Prophylactic ranitidine treatment in critically ill children - a population pharmacokinetic study

Aims: To characterize the population pharmacokinetics of ranitidine in critically ill children and to determine the influence of various clinical and demographic factors on its disposition. Methods: Data were collected prospectively from 78 paediatric patients (n = 248 plasma samples) who received oral or intravenous ranitidine for prophylaxis against stress ulcers, gastrointestinal bleeding or the treatment of gastro-oesophageal reflux. Plasma samples were analysed using high-performance liquid chromatography, and the data were subjected to population pharmacokinetic analysis using nonlinear mixed-effects modelling. Results: A one-compartment model best described the plasma concentration profile, with an exponential structure for interindividual errors and a proportional structure for intra-individual error. After backward stepwise elimination, the final model showed a significant decrease in objective function value (-12.618; P <0.001) compared with the weight-corrected base model. Final parameter estimates for the population were 32.1lh for total clearance and 285l for volume of distribution, both allometrically modelled for a 70kg adult. Final estimates for absorption rate constant and bioavailability were 1.31h and 27.5%, respectively. No significant relationship was found between age and weight-corrected ranitidine pharmacokinetic parameters in the final model, with the covariate for cardiac failure or surgery being shown to reduce clearance significantly by a factor of 0.46. Conclusions: Currently, ranitidine dose recommendations are based on children's weights. However, our findings suggest that a dosing scheme that takes into consideration both weight and cardiac failure/surgery would be more appropriate in order to avoid administration of higher or more frequent doses than necessary.

Holocene tephras highlight complexity of volcanic signals in Greenland ice cores

Acidity peaks in Greenland ice cores have been used as critical reference horizons for synchronizing ice core records, aiding the construction of a single Greenland Ice Core Chronology (GICC05) for the Holocene. Guided by GICC05, we examined sub-sections of three Greenland cores in the search for tephra from specific eruptions that might facilitate the linkage of ice core records, the dating of prehistoric tephras and the understanding of the eruptions. Here we report the identification of 14 horizons with tephra particles, including 11 that have not previously been reported from the North Atlantic region and that have the potential to be valuable isochrons. The positions of tephras whose major element data are consistent with ash from the Katmai AD 1912 and Öraefajökull AD 1362 eruptions confirm the annually resolved ice core chronology for the last 700 years. We provide a more refined date for the so-called “AD860B” tephra, a widespread isochron found across NW Europe, and present new evidence relating to the 17th century BC Thera/Aniakchak debate that shows N. American eruptions likely contributed to the acid signals at this time. Our results emphasize the variable spatial and temporal distributions of volcanic products in Greenland ice that call for a more cautious approach in the attribution of acid signals to specific eruptive events.

The machinist landscape:Land Art Generator Initiative (Competition)

THE MACHINIST LANDSCAPE: AN ENTROPIC GRID OF VARIANCE
‘By drawing a diagram, a ground plan of a house, a street plan to the location of a site, or a topographic map, one draws a “logical two dimensional picture”. A “logical picture” differs from a natural or realistic picture in that it rarely looks like the thing it stands for.’
A Provisional Theory of Non-Sites, Robert Smithson (1968)

Between design and ground there are variances, deviations and gaps. These exist as physical interstices between what is conceptualised and what is realised; and they reveal moments in the design process that resist the reconciliation of people and their environment (McHarg 1963). The Machinist Landscape interrogates the significance of these variances through the contrasting processes of coppice and photovoltaic energy. It builds on the potential of these gaps, and in doing so proposes that these spaces of variance can reveal the complexity of relationships between consumption and remediation, design and nature.
Fresh Kills Park, and in particular the draft master plan (2006), offers a framework to explore this artificial construct. Central to the Machinist Landscape is the analysis of the landfill gas collection system, planned on a notional 200ft grid. Variations are revealed between this diagrammatic grid measure and that which has been constructed on the site. These variances between the abstract and the real offer the Machinist Landscape a powerful space of enquiry. Are these gaps a result of unexpected conditions below ground, topographic nuances or natural phenomena? Does this space of difference, between what is planned and what is constructed, have the potential to redefine the dynamic processes and relations with the land?
The Machinist Landscape is structured through this space of variance with an ‘entropic grid’, the under-storey of which hosts a carefully managed system of short-rotation coppice (SRC). The coppice, a medieval practice related to energy, product, and space, operates on theoretical and programmatic levels. It is planted along a structure of linear bunds, stabilized through coppice pole retaining structures and enriched with nutrients from coppice produced bio-char. Above the coppice is built an upper-storey of photovoltaic (PV); its structures fabricated from the coppiced timber and the PV produced with graphene from coppice charcoal processes.

Serum eosinophil cationic protein (ECP):reference values in healthy nonatopic children

BACKGROUND: Although serum ECP concentrations have been reported in normal children, there are currently no published upper cutoff reference limits for serum ECP in normal, nonatopic, nonasthmatic children aged 1-15 years.
METHODS: We recruited 123 nonatopic, nonasthmatic normal children attending the Royal Belfast Hospital for Sick Children for elective surgery and measured serum ECP concentrations. The effects of age and exposure to environmental tobacco smoke (ETS) on the upper reference limits were studied by multiple regression and fractional polynomials.
RESULTS: The median serum ECP concentration was 6.5 microg/l and the 95th and 97.5 th percentiles were 18.8 and 19.9 microg/l. The median and 95th percentile did not vary with age. Exposure to ETS was not associated with altered serum ECP concentrations (P = 0.14).
CONCLUSIONS: The 95th and 97.5 th percentiles for serum ECP for normal, nonatopic, nonasthmatic children (aged 1-15 years) were 19 and 20 microg/l, respectively. Age and exposure to parental ETS did not significantly alter serum ECP concentrations or the normal upper reference limits. Our data provide cutoff upper reference limits for normal children for use of serum ECP in a clinical or research setting.
PMID: 10604557 [PubMed - indexed for MEDLINE]

The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection):a randomised placebo-controlled trial

Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infarction, ischaemic stroke, and the need for coronary revascularisation in people without kidney disease, but its effects in people with moderate-to-severe kidney disease are uncertain. The SHARP trial aimed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients.

Non-adherence to therapy in children with cystic fibrosis

Hawthorne N., Hawwa A.F., Shields M.D., Reid A.J., McElnay J.C. (2011) Non-adherence to therapy in children with cystic fibrosis. Pediatric Pulmonology, 46: 408.

Non-adherence in children with cystic fibrosis

Hawthorne N., Hawwa A., McElnay J., Shields M., Reid A. (2011) Non-adherence in children with cystic fibrosis. Journal of Pharmacy and Pharmaceutical Sciences, 14: 209s