Establishment of prophylactic enoxaparin dosing recommendations to achieve targeted anti-factor Xa concentrations in children with CHD

Background Enoxaparin may be used to prevent central venous catheter-related thrombosis in patients with CHD. We aimed to determine whether current enoxaparin dosing regimens effectively achieve anti-factor Xa concentrations within prophylactic goal ranges in this patient population. Methods We implemented a formal protocol aimed at reducing central venous catheter-related thrombosis in children with CHD in January, 2016. Standard empiric prophylactic enoxaparin dosing regimens were used – for example, 0.75 mg/kg/dose every 12 hours for patients <2 months of age and 0.5 mg/kg/dose every 12 hours for patients ⩾2 months of age – with anti-factor Xa goal range of 0.25–0.49 IU/ml. Patients <2 years of age who received enoxaparin and had at least one valid steady-state anti-factor Xa measurement between 25 January, 2016 and 31 August, 2016 were retrospectively reviewed. Results During the study period, 47 patients had 186 anti-factor Xa concentrations measured, of which 20 (11%) were above and 112 (60%) were below the prophylactic goal range. Anti-factor Xa concentrations within the goal range were ultimately achieved in 31 patients. Median dose required to achieve anti-factor Xa concentrations within the prophylactic range was 0.89 mg/kg/dose (25, 75%: 0.75, 1.11) for patients <2 months (n=23 patients) and 0.79 mg/kg/dose (25, 75%: 0.62, 1.11) for patients ⩾2 months (n=8 patients). Conclusions Enoxaparin doses required to achieve prophylactic anti-factor Xa concentrations in young children with CHD were consistently higher than the currently recommended prophylactic dosing regimens. Further study is needed to determine whether dose titration to achieve prophylactic anti-factor Xa concentrations is effective in preventing central venous catheter-related thrombosis

Characteristic Functions Describing the Power Absorption Response of Periodic Structures to Partially Coherent Fields

Many new types of sensing or imaging surfaces are based on periodic thin films. It is explained how the response of those surfaces to partially coherent fields can be fully characterized by a set of functions in the wavenumber spectrum domain. The theory is developed here for the case of 2D absorbers with TE illumination and arbitrary material properties in the plane of the problem, except for the resistivity which is assumed isotropic. Sum and difference coordinates in both spatial and spectral domains are conveniently used to represent the characteristic functions, which are specialized here to the case of periodic structures. Those functions can be either computed or obtained experimentally. Simulations rely on solvers based on periodic-boundary conditions, while experiments correspond to Energy Absorption Interferometry (EAI), already described in the literature. We derive rules for the convergence of the representation versus the number of characteristic functions used, as well as for the sampling to be considered in EAI experiments. Numerical examples are given for the case of absorbing strips printed on a semi-infinite substrate.Comment: Submitted to JOSA

Harvest Scheduling as a Timber Appraisal Tool

Appraisers often value a forest that contains many different timber stands that can vary due to factors such as age, stocking, species, and site index. Many assumptions are possible on how the various stands will be harvested and what subsequent cash flows might be generated. We describe harvest scheduling methodology that is widely used to obtain the net present value of such a forest under optimal conditions. We illustrate how a popular software package can be used by appraisers to obtain optimal discounted cash flows using harvest scheduling and resulting timber stand values. ChristopherProduction Economics,

Characterization of Power Absorption Response of Periodic 3D Structures to Partially Coherent Fields

In many applications of absorbing structures it is important to understand their spatial response to incident fields, for example in thermal solar panels, bolometric imaging and controlling radiative heat transfer. In practice, the illuminating field often originates from thermal sources and is only spatially partially coherent when reaching the absorbing device. In this paper, we present a method to fully characterize the way a structure can absorb such partially coherent fields. The method is presented for any 3D material and accounts for the partial coherence and partial polarization of the incident light. This characterization can be achieved numerically using simulation results or experimentally using the Energy Absorption Interferometry (EAI) that has been described previously in the literature. The absorbing structure is characterized through a set of absorbing functions, onto which any partially coherent field can be projected. This set is compact for any structure of finite extent and the absorbing function discrete for periodic structures

Optimizing Guideline-Recommended Antibiotic Doses for Pediatric Infective Endocarditis

The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses. In this perspective, we highlight potential areas for improvement in the statement-recommended doses and summarize evidence supporting antibiotic dosing optimization. The addition of a pediatric clinical pharmacist with expertise in antibiotic dosing to the panel would be beneficial for future updates

The evolution of warning signals as reliable indicators of prey defense

It is widely argued that defended prey have tended to evolve conspicuous traits because predators more readily learn to avoid defended prey when they are conspicuous. However, a rival theory proposes that defended prey have evolved such characters because it allows them to be distinguished from undefended prey. Here we investigated how the attributes of defended (unprofitable) and undefended (profitable) computer-generated prey species tended to evolve when they were subject to selection by foraging humans. When cryptic forms of defended and undefended species were similar in appearance but their conspicuous forms were not, defended prey became conspicuous while undefended prey remained cryptic. Indeed, in all of our experiments, defended prey invariably evolved any trait that enabled them to be distinguished from undefended prey, even if such traits were cryptic. When conspicuous mutants of defended prey were extremely rare, they frequently overcame their initial disadvantage by chance. When Batesian mimicry of defended species was possible, defended prey evolved unique traits or characteristics that would make undefended prey vulnerable. Overall, our work supports the contention that warning signals are selected for their reliability as indicators of defense rather than to capitalize on any inherent educational biases of predators