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BackgroundEnvenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists.MethodsA geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.ResultsA unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.ConclusionsClinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.

Computational precision is sometimes given short shrift in a first programming course. Treating this topic requires discussing integer and floating-point number representations and inaccuracies that may result from their use. An example of a moderately simple programming problem from elementary statistics was examined. It forced students to confront problems associated with number representations and investigate appropriate ways to circumvent them. In the example, integers were represented using two's complement form, and floating-point numbers according to the Institute of Electrical and Electronics Engineers (IEEE) standard 754, both using 32 bits. Floating-point number representation (64-bit) was necessary to achieve results accurate to two decimal positions. Finally, Fortran 90/95 subprograms were written to implement arbitrarily precise operations with large integers. Students in an introductory course can write subprograms for addition and subtraction of large integers. More sophisticated subprograms that depend on the fast Fourier transform were written to perform multiplication and division of large integers. These subprograms are more suited to an advanced programming or numerical analysis course. The subprograms written to perform large-integer operations were used to determine exact solutions for the statistical problem. (Contains 5 tables and 6 figures.)

THE DANGERS OF Hymenoptera (wasps, bees, hornets, and yellow jackets) have long been known as a potential environmental hazard. An estimated 40 deaths occur in the United States each year, [...], Massive envenomations by honey bees are capable of causing multiorgan dysfunction as a result of the direct toxic effects of the large venom load received. Although all varieties of honey bee have the potential for these attacks, the Africanized honey bee (Apis mellifera scutellata) is the most commonly implicated subspecies. In the United States, the Africanized strain is found primarily in the southwestern states and is known for its highly defensive behavior if disturbed. Mechanisms behind the multiorgan dysfunction produced by these mass envenomations are not clearly understood. We present a case of a 13-year-old male who was stung by ~700 honey bees and developed progressive upper-body swelling and systemic manifestations of mass envenomation including rhabdomyolysis, renal insufficiency, and a transient transaminase elevation. Key Words: environmental risk, renal failure, rhabdomyolysis, bee envenomation, Hymenoptera Abbreviations: CPK, creatinine phosphokinase; IV, intravenous(ly)

The isolation of vinyl hydroperoxide is done at a low temperature with activation energy which decreases the lifetime of the substrate. The activation energies for thermolysis of vinyl peroxide is lower than the other peroxide and indicated by ab initio molecular orbital calculation at the MP4\MP2\6-31G (super *). The frequency of this provides the enthalpy and entropy of the reaction. The odd electron in enol\alpha-carbonyl radical is on the carbon atom.

Abstract Background Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists. Methods A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm. Results A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy. Conclusions Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.

The synthetic application of radical cyclization reactions is reported on the basis of a detailed molecular orbital calculations and related ring-opened products. The stabilization of bisected cyclopropylcarbinyl conformer relative to the perpendicular species is found to be greater for the cations as compared to the radicals.

Study Objective: The foraging of wild mushrooms can be complicated by toxicity from several mushroom types. Amatoxin, a peptide contained in several mushroom species, accounts for the majority of severe mushroom poisonings by binding to RNA polymerase II irreversibly, leading to severe hepatonecrosis. There is no effective antidote for severe amatoxin poisoning. We compare the effectiveness of 5 potential antidotal therapies in limiting the degree of hepatonecrosis in a randomized, controlled, murine model of amatoxin-induced hepatotoxicity. Methods: One hundred eighty male Institute of Cancer Research mice were randomized into 6 equal groups. Within each group, 21 mice were intraperitoneally injected with 0.6 mg/kg of alpha-amanitin (amatoxin); the remaining 9 were injected with 0.9% normal saline solution. Four hours postinjection, each group of 30 mice was randomized to 1 of 5 intraperitoneal treatments (N-acetylcysteine, benzylpenicillin, cimetidine, thioctic acid, or silybin) or normal saline solution. Repeated dosing was administered intraperitoneally every 4 to 6 hours for 48 hours. After 48 hours of treatment, each subject was killed, cardiac blood was aspirated for hepatic aminotransferase measurements (alanine transaminase and aspartate transaminase), and liver specimens were harvested to evaluate the extent of hepatonecrosis. The degree of hepatonecrosis was determined by a pathologist blinded to the treatment group and divided into 5 categories according to percentage of hepatonecrosis. Results: Amanitin significantly increased aspartate transaminase in treated mice compared with normal saline solution-treated controls (mean [SD] 2,441 [2,818] IU/L versus 310 [252]; P=.03). None of the antidotal therapies were found to significantly decrease the increase in aminotransferases compared with controls. Further, none of the antidotal therapies demonstrated an important decrease in hepatonecrosis compared with controls when a histologic grading scale was used. Conclusion: In this murine model, N-acetylcysteine, benzylpenicillin, cimetidine, thioctic acid, and silybin were not effective in limiting hepatic injury after alpha-amanitin poisoning. Increases of aminotransferases and degrees of histologic hepatonecrosis were not attenuated by these antidotal therapies. [ABSTRACT FROM AUTHOR]