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IN THIS INCREASINGLY hectic world, the lives of all mankind are enriched by exposure to the fascinating nature of turtles. So unhurried and deliberate are their movements, it seems a [...]

A Danish proverb says, 'It is a lazy bird that will not build its own nest.' To the chagrin of nesting birds everywhere, the brown-headed cowbird fits this figurative description [...]

Homesteaders are perpetually waging war with something, whether it is bugs, weeds, or weather. Often, there is open conflict with all three of these adversaries at one time. As a [...]

* Fall is a wonderful time of year in Ohio. The oppressive heat of summer has been replaced by mild days and cool, crisp nights. More than 100 kinds of [...]

ON A QUIET SATURDAY morning, I roll out of bed and meander downstairs to start my coffee. I gaze through the kitchen window upon the side yard, still blanketed with [...]

I HAVE BEEN FASCINATED WITH LEAVES SINCE childhood. The old sugar maples back home were ablaze with spectacular colors every October. The sight of falling leaves was always a pleasure, [...]

MY FAMILY AND I RETURNED home from church on a rainy Sunday in May. It had been pouring for hours, but just as I pulled into the driveway, the rain [...]

I LOVED GROWING UP in the shade of massive, old sugar maple trees, whose mighty branches stretched up to the sky. For many generations, they stood guard over my parents' [...]

I. The Judicial Gauntlet So much has been written about judicial challenges to the Affordable Care Act (ACA) that one hardly knows where to begin, and end, in summing up [...]

Byline: Mark Hall Los Angeles CA (SPX) Apr 06, 2020, 2020 The world is enthusiastically watching the development of the space industry. Alpha launches from Firefly Aerospace and Orion are [...]

WE HAVE HAD PLENTY OF OLD TREE STUMPS on our tiny farm over the years. In fact, there have been as many as a dozen stumps scattered all around the [...]

Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a “Think globally, act locally” approach is required.

The article titled "The Marigold: A Gardener's Friend" by Mark Hall discusses the benefits of planting marigolds in vegetable gardens. Marigolds are considered companion plants to roses, potatoes, and tomatoes. They repel deer, rabbits, and various bugs, including whiteflies. Marigolds also help prevent root-knot nematodes, which can damage tomato plants. Additionally, marigolds attract beneficial insects like parasitic wasps and pollinators, which can increase fruit production. While some experts question the effectiveness of marigolds as companion plants, many experienced gardeners have found them to be beneficial. The author encourages readers to plant marigolds in their gardens to cultivate a new friendship. [Extracted from the article]

IN COUNTLESS BARNS AND SHEDS across this nation is one of the greatest tools known to man. Its capabilities are such that no homesteader wants to be without it. Thanks [...]

Background:There is currently no standard definition of a severe burn in the pediatric patient population to identify those at higher risk of infectious complications. Our aim was to correlate total burn surface area (TBSA), burn depth, and type of burn injury to nosocomial infection rates and systemic immune system responses to better define risk factors associated with adverse outcomes. Methods:A prospective observational study at a single-center, quaternary-care, American Burn Association–verified pediatric burn center was conducted from 2016 to 2021. Blood was collected within 72 h of injury from 103 pediatric patients. Whole blood was incubated with lipopolysaccharide or phytohemagglutinin stimulation reagent to measure innate and adaptive immune response, respectively. Flow cytometry was performed on whole blood samples to measure both innate and adaptive immune cells. Unstimulated plasma was also extracted, and IL-6 and IL-10 as well as soluble proteins B- and T-lymphocyte attenuator, CD27, and T-cell immunoglobulin mucin 3 were quantified. Results:There was a significant increased risk for nosocomial infection in pediatric patients with TBSA burns of ≥20%, full-thickness burn injuries ≥5%, or flame burn injuries. There was an overall decrease in both innate and adaptive immune function in patients with TBSA burns ≥20% or full-thickness burn injuries ≥5%. Both burn injury characteristics were also associated with a significant increase in unstimulated IL-6 and IL-10 and soluble immunoregulatory checkpoint proteins. We observed a significant decrease in soluble B- and T-lymphocyte attenuator for those with a flame injury, but there were no other differences between flame injury and scald/contact burns in terms of innate and adaptive immune function. Conclusion:Burns with ≥20% TBSA or ≥5% full thickness in pediatric patients are associated with systemic immune dysfunction and increased risk of nosocomial infections.

LONG AGO, MY WIFE AND I visited our little homestead for the first time on a warm September afternoon. The charming, old farmhouse was situated on four beautiful acres that [...]

OVERVIEW: New product development projects are highly risky technical undertakings. Organizations frequently seek to manage the risk involved using standard risk management procedures, knowing that a company that better manages risks is less vulnerable. Nevertheless, NPD projects continue to fail to meet expectations for delivery time, budget, and outcomes. In this paper, we explore reasons why, despite employing self-evidently correct risk management procedures, adversities occurred in 19 major information systems projects. Project managers focused on the familiar, the measurable, the favorable, the noncommittal, and the controllable while excluding other risks that significantly affected their project performance. We have characterized this tendency as a series of five lures that leave projects vulnerable to risks. KEYWORDS: New product development, Project management, Risk management, It is well understood that new product development (NPD) projects are risky endeavors (Cerpa and Verner 2009; Smith 1999; Nelson 2007) and that the management of risk is a vital [...]

IMPORTANCE: In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related complications. OBJECTIVE: To provide an update on the spectrum of SARS-CoV-2–related neurologic involvement among children and adolescents in 2021. DESIGN, SETTING, AND PARTICIPANTS: Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2–related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge. A total of 2253 patients were enrolled during the investigation period. Patients suspected of having multisystem inflammatory syndrome in children (MIS-C) who did not meet criteria (n = 85) were excluded. Patients (<21 years) with positive SARS-CoV-2 test results (reverse transcriptase–polymerase chain reaction and/or antibody) meeting criteria for MIS-C or acute COVID-19 were included in the analysis. EXPOSURE: SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening neurologic involvement was adjudicated by experts based on clinical and/or neuroradiological features. Type and severity of neurologic involvement, laboratory and imaging data, vaccination status, and hospital discharge outcomes (death or survival with new neurologic deficits). RESULTS: Of 2168 patients included (58% male; median age, 10.3 years), 1435 (66%) met criteria for MIS-C, and 476 (22%) had documented neurologic involvement. Patients with neurologic involvement vs without were older (median age, 12 vs 10 years) and more frequently had underlying neurologic disorders (107 of 476 [22%] vs 240 of 1692 [14%]). Among those with neurologic involvement, 42 (9%) developed acute SARS-CoV-2–related life-threatening conditions, including central nervous system infection/demyelination (n = 23; 15 with possible/confirmed encephalitis, 6 meningitis, 1 transverse myelitis, 1 nonhemorrhagic leukoencephalopathy), stroke (n = 11), severe encephalopathy (n = 5), acute fulminant cerebral edema (n = 2), and Guillain-Barré syndrome (n = 1). Ten of 42 (24%) survived with new neurologic deficits at discharge and 8 (19%) died. Among patients with life-threatening neurologic conditions, 15 of 16 vaccine-eligible patients (94%) were unvaccinated. CONCLUSIONS AND RELEVANCE: SARS-CoV-2–related neurologic involvement persisted in US children and adolescents hospitalized for COVID-19 or MIS-C in 2021 and was again mostly transient. Central nervous system infection/demyelination accounted for a higher proportion of life-threatening conditions, and most vaccine-eligible patients were unvaccinated. COVID-19 vaccination may prevent some SARS-CoV-2–related neurologic complications and merits further study.

Thermal injury results in changes in the inflammatory and innate immune response of pediatric patients. Plasma cytokines, cellular profiles, and reduction in innate immune function following burn injury have also been correlated to adverse outcomes (e.g., mortality and infectious complications). Changes in adaptive immune function following thermal injury are not as well characterized. Our goal was to better understand if adaptive immune dysfunction occurs early after pediatric thermal injury and is a risk factor for nosocomial infections (NIs). A prospective, longitudinal immune function observational study was performed at a single American Burn Association (ABA)-verified pediatric burn center. Eighty burn patients were enrolled with 20 developing NI, defined using Centers for Disease Control and Prevention (CDC) criteria. We collected whole blood samples from pediatric burn patients within the first 72 hours from injury and between days 4 and 7, where applicable to analyze adaptive immune function. We compared immune function between burn patients who went on to develop NI and those that did not. Within the first 72 hours of injury, burn patients who developed NI had significantly lower absolute CD4+lymphocyte counts and whole blood ex vivo phytohemagglutinin (PHA)-induced interferon gamma (IFNγ) and interleukin-10 (IL-10) production capacity compared to those that did not develop infection. Further analysis using receiver operating characteristic curve revealed that PHA-induced IL-10 production capacity had the highest area under the curve. Our data demonstrate that early adaptive immune suppression occurs following pediatric thermal injury and PHA-induced IL-10 production capacity appears to be a predictor for the development of NI.

For decades, alcohol exclusion laws (AELs) have allowed insurance companies to reject claims for physical injuries caused by alcohol consumption, including injuries from impaired driving. A central premise of AELs is that they function as a deterrent to risk‐taking behaviors, such as excessive drinking. If this assumption is correct, state repeal of these laws should result in increased drinking. This study examines whether the repeal of AELs by some states affects drinking behaviors. Data were obtained from the 1993 to 2017 Behavioral Risk Factor Surveillance System nationwide survey. Exploiting the natural experiment presented by state repeal of AELs, we assessed the impact on current drinking and binge drinking. We used a rigorous quasi‐experimental difference‐in‐differences analysis and conducted a battery of sensitivity analyses to assure robust findings. Overall, the study found no discernable impact of state repeal of AELs on alcohol consumption. While the repeal of AELs significantly decreased the odds of reporting drinking in the past 30 days compared to those living in states with AELs or that never had AELs, the effects were small (aOR = 0.98, 95% CI = 0.96, 0.99). Likewise, there were higher odds of binge drinking among individuals living in states that repealed AELs compared to those living in states without AELs, yet with small effects (aOR = 1.03, 95% CI = 1.01, 1.05). After additionally adjusting for state‐varying characteristics and state‐specific time trends, no significant effects were identified regarding current and binge drinking. Findings from the sensitivity analyses were largely consistent with the main analysis. This study found no evidence supporting the idea that repealing AELs increased alcohol consumption or binge drinking. Future studies should consider other state‐specific dimensions within the Uniform Accident and Sickness Policy Provision Law. Alcohol Exclusion Laws were primarily implemented to deter risk‐taking behaviors, such as excessive drinking. With Alcohol Exclusion Laws (AELs), insurance companies can reject claims for physical injuries caused by alcohol consumption, including injuries from impaired driving. A central premise of AELs is that they function as a deterrent to risk‐taking behaviors; as such, their repeal will lead to problem drinking. This study examined this premise and found no discernible impact of AEL repeal on drinking.

AbstractThe propagation and management of stingless bees for pollination services is a growing industry in Australia, but we need to better understand in which crops and environments these pollinators are most useful. We investigated the potential of two Australian stingless bee species, Tetragonula carbonariaand Tetragonula hockingsi, to pollinate cucumber and watermelon crops in both field and protected cropping (greenhouse or polytunnel) environments. We recorded floral visitation rates and fruit yield in cucumber and watermelon and characterized the assemblage of wild pollinators visiting both field-grown crops. Of 229 surveys of cucumber flowers and 144 surveys of watermelon flowers in field experiments where T. carbonariacolonies were deployed, no stingless bees were recorded visiting cucumber flowers, and only one was recorded visiting watermelon flowers. Visitor assemblages in both crops were dominated by the introduced Apis mellifera, with a high number of native solitary halictid bees also visiting watermelon flowers. In a no-choice experiment, stingless bee (T. carbonariaand T. hockingsi) visits to watermelon flowers in a polytunnel occurred after four days but were low in number at first, compared to a greenhouse experiment where visits to cucumber flowers occurred only after 22 days and resulted in poor fruit set. In fact, T. hockingsimore readily collected fungal spores than pollen from cucumbers. Our results indicate that T. carbonariaand T. hockingsido not make major contributions to the pollination of cucumber and watermelon, but other native flower visitors, including halictid bees, may be important pollinators of these crops.

Defenders of health insurance reform might rightly claim that blood will be on the hands of a court that strikes down the Patient Protection and Affordable Care Act (ACA). (1) [...]

Objective. To assess the impact of state laws requiring or encouraging employers to establish 'section 125' cafeteria plans that shelter employees' premium contributions from tax. Data Sources. Available descriptive statistics, 65 key-informant interviews, and relevant documents in study states and nationally, 2008-2009. Study Design. Case studies were conducted in Indiana, Massachusetts, and Missouri--three states adopting laws in 2007. Descriptive quantitative information came from insurers, regulators, and surveys of employers. In each state, 15-17 semistructured but open ended interviews were conducted with insurance agents, insurers, government officials, and third-party administration firms, and 29 informed sources were interviewed from a national perspective or other states. Key informants were selected based on their known or reported experience, in a 'snowball' fashion until saturation was reached. Interview notes were coded for systematic analysis. Finally, relevant rulings, brochures, instructions, marketing materials, and other documents were collected and analyzed. Findings. Despite the potential for substantial cost savings, use of section 125 plans to purchase individual insurance remained low in these states after 1 or 2 years. Absent a mandate, few employers were strongly motivated to offer these plans in order to retain an adequate workforce, and uncertainty about federal legality deterred doing so. For smaller employers, benefits to owners did not outweigh administrative complexities. Nevertheless, few downsides were found to states mandating or encouraging these plans. In particular, there is little evidence that many employers dropped group coverage as a result. Conclusions. Section 125 plans remain a limited tool for states to reduce the inequitable tax treatment of individually purchased insurance, but a complete remedy requires reform of federal tax law. Key Words. Health insurance, law, taxation, cafeteria plans, crowd-out, list-billing, BACKGROUND The Patient Protection and Accountable Care Act of 2010 (PPACA) fundamentally changed much about the way health insurance is bought and paid for, but one thing it left unchanged [...]

MANY INFORMATION TECHNOLOGY DEPARTMENTS struggle with how recurring problems hurt business, and many also struggle with how to proceed with formally investigating each major problem. The risks are so significant [...]

ABSTRACT: Who owns a patient's medical information? The patient, the provider, or the insurer ? All of the above ? None of the above? In the emerging era of electronic [...]

PRIVATE CLOUDS--where companies use their own infrastructure and provision virtualized services to end users via automated tools--are gaining ground among IT leaders who want to deliver advanced services at lower […]

EXECUTIVE SUMMARY Introduction Health insurance mandates have been a component of many recent health care reform proposals. Because a federal requirement that individuals transfer money to a private party is [...]

The management of risk is considered a key discipline by the Project Management Institute and the Association for Project Management. However, knowledge of what needs to be done frequently fails to result in action consistent with that knowledge. The reasons for this seem to have received little attention. This study researched the degree of use of project risk management and barriers that prevent IT project managers from using risk management. Interviews and a survey were carried out. The results show that, in one-third of cases, because of the problem of cost justification, no formal project risk management process was applied. KEYWORDS: IT projects; risk management; rationality

IT'S A CASE where perception doesn't match reality. The phenomenal success of NetSuite Inc. and Salesforce.com Inc., two high-profile public companies with Silicon Valley roots that offer CRM suites, has […]

Then said Evangelist, "If this be thy condition, why standest thou still?" He answered, "Because I know not whither to go." John Bunyan The Pilgrim's Progress ABSTRACT The ultimate aim [...]

No therapies for acute coronavirus disease 2019 (COVID-19) have been tested in children to establish effectiveness. Despite this, across 48 hospitals, 235/424 children (55%) admitted to the intensive care or step-down unit with COVID-19 received directed therapies. Systemic steroids and remdesivir were most commonly administered, with use rising from March 2020 to December 2020.

TREND NO. 1 Tightfisted Budgets Loosen a Bit Yet the economy continues to cast a shadow of uncertainty over the best-laid tech spending plans. WHEN Bogdan Butoi-Teodorescu, chief technology officer […]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2007.06.482 Byline: Michael J. Stoner (a), Deborah G. Goodman (a), Daniel M. Cohen (a), Soledad A. Fernandez (d), Mark W. Hall (b)(c) Abstract: The 2002 American College of Critical Care Medicine (ACCM) guidelines for the resuscitation of pediatric septic shock suggest that 20 mL/kg of bolus intravenous fluid be given within 5 minutes. Of 3 commonly used, inexpensive methods of fluid delivery, we hypothesized that only use of a manual push-pull system will permit guideline adherence. Author Affiliation: (a) Section of Emergency Medicine, Columbus Children's Hospital, Columbus, OH (b) Section of Critical Care Medicine, Columbus Children's Hospital, Columbus, OH (c) Columbus Children's Research Institute, Columbus, OH (d) Center for Biostatistics, The Ohio State University, Columbus, OH. Article History: Received 26 December 2006; Revised 24 April 2007; Revised 23 May 2007; Accepted 25 June 2007 Article Note: (footnote) Supervising editor: Kathy N. Shaw, MD, MSCE Author contributions: MJS and MWH conceived of the study. MJS, DGG, DMC, and MWH designed the study. MJS and DGG recruited subjects and collected data. MJS, MWH, and DMC performed data analysis. MJS and MWH drafted the article, with substantial contributions to its revision from DGG and DMC. SAF performed additional statistical analyses and provided substantial contributions to the article revision. MWH takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was funded in part by NICHD K12HD43372-03, NHLBI K08HL085525-01. Publication dates: Available online August 30, 2007. Reprints not available from the authors.

Abstract Purpose This study measured the extent of insurance and employment problems associated with population screening for hereditary hemochromatosis and iron overload. Methods 101,168 primary care patients from the US [...]

I INTRODUCTION In a tour de force, Clark Havighurst and Barak Richman advance the bold and sweeping thesis that health care law and policy systematically favor those who are relatively [...]

Investigator and institutional financial conflicts of interest have raised concerns about both the integrity of clinical research and protecting the rights and welfare of research participants. (1) In response, professional [...]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1468-2338.2006.00415.x Byline: Mark Hall (1) Abstract: ABSTRACT One year on from the introduction of the Information and Consultation of Employees Regulations, this article reviews the emerging patterns of implementation in the light of the legislation's 'reflexive' design. The available evidence suggests considerable employer-led activity in terms of reviewing, modifying and introducing information and consultation arrangements but a relative paucity of formal 'pre-existing agreements', despite the protection they offer against the Regulations' statutory procedures being invoked by employees. This picture is consistent with a 'risk assessment' rather than a 'compliance' approach by management, facilitated by union ambivalence towards the legislation and low use of its provisions by employees. Author Affiliation: (1)Industrial Relations Research Unit, University of Warwick Article note: Mark Hall, Industrial Relations Research Unit, Warwick Business School, University of Warwick, Coventry CV4 7AL, UK; email: mark.hall@warwick.ac.uk

Extrusion processing has been a preferred mode of fabrication in the plastics industry for nearly a century. It is widely used today to produce films, sheets, and pipes cost effectively. [...]