Therapeutic drug monitoring of once daily aminoglycoside dosing: comparison of two methods and investigation of the optimal blood sampling strategy.

PURPOSE Therapeutic drug monitoring of patients receiving once daily aminoglycoside therapy can be performed using pharmacokinetic (PK) formulas or Bayesian calculations. While these methods produced comparable results, their performance has never been checked against full PK profiles. We performed a PK study in order to compare both methods and to determine the best time-points to estimate AUC0-24 and peak concentrations (C max). METHODS We obtained full PK profiles in 14 patients receiving a once daily aminoglycoside therapy. PK parameters were calculated with PKSolver using non-compartmental methods. The calculated PK parameters were then compared with parameters estimated using an algorithm based on two serum concentrations (two-point method) or the software TCIWorks (Bayesian method). RESULTS For tobramycin and gentamicin, AUC0-24 and C max could be reliably estimated using a first serum concentration obtained at 1 h and a second one between 8 and 10 h after start of the infusion. The two-point and the Bayesian method produced similar results. For amikacin, AUC0-24 could reliably be estimated by both methods. C max was underestimated by 10-20% by the two-point method and by up to 30% with a large variation by the Bayesian method. CONCLUSIONS The ideal time-points for therapeutic drug monitoring of once daily administered aminoglycosides are 1 h after start of a 30-min infusion for the first time-point and 8-10 h after start of the infusion for the second time-point. Duration of the infusion and accurate registration of the time-points of blood drawing are essential for obtaining precise predictions.

Predicting State Allocation of Funds: The Case of John Rowland and his Hometown of Waterbury, Connecticut.

This study attempts to analyze the underlying factors and motives influencing the allocation of discretionary state expenditures. The fact that some cities receive more money than other cities begs the question of what accounts for this variation. After framing the provision of state money within the theoretical framework of political patronage, a case study of Governor Rowland’s tenure in office and the accompanying expenditures to Connecticut’s 17 largest cities from 1995 to 2004 was conducted to evaluate whether a disproportionate amount of money was given to Rowland’s hometown of Waterbury, Connecticut. Besides employing a statistical analysis that determined that cities with similar characteristics received different amounts of money, interviewing was conducted to identify reasons for such variation. The results indicate that Waterbury received a greater amount of money than was predicted based on the city’s economic and demographic characteristics, and that non-objective and biased factors such as favoritism, the need to reward political support, or the desire to increase political loyalty sometimes take precedence over more objective factors.

Input Price Variation Across Locations and a Generalized Measure of Cost Efficiency

We propose a nonparametric model for global cost minimization as a framework for optimal allocation of a firm's output target across multiple locations, taking account of differences in input prices and technologies across locations. This should be useful for firms planning production sites within a country and for foreign direct investment decisions by multi-national firms. Two illustrative examples are included. The first example considers the production location decision of a manufacturing firm across a number of adjacent states of the US. In the other example, we consider the optimal allocation of US and Canadian automobile manufacturers across the two countries.

Optimal frequency of Imiquimod (Aldara(RTM)) 5% cream treatment of external genital warts in immunocompetent adults. Systematic review and meta-analysis

Genital warts are a sexually transmitted disease with high prevalence in the U.S. Imiquimod 5% cream is a self-applied treatment, prescribed three-times weekly, at bedtime, for 16 weeks. The post-marketing research addressed questions of imiquimod dosing frequency. MEDLINE, Embase, and the Cochrane Library were searched for randomized trials on efficacy and safety of imiquimod 5% cream with either three-times weekly or once-daily regimens to systemically review treatment options. Efficacy was evaluated by completely cleared warts at the end of treatment, and safety - by frequency of adverse events and at least one rest period taken from treatment. Six studies were selected for the analysis, including circumcised men, uncircumcised men, and women. The once-daily compared to three-times weekly regimen did not improve the efficacy, but resulted in increased incidence of local skin reactions and events, when at least one rest period was taken from treatment. The optimal regimen is three-times weekly.^

Design and Optimization of Power Delivery and Distribution Systems Using Evolutionary Computation Techniques

Nowadays computing platforms consist of a very large number of components that require to be supplied with diferent voltage levels and power requirements. Even a very small platform, like a handheld computer, may contain more than twenty diferent loads and voltage regulators. The power delivery designers of these systems are required to provide, in a very short time, the right power architecture that optimizes the performance, meets electrical specifications plus cost and size targets. The appropriate selection of the architecture and converters directly defines the performance of a given solution. Therefore, the designer needs to be able to evaluate a significant number of options in order to know with good certainty whether the selected solutions meet the size, energy eficiency and cost targets. The design dificulties of selecting the right solution arise due to the wide range of power conversion products provided by diferent manufacturers. These products range from discrete components (to build converters) to complete power conversion modules that employ diferent manufacturing technologies. Consequently, in most cases it is not possible to analyze all the alternatives (combinations of power architectures and converters) that can be built. The designer has to select a limited number of converters in order to simplify the analysis. In this thesis, in order to overcome the mentioned dificulties, a new design methodology for power supply systems is proposed. This methodology integrates evolutionary computation techniques in order to make possible analyzing a large number of possibilities. This exhaustive analysis helps the designer to quickly define a set of feasible solutions and select the best trade-off in performance according to each application. The proposed approach consists of two key steps, one for the automatic generation of architectures and other for the optimized selection of components. In this thesis are detailed the implementation of these two steps. The usefulness of the methodology is corroborated by contrasting the results using real problems and experiments designed to test the limits of the algorithms.

Allocation of 14C assimilated in late spring to tissue and biochemical stem components of cork oak (Quercus suber L.) over the seasons

Carbon distribution in the stem of 2-year-old cork oak plants was studied by 14CO2 pulse labeling in late spring in order to trace the allocation of photoassimilates to tissue and biochemical stem components of cork oak. The fate of 14C photoassimilated carbon was followed during two periods: the first 72 h (short-term study) and the first 52 weeks (long-term study) after the 14CO2 photosynthetic assimilation. The results showed that 14C allocation to stem tissues was dependent on the time passed since photoassimilation and on the season of the year. In the first 3 h all 14C was found in the polar extractives. After 3 h, it started to be allocated to other stem fractions. In 1 day, 14C was allocated mostly to vascular cambium and, to a lesser extent, to primary phloem; no presence of 14C was recorded for the periderm. However, translocation of 14C to phellem was observed from 1 week after 14CO2 pulse labeling. The phellogen was not completely active in its entire circumference at labeling, unlike the vascular cambium; this was the tissue that accumulated most photoassimilated 14C at the earliest sampling. The fraction of leaf-assimilated 14C that was used by the stem peaked at 57% 1 week after 14CO2 plant exposure. The time lag between C photoassimilation and suberin accumulation was ∼8 h, but the most active period for suberin accumulation was between 3 and 7 days. Suberin, which represented only 1.77% of the stem weight, acted as a highly effective sink for the carbon photoassimilated in late spring since suberin specific radioactivity was much higher than for any other stem component as early as only 1 week after 14C plant labeling. This trend was maintained throughout the whole experiment. The examination of microautoradiographs taken over 1 year provided a new method for quantifying xylem growth. Using this approach it was found that there was more secondary xylem growth in late spring than in other times of the year, because the calculated average cell division time was much shorter.

Optimal Design of Envelope Amplifier Based on Linear Assisted Buck Converter

Envelope Tracking (ET) and Envelope Elimination and Restoration (EER) are two techniques that have been used as a solution for highly efficient linear RF Power Amplifiers (PA). In both techniques the most important part is a dc-dc converter called envelope amplifier that has to supply the RF PA with variable voltage. Besides high efficiency, its bandwidth is very important as well. Envelope amplifier based on parallel combination of a switching dc-dc converter and a linear regulator is an architecture that is widely used due to its simplicity. In this paper we discuss about theoretical limitations of this architecture regarding its efficiency and we demonstrate two possible way of its implementation. In order to derive the presented conclusions, a theoretical model of envelope amplifier's efficiency has been presented. Additionally, the benefits of the new emerging GaN technology for this application have been shown as well.

Optimal design of AC EMI filters with damping networks and effect on the systems power factor

The cutoff frequencies of an EMI filter are normally given by the noise attenuation requirements the filter has to fulfill. In order to select the component values of the filter elements, i.e. inductances and capacitances, an additional design criterium is needed. In this paper the effect of the EMI filter input and output impedances are considered. The input impedance influences the filters effect on the system displacement power factor and the output impedance plays a key role in the system stability. The effect of filter element values, the number of filter stages as well as additional damping networks are considered and a design procedure is provided. For this analysis a two-port description of the input filters employing ABCD-parameters is used.

Comparison of the ion channel characteristics of proapoptotic BAX and antiapoptotic BCL-2

The BCL-2 family of proteins is composed of both pro- and antiapoptotic regulators, although its most critical biochemical functions remain uncertain. The structural similarity between the BCL-XL monomer and several ion-pore-forming bacterial toxins has prompted electrophysiologic studies. Both BAX and BCL-2 insert into KCl-loaded vesicles in a pH-dependent fashion and demonstrate macroscopic ion efflux. Release is maximum at ≈pH 4.0 for both proteins; however, BAX demonstrates a broader pH range of activity. Both purified proteins also insert into planar lipid bilayers at pH 4.0. Single-channel recordings revealed a minimal channel conductance for BAX of 22 pS that evolved to channel currents with at least three subconductance levels. The final, apparently stable BAX channel had a conductance of 0.731 nS at pH 4.0 that changed to 0.329 nS when shifted to pH 7.0 but remained mildly Cl− selective and predominantly open. When BAX-incorporated lipid vesicles were fused to planar lipid bilayers at pH 7.0, a Cl−-selective (PK/PCl = 0.3) 1.5-nS channel displaying mild inward rectification was noted. In contrast, BCL-2 formed mildly K+-selective (PK/PCl = 3.9) channels with a most prominent initial conductance of 80 pS that increased to 1.90 nS. Fusion of BCL-2-incorporated lipid vesicles into planar bilayers at pH 7.0 also revealed mild K+ selectivity (PK/PCl = 2.4) with a maximum conductance of 1.08 nS. BAX and BCL-2 each form channels in artificial membranes that have distinct characteristics including ion selectivity, conductance, voltage dependence, and rectification. Thus, one role of these molecules may include pore activity at selected membrane sites.

Voltage dependence of the pattern and frequency of discrete Ca2+ release events after brief repriming in frog skeletal muscle

Applying a brief repolarizing pre-pulse to a depolarized frog skeletal muscle fiber restores a small fraction of the transverse tubule membrane voltage sensors from the inactivated state. During a subsequent depolarizing test pulse we detected brief, highly localized elevations of myoplasmic Ca2+ concentration (Ca2+ “sparks”) initiated by restored voltage sensors in individual triads at all test pulse voltages. The latency histogram of these events gives the gating pattern of the sarcoplasmic reticulum (SR) calcium release channels controlled by the restored voltage sensors. Both event frequency and clustering of events near the start of the test pulse increase with test pulse depolarization. The macroscopic SR calcium release waveform, obtained from the spark latency histogram and the estimated open time of the channel or channels underlying a spark, exhibits an early peak and rapid marked decline during large depolarizations. For smaller depolarizations, the release waveform exhibits a smaller peak and a slower decline. However, the mean use time and mean amplitude of the individual sparks are quite similar at all test depolarizations and at all times during a given depolarization, indicating that the channel open times and conductances underlying sparks are essentially independent of voltage. Thus, the voltage dependence of SR Ca2+ release is due to changes in the frequency and pattern of occurrence of individual, voltage-independent, discrete release events.

The regulators of G protein signaling (RGS) domains of RGS4, RGS10, and GAIP retain GTPase activating protein activity in vitro

Regulators of G protein signaling (RGS) proteins accelerate GTP hydrolysis by Gi but not by Gs class α-subunits. All RGS proteins share a conserved 120-amino acid sequence termed the RGS domain. We have demonstrated that the RGS domains of RGS4, RGS10, and GAIP retain GTPase accelerating activity with the Gi class substrates Giα1, Goα, and Gzα in vitro. No regulatory activity of the RGS domains was detected for Gsα. Short deletions within the RGS domain of RGS4 destroyed GTPase activating protein activity and Giα1 substrate binding. Comparable protein–protein interactions between Giα1–GDP–AlF4− and the RGS domain or full-length RGS4 were detected using surface plasmon resonance.

Direct physical interaction between DnaG primase and DnaB helicase of Escherichia coli is necessary for optimal synthesis of primer RNA

The primase DnaG of Escherichia coli requires the participation of the replicative helicase DnaB for optimal synthesis of primer RNA for lagging strand replication. However, previous studies had not determined whether the activation of the primase or its loading on the template was accomplished by a helicase-mediated structural alteration of the single-stranded DNA or by a direct physical interaction between the DnaB and the DnaG proteins. In this paper we present evidence supporting direct interaction between the two proteins. We have mapped the surfaces of interaction on both DnaG and DnaB and show further that mutations that reduce the physical interaction also cause a significant reduction in primer synthesis. Thus, the physical interaction reported here appears to be physiologically significant.

The tomato ethylene receptors NR and LeETR4 are negative regulators of ethylene response and exhibit functional compensation within a multigene family

The plant hormone ethylene is involved in many developmental processes, including fruit ripening, abscission, senescence, and leaf epinasty. Tomato contains a family of ethylene receptors, designated LeETR1, LeETR2, NR, LeETR4, and LeETR5, with homology to the Arabidopsis ETR1 ethylene receptor. Transgenic plants with reduced LeETR4 gene expression display multiple symptoms of extreme ethylene sensitivity, including severe epinasty, enhanced flower senescence, and accelerated fruit ripening. Therefore, LeETR4 is a negative regulator of ethylene responses. Reduced expression of this single gene affects multiple developmental processes in tomato, whereas in Arabidopsis multiple ethylene receptors must be inactivated to increase ethylene response. Transgenic lines with reduced NR mRNA levels exhibit normal ethylene sensitivity but elevated levels of LeETR4 mRNA, indicating a functional compensation of LeETR4 for reduced NR expression. Overexpression of NR in lines with lowered LeETR4 gene expression eliminates the ethylene-sensitive phenotype, indicating that despite marked differences in structure these ethylene receptors are functionally redundant.

Interaction of voltage-gated sodium channels with the extracellular matrix molecules tenascin-C and tenascin-R

The type IIA rat brain sodium channel is composed of three subunits: a large pore-forming α subunit and two smaller auxiliary subunits, β1 and β2. The β subunits are single membrane-spanning glycoproteins with one Ig-like motif in their extracellular domains. The Ig motif of the β2 subunit has close structural similarity to one of the six Ig motifs in the extracellular domain of the cell adhesion molecule contactin (also called F3 or F11), which binds to the extracellular matrix molecules tenascin-C and tenascin-R. We investigated the binding of the purified sodium channel and the extracellular domain of the β2 subunit to tenascin-C and tenascin-R in vitro. Incubation of purified sodium channels on microtiter plates coated with tenascin-C revealed saturable and specific binding with an apparent Kd of ≈15 nM. Glutathione S-transferase-tagged fusion proteins containing various segments of tenascin-C and tenascin-R were purified, digested with thrombin to remove the epitope tag, immobilized on microtiter dishes, and tested for their ability to bind purified sodium channel or the epitope-tagged extracellular domain of β2 subunits. Both purified sodium channels and the extracellular domain of the β2 subunit bound specifically to fibronectin type III repeats 1–2, A, B, and 6–8 of tenascin-C and fibronectin type III repeats 1–2 and 6–8 of tenascin-R but not to the epidermal growth factor-like domain or the fibrinogen-like domain of these molecules. The binding of neuronal sodium channels to extracellular matrix molecules such as tenascin-C and tenascin-R may play a crucial role in localizing sodium channels in high density at axon initial segments and nodes of Ranvier or in regulating the activity of immobilized sodium channels in these locations.

Large conductance voltage- and calcium-dependent K+ channel, a distinct member of voltage-dependent ion channels with seven N-terminal transmembrane segments (S0-S6), an extracellular N terminus, and an intracellular (S9-S10) C terminus

Large conductance voltage- and Ca2+-dependent K+ (MaxiK) channels show sequence similarities to voltage-gated ion channels. They have a homologous S1-S6 region, but are unique at the N and C termini. At the C terminus, MaxiK channels have four additional hydrophobic regions (S7-S10) of unknown topology. At the N terminus, we have recently proposed a new model where MaxiK channels have an additional transmembrane region (S0) that confers β subunit regulation. Using transient expression of epitope tagged MaxiK channels, in vitro translation, functional, and “in vivo” reconstitution assays, we now show that MaxiK channels have seven transmembrane segments (S0-S6) at the N terminus and a S1-S6 region that folds in a similar way as in voltage-gated ion channels. Further, our results indicate that hydrophobic segments S9-S10 in the C terminus are cytoplasmic and unequivocally demonstrate that S0 forms an additional transmembrane segment leading to an exoplasmic N terminus.