Quality Improvement to Engage General Pediatrics in Reducing Inaccurate Penicillin Allergy Labels.

Objective: To remove inaccurate penicillin allergy labels in the general pediatric clinic setting.

Methods: From October 2017 through December 2021, this collaborative, quality improvement project used education, feedback, electronic health record alerts, and the introduction of oral amoxicillin challenges in a general pediatric clinic setting with the primary aim of decreasing the proportion of penicillin allergy labeled patients. Control charts were used to track the relationship between interventions and improvements in referral rates to allergy clinic, removal of the allergy label at clinic visits and the overall proportion of clinic patients labeled as PCN allergic.

Anti-tumor effects of RTX-240: an engineered red blood cell expressing 4-1BB ligand and interleukin-15.

Recombinant agonists that activate co-stimulatory and cytokine receptors have shown limited clinical anticancer utility, potentially due to narrow therapeutic windows, the need for coordinated activation of co-stimulatory and cytokine pathways and the failure of agonistic antibodies to recapitulate signaling by endogenous ligands. RTX-240 is a genetically engineered red blood cell expressing 4-1BBL and IL-15/IL-15Rα fusion (IL-15TP). RTX-240 is designed to potently and simultaneously stimulate the 4-1BB and IL-15 pathways, thereby activating and expanding T cells and NK cells, while potentially offering an improved safety profile through restricted biodistribution.

Engineered red blood cells as an off-the-shelf allogeneic anti-tumor therapeutic.

Checkpoint inhibitors and T-cell therapies have highlighted the critical role of T cells in anti-cancer immunity. However, limitations associated with these treatments drive the need for alternative approaches. Here, we engineer red blood cells into artificial antigen-presenting cells (aAPCs) presenting a peptide bound to the major histocompatibility complex I, the costimulatory ligand 4-1BBL, and interleukin (IL)-12.

Experience with a "Feed and Swaddle" program in infants up to six months of age.

Background: Feed and swaddle is a technique in which an infant is fed and allowed to fall asleep to facilitate diagnostic imaging. This study reviews our experience and diagnostic success in premature and term infants up to 6 months old undergoing brain magnetic resonance imaging (MRI) using a feed and swaddle technique and with comparable patients imaged under anesthesia.

Methods: We reviewed the charts of all infants ≤6 months who underwent brain MRI at our institution between 1 January 2013 and 31 March 2016.

Assessment of Common Criteria for Awake Extubation in Infants and Young Children.

Background: Practice patterns surrounding awake extubation of pediatric surgical patients remain largely undocumented. This study assessed the value of commonly used predictors of fitness for extubation to determine which were most salient in predicting successful extubation following emergence from general anesthesia with a volatile anesthetic in young children.

Methods: This prospective, observational study was performed in 600 children from 0 to 7 yr of age.

Microbial stability of syringes of anesthetic drugs prepared in the operating room.

Study Objective: To determine whether microbial contamination of anesthesia syringes prepared in the operating room (OR) become contaminated in a time-dependent fashion.

Design: Observational.

Setting: Operating suite in a major university hospital.

Management of headwaters based on macroinvertebrate assemblages and environmental attributes.

The ecosystem function of headwaters is important and increasingly well-recognized, but institutional structures to administer their protection and management are lacking or poorly developed. Although the reasons for this mismatch are various, one of practical concern is the potential administrative burden imposed by the sizable number of headwaters. Two essential components of an administrative framework for managing waters is classification by type so that proper expectations can be set, and development of indicators that measure whether those expectations are being met.

Quantifying Variability in Four US Streams Using a Long-Term Data Set: Patterns in Water Quality Endpoints.

Temporal and spatial patterns of variability in aquatic ecosystems can be complex and difficult to quantify or predict. However, understanding this variability is critical to making a wide range of water quality assessment and management decisions effectively. Here we report on the nature and magnitude of spatial and temporal variation observed in conductivity, total phosphorus, and total nitrogen during a 15-year study of four U.

Quantifying Variability in Four U.S. Streams Using a Long-Term Dataset: Patterns in Biotic Endpoints.

Effective water resources assessment and management requires quantitative information on the variability of ambient and biological conditions in aquatic communities. Although it is understood that natural systems are variable, robust estimates of long-term variation in community-based structure and function metrics are rare in U.S.

Assessing the fit of biotic ligand model validation data in a risk management decision context.

Biotic ligand models (BLMs) have advanced the ability to predict the concentrations of metals in surface waters likely to harm aquatic organisms. BLMs have been developed for several metals including Cu, Zn, Cd, and Ag. Additionally, the US Environmental Protection Agency has published guidance on the use of a BLM to develop water quality criteria for Cu.

Maximizing the accuracy of field-derived numeric nutrient criteria in water quality regulations.

High levels of the nutrients nitrogen and phosphorus can cause unhealthy biological or ecological conditions in surface waters and prevent the attainment of their designated uses. Regulatory agencies are developing numeric criteria for these nutrients in an effort to ensure that the surface waters in their jurisdictions remain healthy and productive, and that water quality standards are met. These criteria are often derived using field measurements that relate nutrient concentrations and other water quality conditions to expected biological responses such as undesirable growth or changes in aquatic plant and animal communities.

Assessing the predictive performance of risk-based water quality criteria using decision error estimates from receiver operating characteristics (ROC) analysis.

Field data relating aquatic ecosystem responses with water quality constituents that are potential ecosystem stressors are being used increasingly in the United States in the derivation of water quality criteria to protect aquatic life. In light of this trend, there is a need for transparent quantitative methods to assess the performance of models that predict ecological conditions using a stressor-response relationship, a response variable threshold, and a stressor variable criterion. Analysis of receiver operating characteristics (ROC analysis) has a considerable history of successful use in medical diagnostic, industrial, and other fields for similarly structured decision problems, but its use for informing water quality management decisions involving risk-based environmental criteria is less common.

Structures of adnectin/protein complexes reveal an expanded binding footprint.

Adnectins are targeted biologics derived from the tenth type III domain of human fibronectin (¹⁰Fn3), a member of the immunoglobulin superfamily. Target-specific binders are selected from libraries generated by diversifying the three ¹⁰Fn3 loops that are analogous to the complementarity determining regions of antibodies. The crystal structures of two Adnectins were determined, each in complex with its therapeutic target, EGFR or IL-23.

Estimating the designated use attainment decision error rates of US Environmental Protection Agency's proposed numeric total phosphorus criteria for Florida, USA, colored lakes.

The utility of numeric nutrient criteria established for certain surface waters is likely to be affected by the uncertainty that exists in the presence of a causal link between nutrient stressor variables and designated use-related biological responses in those waters. This uncertainty can be difficult to characterize, interpret, and communicate to a broad audience of environmental stakeholders. The US Environmental Protection Agency (USEPA) has developed a systematic planning process to support a variety of environmental decisions, but this process is not generally applied to the development of national or state-level numeric nutrient criteria.

Using Monte Carlo analysis to characterize the uncertainty in final acute values derived from aquatic toxicity data.

Many ambient water quality criteria established to protect aquatic life from acute toxicity are calculated using a procedure described in the US Environmental Protection Agency's "1985 Guidelines" (USEPA 1985). The procedure yields a final acute value (FAV) from acceptable median lethal or effective concentrations (LC50 or EC50, respectively) that is a single-point, deterministic estimate of the concentration of a chemical substance that will protect 95% of aquatic species from >50% mortality or other acute toxic effects. However, because of variation and uncertainty associated with toxicity test results, uncertainty in the estimated FAV exists that is not accounted for by the 1985 Guidelines procedure.

Office-based interventions for recognizing abnormal pediatric blood pressures.

Interventions to improve pediatric blood pressure (BP) screening have not been well studied. The authors measured staff acceptance of 2 simple in-office interventions and measured the effect on physician recognition of elevated BP measurements. Group 1 used simplified normative pediatric BP tables affixed to the growth chart, group 2 used a personal digital assistant program (PDA) to calculate BP percentiles as part of the vital signs, and group 3 served as the control.

Learning management systems: technology to measure the medical knowledge competency of the ACGME.

Aims: We report how the learning management system (LMS) Web Course Tools (WebCT) was used to design, implement and evaluate the web-based course "Principles of Ambulatory Paediatrics", taken by paediatric residents during an ambulatory block rotation. This report also illustrates how WebCT can be used to measure the medical knowledge competency required by the Accreditation Council for Graduate Medical Education (ACGME).

Methods: Eighty paediatric residents completed a 1-month outpatient rotation between July 1, 2001 and June 30, 2002.