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The widespread outbreak of the COVID-19 pandemic forced almost every aspect of our lives to shift to online modalities. One outcome of the pandemic was to effectively establish digital learning as a major system for education. The purpose of this chapter is to describe the development and implementation of a web-based resource for college instruction. The foundation for this pedagogical tool is sociocultural learning theory. This instructional tool has been deployed with over 2000 students to date. Its successful employment with college students in India and the USA is outlined, and suggestions are included for its generalized use to other content and courses.

Practitioners in many domains–e.g., clinical psychologists, college instructors, researchers–collect written responses from clients. A well-developed method that has been applied to texts from sources like these is the computer application Linguistic Inquiry and Word Count (LIWC). LIWC uses the words in texts as cues to a person’s thought processes, emotional states, intentions, and motivations. In the present study, we adopt analytic principles from LIWC and develop and test an alternative method of text analysis using naïve Bayes methods. We further show how output from the naïve Bayes analysis can be used for mark up of student work in order to provide immediate, constructive feedback to students and instructors. References Blei, D. M., Ng, A. Y., & Jordan, M. I. (2003). Latent Dirichlet Allocation. Journal of Machine Learning Research 3, 993-1022. Boot, P., Zijlstra, H., & Geenen, R. (2017). The Dutch translation of the Linguistic Inquiry and Word Count (LIWC) 2007 dictionary. Dutch Journal of Applied Linguistics, 6(1), 65-76. Chung, C. K., & Pennebaker, J. W. (2008). Revealing dimensions of thinking in open-ended self-descriptions: An automated meaning extraction method for natural language. Journal of research in personality, 42(1), 96-132. Hsieh, H-F., & Shannon, S. E. (2005).Three approaches to qualitative content analysis. Qualitative health research, 15(9), 277-1288. Kintsch, W. (1998). Comprehension: A paradigm for cognition. New York: Cambridge University Press. Landauer, T. K., Foltz, P. W., & Laham, D. (1998). An introduction to latent semantic ana­lysis. Discourse processes, 25(2-3), 259-284. Lund, K., & Burgess, C. (1996). Producing high-dimensional semantic spaces from lexical co-occurrence. Behavior Research Methods, Instruments, & Computers, 28(2), 203-208. Massó, G., Lambert, P., Penagos, C. R., & Saurí, R. (2013, December). Generating New LIWC Dictionaries by Triangulation. In Asia Information Retrieval Symposium (pp. 263-271). Springer, Berlin, Heidelberg. Newman, M., Groom, C.J., Handelman, L.D., & Pennebaker, J.W. (2008). Gender differences in language use: An analysis of 14,000 text samples. Discourse Processes, 45(3), 211-236. Pennebaker, J.W., Boyd, R.L., Jordan, K., & Blackburn, K. (2015). The development and psychometric properties of LIWC 2015. Austin, TX: University of Texas at Austin. Tausczik, Y. R., & Pennebaker, J. W. (2010). The psychological meaning of words: LIWC and computerized text analysis methods. Journal of language and social psychology, 29(1), 24-54. Van Wissen, L., & Boot, P. (2017, September). An Electronic Translation of the LIWC Dictionary into Dutch. In: Electronic lexicography in the 21st century: Proceedings of eLex 2017 Conference. (pp. 703-715). Lexical Computing.

Fewer than 20 transiting Kepler planets have periods longer than one year. Our early search of the Kepler light curves revealed one such system, Kepler-1654 b (originally KIC~8410697b), which shows exactly two transit events and whose second transit occurred only 5 days before the failure of the second of two reaction wheels brought the primary Kepler mission to an end. A number of authors have also examined light curves from the Kepler mission searching for long period planets and identified this candidate. Starting in Sept. 2014 we began an observational program of imaging, reconnaissance spectroscopy and precision radial velocity measurements which confirm with a high degree of confidence that Kepler-1654 b is a {\it bona fide} transiting planet orbiting a mature G2V star (T$_{eff}= 5580$K, [Fe/H]=-0.08) with a semi-major axis of 2.03 AU, a period of 1047.84 days and a radius of 0.82$\pm$0.02 R$_{Jup}$. Radial Velocity (RV) measurements using Keck's HIRES spectrometer obtained over 2.5 years set a limit to the planet's mass of $, Comment: accepted to Astronomical Journal

International audience; De nouvelles recommandations internationales pour l’évaluation du statut HER2 dans les cancers du sein, basées sur plus de dix ans d’expérience et sur les résultats d’études cliniques et de concordance entre les différentes techniques de détection, viennent tout juste de voir le jour. Le présent article a pour objet de faire le point sur ces nouvelles recommandations, à la lumière de la publication récente du groupe de travail de l’American Society of Clinical Oncology (ASCO) et du Collège des pathologistes américains (CAP), adaptées à la pratique de la pathologie en France et revues par le groupe GEFPICS. À l’ère de la médecine personnalisée, la détermination du statut HER2 reste un élément phare dans le panel des biomarqueurs théranostiques des cancers du sein. Si l’interprétation du statut HER2 dans les cancers du sein est aisée dans la majorité des cas, un certain nombre de situations anatomocliniques est d’interprétation plus délicate, telles que la possibilité rare mais réelle de l’hétérogénéité intra-tumorale du statut de HER2, les formes à différenciation micropapillaire ou la ré-évaluation du statut des biomarqueurs lors de la rechute métastatique. Ces nouvelles recommandations abordent ces différentes questions, reprécisent les conditions pré-analytiques optimales et les critères d’interprétation (notamment des cas 2+), afin de réduire au maximum le risque de faux négatifs. Plus que jamais, la mobilisation de la spécialité d’anatomo-cytopathologie autour de la qualité des tests théranostiques témoigne de son implication dans la chaîne des soins en cancérologie., Summary International guidelines on HER2 determination in breast cancer have just been updated by the American Society of Clinical Oncology (ASCO) and College of American Pathologists (CAP), on the basis of more than ten-year practice, results of clinical trials and concordance studies. The GEFPICS group, composed of expert pathologists in breast cancer, herein presents these recommendations, adapted to the French routine practice. These guidelines highlight the possible diagnosis difficulties with regards to HER2 status determination, such as intra-tumor heterogeneity, special histological subtypes and biomarker re-evaluation during metastatic relapse. Pre-analytical issues and updated scoring criteria (especially for equivocal cases) are detailed, in order to decrease the occurrence of false negative cases. In the era of personalized medicine, pathologists are more than ever involved in the quality of oncotheranostic biomarker evaluation.]

Resume But Comparer et valider les nomogrammes de Ohori et de Steuber sur la prediction de l’extension extra-prostatique (EEP) specifiquement au cote pour aider au choix de realiser ou non une conservation des bandelettes neurovasculaires (BNV) lors de la prostatectomie totale. Patients et methode Les nomogrammes ont ete utilises pour predire le risque d’EEP specifiquement au cote a partir du PSA, du stade clinique, du score de Gleason biopsique, du pourcentage de biopsies positives et de l’envahissement tumoral par biopsie. Une base de donnees de 968 lobes prostatiques a ete analysee pour cette validation externe a partir de 484 patients traites par prostatectomie totale par voie ouverte ou cœlioscopique robot-assiste pour un cancer de prostate localise. Resultat La capacite de prediction du nomogramme de Ohori a ete evaluee a 0,80 et celle du nomogramme de Steuber a 0,78 (comparaison > 0,05). La courbe de calibration du nomogramme de Ohori etait plus proche de la prediction ideale que celle du nomogramme de Steuber. Le meilleur seuil de prediction de l’EEP semblait etre ≤ 10 % pour le nomogramme de Ohori permettant de realiser une conservation des BNV pour 59,7 % des lobes prostatiques avec un taux de faux negatif de 10 %. Pour le nomogramme de Steuber, un seuil ≤ 8 % permettait une conservation des BNV pour 44 % des lobes prostatiques avec un taux de faux negatif de 12,5 %. Conclusion L’utilisation des nomogrammes de Ohori et de Steuber ont permis une prediction precise et comparable de l’extension extra-prostatique specifiquement au cote. Niveau de preuve 4.

A prospective study was lead in order to analyze the accuracy of an X-ray device settled in the operating room for margin assessment, when performing breast-conserving surgery. Patients and methods One hundred and seventy patients were included. All lesions were visible on the preoperative mammograms. An intraoperative X-ray of the lumpectomy specimen was systematically performed for margins assessment. Final histological data were collected and the accuracy of intraoperative specimen radiography (IOSR) for margin assessment was analyzed. Results IOSR allowed an evaluation of margins status in 155 cases (91.2%). After final histological examination, the positive margins rate would have been 6.5% if margin assessment had relied only on IOSR. Conclusion Margin assessment with a two-dimensional X-ray device would have allowed the achievement of negative margins in 93.5% of the cases. Moreover, this procedure allows important time-saving and could have a substantial economical impact.

The early detection of some possible structural damage, requires the implementation of appropriate structural health monitoring systems, including efficient computational tools to extract the most relevant structural features characterizing the structural performance. In this context, this paper describes the application of Self Organizing Maps SOM, a type of neural network, to the processing of monitoring data of Infante D. Henrique Bridge, over Douro River in Porto, Portugal. This bridge has been monitored since 2007 (Magalhães, 2010) and the resulting database has been used as a source of information for training and testing the neural networks. In order to test the performance of SOM, four damaged models were simulated with the reduction of inertia in some elements. The results showed a good performance of the SOM, as the implemented method was able to detect relatively small structural changes. (c) 2016 Taylor & Francis Group, London.

The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of herpes zoster recurrence among persons with a recent episode of clinically diagnosed herpes zoster.This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥ 60 years old with a recent episode of herpes zoster. Incidence of recurrent herpes zoster was compared between the vaccinated and the unvaccinated matched cohorts.A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent herpes zoster among persons aged70 years was 0.99 (95% confidence interval [CI], .02-5.54) and 2.20 (95% CI, 1.10-3.93) cases per 1000 person-years in the vaccinated and unvaccinated cohorts, respectively. The adjusted hazard ratio was 0.39 (95% CI, .05-4.45) among persons aged70 years and 1.05 (95% CI, .30-3.69) among persons aged ≥ 70 years.The risk of herpes zoster recurrence following a recent initial episode is fairly low among immunocompetent adults, regardless of vaccination status. Such a low risk suggests that one should evaluate the necessity of immediately vaccinating immunocompetent patients who had a recent herpes zoster episode.

Background Sunitinib is a standard of care for metastatic renal cell carcinoma (mRCC). Hypothyroidism is frequently observed under sunitinib therapy. This study was conducted to prospectively determine the correlation between thyroid function and progression-free survival (PFS) in this population. Patients and methods One hundred and eleven mRCC patients treated with sunitinib were evaluated for serum thyroid-stimulating hormone (TSH) and T4 levels before treatment and every 6 weeks during treatment. Survival was analysed according to a landmark method with a cut-off of 6 months, excluding early progressive or early-censored patients. Results Out of the 102 patients with normal baseline thyroid function, 53% developed thyroid dysfunction, including 95% hypothyroidisms out of which 90.9% received L-thyroxine replacement. Median time to TSH alteration was 5.4 months. Median PFS was 11.7 months for the entire population. Median PFS was not different between the groups with abnormal or normal thyroid function after 6 months of treatment (18.9 and 15.9 months, respectively, log-rank P = 0.94, hazard ratio = 1.02, 95% confidence interval = 0.54–1.93). There was no difference even after adjustment for Memorial Sloan-Kettering Cancer Centre classification and therapy line. Conclusions Abnormal thyroid function with hormonal substitution did not increase survival in our population, independent of initial prognosis and previous treatments. Larger comparative studies are deserved to validate these conclusions.

Resume But L’echographie conventionnelle en echelle de gris a une sensibilite et une specificite limitees en ce qui concerne la detection du cancer de prostate. L’elastographie en temps reel a montre des resultats prometteurs susceptibles de pallier a ces limites. L’objectif de cette etude consistait a evaluer les premieres experiences realisees avec l’elastographie en comparant les resultats preoperatoires avec les pieces des prostatectomies totales. Patients De novembre 2008 a mai 2009, 28 patients ayant un cancer de prostate et planifies pour une prostatectomie totale ont subi une elastographie en preoperatoire. Cet examen etait realise avec un appareil d’echographie Hitachi ® EUB 7500 muni d’une sonde rectale V53W de 7,5 MHz. Au decours de ces examens, les zones suspectes en faveur d’un foyer de cancer de prostate etaient marquees et notees en prospectif en fonction de leur localisation (cote droit/gauche, zone anterieure/posterieure, base, partie moyenne, apex), par un seul operateur. Les pieces de prostatectomie etaient analysees selon le protocole de Stanford avec des coupes tous les 3–5 mm, en grandes cassettes et grandes lames. Les resultats preoperatoires etaient compares avec les resultats anatomopathologiques. Resultats Au total, 88 lesions tumorales etaient mises en evidence et il etait identifie 125 secteurs atteints d’un cancer de prostate sur un total de 336 secteurs evalues. Grâce a l’elastographie, il etait identifie 134 secteurs prostatiques suspectes de lesions tumorales. La sensibilite et la specificite de cet examen pour l’identification du cancer etaient de 73,4 et 79,0 %. Les valeurs predictives positive et negative etaient de 67,4 et 83,4 %. L’exactitude de la prediction etait a 76,5 %. Conclusion La valeur diagnostique de l’elastographie en temps reel s’est averee elevee dans le cadre de l’identification des lesions suspectes de cancer de prostate. L’utilisation routiniere de cette technique pourrait ameliorer le diagnostic du cancer de prostate et la prise en charge therapeutique.

Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, Weintraub E, Baggs J, Weinmann S, Baxter R, Nordin J, Daley MF, Jackson L, Jacobsen SJ, for the Vaccine Safety Datalink (VSD) Team (Kaiser Permanente, Pasadena, CA; Kaiser Permanente, Oakland, CA; Centers for Disease Control and Prevention, Atlanta, GA; Kaiser Permanente, Portland, OR; HealthPartners Research Foundation, Minneapolis, MN; Kaiser Permanente, Denver, CO; and Group Health Cooperative of Puget Sound, Seattle, WA; USA). Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink study. J Intern Med 2012; 271: 510–520. Objectives. The aim of this study was to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of prespecified adverse events requiring medical attention. Design. Two self-comparison approaches, including a case-centred approach and a self-controlled case series (SCCS) analysis were used. Setting. Eight managed-care organizations participating in the Vaccine Safety Datalink project in the United States. Subjects. A total of 193 083 adults aged 50 and older receiving a zoster vaccine from 1 January 2007 to 31 December 2008 were included. Main outcome measures. Prespecified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD-9) codes in automated health plan datasets. Results. The risk of allergic reaction was significantly increased within 1–7 days of vaccination [relative risk = 2.13, 95% confidence interval (CI): 1.87–2.40 by case-centred method and relative rate = 2.32, 95% CI: 1.85–2.91 by SCCS]. No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis; encephalitis; and encephalopathy; and Ramsay-Hunt syndrome and Bell’s palsy. Conclusions. The results of this study support the findings from the prelicensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well-tolerated with a small increased risk of allergic reactions in 1–7 days after vaccination.

Resume But Nous decrivons les resultats concernant les complications per- et post-operatoires ainsi que les resultats anatomopathologiques et fonctionnels de la prostatectomie totale robot-assistee pendant la periode d’instauration de la technique et de la courbe d’apprentissage. Patients Les donnees cliniques, paracliniques et evenements per- et post-operatoires chez les 102 premiers patients ont ete notifiees. Les complications post-operatoires ont ete classees selon la classification de Clavien. Pour les resultats fonctionnels, la continence urinaire etait definie chez les patients avec 0 protection ou une protection de securite. La fonction erectile etait classee en absence d’erection spontanee, erections trop faibles pour des rapports sexuels et erections suffisantes pour des rapports sexuels. Resultats La duree mediane d’intervention etait de 240 minutes et les pertes sanguines de 400 mL avec un taux de transfusion de 2 %. Au total, 7,8 % des patients ont eu des complications peroperatoires, 13,7 % des complications post-operatoires mineures et 4,9 % des complications plus serieuses. Le taux des marges chirurgicales positives a ete de 16,0 %, tous stades confondus. A 12 mois de l’intervention, 87 % des patients etaient continents, 21,1 % avaient des erections spontanees et 47,4 % des rapports sexuels. Conclusion Dans cette etude, au cours de la mise en route de la prostatectomie totale robot-assistee, les premiers patients traites ont eu un taux de complications per- et post-operatoires, des resultats anatomopathologiques et des resultats fonctionnels comparables avec les etudes publiees par les centres de reference.

Background Erlotinib is an orally active small-molecule tyrosine kinase inhibitor targeted against human epidermal growth factor receptor 1/epidermal growth factor receptor (ErbB1), known to be overexpressed in a variety of cancers, including prostate cancer. Patients and methods This was a phase II monocentric study of 30 patients with advanced or metastatic prostate cancer, 29 had castration-resistant prostate cancer and 23 had received prior chemotherapy. Patients received erlotinib: 150 mg/day, increased to 200 mg at week 4, and continued until progression or unacceptable toxicity. Efficacy was defined as a decrease or stabilization of prostate-specific antigen (PSA) without clinical progression. Clinical benefit was evaluated by Karnofsky performance status and pain intensity, and response was an improvement in one of these parameters without worsening in the other. Results Median age was 69 years (range 51–77 years), and median PSA 102 ng/ml (range 3–1213 ng/ml). Dose escalation to 200 mg was possible in 16 (55%) patients. Moderate toxicity was observed. No patient had a decrease in PSA, 14% had stabilization, less than the ≥20% expected. PSA-doubling time, evaluated before and after erlotinib, was increased for 10 patients (P = 0.0058). Clinical benefit was achieved in 40% of patients. Conclusion Erlotinib demonstrated an improvement in clinical benefit. Future directions should include evaluating its use in less advanced prostate cancer.

Immunocytochemistry (ICC) of thyroid peroxidase (TPO) using the monoclonal antibody MoAb47 has been used as malignancy marker on thyroid fine needle aspiration. However, little is known about the fate of TPO in thyroid carcinoma. We performed a qualitative PCR (Q-PCR) analysis to measure the expression of variants of tpo mRNA in 13 normal tissue samples, 30 benign tumors (BT), 21 follicular carcinomas (FC), 20 classical papillary carcinomas (PCc), 12 follicular variants of papillary carcinomas (PCfv) and nine oncocytic carcinomas (OC). We also studied mutations involving the ras, Braf, ret or pax8 genes. Results of Q-PCR were closely correlated with those of ICC (P < 0.0001; R = 0.59) and showed that overall tpo expression was lower in all carcinomas than in normal and BT (P < 0.05). The ratio tpo2 or tpo3 to tpo1 was inversed in follicular tumors. Genetic mutations were observed in 90% of PCc, 61.9% of FC, 41.7% of PCfv, 0% of OC and 10% in BT. pax8-ppar γ1 rearrangement was correlated with qualitative changes in tpo mRNA (P < 0.01). These results confirmed the decrease of TPO expression in 97% of thyroid carcinomas regardless of histological type and the overexpression of shorter splice variants in follicular tumors. Both reduction in quantity of TPO and impairment of its maturation process could account for the atypical immunohistochemical reaction of MoAb47 with TPO.

Like children exposed to Chernobyl fallout, the workers who cleaned up after the accident, also known as liquidators, have exhibited an increased incidence of thyroid cancer. A high prevalence of ret/PTC3 rearrangement has been found in pediatric post-Chernobyl thyroid tumors, but this feature has not been investigated in liquidator thyroid tumors. In this study we analyzed the prevalence of ret/PTC1 and ret/PTC3 in thyroid tumors from 21 liquidators, 31 nonirradiated adult Ukrainian patients, and 34 nonirradiated adult French patients. ret rearrangements in carcinomas were found in 83.3% of liquidators, 64.7% of Ukrainian patients, and 42.9% of French patients. The prevalence of ret/PTC1 was statistically similar in the three groups. The prevalence of ret/PTC3 was significantly higher in liquidators than in French patients (P = 0.03) but it was also high in nonirradiated Ukrainian patients who exhibited values intermediate between liquidators and French patients. In adenomas the prevalence of rearrangement was significantly higher in all Ukrainians than in French patients (P = 0.004). Like children exposed to Chernobyl fallout, liquidators showed a high prevalence of ret/PTC3. This finding suggests that irradiation had the same effect regardless of age. However, given the high rate of ret/PTC3 in nonirradiated adult Ukrainians, the possibility of genetic susceptibility or low-level exposure to radiation in that group cannot be excluded.

Background Medullary thyroid carcinoma (MTC) is a rare disease, with variable tendency to lymphatic spread. The aim of this retrospective study was to identify distinctive features of large MTC with and without nodal metastases. Methods Between 1993 and 2003, 28 consecutive patients underwent total thyroidectomy and neck node dissection for sporadic MTC larger than 10 mm in diameter. Results All tumours were confirmed to be malignant with a locally invasive pattern of growth. Lymph node metastases were present in 16 patients (N1) and absent in 12 (N0). There were no statistically significant differences between patients with N0 and N1 tumours concerning age (mean 52·1 versus 53·4 years), male:female ratio (0·7 versus 1·0), basal preoperative calcitonin concentration (mean 3238 versus 3076 pg/ml) and tumour size (23·3 versus 23·9 mm). There were differences in the incidence of tumour invasion (P < 0·001), vascular embolism (P = 0·011) and peritumoral thyroiditis (P = 0·039). Measurement of basal and stimulated calcitonin levels after surgery confirmed biochemical cure in all patients with N0 tumours and half of those with N1 disease (P = 0·006). Conclusion There were no preoperative factors that predicted node status for MTC larger than 1 cm in this series. Total thyroidectomy and nodal dissection remains the optimal treatment.

This panel discussion seeks to engage engineering professionals in a discussion of their responsibilities and obligations to perform duties in an ethical manner. Specifically, the panel will explore how learned professionals learn about these responsibilities and the potential consequences resulting from different responses to a myriad of unforeseen circumstances. The roles of formal education, continuing education, and on-the-job experience are examined as key components of the educational process.

To perform a head to head comparison of these two nomograms by an external validation combined with an identification of probability cut-offs when to indicate NS.The full models of the nomograms of Ohori et al. and Steuber et al. were used to calculate the risk of ECE based on PSA and side specific information on clinical stage, biopsy Gleason score, % positive cores, and % cancer in cores. A dataset of 968 prostate half lobes was used retrospectively for analysis. All patients underwent laparoscopic robot-assisted or open radical prostatectomy for localized prostate cancer.The predictive accuracy of the Ohori nomogram was at 0.80 and for the Steuber Nomogram at 0.78 (comparison P0.05). In the calibration plot, the Ohori nomogram showed less departures from ideal predictions than the Steuber nomogram. The best probability cut-off to allow NS for the Ohori nomogram seemed to be ≤ 10%, permitting NS in 59.7% of all cases and being associated with a false negative rate of 10%. The best cut-off for the Steuber nomogram seemed to be ≤ 8%, permitting NS in 44% and associated with a false negative rate 12.5%.The Ohori et al. and the Steuber et al. nomograms allow highly accurate and comparable predictions of the risk of side specific ECE.4.

Background Trivalent formulations of an experimental, cold-adapted, intranasal influenza (CAIV) vaccine have been shown to be safe, immunogenic and efficacious in young children. Methods We evaluated the safety and immunogenicity of three consistency lots of CAIV in children 12 to 36 months of age randomized to one of five groups: Groups 1, 2 and 3 received separate lots containing A/Shenzhen/227/95 (H1N1), A/Wuhan/359/95(H3N2) and B/Harbin/7/94-like viral strains. Group 4 received an earlier efficacy trial lot which included a different H1N1 strain (A/Texas/36/91-like); and Group 5 received placebo. We performed strain-specific serum hemagglutination inhibition antibody levels against type A (H3N2 or H1N1) or type B as appropriate. Results Overall 474 children received 2 doses, 2 months apart. Each lot was well-tolerated, and there were no significant group differences between consistency lots in the proportion of children with fever and local or systemic reactions after vaccination. The 3 consistency lots were not statistically different with regard to immunogenicity as measured by seroconversion or absolute geometric mean titer. Immune responses were more robust among initially seronegative children and for H3N2 and B strains than for H1N1 strains. After 2 doses of vaccine 97, 84 and 62% had hemagglutination inhibition titers > or = 1/32 against A/H3N2, B and H1N1 strains, respectively. For A/H3N2 only, immune responses after 1 dose of vaccine are similar to those seen after 2 doses. Conclusions Each consistency lot of CAIV is as or more immunogenic than a lot used in a large efficacy trial.

Recommendations for routine varicella vaccination were published by the American Academy of Pediatrics in May 1995, but many eligible children remain unimmunized. This update provides additional information on the varicella disease burden before the availability of varicella vaccine, potential barriers to immunization, efforts to increase the level of coverage, new safety data, and new recommendations for use of the varicella vaccine after exposure and in children with human immunodeficiency virus infections. Pediatricians are strongly encouraged to support public health officials in the development and implementation of varicella immunization requirements for child care and school entry.

Lyme disease is currently the most frequently reported vector-borne illness in the United States, accounting for more than 95% of such cases. The purpose of this report is to provide recommendations for preventing Lyme disease, including the use of Lyme disease vaccine. Individuals can reduce their risk of Lyme disease by avoiding tick-infested habitats when in endemic areas. If exposure to tick-infested habitats cannot be avoided, individuals may reduce their risk of infection by using repellents, wearing protective clothing, and regularly checking for and removing attached ticks. Morbidity from Lyme disease can be reduced significantly by detecting and treating the infection in its early stages; early and appropriate treatment almost always results in a prompt and uncomplicated cure. A Lyme disease vaccine (LYMErix, SmithKline Beecham, Collegeville, PA) was licensed by the US Food and Drug Administration on December 21, 1998, for persons 15 to 70 years of age. This vaccine seems to be safe and effective, but whether its use is cost-effective has yet to be clearly established. Use of this vaccine causes false-positive enzyme immunoassay results for Lyme disease. Lyme disease can be diagnosed in vaccinated persons by immunoblot testing. Decisions about the use of this vaccine should be based on an assessment of a person's risk as determined by activities and behaviors relating to tick exposure in endemic areas. This vaccine should be considered an adjunct to, not a replacement for, the practice of personal protective measures against tick exposure and the early diagnosis and treatment of Lyme disease.

By the mid-1970s, the U.S. National Science Foundation was funding two large projects, PLATO and TICCIT, designed to demonstrate the efficacy of teaching with the help of computers. Although neither project proved successful, they nevertheless propelled teaching with computers to a level that laid the foundation for most later efforts. © 2000 John Wiley & Sons, Inc. Comput Appl Eng Educ 8: 127–131, 2000

Current recommendations of the American Academy of Pediatrics (AAP) for infection control practices to prevent transmission of blood-borne pathogens, including human immunodeficiency virus (HIV) in hospitals, other medical settings, schools, and child care facilities, are reviewed and explained. Hand-washing is essential, whether or not gloves are used, and gloves should be used when contact with blood or blood-containing body fluids may occur. In hospitalized children, the 1996 recommendations of the Centers for Disease Control and Prevention (CDC) should be implemented as modified in the 1997 Red Book. The generic principles of Standard Precautions in the CDC guidelines generally are applicable to children in all health care settings, schools, child care facilities, and the home. However, gloves are not required for routine changing of diapers or for wiping nasal secretions of children in most circumstances. This AAP recommendation differs from that in the CDC guidelines. Current US Public Health Service guidelines for the management of potential occupational exposures of health care workers to HIV are summarized. As previously recommended by the AAP, HIV-infected children should be admitted without restriction to child care centers and schools and allowed to participate in all activities to the extent that their health and other recommendations for management of contagious diseases permit. Because it is not required that the school be notified of HIV infection, it may be helpful if the pediatrician notify the school that he or she is operating under a policy of nondisclosure of infection with blood-borne pathogens. Thus, it is possible that the pediatrician will not report the presence of such infections on the form. Because HIV infection occurs in persons throughout the United States, these recommendations for prevention of HIV transmission should be applied universally.

Some principles that have guided the development of engineering courses in the past are identified and applied to the development of strategies for contemporary circumstances. Implications of current changes in constraints are explored for class meetings and for student work outside of class. The realization that two-thirds of a typical university academic course, and most of the learning, occurs outside the class meeting times compels careful focus by faculty on the design of interactive learning experiences to help students learn proficiently outside the class room. Designing courses of study in which the learning activities outside, as well as inside, the class room form a coherent and effective whole can improve courses dramatically.

Virtually all children experience rotavirus (Rv) infection before school entry. In the United States and other temperate countries, Rv disease peaks in the winter and during this time is responsible for the majority of episodes of diarrhea in infants and young children.1–4 Data collected by the Centers for Disease Control and Prevention from 1979 through 1992 indicate that approximately 50 000 hospitalizations attributable to Rv occur annually in the United States, a number that approximates about 1 in 78 children being hospitalized with Rv diarrhea by 5 years of age.2,5 RotaShield (Wyeth-Lederle Vaccines and Pediatrics, Philadelphia, PA) was licensed by the Food and Drug Administration on August 31, 1998, for oral administration to infants at 2, 4, and 6 months of age. The rationale for using Rv immunization for prevention or modification of Rv disease is based on several considerations. First, the rate of illness attributable to Rv among children is comparable in industrialized and developing countries, which indicates that improved public sanitation is unlikely to decrease the incidence of disease.6,7 Second, although implementation of oral rehydration programs to prevent dehydration has improved in the United States, widespread use is inadequate to prevent significant morbidity.8–11 Third, trials of rhesus rotavirus-tetravalent (Rv) vaccine in the United States, Finland, and Venezuela show efficacy rates of approximately 80% for prevention of severe illness and 48% to 68% against Rv-induced diarrheal episodes.12–16 These results are similar to the protection observed after natural Rv infection, which also confers better protection against subsequent episodes of severe disease than against mild illness.17–19 This statement provides recommendations regarding the use of Rv vaccine in infants in the United States.

The purpose of this statement is to inform physicians of a modification in the recommendation of the appropriate age for routine administration of the second dose of measles–mumps–rubella (MMR) vaccine. The implementation of the two-dose measles vaccine schedule has improved the control of measles, but some outbreaks continue to occur in school children, although ≥95% of children in school have received one dose of vaccine. Because most measles vaccine failures are attributable to failure to respond to the first dose, that all children receive two doses of measles-containing vaccine is essential for the control of measles. Routine administration of the second dose of MMR vaccine at school entry (4 to 6 years of age) will help prevent school-based outbreaks. Physicians should continue to review the records of all children 11 to 12 years of age to be certain that they have received two doses of MMR vaccine after their first birthday. Documenting that all school children have received two doses of measles-containing vaccine by the year 2001 will help ensure the elimination of measles in the United States and contribute to the global effort to control and possibly eradicate measles.

The course of severe invasive group A β-hemolytic streptococcal (GABHS) infections is often precipitous, requiring prompt diagnosis and rapid initiation of appropriate therapy. Therefore, physicians must have a high index of suspicion of this disease, particularly in patients at increased risk (eg, those with varicella or diabetes mellitus). Although a relationship between the use of nonsteroidal antiinflammatory drugs and severe invasive GABHS infections has been suggested, at present data on which to base a clinical decision about the use or restriction of nonsteroidal antiinflammatory drugs in children with varicella are insufficient. When necrotizing fasciitis is suspected, prompt surgical drainage, debridement, fasciotomy, or amputation often is necessary. Many experts recommend intravenously administered penicillin G and clindamycin for the treatment of invasive GABHS infections on the basis of animal studies. Some evidence exists that intravenous immunoglobulin given in addition to appropriate antimicrobial and surgical therapy may be beneficial. Although chemoprophylaxis for household contacts of persons with invasive GABHS infections has been considered by some experts, the limited available data indicate that the risk of secondary cases is low (2.9 per 1000) and data about the effectiveness of any drug are insufficient to make recommendations. Because of the low risk of secondary cases of invasive GABHS infections in schools or child care facilities, chemoprophylaxis is not indicated in these settings. Routine immunization of all healthy children against varicella is recommended and is an effective means to decrease the risk of invasive GABHS infections.

Objective. To fill the large “gaps and limitations” in current scientific knowledge of rare vaccine adverse events identified in recent reviews of the Institute of Medicine. Methods. Computerized information on immunization, medical outcomes, and potential confounders on more than 500 000 children 0 to 6 years of age is linked annually at several health maintenance organizations to create a large cohort for multiple epidemiologic studies of vaccine safety. Results. Analysis of 3 years of follow-up data shows that 549 488 doses of diphtheria-tetanus-pertussis (DTP) and 310 618 doses of measles-mumps-rubella (MMR) vaccines have been administered to children in the study cohort. Analyses for associations between vaccines and 34 medical outcomes are underway. Screening of automated data shows that seizures are associated with receipt of DTP on the same day (relative risk [RR], 2.1; 95% confidence interval [CI], 1.1 to 4.0) and 8 to 14 days after receipt of MMR (RR, 3.0; 95% CI, 2.1 to 4.2). The diversity of vaccination exposures in this large cohort permits us to show that an apparent association of seizures 8 to 14 days after Haemophilus influenzae type b vaccine (RR, 1.6; 95% CI, 1.2 to 2.1) was attributable to confounding by simultaneous MMR vaccination; the association disappears with appropriate adjustment (RR, 1.0; 95% CI, 0.7 to 1.4). Conclusion. Preliminary design, data collection, and analytic capability of the Vaccine Safety Datalink project has been validated by replication of previous known associations between seizures and DTP and MMR vaccines. The diversity in vaccine administration schedules permits potential disentangling of effects of simultaneous and combined vaccinations. The project provides a model of public health-managed care collaborations in addition to an excellent infrastructure for safety and other studies of vaccines.

Respiratory syncytial virus immune globulin intravenous (RSV-IGIV) has been approved by the Food and Drug Administration for use in the prevention of severe RSV infections in infants and children younger than 24 months with bronchopulmonary dysplasia or a history of premature birth (≤35 weeks of gestation). RSV-IGIV administered monthly during the RSV season resulted in a 41% to 65% reduction in hospitalization rates in two clinical trials; however, RSV-IGIV is costly, and intravenous administration can be logistically demanding. RSV-IGIV should be considered for infants with bronchopulmonary dysplasia who are receiving or have received oxygen therapy in the past 6 months. Infants with gestational ages of 32 weeks or less may also benefit clinically from RSV-IGIV prophylaxis. Immunization with measles-containing vaccines should be delayed for 9 months after the last dose of RSV-IGIV, but no changes need to be made for all other routinely administered vaccines. RSV-IGIV has not been approved for use in children with congenital heart disease, and available data indicate that RSV-IGIV should not be administered to children with cyanotic congenital heart disease because of safety concerns.