzed with nonlinear mixed-effects modeling software (NONMEM Version 7.3 [ICON Development Solutions, Ellicott City, MD]). Probability of target attainment simulations gave a dosing schedule that maximally attains concentration targets of 150-250 μg/L. Milrinone pharmacokinetics was described by a one-compartmental linear model with allometric scaling to bodyweight and an age maturation function of glomerular filtration rate. Parameter estimates for a patient with the median weight were 0.350 (L/hr) for clearance and 0.329 (L) for volume of distribution. The best probability of target attainment was achieved with a loading dose of 0.50 μg/kg/min for 3 hours followed by 0.15 μg/kg/min (postmenstrual age < 27 wk) or 0.20 μg/kg/min (postmenstrual age ≥ 27 wk). CONCLUSIONS: Population pharmacokinetic modeling and simulations suggest a slow loading dose followed by maintenance infusion to reach therapeutic milrinone plasma concentrations within the timeframe of the postligation cardiac syndrome

Population pharmacokinetics and pharmacodynamics of dobutamine in neonates on the first days of life

Aims: To describe the pharmacokinetics (PK) and concentration‐related effects of dobutamine in critically ill neonates in the first days of life, using nonlinear mixed effects modelling. Methods: Dosing, plasma concentration and haemodynamic monitoring data from a dose‐escalation study were analysed with a simultaneous population PK and pharmacodynamic model. Neonates receiving continuous infusion of dobutamine 5–20 μg kg−1 min−1 were included. Left ventricular ejection fraction (LVEF) and cardiac output of right and left ventricle (RVO, LVO) were measured on echocardiography; heart rate (HR), mean arterial pressure (MAP), peripheral arterial oxygen saturation and cerebral regional oxygen saturation were recorded from patient monitors. Results: Twenty‐eight neonates with median (range) gestational age of 30.4 (22.7–41.0) weeks and birth weight (BW) of 1618 (465–4380) g were included. PK data were adequately described by 1‐compartmental linear structural model. Dobutamine clearance (CL) was described by allometric scaling on BW with sigmoidal maturation function of postmenstrual age (PMA). The final population PK model parameter mean typical value (standard error) estimates, standardised to median BW of 1618 g, were 41.2 (44.5) L h−1 for CL and 5.29 (0.821) L for volume of distribution, which shared a common between subject variability of 29% (17.2%). The relationship between dobutamine concentration and RVO/LVEF was described by linear model, between concentration and LVO/HR/MAP/cerebral fractional tissue oxygen extraction by sigmoidal Emax model. Conclusion: In the postnatal transitional period, PK of dobutamine was described by a 1‐compartmental linear model, CL related to BW and PMA. A concentration–response relationship with haemodynamic variables has been established

Liability for Environmental Harm as a Response to the Anthropocene

The Anthropocene is often framed in terms of understanding and mitigating large-scale human-induced environmental change. However, facing unprecedented planetary transformations, the differentiated impacts that global environmental change has across communities, species, time and place must not only be considered and characterised, but actively remedied. Instruments that help reconcile related inequities and facilitate our daily existence within injured environments are also essential. We argue that ‘liability for environmental harm’ provides a critical, if under-utilised and challenging, legal response to the Anthropocene