Optimising intravenous salbutamol in children: a phase 2 study

OBJECTIVE: The β2-agonists such as salbutamol are the mainstay of asthma management. Pharmacokinetic-pharmacodynamic (PKPD) models to guide paediatric dosing are lacking. We explored the relationship between salbutamol dose, serum concentration, effectiveness and adverse effects in children by developing a PKPD model. DESIGN: A prospective cohort study of children admitted to hospital with acute asthma, who received intravenous salbutamol. SETTING: Children were recruited in two cohorts: the emergency departments of two London hospitals or those retrieved by the Children's Acute Transport Service to three London paediatric intensive care units. PATIENTS: Patients were eligible if aged 1-15 years, admitted for acute asthma and about to receive or receiving intravenous salbutamol. INTERVENTIONS: Treatment was according to local policy. Serial salbutamol plasma levels were taken. Effectiveness measurements were recorded using the Paediatric Asthma Severity Score (PASS). Toxicity measurements included lactate, pH, glucose, heart rate, blood pressure and arrhythmias. PKPD modelling was performed with non-linear mixed-effect models. MAIN OUTCOMES: Fifty-eight children were recruited with 221 salbutamol concentration measurements from 54 children. Median (range) age was 2.9 (1.1-15.2) years, and weight was 13.6 (8-57.3) kg. Ninety-five PASS measurements and 2078 toxicity measurements were obtained. RESULTS: A two-compartment PK model adequately described the time course of salbutamol-plasma concentrations. An EMAX (maximum drug effect) concentration-effect relationship described PASS and toxicity measures. PKPD simulations showed an infusion of 0.5 µg/kg/min (maximum 20 µg/min) for 4 hours after bolus achieves >90% maximal bronchodilation for 12 hours. CONCLUSIONS: A paediatric PKPD model for salbutamol is described. An infusion of 0.5 µg/kg/min after bolus achieves effective bronchodilation. Higher rates are associated with greater tachycardia and hyperglycaemia

Dayton Ostrich Plume Company broadside

Broadside advertising that a representative of the Dayton Ostrich Plume Company will be at Easton's Wall Paper Store on High Street on October 2, 1909. The representative displayed the company's line of South African ostrich plumes. This advertisement may refer to High Street in Dayton, Ohio, or possibly Columbus. In the 1909-1910 Williams' Dayton Directory, the company is listed as being located at the Reibold Building on South Main Street, with Petosky and Becker as its proprietors

Community recording and monitoring of vulnerable sites in England

Signifi cant archaeological sites along England’s sinuous coast and on the foreshores of tidal estuaries are continually eroded by winds, waves and tidal scour. Alarmed by the rate of loss, the location of many of these sites has been noted during the national ‘Rapid Coastal Zone Assessment Survey’ programme initiated by English Heritage (now Historic England) and also by archaeological groups around the country. But until recently there had been no national standardised system in place to record these vulnerable sites in detail or to regularly monitor their fate over the longer term. CITiZAN: the Coastal and InterTidal Zone Archaeological Network provides a systematic national response to natural and anthropogenic forces threatening coastal and intertidal archaeology in England. The project employs similar methodologies to the recording and monitoring of fragile intertidal archaeology as its sister project, the Thames Discovery Programme, which has for the last decade monitored the archaeology of the Greater London Thames foreshore. Both projects employ a system of community-based training and outreach programmes, creating an infrastructure to support a network of volunteers with the skills and systems in place to enable them to monitor and survey the highly significant but threatened archaeological sites around England’s coast and foreshores. This paper looks at the evolution of the methodologies employed by these projects, both archaeological and educational, as well as the implementation of standardised recording and monitoring using crowd-sourced data, and presents key findings from this ‘citizen science’ programme. Coastal erosion can rarely be halted, but the hope of TDP and CITiZAN is to involve the public in such a way that will help ensure archaeological sites can be recorded before they are destroyed.No Full Tex