Recognition and Differential Diagnosis of Hereditary Angioedema in the Emergency Department.

BACKGROUND: Angioedema (AE) is a clinical syndrome marked by localized swelling of the subcutaneous layer of the skin or the submucosal layer of the respiratory or gastrointestinal tracts. While AE is commonly mediated by histamine (allergic AE), some types result from excessive bradykinin activity, including hereditary AE (HAE), acquired AE, and angiotensin-converting enzyme inhibitor-induced AE. These are less common but important to consider given different treatment requirements and potentially serious outcomes, including death from laryngeal swelling. OBJECTIVE: This review describes the pathophysiology and clinical features of AE as well as the diagnosis and treatment of AE in the emergency department (ED). DISCUSSION: Bradykinin-mediated AE does not respond to antihistamines and corticosteroids. By contrast, several targeted, effective therapies are available, including C1-inhibitor (C1-INH) concentrates, which replace the missing protein activity underlying some bradykinin-mediated AE, and medications that directly lessen bradykinin activity (eg, ecallantide and icatibant). Urticaria is generally absent in bradykinin-mediated AE and serves as a primary differentiating factor in the clinical diagnosis. Relevant laboratory assessments may include C1-INH levels, C1-INH function, and C4 complement. Patients with HAE or a family member can communicate their known diagnosis when presenting to the ED, and some may even bring their own medication(s) with them. Patients newly diagnosed with HAE in the ED should be referred for specialized outpatient care upon ED discharge. CONCLUSIONS: There is a great need for ED clinicians to be aware of HAE, its differential diagnosis, and appropriate treatment to ensure that patients receive optimal and timely treatment.

Determination of total sulfur in fertilizers by high temperature combustion: single-laboratory validation.

Asingle-laboratory validation study was conducted for the determination of total sulfur (S) in a variety of common, inorganic fertilizers by combustion. The procedure involves conversion of S species into SO2 through combustion at 1150 degrees C, absorption then desorption from a purge and trap column, followed by measurement by a thermal conductivity detector. Eleven different validation materials were selected for study, which included four commercial fertilizer products, five fertilizers from the Magruder Check Sample Program, one reagent grade product, and one certified organic reference material. S content ranged between 1.47 and 91% as sulfate, thiosulfate, and elemental and organically bound S. Determinations of check samples were performed on 3 different days with four replicates/day. Determinations for non-Magruder samples were performed on 2 different days. Recoveries ranged from 94.3 to 125.9%. ABS SL absolute SD among runs ranged from 0.038 to 0.487%. Based on the accuracy and precision demonstrated here, it is recommended that this method be collaboratively studied for the determination of total S in fertilizers.

Collective orientation and team performance: development of an individual differences measure.

OBJECTIVE: We examine the construct of collective orientation, develop a measure to assess individual differences in collective orientation, and examine the extent to which the collective orientation of team members predicts performance on a variety of team tasks. BACKGROUND: Scholars increasingly emphasize the importance of teamwork in collaborative work environments, and evidence indicates that a lack of teamwork is a prominent factor in many real-world accidents. Although it is clear that some persons are more team oriented than others are, there are few instruments available to assess individual differences in collective orientation in a team context. METHOD: We develop a scale to measure collective orientation in teams, gather evidence on reliability and construct validity, and examine the extent to which collective orientation predicts team performance. RESULTS: Results indicate that the Collective Orientation Scale is reliable, correlates with cognate measures, and predicts performance on a variety of team tasks. CONCLUSION: We discuss the role of collective orientation in teams and the application of this scale to assess and diagnose teamwork deficiencies in work groups. APPLICATION: This research should contribute to a further understanding of factors that influence collaboration and coordination in teams.