Helen Green

Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement

There is compelling evidence to support the rationale for managing children on intravenous antimicrobial therapy at home whenever possible, including parent and patient satisfaction, psychological well-being, return to school/employment, reductions in healthcare-associated infection and cost savings. As a joint collaboration between the BSAC and the British Paediatric Allergy, Immunity and Infection Group, we have developed good practice recommendations to highlight good clinical practice and governance within paediatric outpatient parenteral antibiotic therapy (p-OPAT) services across the UK. These guidelines provide a practical approach for safely delivering a p-OPAT service in both secondary care and tertiary care settings, in terms of the roles and responsibilities of members of the p-OPAT team, the structure required to deliver the service, identifying patients and pathologies that are suitable for p-OPAT, ensuring appropriate vascular access, antimicrobial choice and delivery and the clinical governance aspects of delivering a p-OPAT service. The process of writing a business case to support the introduction of a p-OPAT service is also addressed.

1.32 ± 0.11 Ma age for underwater remains constrain antiquity and longevity of the Dominican primate Antillothrix bernensis

Endemic New World monkeys are an important element of the extinct mammal faunas of the Caribbeans Greater Antilles. Here we report the first geochronometric evidence that the primate Antillothrix bernensis existed in the Dominican Republic during the Pleistocene, based on the uranium-series age of carbonate speleothem that encased a tibia when it was collected in a flooded cave. Three-dimensional geometric morphometrics of laser-scanned living and extinct samples provide evidence to support the hypothesis that this specimen and other Dominican primate tibial remains belong to that same species. U-Th dating of the host cave carbonate returns ages consistently at the 600 ka upper limit of the technique. However, U-Pb, capable of resolving ages of greater antiquity, is more robust in this context, returning a secure age of 1.32 ± 0.11 Ma, which is the oldest chronometric age recorded for a Hispaniolan mammal. While its origins and manner and time of arrival are obscure, the morphometric studies are consistent with phylogenetic analyses that place A. bernensis within the pitheciid clade of the platyrrhines. The species apparently endured for over 1 million years during the climatic perturbations of the Pleistocene, as a frugivorous climbing quadruped, one of two known primate species occupying the hazard prone island of Hispaniola.

Characterisation of mineral deposition systems associated with rock art in the Kimberley region of northwest Australia

This data article contains mineralogical and chemical data from mineral accretions sampled from rock art shelters in the Kimberley region of north west Australia. The accretions were collected both on and off pigment and engraved rock art of varying styles observed in the Kimberley with an aim of providing a thorough understanding of the formation and preservation of such materials in the context of dating [1]. This contribution includes processed powder X-ray Diffraction data, Scanning Electron Microscopy energy dispersive spectroscopy data, and Laser Ablation ICP-MS trace element mapping data.

WHAT IS THE MAXIMUM TEMPERATURE REACHED IN ELASTOMERIC DEVICES UNDER SIMULATED OPAT CONDITIONS

Aim Outpatient parenteral antimicrobial therapy (OPAT), both in children and adults, is increasing in use as part of a cost saving measure for the NHS.1 However there is a general lack of stability data for antibiotics in elastomeric devices. The ‘Yellow Covered Document’2 (YCD), as it is commonly known, specifies the storage conditions, under which stability testing should be carried out ranging from freezing to a worst case scenario of 37°C±2°C. It is assumed that a temperature of 37°C equates to wearing a device reservoir under clothing close to the body e.g. under a winter coat, however evidence supporting this assumption is lacking. The main aim of the study was to determine how warm the solution in an elastomeric device becomes under various simulated conditions to inform future stability studies. Method The study was conducted during the winter months. Miniature Type K Thermocouples, were inserted into 2 types of elastomeric devices: 240 ml Baxter Infusor LV 10 (BI) and 120 ml I-Flow Homepump Eclipse® C-Series (IFHE). The elastomeric devices were filled with sterile water to simulate the drug solution. Temperature data was collected from devices stored for 24 hrs in a fridge followed by a 24 hour period at ambient temperature, simulating patients going about their daily lives including wearing devices under clothing when it was cold. Results The water in the BI took 4 hrs 0 min to decrease from 20°C (ambient temperature on the day) to 5°C when refrigerated, compared to 1 hr 22 min for the IFHE. After removal from the fridge the BI took an average of 6 hrs 12 min to reach 20°C compared to 2 hrs 28 min for the IFHE. The average maximum temperature if worn normally, therefore not under any clothing, was 23.3±0.8°C in the BI and 23.8±0.6°C in the IFHE. When worn under clothing the maximum temperature reached in the BI was 28.1°C and in the IFHE 23.4°C. Conclusion Since it is well known that an increase in temperature leads to an increase in drug degradation,3 the results of this study justifies stability testing in elastomeric devices at a more realistic temperature, preventing antibiotics and other drugs potentially being excluded from outpatient parenteral administration. A temperature of 30°C is suggested allowing for slight body temperature variation between patients as well as allowing for warmer days during summer in the UK. It is hypothesised that the delay in temperature change observed for the BI is due to the protective casing around the balloon, acting as an insulator to the environment.

A model for the formation of layered soda-straw stalactites

*bpaul@unimelb.edu.au, jdwood@unimelb.edu.au and disadvantages. For example, tree-ring records in Australia are limited to species growing in only a few specific ecological environments (Pearson & Searson, 2002). Additionally, some proxies are not necessarily located near large population centres, which are key to future water-use and infrastructure policy planning. One well-established source of climate proxy information is speleothem calcite. Speleothems have the advantage of being widely distributed geographically and thus allow us to reconstruct local palaeoclimate conditions at many sites. In addition, they appear to be sensitive to both temperature and rainfall (Proctor et al., 2002; Johnson et al., 2006) and are ideally suited to radiometric dating via U-Th and U-Pb protocols. This has led to their widespread applicability to address a variety of palaeoclimate problems (Mariethoz et al., 2012). In general, however, INTRODUCTION