Population pharmacokinetics of tacrolimus in children who receive cut-down or full liver transplants

Background. The aim of this study was to investigate the population pharmacokinetics of tacrolimus in pediatric liver transplant recipients and to identify factors that may explain pharmacokinetic variability. Methods. Data were collected retrospectively from 35 children who received oral immunosuppressant therapy with tacrolimus. Maximum likelihood estimates were sought for the typical values of apparent clearance (CL/F) and apparent volume of distribution (V/F) with the program NONMEM. Factors screened for influence on the pharmacokinetic parameters were weight, age, gender, postoperative day, days since commencing tacrolimus therapy, transplant type (whole child liver or cut-down adult liver), liver function tests (bilirubin, alkaline phosphatase [ALP], aspartate aminotransferase [AST], gamma -glutamyl transferase [GGT], alanine aminotransferase [ALT]), creatinine clearance, hematocrit, corticosteroid dose, and concurrent therapy with metabolic inducers and inhibitors of tacrolimus. Results. No clear correlation existed between tacrolimus dosage and blood concentrations (r(2) =0.003). Transplant type, age, and liver function test values were the most important factors (P

Application of heterogeneous vacancy solution theory to characterization of microporous solids

The vacancy solution theory of adsorption is re-formulated here through the mass-action law, and placed in a convenient framework permitting the development of thermodynamic ally consistent isotherms. It is shown that both the multisite Langmuir model and the classical vacancy solution theory expression are special cases of the more general approach when the Flory-Huggins activity coefficient model is used, with the former being the thermodynamically consistent result. The improved vacancy solution theory approach is further extended here to heterogeneous adsorbents by considering the pore-width dependent potential along with a pore size distribution. However, application of the model to numerous hydrocarbons as well as other adsorptives on microporous activated carbons shows that the multisite model has difficulty in the presence of a pore size distribution, because pores of different sizes can have different numbers of adsorbed layers and therefore different site occupancies. On the other hand, use of the classical vacancy solution theory expression for the local isotherm leads to good simultaneous fit of the data, while yielding a site diameter of about 0.257 nm, consistent with that expected for the potential well in aromatic rings on carbon pore surfaces. It is argued that the classical approach is successful because the Flory-Huggins term effectively represents adsorbate interactions in disguise. When used together with the ideal adsorbed solution theory the heterogeneous vacancy solution theory successfully predicts binary adsorption equilibria, and is found to perform better than the multisite Langmuir as well as the heterogeneous Langmuir model. (C) 2001 Elsevier Science Ltd. All rights reserved.

Taking telehealth to the bush: lessons from north Queensland

Networking North Queensland (NNQ) was a two-year project to improve access to health services in rural and remote communities. The project involved email and Internet access in 61 communities, in a region almost three times the size of the UK. Videoconferencing equipment was also installed at 21 sites and a total of 197 h of videoconferencing was recorded at 10 of the remote sites over 12 months. As a result of the project, health consumers enjoyed improved access to medical, specialist, allied health and primary health services. In addition, health service providers had better access to reliable, up-to-date health-care information via intranet and Internet services. Consideration of local issues-local needs and existing resources-was vital to the achievements of the project. Community involvement and community access were also important factors in its success.