What do I need to know about glycopeptide antibiotics?

Glycopeptides have been crucial in the fight against Gram-positive pathogens with their use within paediatrics becoming ever prevalent. This article reviews the pharmacology of the commonly used glycopeptides, vancomycin and teicoplanin, and discusses the practical aspects of their use in the clinical setting.

A practitioner's guide for exploring water quality patterns using principal components analysis and Procrustes.

To design sustainable water quality monitoring programs, practitioners must choose meaningful variables, justify the temporal and spatial extent of measurements, and demonstrate that program objectives are successfully achieved after implementation. Consequently, data must be analyzed across several variables and often from multiple sites and seasons. Multivariate techniques such as ordination are common throughout the water quality literature, but methods vary widely and could benefit from greater standardization. We have found little clear guidance and open source code for efficiently conducting ordination to explore water quality patterns. Practitioners unfamiliar with techniques such as principal components analysis (PCA) are faced with a steep learning curve to summarize expansive data sets in periodic reports and manuscripts. Here, we present a seven-step framework for conducting PCA and associated tests. The last step is dedicated to conducting Procrustes analysis, a valuable but rarely used test within the water quality field that describes the degree of concordance between separate multivariate data matrices and provides residual values for similar points across each matrix. We illustrate the utility of these tools using three increasingly complex water quality case studies in US parklands. The case studies demonstrate how PCA and Procrustes analysis answer common applied monitoring questions such as (1) do data from separate monitoring locations describe similar water quality regimes, and (2) what time periods exhibit the greatest water quality regime variability? We provide data sets and annotated R code for recreating case study results and as a base for crafting new code for similar monitoring applications.

Practical pharmacokinetics: what do you really need to know?

Having some understanding of pharmacokinetics is important for all clinicians when prescribing medications. Key elements to effective and safe prescribing include making sure that we don't underdose a medication making it ineffective, but also do not overprescribe a treatment known to cause toxic effects. In paediatrics, there are significant physiological and developmental differences that add to the challenges of safe prescribing. This article aims to provide the clinician with some basic paediatric pharmacokinetic principles with clinical examples to aid their prescribing skills.

Intravenous salbutamol for childhood asthma: evidence-based medicine?

Intravenous salbutamol is commonly used to treat children with severe asthma unresponsive to inhaled ß2-agonist therapy. However, in this setting, there is little clinical trial data demonstrating its effectiveness. Additionally, there are significant concerns that intravenous salbutamol-dosing recommendations for children with acute asthma are excessive, and unnecessarily raise the potential for adverse reactions, such as lactic acidosis and tachycardia which, by increasing respiratory workload, exacerbate respiratory failure. Here, we review salbutamol clinical pharmacology and toxicology, evidence relating to its use in acute asthma and highlight gaps in the evidence base.

Propranolol for infantile haemangiomas: a review.

Infantile haemangiomas are the most common benign tumour of infancy. However the majority are self-resolving and only a small minority of cases require treatment, with various different medications being used in the past. Over the last few years, propranolol, a non-selective ß-blocker, has become a popular and successful treatment for infantile haemangiomas. However, further research on its safety is needed if it is going to be used more frequently. This article summarises the current literature on propranolol for haemangioma treatment with emphasis on its toxicity and adverse event profile.

Simulating Secondary Succession of Elk Forage Values in a Managed Forest Landscape, Western Washington

Modern timber management practices often influence forage production for elk (Cervus elaphus) on broad temporal and spatial scales in forested landscapes. We incorporated site-specific information on postharvesting forest succession and forage characteristics in a simulation model to evaluate past and future influences of forest management practices on forage values for elk in a commercially managed Douglas fir (Pseudotsuga menziesii, PSME)-western hemlock (Tsuga heterophylla, TSHE) forest in western Washington. We evaluated future effects of: (1) clear-cut logging 0, 20, and 40% of harvestable stands every five years; (2) thinning 20-year-old Douglas fir forests; and (3) reducing the harvesting cycle from 60 to 45 years. Reconstruction of historical patterns of vegetation succession indicated that forage values peaked in the 1960s and declined from the 1970s to the present, but recent values still were higher than may have existed in the unmanaged landscape in 1945. Increased forest harvesting rates had little short-term influence on forage trends because harvestable stands were scarce. Simulations of forest thinning also produced negligible benefits because thinning did not improve forage productivity appreciably at the stand level. Simulations of reduced harvesting cycles shortened the duration of declining forage values from approximately 30 to 15 years. We concluded that simulation models are useful tools for examining landscape responses of forage production to forest management strategies, but the options examined provided little potential for improving elk forages in the immediate future.KEY WORDS:Cervus elaphus; Elk; Forage; Forest management; Modeling; Secondary succession