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In 'Learning Curve' [February 2020], you wrote: 'On March 18, 2018, Elaine Herzberg was killed by a car that was learning to drive' [February 2020]. That statement is wrong. She [...]

The repeating arrangement of tubulin dimers confers great mechanical strength to microtubules, which are used as scaffolds for intracellular macromolecular transport in cells and exploited in biohybrid devices. The crystalline order in a microtubule, with lattice constants short enough to allow energy transfer between amino acid chromophores, is similar to synthetic structures designed for light harvesting. After photoexcitation, can these amino acid chromophores transfer excitation energy along the microtubule like a natural or artificial light-harvesting system? Here, we use tryptophan autofluorescence lifetimes to probe energy hopping between aromatic residues in tubulin and microtubules. By studying how the quencher concentration alters tryptophan autofluorescence lifetimes, we demonstrate that electronic energy can diffuse over 6.6 nm in microtubules. We discover that while diffusion lengths are influenced by tubulin polymerization state (free tubulin versus tubulin in the microtubule lattice), they are not significantly altered by the average number of protofilaments (13 versus 14). We also demonstrate that the presence of the anesthetics etomidate and isoflurane reduce exciton diffusion. Energy transport as explained by conventional Förster theory (accommodating for interactions between tryptophan and tyrosine residues) does not sufficiently explain our observations. Our studies indicate that microtubules are, unexpectedly, effective light harvesters.

The article focuses on the implementation of professional learning and lessons concerning facilitating teacher professional learning, and mentions approaches for making instruction and curriculum inclusive of Indigenous culture. Topics discussed include relationship based learning of Indigenous Arts and Sciences, collaboration and collective understanding of shared goals through professional learning, and making inclusive and equitable schooling priorities.

The chronic conditions and functional limitations experienced by children with medical complexity (CMC) place them at disproportionate risk for COVID-19 transmission and poor outcomes. To promote robust vaccination uptake, specific constructs associated with vaccine hesitancy must be understood. Our objective was to describe demographic, clinical, and vaccine perception variables associated with CMC parents’ intention to vaccinate their child against COVID-19.We conducted a cross-sectional survey (June–August 2021) for primary caregivers of CMC between ages 5 to 17 at an academic medical center in the Midwest. Multivariable logistic regression examined associations between vaccination intent and selected covariates.Among 1330 families, 65.8% indicated vaccination intent. In multivariable models, demographics had minimal associations with vaccination intent; however, parents of younger children (<12 years) had significantly lower adjusted odds of vaccination intent (adjusted odds ratio [95% confidence interval]: 0.26 [0.17–0.3]) compared to parents of older children (≥12 years). CMC with higher severity of illness, ie, those with ≥1 hospitalization in the previous year (versus none) or >1 complex chronic condition (vs 1), had higher adjusted odds of vaccination intent (1.82 [1.14–2.92] and 1.77 [1.16–2.71], respectively). Vaccine perceptions associated with vaccine intention included “My doctor told me to get my child a COVID-19 vaccine” (2.82 [1.74–4.55]); and “I’m concerned about my child’s side effects from the vaccine” (0.18 [0.12–0.26]).One-third of CMC families expressed vaccine hesitation; however, constructs strongly associated with vaccination intent are potentially modifiable. Pediatrician endorsement of COVID-19 vaccination and careful counseling on side effects might be promising strategies to encourage uptake.

OVERVIEW: Industrial research institutes used to be government-financed organizations with mandates to advance industrial technology and improve economic competitiveness. Good R&D people were assembled and expected to contribute to the welfare of industry and society without having any clear link to business needs and strategy. Today, institutes have evolved into market-driven hybrids paid for value delivered to industry while still receiving a portion of their funding from public sources. They are strongly networked to enhance the probability of finding rapid and cost-effective solutions to technical problems brought to them by industry. The handling of technology transfer to industry and associated intellectual property rights has been facilitated by model contracts and master alliance agreements, and modern industrial institutes use web-based tools to speed identification of new technologies with high potential, to gauge potential value of those technologies to member companies, and to establish a project strategy that will lead to defensible IP. KEY CONCEPTS: research institutes, intellectual property, technology partnering, innovation., From the perspective of economists, industrial research institutes exist to compensate for chronic under-spending by companies in research and development. Left to their own devices, companies are generally too risk [...]

Acetaminophen poisoning occurs in all age groups; however, hospital-based outcomes of children with these poisonings were not well characterized. Our objectives were to describe the incidence, characteristics, and outcomes of hospital stays in children with acetaminophen poisoning and evaluate the contribution of intentionality.We used the 2016 Kids’ Inpatient Database and validated International Classification of Diseases, 10th Revision diagnostic codes to identify hospitalizations of children aged 0 to 19 years for acetaminophen poisoning. We used standard survey methods to generate weighted population estimates and describe characteristics and outcomes, both overall and stratified by intentionality.There were 9935 (95% confidence interval [CI], 9252–10 619) discharges from acute care hospitals for acetaminophen poisoning in U.S. children aged 0 to 19 years during 2016, corresponding to a population rate of 12.1 (95% CI, 11.3–12.9) hospitalizations per 100 000 children. Most hospitalizations for both intentional and unintentional acetaminophen poisoning occurred in females, with a strongly age-related sex distribution. Median length of stay was 2 days (interquartile range, 1–4 days); however, nearly half of discharges were subsequently transferred to another type of facility (eg, psychiatric hospital). Median hospital charges for acute care were $14 379 (interquartile range, $9162–$23 114), totaling $204.7 million (95% CI, $187.4–$221.9) in aggregate. Of 31 632 hospital discharges associated with self-harm medication poisoning in children aged 0 to 19 years, acetaminophen was the single most commonly implicated agent.Acetaminophen poisoning was the most common cause of U.S. hospital stays associated with medication self-harm poisoning. More effective acetaminophen poisoning prevention strategies are needed, which may reduce the burden of this common adolescent malady.

Objective: To determine how and what pediatric residency programs are teaching residents about normal newborn care in the nursery. Design: A mailed survey distributed in 1994. Participants: All 237 known pediatric residency programs in the United States, Canada, and Puerto Rico. Result: Survey response rate was 77% (184 of 237 questionnaires were returned and completed). In 40% of the programs, neonatologists were primarily responsible or co-responsible for teaching residents about management of normal newborns. A normal newborn nursery curriculum had been developed and implemented in 56% of the programs,30% of programs were developing one, and 13% reported no curriculum. Specific instruction about breast-feeding was not offered in 16% of programs. Circumcisions were most commonly performed by obstetricians; anesthetic use was low (overall median use, 10%) but was more common (P [is less than] .002) when circumcisions were performed by pediatricians. The hospital environment and lack of faculty time were cited as the main barriers to teaching residents about normal newborn care. Conclusions: Although general pediatricians spend a substantial amount of practice time on newborn care, neonatologists were responsible for this teaching in almost half of the pediatric residency programs. Many programs have not developed a curriculum. Instruction about breast-feeding was not universal. Most pediatric residents do not learn to perform circumcisions. General pediatricians should be more involved in the development, implementation, and evaluation of comprehensive newborn nursery curricula to improve training in this important aspect of general pediatric practice., Lack of time spent in pediatric residency programs on normal newborn care may point out the need for general pediatricians to train residents in circumcision and breastfeeding. Researchers surveyed 184 pediatric residency programs regarding instruction in normal newborn care. About half (56%) of programs had implemented a normal newborn nursery curriculum. Breastfeeding instruction was not included in 16% of programs. Most pediatric residents were not taught how to perform circumcisions. Involvement of general pediatricians in training pediatric residents may increase the use of anesthesia before circumcision and increase instruction in breastfeeding.

Social resistance to deregulation of the energy industry in the industrial nations can be overcome by implementing privatized compliance monitoring methods. A deposit-refund pollution control model is a cost-effective incremental way to privatize enforcement by placing compliance burdens on emitters rather than on regulators. Private compliance monitoring can help address issues such as potential environmental damage, regulatory bureaucracy, and lack of funding.

* PURPOSE: To evaluate the effect of noncontact transscleral Nd:YAG cyclophotocoagulation for refractory glaucoma after penetrating keratoplasty on intraocular pressure, visual acuity, and graft status. * METHODS: We reviewed the records of all patients treated at the Duke University Eye Center between 1988 and 1993 who had noncontact transscleral Nd:YAG cyclophotocoagulation for uncontrolled glaucoma associated with penetrating keratoplasty. * RESULTS: One eye each of 39 patients was included in the study. At final follow-up, ranging from three to 63 months (mean, 27 [= OR -] 18 months), the average decrease in intraocular pressure was 15 mm Hg (P = .0001). Thirty-one patients (77%) had a final intraocular pressure between 7 and 21 mm Hg. The number of medications was reduced by an average of 1.4 (P = .0001). Five patients (13%) showed an improvement in best, corrected visual acuity at final follow-up; 12 (31%) maintained stable acuity, and 22 (56%) demonstrated a deterioration in acuity. Of 25 patients with clear grafts before cyclophotocoagulation, 11 (44%) had graft decompensation. * CONCLUSIONS: Noncontact transscleral Nd:YAG cyclophotocoagulation is effective in lowering intraocular pressure in eyes with refractory glaucoma and associated penetrating keratoplasty, although loss of visual acuity and graft decompensation remain important concerns. Further study is needed of other cyclophotocoagulation protocols and alternative treatments for this patient population.

We performed contact transscleral cyclophotocoagulation in two human autopsy eyes with continuous-wave Nd:YAG and diode lasers. Duration of exposure was two seconds, and powers were 4 to 7.3 W with the Nd:YAG laser and 1.75 to 2.5 W with the diode laser. In both procedures, we used hand-held quartz fiberoptic contact probes for energy delivery. Tissue responses were viewed with high-magnification videographic recording technique to analyze the real-time laser effects. The treated tissues were then studied by light microscopy. We observed different tissue responses both videographically and histologically. Nd:YAG laser lesions were characterized by prominent tissue whitening and contraction of the ciliary epithelium, while the diode laser lesions had less whitening and the tissue contraction appeared to be deeper in the ciliary body. The histologic correlate was coagulation and disruption of the ciliary epithelium and little effect on the underlying ciliary muscle with the Nd:YAG laser, while the diode laser had less effect on the ciliary epithelium but caused a significant coagulative response in the ciliary muscle. Comparative trials are needed to establish the clinical significance of these videographic and histologic observations.

Premium receipts of life insurers will grow an estimated 6 percent in 1994 to nearly $317 billion, led by sales of individual annuities. Net written premiums of property/casualty insurers will grow 4 percent in 1994 to about $245 billion, largely reflecting rate increases in automobile insurance. Real estate problems for some life insurers and poor underwriting performance for some property/casualty insurers will adversely affect the financial health of many companies., LIFE INSURANCE Premium receipts of life insurance companies grew nearly 6 percent in 1993 to $298.9 billion. Strong annuity sales and modest growth in health premiums led this growth. Life [...]

Premium receipts of life insurers am expected to grow 4.5 percent in 1993 to about $285 billion. Net written premiums of property/casualty insurers are expected to increase 4 percent to [...]

The Columbus quincetenary has focused the study on the indigenous population of the Americas prior to European discovery. Pre-conquest population was placed at 90 to 110 million with the greater concentration in Mesoamerica, which includes Mexico and neighboring countries. Mesoamerican population was estimated at about 41 million and the Central Andean population reaching 30 million. Other major culture areas were the Circum-Caribbean area, the Tropical Forest peoples of the Amazon Basin and Southeast Brazil and the nomadic tribes of the Marginal Regions. Mortality was greatest among the coastal population which were in contact with the invading Europeans.

Premium receipts of life insurance companies will increase 7.2 percent in 1992. Annuities will again lead growth. Premiums of property-casualty insurers will increase a moderate 5.5 percent. Competition will remain strong in the industry and consolidation will increase. Insolvencies will likely stay at the current levels. Life insurers will experience continued problems with assets. Suppressed rates in many lines and uncertain liability losses will threaten the financial health of many property-casualty insurance companies., LIFE INSURANCE Premium receipts of life insurance companies increased an estimated 7.4 percent in 1991, to $283.5 billion. Strong annuity sales and expanding premiums for health insurance accounted for the [...]

Glaucoma is an abnormal condition of elevated intraocular pressure caused by obstruction of the outflow of aqueous humor from the anterior chamber, the area between the cornea and the iris and lens. Treatment of glaucoma that does not respond to other therapies may be directed at increasing outflow of aqueous by destruction of a portion of the ciliary process to produce an opening between the anterior chamber and the suprachoroidal space so that the aqueous humor can escape. Cyclophotocoagulation uses laser energy transmitted through the sclera to destroy the ciliary epithelium. A study was undertaken of 100 patients who were unable to have their intraocular pressure adequately controlled with medical treatment, and who were at high risk for failure of routine glaucoma filtering surgery. These patients underwent transscleral Nd:YAG laser cyclophotocoagulation with contact lens. The contact lens was used to maintain eyelid separation during the procedure, to compress the conjunctiva and to permit accurate placement of the laser beam. The average patient age in the study group was 62 years. Results achieved in these 100 patients using this technique were compared with those from a previously reported group of 100 patients treated with laser, but without the use of the contact lens. In the study group the accurate placement of the laser beam provided early postoperative advantages of fewer burns on the conjunctiva, and complications included conjunctival hyperemia (collection of blood). Comparison of the study and historical groups revealed similar long-term outcomes, except that there was a higher incidence of phthisis (atrophy of the eye) in the study patients; six patients developed this condition. These results support the use of a contact lens in laser cyclophotocoagulation; because the lens compresses the conjunctiva, a lower level of the laser energy may be effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Today, many corporate managers and their advisors must face the challenge of dealing with financially troubled companies. [1] A finacially troubled company's management initially must decide upon a course of [...]

Glaucoma is an eye disease characterized by elevated pressure (above 21 millimeters of mercury, mmHg) within the eye caused by obstruction of the outflow of aqueous humor from the anterior chamber (portion of the eye between the cornea and the lens). This condition causes gradual loss of peripheral vision, and possibly later loss of central vision. Glaucoma that remains uncontrolled despite apparently adequate medical treatment may be treated surgically, by trabeculectomy, a procedure allowing drainage of the aqueous humor beneath the conjunctiva by connecting the anterior chamber of the eye with the subconjunctival space. There is disagreement over the benefit of removing part or all of Tenon's capsule, the membrane that envelops the eyeball from the back to the area of the iris. A study was carried out of 49 eyes before trabeculectomy; 23 underwent partial tenonectomy (excision of Tenon's capsule), and 26 underwent total tenonectomy. A final intraocular pressure below 18 mmHg was achieved in 19 of 23 patients (83 percent) in the partial tenonectomy group, and in 18 of 26 patients (69 percent) in the total tenonectomy group. A pressure below 21 mmHg was obtained by 87 percent of the partial group, and 81 percent of the total group. There was no significant statistical difference between the two groups. It is concluded that equivalent results may be expected using either procedure. A total tenonectomy requires more careful dissection and may be associated with inadvertent creation of a hole. Therefore, a partial tenonectomy, in most cases, has intraoperative advantages over total tenonectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Glaucoma is an abnormal condition of elevated pressure (above 21 mm of mercury) within the eye caused by obstruction of the outflow of aqueous humor from the anterior chamber (portion of the eye between the cornea and the lens). Glaucoma results in gradual loss of peripheral vision, followed later by loss of central vision and blindness due to atrophy of the optic nerve. Treatment of glaucoma is directed toward decreasing intraocular pressure to prevent further damage to the optic nerve and further loss of peripheral vision. However, there are few criteria to indicate how low the intraocular pressure should be for a specific patient to prevent this damage. To determine what a 'safe' level of intraocular pressure is, and to identify factors associated with progression of glaucoma, a study was undertaken of 55 patients with glaucoma and early eye damage who had received medical treatment and surgery. Patients were followed from 4 to 11 years. Eyes with intraocular pressure higher than 21 mm of mercury had progressive changes, whereas eyes with pressure lower than 17 remained stable. About half of the eyes with pressure between 17 and 21 had progression of disease. Patients with stable glaucoma tended to be slightly younger than patients who experienced disease progression. These results support the importance of controlling intraocular pressure in patients with glaucoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Equipment Leasing Equipment leasing will increase an estimated 8.1 percent in 1991 to approximately $143.7 billion. Varying growth among equipment types will push the overall industry upward. The industry will [...]

Insurance Premium receipt of life insurance companies will increase 8 percent in 1991, with annuities leading the way. Premiums written by property-casualty insurers will grow 6.2 percent. Despite small commercial [...]

The use of transscleral cyclophotocoagulation with neodymium:YAG (Nd:YAG) laser has become increasingly popular as an alternative to other surgical procedures. This technique involves the use of a laser which burns the anterior segment of the eye called the ciliary body. Some technical difficulties exist in the use of this laser technique. The authors studied cadaver eyes to determine if the use of a contact lens, through which the laser beam passes, would improve the precision of the treatment and eliminate other technical difficulties of the procedure. It was anticipated that the lens would assist in compressing the conjunctiva, the mucus membrane that lines the eyelids, and blanching the vessels of the eye. It was determined that when the beam was delivered directly, or through the contact lens, the laser burns produced on the ciliary body were similar. The use of the lens helped keep the surgeon's fingers away from the laser beam and helped to separate and protect the patient's eyelids. It was noted that living eyes may respond differently than the autopsy eyes. (Consumer Summary produced by Reliance Medical Information, Inc.)

OVERVIEW: Every technology-based company struggles to keep R&D focus in alignment with corporate business strategy. However, ensuring that the unique perspective of the R&D organization is included in the corporate strategic planning process is' often a greater challenge, but one that is crucial for a company confronting new and emerging technologies with the potential to significantly change the competitive landscape. International Paper has found a 'Voice of Technology' protocol and an Innovation Council to be effective in creating such alignment and fostering R&D input into the strategic planning of the business., The Voice of Technology (VOT) is a reporting protocol for R&D staff to analyze new and emerging technologies for senior management. Specifically, the threats and opportunities created by new technologies [...]

Now add a V-8 or the twin-turbo 3.5-liter V-6 and F-150 towing numbers if you actually want me to buy one. Why have all the hardware of an exhaust-driven turbo when an electric motor would be so much simpler? - George Hovany, Gig Harbor, WA Your description of a turbo spun by an electric motor and without the exhaust-driven hardware is actually an electric supercharger. However, electrified turbos, where an electric motor assists the exhaust-driven turbine, are the next frontier. [Extracted from the article]

A decade ago most business correspondence went by post. Today we are impatient if an E-mail or fax is not answered the same day. Similar expectations are becoming a reality [...]

Application: Using 1-butene, 1-hexene, and 1-octene as a comonomer gives blown film performance that increases with increasing length of the a-olefin used. Linear low density polyethylene (LLDPE) resins are a [...]

Objective: To study the long-tern] effect of Nd:YAG capsulotomy on intraocular pressure (IOP). Methods: We reviewed the records of patients with bilateral pseudophakia who received Nd:YAG capsulotomy in only 1 eye. Using the Wilcoxon rank sum test, we compared the mean change in IOP in eyes before and after capsulotomy with that of the noncapsulotomy eyes at corresponding time intervals. Using multiple regression tests, we analyzed the factors significantly associated with postcapsulotomy long-term IOP increases. Results: The study included 100 patients who were followed up for a median of 1.5 years after capsulotomy. The mean [+ or -] SD age of the study group was 76 [+ or -] 7 years, and 37 patients had glaucoma. The changes in IOP in the eyes treated with capsulotomy were significantly higher than those in noncapsulotomy eyes at each time interval following capsulotomy. The long-term IOP increase was significantly associated with the IOP increase measured 1 hour after the capsulotomy (P = .001). Patients with glaucoma were more likely to require long-term additional glaucoma medication than were nonglaucoma patients to require initial glaucoma therapy after the capsulotomy (P = .002). Conclusion: After Nd:YAG capsulotomy, long-term IOP is often elevated above precapsulotomy baselines, especially in glaucoma patients or patients who experience a significant IOP increase within hours after the capsulotomy. Arch Ophthalmol. 2000; 118:1334-1337

IMPORTANCE: An association between antibiotic use and excessive weight gain or obesity in healthy infants and young children has been reported, but evidence is inconsistent and based on observational studies of growth in relation to incidental antibiotic exposures. OBJECTIVE: To evaluate whether prolonged antibiotic exposure is associated with weight gain in children participating in a clinical trial of antibiotic prophylaxis to prevent recurrent urinary tract infection. DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of data from the Randomized Intervention for Children With Vesicoureteral Reflux Study, a 2-year randomized clinical trial that enrolled participants from 2007 to 2011. All 607 children who were randomized to receive antibiotic (n = 302) or placebo (n = 305) were included. Children with urinary tract anomalies, premature birth, or major comorbidities were excluded from participation. INTERVENTIONS: Trimethoprim-sulfamethoxazole or placebo taken orally, once daily, for 2 years. MAIN OUTCOMES AND MEASURES: Weight gain as measured by change in weight-for-age z score from baseline to the end-of-study visit at 24 months. Secondary outcomes included weight gain at 6, 12, and 18 months and the prevalence of overweight or obesity at 24 months. RESULTS: Participants had a median age of 12 months (range, 2-71 months) and 558 of 607 (91.9%) were female. Anthropometric data were complete at the 24-month visit for 428 children (214 in the trimethoprim-sulfamethoxazole group and 214 in the placebo group). Weight gain in the trimethoprim-sulfamethoxazole group and the placebo group was similar (mean [SD] change in weight-for-age z score: +0.14 [0.83] and +0.18 [0.85], respectively; difference, −0.04 [95% CI, −0.19 to 0.12]; P = .65). There was no significant difference in weight gain at 6, 12, or 18 months or in the prevalence of overweight or obesity at 24 months (24.8% vs 25.7%; P = .82). Subgroup analyses showed no significant interaction between weight gain effect and age, sex, history of breastfeeding, prior antibiotic use, adherence to study medication, or development of urinary tract infection during the study. CONCLUSIONS AND RELEVANCE: Based on a secondary analysis of data from a large clinical trial of trimethoprim-sulfamethoxazole prophylaxis, there was no evidence that prolonged exposure to this antibiotic has a concurrent effect on weight gain or the prevalence of overweight or obesity in healthy infants and young children.

Computerized image analysis of the head of the optic nerve now gives ophthalmologists a means of documenting and following changes caused by glaucoma. The question remaining is, when will this sophisticated technology be available for the clinician to use in office practice? This may well be 10 years away. There are several general areas which present problems for its clinical use. Each instrument varies in its ability to provide information that is reproducible and accurate. Various researchers have studied the ability of the Optic Nerve Head Analyzer to produce consistent measurements and it has been concluded that more development is needed for it to analyze pallor of the optic nerve head, but its ability to measure the landmarks of this structure is better. When this instrument is able to provide reproducible and accurate measurements, it will then have to be further studied to determine how it can be used in clinical practice. Other problems that must be solved before it can be reliably used clinically concern how to use the data the instrument provides and how to determine which structures are most important to study in order to show changes of progressive glaucoma. A tremendous amount of work still has to be done before this instrument will become a standard tool used to study glaucoma.

Pigment dispersion syndrome is a condition in which granules of pigment from the iris are dispersed into adjoining structures of the eye. In some cases, the pigment becomes embedded in the trabecular meshwork, the structure that allows fluid to drain from the eye, and this may result in pigmentary glaucoma. A study was conducted to identify those factors that present the greatest risk of secondary glaucoma caused by pigment dispersion so that patients at risk might benefit from preventive therapy. The study examined the medical records of 93 patients with pigmentary glaucoma and 18 patients with pigmentary dispersion syndrome. The authors concluded that those most significantly at risk of developing glaucoma were male, black, severely nearsighted, or having Krukenberg's spindles, in which pigment granules are dispersed into the corneal lining. The men in the study were diagnosed for pigment dispersion syndrome at an earlier age than women; they had a higher proportion of individuals in the glaucoma group, despite the fact that women predominated in the pigment dispersion group; and they required more aggressive therapy. Although only four blacks were included in the study, all of them required glaucoma surgery. The authors suspected that the high risk to nearsighted patients was caused by the deeper anterior chambers of nearsighted eyes, which are more susceptible to rubbing between the iris and portions of the lens, leading to pigment dispersion. A follow-up by the authors indicated that approximately half of the individuals studied with pigment dispersion will progress to glaucoma and will require surgery.