Validity and reliability of telephone administration of the patient-specific functional scale for the assessment of recovery from snakebite envenomation

OBJECTIVES: Although more than 1.8 million people survive snakebite envenomation each year, their recovery is understudied. Obtaining long-term follow-up is challenging in both high- and low-resource settings. The Patient-Specific Functional Scale (PSFS) is an easily administered, well-accepted patient-reported outcome that is validated for assessing limb recovery from snakebite envenomation. We studied whether the PSFS is valid and reliable when administered by telephone. METHODS: This is a secondary analysis of data from a randomized clinical trial. We analyzed the results of PSFS collected in-person on days 3, 7, 14, 21, and 28 and by telephone on days 10, 17, and 24. We assessed the following scale psychometric properties: (a) content validity (ceiling and floor effects), (b) internal structure and consistency (Cronbach\u27s alpha), and (c) temporal and external validity using Intraclass Correlation Coefficient (ICC). Temporal stability was assessed using Spearman\u27s correlation coefficient and agreement between adjacent in-person and telephonic assessments with Cohen\u27s kappa. Bland Altman analysis was used to assess differential bias in low and high score results. RESULTS: Data from 74 patients were available for analysis. Floor effects were seen in the early post-injury time points (median: 3 (IQR: 0, 5) at 3 days post-enrollment) and ceiling effects in the late time points (median: 9 (IQR: 8, 10). Internal consistency was good to excellent with both in-person (Cronbach α: 0.91 (95%CI 0.88, 0.95)) and telephone administration (0.81 (0.73, 0.89). Temporal stability was also good (ICC: 0.83 (0.72, 0.89) in-person, 0.80 (0.68, 0.88) telephone). A strong linear correlation was found between in-person and telephone administration (Spearman\u27s ρ: 0.83 (CI: 0.78, 0.84), consistency was assessed as excellent (Cohen\u27s κ 0.81 (CI: 0.78, 0.84), and Bland Altman analysis showed no systematic bias. CONCLUSIONS: Telephone administration of the PSFS provides valid, reliable, and consistent data for the assessment of recovery from snakebite envenomation

Regulating for Public Health: Motivations for and Efficacy of State Alcohol Regulations

Health Economics and Policy,

Acute liver failure of unclear cause? Acetaminophen-protein adducts make the diagnosis

Acetaminophen poisoning remains a leading cause of acute liver failure. Some cases may be difficult to diagnose when clinical findings are equivocal, the patient\u27s history is misleading or incomplete, or the acetaminophen concentration is low or undetectable at arrival to care. We describe a case of a medically complicated young child whose acute liver failure had two of these features. Measurement of acetaminophen-protein adducts confirmed acetaminophen as the primary cause of her liver failure

Management of acetaminophen poisoning in the US and Canada: A consensus statement

IMPORTANCE: The US and Canada currently have no formal published nationwide guidelines for specialists in poison information or emergency departments for the management of acetaminophen poisoning, resulting in significant variability in management. OBJECTIVE: To develop consensus guidelines for the management of acetaminophen poisoning in the US and Canada. EVIDENCE REVIEW: Four clinical toxicology societies (America\u27s Poison Centers, American Academy of Clinical Toxicology, American College of Medical Toxicology, and Canadian Association of Poison Control Centers) selected participants (n = 21). Led by a nonvoting chairperson using a modified Delphi method, the panel created a decision framework and determined the appropriate clinical management of a patient with acetaminophen poisoning. Unique to this effort was the collection of guidelines from most poison centers in addition to systematic collection and review of the medical literature. Comments from review by external organizations were incorporated before the guideline was finalized. The project began in March 2021 and ended in March 2023. FINDINGS: The search retrieved 84 guidelines and 278 publications. The panel developed guidelines for emergency department management of single or repeated ingestion of acetaminophen. In addition, the panel addressed extended-release formulation, high-risk ingestion, coingestion of anticholinergics or opioids, age younger than 6 years, pregnancy, weight greater than 100 kg, and intravenous acetaminophen use. Differences from current US practice include defining acute ingestion as an ingestion presentation from 4 to 24 hours after overdose was initiated. A revised form of the Rumack-Matthew nomogram was developed. The term massive ingestion was replaced with the term high-risk ingestion and denoted by a specific nomogram line. Other recommendations include specific criteria for emergency department triage, laboratory evaluation and monitoring parameters, defining the role of gastrointestinal decontamination, detailed management of acetylcysteine treatment, associated adverse effects, and stopping criteria for acetylcysteine treatment, as well as criteria for consultation with a clinical toxicologist. Finally, specific treatment considerations, including acetylcysteine dosing, fomepizole administration, and considerations for extracorporeal elimination and transplant evaluation, were addressed. CONCLUSIONS AND RELEVANCE: This qualitative study provides a consensus statement on consistent evidence-based recommendations for medical, pharmacy, and nursing education and practice to optimize care of patients with acetaminophen poisoning

Low temperature/short duration steaming as a sustainable method of soil disinfection

This report was presented at the UK Organic Research 2002 Conference. Soil samples containing resting structures of fungal crop pathogens (Verticillium dahliae, Sclerotinia sclerotiorum, Sclerotium cepivorum, Pythium ultimum), potato cyst nematodes (Globodera rostochiensis and Globodera pallida) and weeds (Chenopodium album and Agropyron repens) were treated with aerated steam in the laboratory at temperatures ranging from 50–80oC in a specially constructed apparatus. Steaming at 50 or 60oC for three minutes, followed by an eight-minute resting period in the steamed soil and immediate removal from the soil thereafter, resulted in 100% kill of all weeds, fungi and nematodes. Low temperature/ short duration soil steaming could become a sustainable alternative to chemical or high-temperature steam soil disinfestation

Developing Cyberspace Data Understanding Using CRISP-DM for Host-based IDS Feature Mining

Current intrusion detection systems (IDS) generate a large number of specific alerts, but typically do not provide actionable information. Compounding this problem is the fact that many alerts are false positive alerts. This paper applies the Cross Industry Standard Process for Data Mining (CRISP-DM) to develop an understanding of a host environment under attack. Data is generated by launching scans and exploits at a machine outfitted with a set of host-based forensic data collectors. Through knowledge discovery, features are selected to project human understanding of the attack process into the IDS model. By discovering relationships between the data collected and controlled events, false positive alerts were reduced by over 91% when compared to a leading open source IDS. This method of searching for hidden forensic evidence relationships enhances understanding of novel attacks and vulnerabilities, bolstering ones ability to defend the cyberspace domain. The methodology presented can be used to further host-based intrusion detection research

VRA Modeling, phase 1

The destruction of organic contaminants in waste water for closed systems, such as that of Space Station, is crucial due to the need for recycling the waste water. A co-current upflow bubble column using oxygen as the gas phase oxidant and packed with catalyst particles consisting of a noble metal on an alumina substrate is being developed for this process. The objective of this study is to develop a plug-flow model that will predict the performance of this three phase reactor system in destroying a multicomponent mixture of organic contaminants in water. Mass balances on a series of contaminants and oxygen in both the liquid and gas phases are used to develop this model. These mass balances incorporate the gas-to-liquid and liquid-to-particle mass transfer coefficients, the catalyst effectiveness factor, and intrinsic reaction rate. To validate this model, a bench scale reactor has been tested at Michigan Technological University at elevated pressures (50-83 psig,) and a temperature range of 200 to 290 F. Feeds consisting of five dilute solutions of ethanol (approx. 10 ppm), chlorobenzene (approx. 20 ppb), formaldehyde (approx. 100 ppb), dimethyl sulfoxide (DMSO approx. 300 ppb), and urea (approx. 20 ppm) in water were tested individually with an oxygen mass flow rate of 0.009 lb/h. The results from these individual tests were used to develop the kinetic parameter inputs necessary for the computer model. The computer simulated results are compared to the experimental data obtained for all 5 components run in a mixture on the differential test column for a range of reactor contact times