bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adaption of human antibody λ and κ light chain architectures to CDR repertoires
Authors: van der Kant Rob , Bauer Joschka , Karow-Zwick Anne R , Kube Sebastian , Garidel Patrick , Blech Michaela , Rousseau Frederic , Schymkowitz Joost 
Published: June 2019

AbstractMonoclonal antibodies bind with high specificity to a wide range of diverse antigens, primarily mediated by their hypervariable complementarity determining regions (CDRs). The defined antigen binding loops are supported by the structurally conserved β-sandwich framework of the light chain (LC) and heavy chain (HC) variable regions. The LC genes are encoded by two separate loci, subdividing the entity of antibodies into kappa (LCκ) and lambda (LCλ) isotypes that exhibit distinct sequence and conformational preferences. In this work, a diverse set of techniques were employed including machine learning, force field analysis, statistical coupling analysis and mutual information analysis of a non-redundant antibody structure collection. Thereby, it was revealed how subtle changes between the structures of LCκ and LCλ isotypes increase the diversity of antibodies, extending the predetermined restrictions of the general antibody fold and expanding the diversity of antigen binding. Interestingly, it was found that the characteristic framework scaffolds of κ and λ are stabilized by diverse amino acid clusters that determine the interplay between the respective fold and the embedded CDR loops. In conclusion, this work reveals how antibodies use the remarkable plasticity of the beta-sandwich Ig fold to incorporate a large diversity of CDR loops.
User-defined single pot mutagenesis using unamplified oligo pools
Authors: Medina-Cucurella Angélica V , Steiner Paul J , Faber Matthew S , Beltrán Jesús , Borelli Alexandra N , Kirby Monica B , Cutler Sean R , Whitehead Timothy A 
Published: June 2019

Abstract
User-defined mutagenic libraries are fundamental for applied protein engineering workflows. Here we show that unamplified oligo pools can be used to prepare site saturation mutagenesis libraries from plasmid DNA with near-complete coverage of desired mutations and few off-target mutations. We find that oligo pools yield higher quality libraries when compared to individually synthesized degenerate oligos. We also show that multiple libraries can be multiplexed into a single oligo pool, making preparation of multiple libraries less expensive and more convenient. We provide software for automatic oligo pool design that can generate mutagenic oligos for saturating or focused libraries.
Type II DFT solutions from Poisson–Lie $T$-duality/plurality
Authors: Sakatani Yuho 
Published: June 2019

Abstract
String theory has $T$-duality symmetry when the target space has Abelian isometries. A generalization of $T$-duality, where the isometry group is non-Abelian, is known as non-Abelian $T$-duality, which works well as a solution-generating technique in supergravity. In this paper we describe non-Abelian $T$-duality as a kind of $\text{O}(D,D)$ transformation when the isometry group acts without isotropy. We then provide a duality transformation rule for the Ramond–Ramond fields by using the technique of double field theory (DFT). We also study a more general class of solution-generating technique, the Poisson–Lie (PL) $T$-duality or $T$-plurality. We describe the PL $T$-plurality as an $\text{O}(n,n)$ transformation and clearly show the covariance of the DFT equations of motion by using the gauged DFT. We further discuss the PL $T$-plurality with spectator fields, and study an application to the $\text{AdS}_5\times\text{S}^5$ solution. The dilaton puzzle known in the context of the PL $T$-plurality is resolved with the help of DFT.
Impact of overweight or obesity trajectory on health expenditure in Korea
Authors: Kim T H , Han E 
Published: June 2019

Abstract

Background
This study aimed to identify the effect of the overweight or obesity (OWOB) trajectory on current health care expenditure in South Korea.

Methods
Ten years of publicly released data (2002–12) were obtained in 2016 from a retrospective cohort of National Health Insurance System claims. This study included 51,844 adults (aged 30–59 years in 2002) and 21,196 elderly adults (aged ≥ 60 years in 2002).

Results
Compared with adults who maintained normal weight (NW), higher yearly total health expenditures were estimated for adults who lost weight over the 10-year period: by 11.5% (95% confidence interval (CI): 0.18–22.96%) when changing from NW to underweight (UW) and 6.2% (95% CI: 0.47–12.01%) from OWOB to UW/NW. Elderly adults had higher health expenditures when they lost weight by 14.0% (95% CI: 0.37–27.70%) from NW to UW and 6.8% (95% CI: 0.13–13.51%) from OWOB to UW/NW compared with when they maintained NW.

Conclusions
These findings indicate the importance of early intervention to control OWOB, particularly because people in late adulthood have greater health care needs for reasons other than OWOB.
‘Life is about risk management’: lay finance and the generalization of risk thinking to nonfinancial domains
Authors: Ailon Galit 
Published: June 2019

Abstract
This article examines the financial discourse on insecurity using a case study of the promotion of lay finance in Israel. Based on an analysis of financial courses, conferences, online texts and books that are designed for the lay public, the analysis shows that promoters of financial market engagements use everyday stories of marital and work-related insecurities—stories of divorce, betrayal, abandonment, unemployment and the like—to illustrate that economic risks are ubiquitous. Their stories render risk-thinking a general practice of knowing that is applicable to everyday life. At the same time, the stories shift the focus from the statistical meaning to the symbolic meaning of the risks taken. They present the risks of key social institutions as symbols of personal weakness, helplessness or humiliation, and grant the impersonal risks of financial markets a relative advantage. Analysing these findings from the perspective of the sociology of knowledge, I argue that lay financial discourse marks a radicalization of neoliberal discourse as studied by Foucault and that it is characterized by a much broader deconstructive scope than currently acknowledged. Its focus on frightening insecurities deconstructs the social knowledge that constitutes key institutions, exacerbating and feeding on their dissolution.
Respiratory costs of producing and maintaining stem biomass in eight co-occurring tree species
Authors: Rodríguez-Calcerrada Jesús , Salomón Roberto L , Gordaliza Guillermo G , Miranda José C , Miranda Eva , de la Riva Enrique G , Gil Luis 
Published: June 2019

AbstractGiven the importance of carbon allocation for plant performance and fitness, it is expected that competition and abiotic stress influence respiratory costs associated with stem wood biomass production and maintenance. In this study, stem respiration (R) was measured together with stem diameter increment in adult trees of eight co-occurring species in a sub-Mediterranean forest stand for 2 years. We estimated growth R (Rg), maintenance R (Rm) and the growth respiration coefficient (GRC) using two gas exchange methods: (i) estimating Rg as the product of growth and GRC (then Rm as R minus Rg) and (ii) estimating Rm from temperature-dependent kinetics of basal Rm at the dormant season (then Rg as R minus Rm). In both cases, stem basal-area growth rates governed intra-annual variation in R, Rg and Rm. Maximum annual Rm occurred slightly before or after maximum Rg. The mean contribution of Rm to R during the growing season ranged from 56% to 88% across species using method 1 and from 23% to 66% using method 2. An analysis accounting for the phylogenetic distance among species indicated that more shade-tolerant, faster growing species exhibited higher Rm and Rg than less shade-tolerant, slower growing ones, suggesting a balance between carbon supply and demand mediated by growth. However, GRC was not related to species growth rate, wood density, or drought and shade tolerance across the surveyed species nor across 27 tree species for which GRC was compiled. The GRC estimates based on wood chemical analysis were lower (0.19) than those based on gas exchange methods (0.35). These results give partial support to the hypothesis that wood production and maintenance costs are related to species ecology and highlight the divergence of respiratory parameters widely used in plant models according to the methodological approach applied to derive them.
Standardization of Postoperative Transitions of Care to the Pediatric Intensive Care Unit Enhances Efficiency and Handover Comprehensiveness
Authors: Sochet Anthony A. , Siems Ashley , Ye Grace , Godiwala Nihal , Hebert Lauren , Corriveau Christiane 
Published: June 2019

Introduction:
To determine the impact of standardization of postoperative transitions of care to the pediatric intensive care unit on handover efficiency and the quality of healthcare data exchange.

Methods:
This was a prospective, pre–post observational study after standardization of postoperative transitions in a 44-bed pediatric intensive care unit in a 313-bed tertiary care pediatric hospital from April to July 2015. Standardization was completed using a multidisciplinary handover checklist. Primary outcomes were efficiency expressed as mean handover duration and the comprehensiveness of healthcare data exchange.

Results:
Forty-seven postoperative transitions were observed of which 23 were preintervention and 24 were postintervention. After standardization, efficiency improved from 10.5 ± 5.4 to 7.8 ± 2.7 minutes (P < 0.05). Healthcare data exchanged between surgical, anesthesia, and critical care providers were more robust including intraoperative, historical, and anticipatory guidance (all P < 0.05). After intervention, attendance through completion of handover for surgical services increased from 13% to 88% (P < 0.05).

Conclusions:
Standardization of postoperative transitions improved efficiency, healthcare data exchange, and anticipatory planning. Future research is required to link standardization of transitions to improved patient outcomes and measure the development of shared mental models.
Return to Drive Counseling After Sports-Related Concussion: A Quality Improvement Project
Authors: Stuart Emily A. , Duerson Drew H. , Rodenberg Richard E. , Ravindran Reno , MacDonald James P. 
Published: June 2019

Introduction:
Concussion is a common injury in adolescent athletes, many of whom also drive. Counseling athletes and their families about driving risks post concussion is a potentially significant intervention. The aim of this quality improvement project was to increase driving recommendations for concussed athletes in a pediatric sports medicine clinic.

Methods:
Patients in this quality improvement project were seen in the sports medicine concussion clinic between February 2014 and August 2015. We determined how often driving recommendations were documented through a retrospective chart review. Once the “return to drive” project was introduced to the sports medicine staff, multiple interventions were completed including handing out flyers to remind families about driving and creating changes to the electronic medical record.

Results:
At baseline, 9.3% of visits had driving recommendations documented. After an intervention requiring clinical documentation in the electronic medical record, 97% of patients received driving recommendations.

Conclusions:
The quality improvement effort was successful at increasing the frequency of delivery of appropriate driving recommendations provided to concussed athletes.
Optimizing a Nurse-led Transitional Home Visit Program in Preparation for a Randomized Control Trial
Authors: Sauers-Ford Hadley S. , Tubbs-Cooley Heather , Statile Angela M. , Pickler Rita H. , White Christine M. , Wade-Murphy Susan , Gold Jennifer M. , Shah Samir S. , Simmons Jeffrey M. ,   On behalf of the H2O Study Group
Published: June 2019

Introduction:
The Hospital to Home Outcomes study began with the end goal of evaluating the effectiveness of a single, nurse-led transitional home visit (home visit) program, for acutely ill, pediatric patients, which had been piloted at our institution. As part of the overall study design, building on prior randomized control trials that utilized a run-in period prior to the trial, our study team designed an optimization period to test the home visit and study procedures under real-world conditions.

Methods:
For this optimization project, there were 3 process improvement goals: to improve the referral process to the home visit, to optimize the home visit content, and to define and operationalize measures of patient- and family-centered outcomes to be used in the subsequent randomized control trial. During the optimization period, a multidisciplinary study team met weekly to review family and stakeholder feedback about the iterative modifications made to the home visit process, content, and outcome measures.

Results:
Optimization home visits were completed with 301 families across a variety of discharge diagnoses. The outcomes planned for the clinical trial were tested and refined. Feedback from families and stakeholders indicated that the content changes made to the home visits resulted in increased family knowledge of warning signs to monitor postdischarge. Thirty-one percent of families reported that they altered the care of their child after the home visit.

Conclusion:
Through iterative testing, informed by multistakeholder feedback, we leveraged patient and family engagement to maximize the effectiveness and generalizability of the home visit intervention.
Is the “July Effect” Real? Pediatric Trainee Reported Medical Errors and Adverse Events
Authors: Shah Ankoor Y. , Abreo Andrew , Akar-Ghibril Nicole , Cady Rebecca F. , Shah Rahul K. 
Published: June 2019

Introduction:
The “July Effect” suggests an increase in patient adverse events in July compared with other months due to the introduction of new providers throughout the training continuum. The aim of this initiative was to analyze reported pediatric trainee medical errors from May through September 2015 at a tertiary care free-standing academic children’s hospital to determine if there were more reported medical errors and more adverse events from those errors in July.

Methods:
An error surveillance system is used to report and track near misses, adverse events, and medical errors. Three of the authors reviewed each report, which was electronically collected in the institution during the time period of interest. The reported medical error incidence per 1,000 trainee-days was compared against those in July for a significant difference.

Results:
There are a total of 282 trainees (86 pediatric residents, 81 nonpediatric residents, and 115 fellows) who are clinically active in the hospital at any given month. Pediatric residents had more reported medical errors in July (31) compared with May (16; P = 0.015), June (16; P = 0.019), and August (19; P = 0.046). There was no significant difference in the number of adverse events from reported medical errors by trainees in July (7) compared with May (5), June (8), August (4), or September (8; P > 0.2).

Conclusion:
In this single-center evaluation, there is an increase in reported medical errors involving pediatric residents in July compared with the months surrounding July. However, there is no difference in numbers of adverse events from those errors between these months.
An Intervention to Improve Caregiver Adherence to Oral Rehydration Therapy
Authors: Sundberg Melissa J. , Parver Stephanie , Morin Michele , Stack Anne M. 
Published: June 2019

Objective:
To improve oral rehydration therapy (ORT) after discharge for children presenting to the emergency department (ED) with acute gastroenteritis (AGE).

Methods:
We designed and implemented a quality improvement initiative to improve caregiver adherence to ORT in children 6 months to 21 years old with AGE. The intervention consisted of ORT “kits” with rehydration supplies and caregiver instructions. In the preintervention period we monitored patient/caregiver adherence to ORT recommendations and additionally monitored ORT kit and educational material distribution during the intervention phase via a caregiver survey after discharge. We utilized statistical process control methodology to assess responses to the intervention. As a balancing measure, we monitored the ED length of stay for patients with AGE.

Results:
Over the study period from November 2013 to April 2015, we included 174 encounters during the preintervention period and 256 encounters during the intervention period. More than 9 of 10 children received ORT kits in the intervention period. Self-reported adherence to ORT between the 2 time periods remained constant. The ED length of stay did not change between the preintervention and intervention period.

Conclusions:
Despite successful distribution of novel ORT materials and education for caregivers of children with AGE in a pediatric ED, caregiver self-reported adherence to ORT postdischarge visit was unchanged. An unexpected high baseline adherence to ORT practices may have limited improvement.
Application of Conjoint Analysis to Improve Reliability of Dietician Consultation in Pediatric Celiac Disease
Authors: Kulkarni Sakil , Liss Kim , Samson Charles M. 
Published: June 2019

Introduction:
Celiac disease (CD) management involves lifelong adherence to a gluten-free diet, making the dietician a key member in CD care. However, our institution lacked a standardized process for dietary consultation in newly diagnosed CD.

Methods:
To understand provider CD care preferences, a 24-1 fractional factorial conjoint analysis was performed. Attributes studied (2 levels each) included type of initial follow-up gastroenterology (GI) provider, interval from diagnosis to follow-up, concurrence of initial dietary consultation with gastroenterology visit, and on-going follow-up GI provider. CD care was standardized in July 2014 to facilitate concurrent visits with the clinician and dietician during the same clinical session. Changes to mean time of dietary consultation and reliability of dietary consultation were monitored using an individual-control and G-control chart, respectively. Standard control chart rules were followed.

Results:
Conjoint analysis identified shorter time to initial follow-up visit and concurrent GI/dietician visits as more important attributes in newly diagnosed CD subjects’ care. Types of follow-up provider during first or subsequent visits were identified as less important attributes. After initiation of a standardized follow-up process, a special cause was identified in December 2015 with a decrease in the mean time to dietary consultation from 30 to 20 days. In addition, standardized follow-up resulted in a more reliable process as evident by a special cause on the G-control chart in February 2015.

Conclusion:
Conjoint analysis identified attributes thought to be important in CD follow-up care. After redesign of our care process, a decrease in time to dietary consultation with improved reliability was observed.
Utilizing Lean Principles to Improve Immunization Administration Efficiency in a Pediatric Mobile Clinic Program
Authors: Gupta Aditi , Misra Sanghamitra M. , Garcia Cassandra , Ugalde Margaret 
Published: June 2019

Introduction:
Mobile clinics are vital health care delivery systems because they provide care to those who may not have access otherwise. Unfortunately, clinic flow on mobile clinics is often chaotic and inherently inefficient. Lean is a customer-centric methodology used in industries like health care to continuously improve processes by eliminating waste. The purpose of this project was to use lean principles to improve efficiency, as measured by total time spent receiving services, so that more underserved patients could receive needed immunizations.

Methods:
Using a certified lean expert, lean principles were applied to the mobile clinic program to uniformly organize the program, simplify registration processes, and standardize clinic procedures. Time study data were collected prospectively on a total of 309 patients for 2-week periods both before and after application of lean principles. Staff used a standardized time study form to record patient visit times. Pre- and postintervention data were analyzed using unpaired t tests and nonparametric Mann-Whitney tests as deemed appropriate.

Results:
Using lean principles significantly reduced total times spent for 1-, 2-, and 4-children families. Wait times for 1- and 4-children families were also significantly decreased. Lastly, times spent on board the mobile clinic to receive immunizations for 1- and 3-children families were significantly decreased.

Conclusion:
Application of lean principles can improve efficiency by decreasing total time spent for patients receiving vaccine services on pediatric mobile clinics.
Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship
Authors: Quintos-Alagheband Maria Lyn , Noyola Estela , Makvana Sejal , El-Chaar Gladys , Wang Shan , Calixte Rose , Krilov Leonard R. 
Published: June 2019

Objective:
The increased incidence of multidrug-resistant organisms is associated with increased morbidity, mortality, hospital length of stay, and cost. Estimates show that up to 50% of antimicrobial use is inappropriate. This initiative focuses on inappropriate use of antibiotics in respiratory syncytial virus (RSV) infections. This virus is the most common cause of bronchiolitis during childhood.

Methods:
Baseline data from the 2011–2012 RSV season showed that 56.2% of our RSV-positive patients received antibiotics. To decrease inappropriate antibiotic use in RSV infections, we established an antimicrobial stewardship program (ASP). This process improvement initiative aimed to decrease exposure to antibiotics and days of antibiotic therapy per 1,000 patient days (DOT/1000PD) in hospitalized RSV-positive patients by 25%. Key drivers included building health-care knowledge, proactive interventions using prospective audit and feedback, emergency department engagement, and performance dashboards.

Results:
We included a total of 290 children in the final analysis. After full implementation of the ASP, there was a significant reduction of antibiotic exposure from 56.2% to 30.9% (P < 0.001), an absolute reduction of 25% and a relative reduction of 45%. There was also a significant decrease in DOT/1000PD from 432.7 to 268.1 days (P = 0.017). This change represents a reduction of 164.6 DOT/1000PD from baseline after full ASP implementation.

Conclusion:
Despite the lack of a unified hospitalist group in our institution, we were successful in reducing inappropriate antibiotic use by focusing on standardizing care among different private pediatricians in the community. A multifaceted strategy and well-designed quality improvement methodology led to a sustained reduction in antibiotic use.