Population Pharmacokinetics and Pharmacodynamics of Extended-Infusion Piperacillin and Tazobactam in Critically Ill Children

The study objective was to evaluate the population pharmacokinetics and pharmacodynamics of extended-infusion piperacillintazobactam in children hospitalized in an intensive care unit. Seventy-two serum samples were collected at steady state from 12 patients who received piperacillin-tazobactam at 100/12.5 mg/kg of body weight every 8 h infused over 4 h. Population pharmacokinetic analyses were performed using NONMEM, and Monte Carlo simulations were performed to estimate the piperacillin pharmacokinetic profiles for dosing regimens of 80 to 100 mg/kg of the piperacillin component given every 6 to 8 h and infused over 0.5, 3, or 4 h. The probability of target attainment (PTA) for a cumulative percentage of the dosing interval that the drug concentration exceeds the MIC under steady-state pharmacokinetic conditions (TMIC) of\u3e50% was calculated at MICs ranging from 0.25 to 64 mg/liter. The mean ± standard deviation (SD) age, weight, and estimated glomerular filtration rate were 5 ± 3 years, 17 ± 6.2 kg, and 118 ± 41 ml/min/1.73m2, respectively. A one-compartment model with zero-order input and first-order elimination best fit the pharmacokinetic data for both drugs. Weight was significantly associated with piperacillin clearance, and weight and sex were significantly associated with tazobactam clearance. Pharmacokinetic parameters (mean ± SD) for piperacillin and tazobactam were as follows: clearance, 0.22 ± 0.07 and 0.19 ± 0.07 liter/h/kg, respectively; volume of distribution, 0.43 ± 0.16 and 0.37 ± 0.14 liter/kg, respectively. All extended-infusion regimens achieved PTAs of\u3e90% at MICs of/liter. Only the 3-h infusion regimens given every 6 h achieved PTAs of\u3e90% at an MIC of 32 mg/liter. For susceptible bacterial pathogens, piperacillin-tazobactam doses of\u3e80/10 mg/kg given every 8 h and infused over 4 h achieve adequate pharmacodynamic exposures in critically ill children

eHealth Education and Support for Pediatric Hearing Aid Management: Parent Goals, Questions and Challenges

Purpose: To investigate parent goals, questions, and challenges that emerged during coaching phone calls in an eHealth program designed to provide education and support for hearing aid management. Methods: Coaching phone calls were audio-recorded, transcribed and qualitatively analyzed for emergent themes within the categories of goals, questions, and challenges. Results: Emergent themes revealed parent goals were focused on self-efficacy, routines, device care and child development. Emergent themes for questions revealed parents asked questions related to the device care, audiology appointments, confirmation of learning, and child development. For challenges emergent themes revealed parents’ own struggles (e.g., with emotions), issues related to working with their audiologist, child factors and anticipated challenges. Conclusion: The eHealth intervention allowed parents to raise questions and discuss their challenges in a supportive environment. Supportive accountability helped participants identify and address barriers to hearing aid management based on their priorities and current challenges. Providing supplemental learning support, in addition to routine audiology visits, can help parents develop more effective hearing aid management routines

The ALFALFA "Almost Darks" Campaign: Pilot VLA HI Observations of Five High Mass-to-Light Ratio Systems

We present VLA HI spectral line imaging of 5 sources discovered by ALFALFA. These targets are drawn from a larger sample of systems that were not uniquely identified with optical counterparts during ALFALFA processing, and as such have unusually high HI mass to light ratios. These candidate "Almost Dark" objects fall into 4 categories: 1) objects with nearby HI neighbors that are likely of tidal origin; 2) objects that appear to be part of a system of multiple HI sources, but which may not be tidal in origin; 3) objects isolated from nearby ALFALFA HI detections, but located near a gas-poor early-type galaxy; 4) apparently isolated sources, with no object of coincident redshift within ~400 kpc. Roughly 75% of the 200 objects without identified counterparts in the $\alpha$.40 database (Haynes et al. 2011) fall into category 1. This pilot sample contains the first five sources observed as part of a larger effort to characterize HI sources with no readily identifiable optical counterpart at single dish resolution. These objects span a range of HI mass [7.41 < log(M$_{\rm HI}$) < 9.51] and HI mass to B-band luminosity ratios (3 < M$_{\rm HI}$/L$_{\rm B}$ < 9). We compare the HI total intensity and velocity fields to SDSS optical imaging and to archival GALEX UV imaging. Four of the sources with uncertain or no optical counterpart in the ALFALFA data are identified with low surface brightness optical counterparts in SDSS imaging when compared with VLA HI intensity maps, and appear to be galaxies with clear signs of ordered rotation. One source (AGC 208602) is likely tidal in nature. We find no "dark galaxies" in this limited sample. The present observations reveal complex sources with suppressed star formation, highlighting both the observational difficulties and the necessity of synthesis follow-up observations to understand these extreme objects. (abridged)Comment: Astronomical Journal, in pres

Everyone everywhere: A distributed and embedded paradigm for usability

We present a new paradigm to address the persistence of difficulties that people have in accessing and using information. Our idea consists of two main aspects: engaging wider society with usability and distributing the topic across disciplines. We claim that bad usability is a social justice issue. Primarily, we propose that usability should become the subject of widespread activism across society, enabling more people to realize that their usability problems are not due to inadequacies in themselves but in current designs. People should be encouraged and enabled to complain about their experiences with an expectation of improvements. We also propose that the current restriction of this topic to certain disciplinary units is overly narrow and that instead there should be radical embedding of usability concepts across many different fields and settings. We believe that the usability of information systems is core to information science and that information scientists should resume their historic role as heralds and pioneers of human–computer interaction

X-linked hypophosphatemia caused by the prevailing North American PHEX variant c.*231A\u3eG; exon 13–15 duplication is often misdiagnosed as ankylosing spondylitis and manifests in both men and women

Inactivating mutations of the gene coding for phosphate-regulating endopeptidase homolog X-linked (PHEX) cause X-linked hypophosphatemia (XLH). A nove

Human cytomegalovirus protein pUL36: A dual cell death pathway inhibitor.

Human cytomegalovirus (HCMV) is an important human pathogen and a paradigm of intrinsic, innate, and adaptive viral immune evasion. Here, we employed multiplexed tandem mass tag-based proteomics to characterize host proteins targeted for degradation late during HCMV infection. This approach revealed that mixed lineage kinase domain-like protein (MLKL), a key terminal mediator of cellular necroptosis, was rapidly and persistently degraded by the minimally passaged HCMV strain Merlin but not the extensively passaged strain AD169. The strain Merlin viral inhibitor of apoptosis pUL36 was necessary and sufficient both to degrade MLKL and to inhibit necroptosis. Furthermore, mutation of pUL36 Cys131 abrogated MLKL degradation and restored necroptosis. As the same residue is also required for pUL36-mediated inhibition of apoptosis by preventing proteolytic activation of procaspase-8, we define pUL36 as a multifunctional inhibitor of both apoptotic and necroptotic cell death

Highly purified human-derived follicle-stimulating hormone (Bravelle®) has equivalent efficacy to follitropin-beta (Follistim ®) in infertile women undergoing in vitro fertilization

BACKGROUND: These data compare the efficacy and safety of highly purified human-derived follicle-stimulating hormone (Bravelle(R)) and recombinant follitropin-β (Follistim(R)) in women undergoing in vitro fertilization. METHODS: This report describes the pooled data from two, nearly identical, randomized, controlled, parallel-group, multicenter studies conducted in a total of 19 academic and private IVF-ET centers in the United States. Infertile premenopausal women underwent pituitary down-regulation using leuprolide acetate followed by a maximum of 12 days of subcutaneous Bravelle(R) (n = 120) or Follistim(R) (n = 118), followed by administration of human chorionic gonadotropin, oocyte retrieval and embryo transfer. The primary efficacy measure was the mean number of oocytes retrieved; secondary efficacy measures included the total dose and duration of gonadotropin treatment; peak serum estradion levels; embryo transfer and implantation rates; chemical, clinical and continuing pregnancies; and live birth rates. All adverse events were recorded and injection site pain was recorded daily using a patient, self-assessment diary. RESULTS: Similar efficacy responses were observed for all outcome parameters in the two treatment groups. Although patients receiving Bravelle(R) consistently reported a greater number of chemical, clinical and continuing pregnancies, as well as an increased rate of live birth, the data did not attain statistical significance (P > 0.05). The overall incidence of adverse events was similar in both groups, but compared to Follistim(R), injections of Bravelle(R) were reported by patients to be significantly less painful (P < 0.001). CONCLUSIONS: Bravelle(R) and Follistim(R) had comparable efficacy in controlled ovarian hyperstimulation in women undergoing IVF-ET. There were no differences in the nature or number of adverse events between the treatment groups although Bravelle(R) injections were reported to be significantly less painful

Activism, affect, identification: trans documentary in France and Spain and its reception

This article explores the documentation of trans activism in France and Spain since the 2000s. The first part addresses questions surrounding the place of affect and narrative in documentary film, particularly in relation to trans issues. The second part o f the article analyses an audience case study from a screening at the International Gay and Lesbian Film Festival in Barcelona of Valérie Mitteaux's Girl or Boy, My Sex is not my Gender (2011), considering how different viewers respond to the representatio n of trans identities. The article builds on qualitative research whilst extending the exploration of sexuality and gender in previous audience studies to a consideration of documentary film, seeking to provide a more nuanced understanding of what audience claims for identification in politicised contexts mean