The pharmacokinetics and toxicity of morning vs. evening tobramycin dosing for pulmonary exacerbations of cystic fibrosis:A randomised comparison

AbstractBackgroundCircadian variation in renal toxicity of aminoglycosides has been demonstrated in animal and human studies. People with CF are frequently prescribed aminoglycosides. Altered pharmacokinetics of aminoglycosides are predictive of toxicity.AimTo investigate whether the time of day of aminoglycoside administration modulates renal excretion of tobramycin and toxicity in children with CF. To determine whether circadian rhythms are disrupted in children with CF during hospital admission.MethodsChildren (age 5–18years) with CF scheduled for tobramycin therapy were randomly allocated to receive tobramycin at 0800 or 2000h. Serum tobramycin levels were drawn at 1h and between 3.5 and 5h post-infusion between days 5 and 9 of therapy. Melatonin levels were measured serially at intervals from 1800h in the evening until 1200h on the next day. Circadian rhythm was categorised as normal when dim light melatonin onset was demonstrated between 1800 and 2200h and/or peak melatonin levels were observed during the night. Weight and spirometry were measured at the start and end of the therapy. Urinary biomarkers of kidney toxicity (KIM1, NAG, NGAL, IL-18 and CysC) were assayed at the start and end of the course of tobramycin.ResultsEighteen children were recruited to the study. There were no differences in renal clearance between the morning and evening groups. The increase in urinary KIM-1 was greater in the evening dosage group compared to the morning group (mean difference, 0.73ng/mg; 95% CI, 0.14 to 1.32; p=0.018). There were no differences in the other urinary biomarkers. There was normal circadian rhythm in 7/11 participants (64%).ConclusionsRenal elimination of tobramycin was not affected by the time of day of administration. Urinary KIM-1 raises the possibility of greater nephrotoxicity with evening administration. Four children showed disturbed circadian rhythm and high melatonin levels (ClinicalTrials.gov NCT01207245)

Amperometric separation-free immunosensor for real-time environmental monitoring

Immunoanalytical techniques have found widespread use due to the characteristics of specificity and wide applicability for many analytes, from large polymer antigens, to simple haptens, and even single atoms. Electrochemical sensors offer benefits of technical simplicity, speed and convenience via direct transduction to electronic equipment. Together, these two systems offer the possibility of a convenient, ubiquitous assay technique with high selectivity. However, they are still not widely used, mainly due to the complexity of the associated immunoassay methodologies. A separation-free immunoanalytical technique is described here, which has allowed for the analysis of atrazine in real time and in both quasi-equilibrium and stirred batch configurations. It illustrated that determinations as low as 0.13 muM (28 ppb) could be made using equilibrium incubation with an analytical range of 0.1-10 muM. Measurements could be made between 1 and 10 mM within several minutes using a real-time, stirred batch method. This system offers the potential for fast, simple, cost-effective biosensors for the analysis of many substances of environmental, biomedical and pharmaceutical concern. (C) 2001 Elsevier Science B.V. All rights reserved

Enhancing Communication about Paediatric Medicines: Lessons from a Qualitative Study of Parents' Experiences of Their Child's Suspected Adverse Drug Reaction

Background: There is little research on parents’ experiences of suspected adverse drug reactions in their children and hence little evidence to guide clinicians when communicating with families about problems associated with medicines. Objective: To identify any unmet information and communication needs described by parents whose child had a suspected adverse drug reaction. Methods: Semi-structured qualitative interviews with parents of 44 children who had a suspected adverse drug reaction identified on hospital admission, during in-patient treatment or reported by parents using the Yellow Card Scheme (the UK system for collecting spontaneous reports of adverse drug reactions). Interviews were conducted face-to-face or by telephone; most interviews were audiorecorded and transcribed. Analysis was informed by the principles of the constant comparative method. Results: Many parents described being dissatisfied with how clinicians communicated about adverse drug reactions and unclear about the implications for their child’s future use of medicines. A few parents felt that clinicians had abandoned their child and reported refusing the use of further medicines because they feared a repeated adverse drug reaction. The accounts of parents of children with cancer were different. They emphasised their confidence in clinicians’ management of adverse drug reactions and described how clinicians prospectively explained the risks associated with medicines. Parents linked symptoms to medicines in ways that resembled the established reasoning that clinicians use to evaluate the possibility that a medicine has caused an adverse drug reaction. Conclusion: Clinicians’ communication about adverse drug reactions was poor from the perspective of parents, indicating that improvements are needed. The accounts of parents of children with cancer indicate that prospective explanation about adverse drug reactions at the time of prescription can be effective. Convergence between parents and clinicians in their reasoning for linking children’s symptoms to medicines could be a starting point for improved communication

Cassini UVIS Observations of the Io Plasma Torus. IV. Modeling Temporal and Azimuthal Variability

In this fourth paper in a series, we present a model of the remarkable temporal and azimuthal variability of the Io plasma torus observed during the Cassini encounter with Jupiter. Over a period of three months, the Cassini Ultraviolet Imaging Spectrograph (UVIS) observed a dramatic variation in the average torus composition. Superimposed on this long-term variation, is a 10.07-hour periodicity caused by an azimuthal variation in plasma composition subcorotating relative to System III longitude. Quite surprisingly, the amplitude of the azimuthal variation appears to be modulated at the beat frequency between the System III period and the observed 10.07-hour period. Previously, we have successfully modeled the months-long compositional change by supposing a factor of three increase in the amount of material supplied to Io's extended neutral clouds. Here, we extend our torus chemistry model to include an azimuthal dimension. We postulate the existence of two azimuthal variations in the number of super-thermal electrons in the torus: a primary variation that subcorotates with a period of 10.07 hours and a secondary variation that remains fixed in System III longitude. Using these two hot electron variations, our model can reproduce the observed temporal and azimuthal variations observed by Cassini UVIS.Comment: Revised 24 August 2007 Accepted by Icarus, 50 pages, 2 Tables, 8 figure

Cyclotomic integers, fusion categories, and subfactors

Dimensions of objects in fusion categories are cyclotomic integers, hence number theoretic results have implications in the study of fusion categories and finite depth subfactors. We give two such applications. The first application is determining a complete list of numbers in the interval (2, 76/33) which can occur as the Frobenius-Perron dimension of an object in a fusion category. The smallest number on this list is realized in a new fusion category which is constructed in the appendix written by V. Ostrik, while the others are all realized by known examples. The second application proves that in any family of graphs obtained by adding a 2-valent tree to a fixed graph, either only finitely many graphs are principal graphs of subfactors or the family consists of the A_n or D_n Dynkin diagrams. This result is effective, and we apply it to several families arising in the classification of subfactors of index less then 5.Comment: 47 pages, with an appendix by Victor Ostri

Diagnostic and prognostic significance of systemic alkyl quinolones for P. aeruginosa in cystic fibrosis: a longitudinal study

Background Pulmonary P. aeruginosa infection is associated with poor outcomes in cystic fibrosis (CF) and early diagnosis is challenging, particularly in those who are unable to expectorate sputum. Specific P. aeruginosa 2-alkyl-4-quinolones are detectable in the sputum, plasma and urine of adults with CF, suggesting that they have potential as biomarkers for P. aeruginosa infection. Aim To investigate systemic 2-alkyl-4-quinolones as potential biomarkers for pulmonary P. aeruginosa infection. Methods A multicentre observational study of 176 adults and 68 children with CF. Cross-sectionally, comparisons were made between current P. aeruginosa infection using six 2-alkyl-4-quinolones detected in sputum, plasma and urine against hospital microbiological culture results. All participants without P. aeruginosa infection at baseline were followed up for one year to determine if 2-alkyl-4-quinolones were early biomarkers of pulmonary P. aeruginosa infection. Results Cross-sectional analysis: the most promising biomarker with the greatest diagnostic accuracy was 2-heptyl-4-hydroxyquinoline (HHQ). In adults, areas under the ROC curves (95% confidence intervals) for HHQ analyses were 0.82 (0.75–0.89) in sputum, 0.76 (0.69–0.82) in plasma and 0.82 (0.77–0.88) in urine. In children, the corresponding values for HHQ analyses were 0.88 (0.77–0.99) in plasma and 0.83 (0.68–0.97) in urine. Longitudinal analysis: Ten adults and six children had a new positive respiratory culture for P. aeruginosa in follow-up. A positive plasma HHQ test at baseline was significantly associated with a new positive culture for P. aeruginosa in both adults and children in follow-up (odds ratio (OR) = 6.67;-95% CI:-1.48–30.1;-p = 0.01 and OR = 70; 95% CI: 5–956;-p < 0.001 respectively). Conclusions AQs measured in sputum, plasma and urine may be used to diagnose current infection with P. aeruginosa in adults and children with CF. These preliminary data show that plasma HHQ may have potential as an early biomarker of pulmonary P. aeruginosa. Further studies are necessary to evaluate if HHQ could be used in clinical practice to aid early diagnosis of P. aeruginosa infection in the future

A place-based approach to payments for ecosystem services

Payment for Ecosystem Services (PES) schemes are proliferating but are challenged by insufficient attention to spatial and temporal inter-dependencies, interactions between different ecosystems and their services, and the need for multi-level governance. To address these challenges, this paper develops a place-based approach to the development and implementation of PES schemes that incorporates multi-level governance, bundling or layering of services across multiple scales, and shared values for ecosystem services. The approach is evaluated and illustrated using case study research to develop an explicitly place-based PES scheme, the Peatland Code, owned and managed by the International Union for the Conservation of Nature’s UK Peatland Programme and designed to pay for restoration of peatland habitats. Buyers preferred bundled schemes with premium pricing of a primary service, contrasting with sellers’ preferences for quantifying and marketing services separately in a layered scheme. There was limited awareness among key business sectors of dependencies on ecosystem services, or the risks and opportunities arising from their management. Companies with financial links to peatlands or a strong environmental sustainability focus were interested in the scheme, particularly in relation to climate regulation, water quality, biodiversity and flood risk mitigation benefits. Visitors were most interested in donating to projects that benefited wildlife and were willing to donate around £2 on-site during a visit. Sellers agreed a deliberated fair price per tonne of CO2 equivalent from £11.18 to £15.65 across four sites in Scotland, with this range primarily driven by spatial variation in habitat degradation. In the Peak District, perceived declines in sheep and grouse productivity arising from ditch blocking led to substantially higher prices, but in other regions ditch blocking was viewed more positively. The Peatland Code was developed in close collaboration with stakeholders at catchment, landscape and national scales, enabling multi-level governance of the management and delivery of ecosystem services across these scales. Place-based PES schemes can mitigate negative trade-offs between ecosystem services, more effectively include cultural ecosystem services and engage with and empower diverse stakeholders in scheme design and governance

Distant ionospheric photoelectron energy peak observations at Venus

The dayside of the Venus ionosphere at the top of the planet's thick atmosphere is sustained by photoionization. The consequent photoelectrons may be identified by specific peaks in the energy spectrum at 20–30 eV which are mainly due to atomic oxygen photoionization. The ASPERA-4 electron spectrometer has an energy resolution designed to identify the photoelectron production features. Photoelectrons are seen not only in their production region, the sunlit ionosphere, but also at more distant locations on the nightside of the Venus environment. Here, we present a summary of the work to date on observations of photoelectrons at Venus, and their comparison with similar processes at Titan and Mars. We expand further by presenting new examples of the distant photoelectrons measured at Venus in the dark tail and further away from Venus than seen before. The photoelectron and simultaneous ion data are then used to determine the ion escape rate from Venus for one of these intervals. We compare the observed escape rates with other rates measured at Venus, and at other planets, moons and comets. We find that the escape rates are grouped by object type when plotted against body radius

Growth and mortality of coccolithophores during spring in a temperate Shelf Sea (Celtic Sea, April 2015)

Coccolithophores are key components of phytoplankton communities, exerting a critical impact on the global carbon cycle and the Earth’s climate through the production of coccoliths made of calcium carbonate (calcite) and bioactive gases. Microzooplankton grazing is an important mortality factor in coccolithophore blooms, however little is currently known regarding the mortality (or growth) rates within non-bloom populations. Measurements of coccolithophore calcite production (CP) and dilution experiments to determine microzooplankton (≤63 µm) grazing rates were made during a spring cruise (April 2015) at the Central Celtic Sea (CCS), shelf edge (CS2), and within an adjacent April bloom of the coccolithophore Emiliania huxleyi at station J2. CP at CCS ranged from 10.4 to 40.4 µmol C m−3 d−1 and peaked at the height of the spring phytoplankton bloom (peak chlorophyll-a concentrations ∼6 mg m−3). Cell normalised calcification rates declined from ∼1.7 to ∼0.2 pmol C cell−1 d−1, accompanied by a shift from a mixed coccolithophore species community to one dominated by the more lightly calcified species E. huxleyi and Calciopappus caudatus. At the CCS, coccolithophore abundance increased from 6 to 94 cells mL−1, with net growth rates ranging from 0.06 to 0.21 d−1 from the 4th to the 28th April. Estimates of intrinsic growth and grazing rates from dilution experiments, at the CCS ranged from 0.01 to 0.86 d−1 and from 0.01 to 1.32 d−1, respectively, which resulted in variable net growth rates during April. Microzooplankton grazers consumed 59 to >100% of daily calcite production at the CCS. Within the E. huxleyi bloom a maximum density of 1986 cells mL−1 was recorded, along with CP rates of 6000 µmol C m−3 d−1 and an intrinsic growth rate of 0.29 d−1, with ∼80% of daily calcite production being consumed. Our results show that microzooplankton can exert strong top-down control on both bloom and non-bloom coccolithophore populations, grazing over 60% of daily growth (and calcite production). The fate of consumed calcite is unclear, but may be lost either through dissolution in acidic food vacuoles, and subsequent release as CO2, or export to the seabed after incorporation into small faecal pellets. With such high microzooplankton-mediated mortality losses, the fate of grazed calcite is clearly a high priority research direction