Clearance of Piperacillin-Tazobactam and Vancomycin during Continuous Renal Replacement with Regional Citrate Anticoagulation

Background: The use of regional citrate anticoagulation during continuous venovenous hemodiafiltration (CVVHDF) has increased worldwide. However, data on its effect on the pharmacokinetics of antibiotics are limited. In this study, the authors aimed to measure the clearance of piperacillin–tazobactam and vancomycin in patients receiving CVVHDF with regional citrate anticoagulation. Methods: This study measured piperacillin–tazobactam and vancomycin concentrations in patients receiving CVVHDF with regional citrate anticoagulation. Dosing regimens were independently selected by intensivists. Arterial blood and effluent fluid samples were obtained over a single dosing interval and analyzed using ultra-high-performance liquid chromatography with tandem mass spectrometry. Results: Seventeen sampling intervals in 15 patients (9 receiving piperacillin–tazobactam only, 4 receiving vancomycin only, and 2 receiving both) were used. The median overall clearance for piperacillin was 35.2 mL/min [interquartile range (IQR): 32.2–38.6], 70 mL/min (IQR: 62.7–76.2) for tazobactam, and 29.5 mL/min (IQR: 26.2–32) for vancomycin. Conclusions: This is the first study to quantify the pharmacokinetics of vancomycin and piperacillin–tazobactam in patients receiving CVVHDF with regional citrate anticoagulation. These results indicate high clearance and provide key information to guide optimal dosing.Lucy Sharrock, Melissa J. Ankravs, Adam M. Deane, Thomas Rechnitzer, Steven C. Wallis, Jason A. Roberts and Rinaldo Bellom

'Have you seen Bloomberg?': satellite news channels as agents of the new visibility

With the proliferation of transnational television flows, viewers can see their national affairs, traditionally covered predominantly by national news, portrayed by cross-border news channels. This article examines how transnational satellite news coverage of national events enhances nations' global visibility, and influences national public debate over national narratives. An analysis of the public debates in Spain and France over transnational channels' coverage of the March 2004 terror bombings in Madrid and the October 2005 French riots, respectively, provides the basis for discussing the implications of the `new visibility' (Thompson, 2005) of nations, in today's media age. The analysis demonstrates how transnational networks' coverage of these events generated estrangement, de-familiarized and cast doubt on national narratives and commonsensical discourses of us/them, thereby offering viewers an alternative distance from their national unit and encouraging a self-reflexive process of introspection and critical discussion. This process may open up the possibility for a more inclusive national space and strengthen democratic culture, but at the same time it triggers instabilities, which might contribute to citizens' loss of trust in the news media — a dangerous scenario for democracy

Wittgenstein, Pretend Play and the transferred use of Language

This essay sketches the potential implications of Wittgensteinian thought for conceptualizations of socalled fictive mental states, e.g. mental calculating, imagination, pretend play, as they are currently discussed in developmental psychology and philosophy of mind. In developmental psychology the young child's pretend play and make-belief are seen as a manifestation of the command of an underlying individualistic "theory of mind". When saying "This banana is a telephone" the child's mind entertains simultaneously two mental representations, a primary or veridical representation about the real properties of banana's and a pretend representation. It is the task of psychology to explain how this "double knowledge" does not result in conceptual chaos. Various sorts of internal mechanisms are postulated. In this essay it is argued that the threat of chaos is misconceived, and that the solutions are irrelevant. Following Wittgenstein's sparse remarks about the secondary sense of words, I argue that pretend language does not refer to underlying individual mental representations but to the child's creative transference of words used in one, primary, domain of application to another, secondary domain. The command and use of the secondary domain logically presupposes the command and use of the primary domain. Since the latter domain is necessarily public and social, fictive mental states cannot be dealt with purely individualistically as current mentalism assumes