Paediatric population pharmacokinetics of itraconazole and its active metabolite hydroxy-itraconazole in cystic fibrosis and bone marrow transplant patients

Objectives: The aim of the study was to characterise the population pharmacokinetics (popPK) properties of itraconazole (ITRA) and its active metabolite hydroxy-ITRA in a representative paediatric population of cystic fibrosis (CF) and bone marrow transplant (BMT) patients. The goals were to determine the relative bioavailability between the two oral formulations, and to explore improved dosage regimens in these patients. Methods: All paediatric patients with CF taking oral ITRA for the treatment of allergic bronchopulmonary aspergillosis and patients undergoing BMT who were taking ITRA for prophylaxis of any fungal infection were eligible for the study. A minimum of two blood samples were drawn after the capsules and also after switching to oral solution, or vice versa. ITRA and hydroxy-ITRA plasma concentrations were measured by HPLC[1]. A nonlinear mixed-effect modelling approach (NONMEM 5.1.1) was used to describe the PK of ITRA and hydroxy-ITRA simultaneously. Simulations were used to assess dosing strategies in these patients. Results: Forty-nine patients (29CF, 20 BMT) were recruited to the study who provided 227 blood samples for the population analysis. A 1-compartment model with 1st order absorption and elimination best described ITRA kinetics, with 1st order conversion to hydroxy-ITRA. For ITRA, the apparent clearance (ClItra/F) and volume of distribution (Vitra/F) was 35.5L/h and 672L, respectively; the absorption rate constant for the capsule formulation was 0.0901 h-1 and for the oral solution formulation it was 0.959 h-1. The capsule comparative bioavailability (vs. solution) was 0.55. For hydroxy-ITRA, the apparent volume of distribution and clearance were 10.6 L and 5.28 L/h, respectively. Of several screened covariates only allometrically scaled total body weight significantly improved the fit to the data. No difference between the two populations was found. Conclusion: The developed popPK model adequately described the pharmacokinetics of ITRA and hydroxy-ITRA in paediatric patients with CF and patients undergoing BMT. High inter-patient variability confirmed previous data in CF[2], leukaemia and BMT[3] patients. From the population model, simulations showed the standard dose (5 mg/kg/day) needs to be doubled for the solution formulation and even 4 times more given of the capsules to achieve an adequate target therapeutic trough plasma concentration of 0.5 mg/L[4] in these patients.

A mathematical model for assembly line balancing model to consider disordering sequence of workstations

Purpose – A binary integer programming model for the simple assembly line balancing problem (SALBP), which is well known as SALBP-1, was formulated more than 30 years ago. Since then, a number of researchers have extended the model for the variants of assembly line balancing problem.The model is still prevalent nowadays mainly because of the lower and upper bounds on task assignment. These properties avoid significant increase of decision variables. The purpose of this paper is to use an example to show that the model may lead to a confusing solution. Design/methodology/approach – The paper provides a remedial constraint set for the model to rectify the disordered sequence problem. Findings – The paper presents proof that the assembly line balancing model formulated by Patterson and Albracht may lead to a confusing solution. Originality/value – No one previously has found that the commonly used model is incorrect.

Network lifetime maximization with cross-layer design in wireless sensor networks

This paper investigates a cross-layer design approach for minimizing energy consumption and maximizing network lifetime (NL) of a multiple-source and single-sink (MSSS) WSN with energy constraints. The optimization problem for MSSS WSN can be formulated as a mixed integer convex optimization problem with the adoption of time division multiple access (TDMA) in medium access control (MAC) layer, and it becomes a convex problem by relaxing the integer constraint on time slots. Impacts of data rate, link access and routing are jointly taken into account in the optimization problem formulation. Both linear and planar network topologies are considered for NL maximization (NLM). With linear MSSS and planar single-source and single-sink (SSSS) topologies, we successfully use Karush-Kuhn-Tucker (KKT) optimality conditions to derive analytical expressions of the optimal NL when all nodes are exhausted simultaneously. The problem for planar MSSS topology is more complicated, and a decomposition and combination (D&C) approach is proposed to compute suboptimal solutions. An analytical expression of the suboptimal NL is derived for a small scale planar network. To deal with larger scale planar network, an iterative algorithm is proposed for the D&C approach. Numerical results show that the upper-bounds of the network lifetime obtained by our proposed optimization models are tight. Important insights into the NL and benefits of cross-layer design for WSN NLM are obtained.

An operational research-based integrated approach for mass evacuation planning of a city

Large-scale disasters are constantly occurring around the world, and in many cases evacuation of regions of city is needed. ‘Operational Research/Management Science’ (OR/MS) has been widely used in emergency planning for over five decades. Warning dissemination, evacuee transportation and shelter management are three ‘Evacuation Support Functions’ (ESF) generic to many hazards. This thesis has adopted a case study approach to illustrate the importance of integrated approach of evacuation planning and particularly the role of OR/MS models. In the warning dissemination phase, uncertainty in the household’s behaviour as ‘warning informants’ has been investigated along with uncertainties in the warning system. An agentbased model (ABM) was developed for ESF-1 with households as agents and ‘warning informants’ behaviour as the agent behaviour. The model was used to study warning dissemination effectiveness under various conditions of the official channel. In the transportation phase, uncertainties in the household’s behaviour such as departure time (a function of ESF-1), means of transport and destination have been. Households could evacuate as pedestrians, using car or evacuation buses. An ABM was developed to study the evacuation performance (measured in evacuation travel time). In this thesis, a holistic approach for planning the public evacuation shelters called ‘Shelter Information Management System’ (SIMS) has been developed. A generic allocation framework of was developed to available shelter capacity to the shelter demand by considering the evacuation travel time. This was formulated using integer programming. In the sheltering phase, the uncertainty in household shelter choices (either nearest/allocated/convenient) has been studied for its impact on allocation policies using sensitivity analyses. Using analyses from the models and detailed examination of household states from ‘warning to safety’, it was found that the three ESFs though sequential in time, however have lot of interdependencies from the perspective of evacuation planning. This thesis has illustrated an OR/MS based integrated approach including and beyond single ESF preparedness. The developed approach will help in understanding the inter-linkages of the three evacuation phases and preparing a multi-agency-based evacuation planning evacuation

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 32.1 l h−1 for total clearance and 285 l for volume of distribution, both allometrically modelled for a 70 kg adult. Final estimates for absorption rate constant and bioavailability were 1.31 h−1 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.

Population pharmacokinetic and pharmacogenetic analysis of 6-mercaptopurine in paediatric patients with acute lymphoblastic leukaemia

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The cytotoxic effects of 6-mercaptopurine (6-MP) were found to be due to drug-derived intracellular metabolites (mainly 6-thioguanine nucleotides and to some extent 6-methylmercaptopurine nucleotides) rather than the drug itself. • Current empirical dosing methods for oral 6-MP result in highly variable drug and metabolite concentrations and hence variability in treatment outcome. WHAT THIS STUDY ADDS • The first population pharmacokinetic model has been developed for 6-MP active metabolites in paediatric patients with acute lymphoblastic leukaemia and the potential demographic and genetically controlled factors that could lead to interpatient pharmacokinetic variability among this population have been assessed. • The model shows a large reduction in interindividual variability of pharmacokinetic parameters when body surface area and thiopurine methyltransferase polymorphism are incorporated into the model as covariates. • The developed model offers a more rational dosing approach for 6-MP than the traditional empirical method (based on body surface area) through combining it with pharmacogenetically guided dosing based on thiopurine methyltransferase genotype. AIMS - To investigate the population pharmacokinetics of 6-mercaptopurine (6-MP) active metabolites in paediatric patients with acute lymphoblastic leukaemia (ALL) and examine the effects of various genetic polymorphisms on the disposition of these metabolites. METHODS - Data were collected prospectively from 19 paediatric patients with ALL (n = 75 samples, 150 concentrations) who received 6-MP maintenance chemotherapy (titrated to a target dose of 75 mg m−2 day−1). All patients were genotyped for polymorphisms in three enzymes involved in 6-MP metabolism. Population pharmacokinetic analysis was performed with the nonlinear mixed effects modelling program (nonmem) to determine the population mean parameter estimate of clearance for the active metabolites. RESULTS - The developed model revealed considerable interindividual variability (IIV) in the clearance of 6-MP active metabolites [6-thioguanine nucleotides (6-TGNs) and 6-methylmercaptopurine nucleotides (6-mMPNs)]. Body surface area explained a significant part of 6-TGNs clearance IIV when incorporated in the model (IIV reduced from 69.9 to 29.3%). The most influential covariate examined, however, was thiopurine methyltransferase (TPMT) genotype, which resulted in the greatest reduction in the model's objective function (P < 0.005) when incorporated as a covariate affecting the fractional metabolic transformation of 6-MP into 6-TGNs. The other genetic covariates tested were not statistically significant and therefore were not included in the final model. CONCLUSIONS - The developed pharmacokinetic model (if successful at external validation) would offer a more rational dosing approach for 6-MP than the traditional empirical method since it combines the current practice of using body surface area in 6-MP dosing with a pharmacogenetically guided dosing based on TPMT genotype.

Potassium canrenoate treatment in paediatric patients:a population pharmacokinetic study using novel dried blood spot sampling

Objective: To characterize the population pharmacokinetics of canrenone following administration of potassium canrenoate (K-canrenoate) in paediatric patients. Methods: Data were collected prospectively from 37 paediatric patients (median weight 2.9 kg, age range 2 days–0.85 years) who received intravenous K-canrenoate for management of retained fluids, for example in heart failure and chronic lung disease. Dried blood spot (DBS) samples (n = 213) from these were analysed for canrenone content and the data subjected to pharmacokinetic analysis using nonlinear mixed-effects modelling. Another group of patients (n = 16) who had 71 matching plasma and DBS samples was analysed separately to compare canrenone pharmacokinetic parameters obtained using the two different matrices. Results: A one-compartment model best described the DBS data. Significant covariates were weight, postmenstrual age (PMA) and gestational age. The final population models for canrenone clearance (CL/F) and volume of distribution (V/F) in DBS were CL/F (l/h) = 12.86 ×  (WT/70.0)0.75 × e [0.066 ×  (PMA - 40]) and V/F (l) = 603.30 ×  (WT/70) × (GA/40)1.89 where weight is in kilograms. The corresponding values of CL/F and V/F in a patient with a median weight of 2.9 kg are 1.11 l/h and 20.48 l, respectively. Estimated half-life of canrenone based on DBS concentrations was similar to that based on matched plasma concentrations (19.99 and 19.37 h, respectively, in 70 kg patient). Conclusion: The range of estimated CL/F in DBS for the study population was 0.12–9.62 l/h; hence, bodyweight-based dosage adjustment of K-canrenoate appears necessary. However, a dosing scheme that takes into consideration both weight and age (PMA/gestational age) of paediatric patients seems more appropriate.

Online trendy topics detection in microblogs with selective user monitoring under cost constraints

As microblog services such as Twitter become a fast and convenient communication approach, identification of trendy topics in microblog services has great academic and business value. However detecting trendy topics is very challenging due to huge number of users and short-text posts in microblog diffusion networks. In this paper we introduce a trendy topics detection system under computation and communication resource constraints. In stark contrast to retrieving and processing the whole microblog contents, we develop an idea of selecting a small set of microblog users and processing their posts to achieve an overall acceptable trendy topic coverage, without exceeding resource budget for detection. We formulate the selection operation of these subset users as mixed-integer optimization problems, and develop heuristic algorithms to compute their approximate solutions. The proposed system is evaluated with real-time test data retrieved from Sina Weibo, the dominant microblog service provider in China. It's shown that by monitoring 500 out of 1.6 million microblog users and tracking their microposts (about 15,000 daily) with our system, nearly 65% trendy topics can be detected, while on average 5 hours earlier before they appear in Sina Weibo official trends.

CAPS in Z(2,n)

We consider point sets in (Z^2,n) where no three points are on a line – also called caps or arcs. For the determination of caps with maximum cardinality and complete caps with minimum cardinality we provide integer linear programming formulations and identify some values for small n.

Optimal Decision Rules in Logical Recognition Models

The task of smooth and stable decision rules construction in logical recognition models is considered. Logical regularities of classes are defined as conjunctions of one-place predicates that determine the membership of features values in an intervals of the real axis. The conjunctions are true on a special no extending subsets of reference objects of some class and are optimal. The standard approach of linear decision rules construction for given sets of logical regularities consists in realization of voting schemes. The weighting coefficients of voting procedures are done as heuristic ones or are as solutions of complex optimization task. The modifications of linear decision rules are proposed that are based on the search of maximal estimations of standard objects for their classes and use approximations of logical regularities by smooth sigmoid functions.

Mathematical Optimization for the Train Timetabling Problem

AMS Subj. Classification: 90C57; 90C10;

Solving Maximum Clique Problem for Protein Structure Similarity

Computing the similarity between two protein structures is a crucial task in molecular biology, and has been extensively investigated. Many protein structure comparison methods can be modeled as maximum weighted clique problems in specific k-partite graphs, referred here as alignment graphs. In this paper we present both a new integer programming formulation for solving such clique problems and a dedicated branch and bound algorithm for solving the maximum cardinality clique problem. Both approaches have been integrated in VAST, a software for aligning protein 3D structures largely used in the National Center for Biotechnology Information, an original clique solver which uses the well known Bron and Kerbosch algorithm (BK). Our computational results on real protein alignment instances show that our branch and bound algorithm is up to 116 times faster than BK.

A Fast Algorithm for Weber Problem on a Grid

AMS subject classification: 90B80.

Cost-effective node monitoring for online hot event detection in sina weibo microblogging

We propose a cost-effective hot event detection system over Sina Weibo platform, currently the dominant microblogging service provider in China. The problem of finding a proper subset of microbloggers under resource constraints is formulated as a mixed-integer problem for which heuristic algorithms are developed to compute approximate solution. Preliminary results show that by tracking about 500 out of 1.6 million candidate microbloggers and processing 15,000 microposts daily, 62% of the hot events can be detected five hours on average earlier than they are published by Weibo.