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2,4-Dinitrophenol (DNP) is a highly toxic industrial chemical that is sometimes misused to reduce body fat. Toxicity following ingestion of DNP has recently become more common in the United Kingdom. This research was performed to document the frequency of DNP toxicity as reported to poisons centres in the United States (US) and United Kingdom (UK) and to identify the clinical features associated with fatality. Calls to UK and US poisons centres involving systemic exposure to DNP were extracted for the 12 calendar years 2007-2018. These were analysed using univariate and multivariate statistical techniques. There were 204 cases (n = 86, US; n = 118, UK) of systemic DNP exposure identified, of which 86% were under the age of 40 and 71% were males. Over the study period the incidence of reported DNP toxicity was higher in the United Kingdom than the United States (1.78 vs. 0.26 cases per million population) and annual case numbers have increased in both countries since 2011. Case fatality was high and did not differ significantly between countries (US 11.6%; 95% CI: 6.4–20.1%: UK 16.9%; 95% CI: 11.3–24.7%; X2(1) = 1.12, p = 0.29). Univariate analysis demonstrated significant associations between risk of death and the presence of hypoglycaemia (OR = 17.1, 95% CI 1.7–174.3), hypertonia (OR = 12.9, 95% CI 3.5–47.6), acidosis (OR = 12.5, 95% CI 4.8–32.9), raised lactate (OR = 8.3, 95% CI 2.4–28.4), hyperpyrexia (OR = 6.5, 95% CI 2.8–15.2), tachycardia (OR = 6.4, 95% CI 2.5–16.4), agitation or confusion (OR = 6.0, 95% CI 2.6–13.7), hypertension (OR = 5.6, 95% CI 1.9–16.4) and tachypnoea/dyspnoea (OR = 2.8, 95% CI 1.2–6.1). After backwards stepwise logistic regression, the following were retained as significant independent predictors of mortality: acidosis (OR = 5.4, 95% CI: 1.8 − 16.5), tachycardia (OR = 3.6, 95% CI: 1.2 − 11.0), agitation/confusion (OR = 3.4, 95% CI: 1.2 − 9.7) and hyperpyrexia (OR = 2.8, 95% CI: 1.0 − 7.4). DNP toxicity is uncommonly reported to poisons centres but has recently become more frequent in the United States and United Kingdom. Tachycardia, hyperpyrexia, acidosis, and agitation/confusion are independent risk factors for mortality and their presence should prompt rapid escalation to an intensive care environment for aggressive supportive treatment and monitoring. [ABSTRACT FROM AUTHOR]

Background. Attention-deficit/hyperactivity disorder (ADHD) is widespread, with a national (United States) prevalence of nearly 10%. The 2011 changes in the diagnostic criteria will likely further increase the prevalence of this disorder. Little is known about the incidence of toxicity from unintentional poisonings of ADHD medications. This study attempted to determine the incidence of these ingestions and the corresponding financial impact in the United States. Methods. Four geographically different centers were chosen. Subjects with unintentional poisonings due to ADHD medications were included if the admission dates were between 2000 and 2002 (cohort A) or between 2009 and 2010 (cohort B). Using data from the participating hospitals and the number of monitored beds in each corresponding county, data were extrapolated on a national (United States) level. Results. Sixty-three subjects were admitted at four hospitals (18, cohort A and 45, cohort B). The crude incidence rate ratio increased in the later time frame as compared to that in the earlier time frame (incidence rate ratio, 3.13; 95% CI, 1.80-5.68; p < 0.0001). The median (IQR) charges per patient, adjusted for inflation, were $4780 ($3,895-$8,287) and $5912 ($3,432-$9,433) for cohorts A and B, respectively ( p = 0.57). If the subjects in the participating counties were only admitted to the participating hospitals, the annual charges, extrapolated throughout the United States for the two periods, would be $2,419,016 and $8,129,538, respectively. If the subjects were evenly distributed across all pediatric monitored beds in a given county, the annual charges extrapolated throughout the United States for the two periods would be $5,694,232 and $24,126,640, respectively. Conclusion. The incidence of unintentional poisonings from ADHD drugs is increasing and is associated with a significant cost. [ABSTRACT FROM AUTHOR]

We investigate the predictable component of excess returns in German, Japanese, UK and US aggregate stock indices, finding evidence to suggest that the frequently documented predictable component in excess returns is predominantly due to a failure in previous research to consider risk. [ABSTRACT FROM AUTHOR]

Introduction: Most patients transported by air who require endotracheal intubation undergo endotracheal intubation before transport. However, in-flight endotracheal intubation may be indicated in the setting of certain scene conditions, in-flight patient deterioration, or endotracheal tube dislodgement. A previous report of high endotracheal intubation efficacy in the BK-117 in-flight recommended that flight programs review endotracheal intubation capabilities in their own aircraft. This study was conducted to determine whether in-aircraft endotracheal intubation times in the AS365N2 Dauphin were comparable to those previously reported for the BK-117., Setting: AS365N2 and BK-117 helicopters stationary on a helipad., Methods: Eight flight team members per formed three mannequin endotracheal intubations in each aircraft. Three time intervals were assessed: Setup, time required for equipping and positioning for endotracheal intubation; placement, time from laryngoscopy to endotracheal intubation; and total (Setup + Placement). Mean times for the BK-117 and AS365N2 were compared using the t test (a=0.05)., Results: All endotracheal intubation attempts were successful, but setup (p=0.0001), placement (p=0.0271), and total (p=0.0011) times were longer in the Dauphin. Crew members unanimously expressed endotracheal intubation difficulty caused by positioning problems in the Dauphin., Conclusion: In-aircraft intubation is significantly more time-consuming in the Dauphin than in the BK-117. This prolongation of intubation appears to be due to problems with positioning of the air medical crew and patient.

Introduction: In critically ill patients (e.g., trauma victims) prevention of hypothermia is an important goal. Infusion of warm fluids has been addressed in the hospital setting, but not in the air medical transport setting., Purpose: The purpose of this study was to test the efficacy of an intravenous (IV) fluid warming device that is well-suited for the air medical transport environment., Method: The warmer studied was used with IV fluid heated to approximately 38 degrees C (100 degrees F) and evaluated in environmental temperatures of -16 degrees C (3 degrees F), 2 degrees C (36 degrees F), and 22 degrees C (72 degrees F). The warmer group was compared to a control group of similarly treated IV fluids without a warming device. Temperatures were measured at baseline, 15, 30 and 60 minutes., Results: The 30- and 60-minute fluid temperatures were higher in the warmer than in the control group for all three environmental temperature settings. At 15 minutes, fluid temperatures were higher in the warmer group for the 2 degrees C and -16 degrees C, but not the 22 degrees C, environments. There was no significant drop in temperature in the warmer group in the 22 degrees C and 2 degrees C settings, but a decrease was noted in the -16 degrees C environment. There was a significant drop in the control group at all temperatures tested., Conclusion: The IV fluid warmer tested effectively maintains the temperature of warmed IV fluids in temperatures above 2 degrees C. At -16 degrees C there was significant heat loss, but the loss was significantly less when compared to the control group.

Introduction: Patients transported by air ambulance are often critically ill and, thus, have a relatively high likelihood of requiring advanced life support (ALS) measures during transport. Despite this fact, the ability of the air medical crew to perform ALS interventions efficiently while in flight has not been investigated., Setting: The study was conducted with BO 105 and BK 117 helicopters and a ground transport unit at a university hospital-based air ambulance service., Methods: Ten flight nurses were timed performing various ALS tasks while in flight in each aircraft and in the ground ambulance. Mean times for performance of each task in the aircraft and in the ground unit were analyzed using Dunnett's method for analysis of multiple means; alpha was set at 0.01., Results: Times required to perform all ALS tasks were significantly increased in the BO 105 setting compared to the setting of the BK 117 or the ground ambulance (p < 0.01). Times for performance of interventions in the BK 117 did not differ significantly from corresponding times in the ground setting., Conclusion: It appears that the environment of the BO 105 may impose limitations on the timely performance of certain ALS interventions.