bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in Medication-Associated Fall Risk Among Older Adults After Admission for Fall-Related Trauma
Authors: Gross Amber , Elliott David P. , Lasky Tiffany , Samanta Damayanti , Kafka Wesley , Murphy Miranda , Patel Apexa 
Published: November 2021

Background:
As the population ages, it is predicted that approximately 40% of all patients who experience fall-related trauma will be 65 years of age and older. Most injuries in older adults are caused by falls that are the result of multiple contributing factors including home hazards, comorbidities, frailty, and medications. A variety of medications have been associated with falls, specifically those with sedating and anticholinergic effects. The drug burden index can be used to quantify sedating and anticholinergic drug burden, with higher scores being associated with reduced psychomotor function.

Objective:
Assess the medication-associated fall risk on admission and discharge for older patients admitted to a trauma nurse practitioner service.

Methods:
Retrospective, observational study of patients managed by trauma nurse practitioners at a Level 1 trauma center between January 1, 2018, and December 31, 2019. Patients were included if they were at least 65 years of age, the primary diagnosis for the admission was fall-related trauma, and length of stay was at least 7 days.

Results:
A total of 172 patients were included in the study. The drug burden index was significantly higher at discharge than admission (M = 1.4, SD = 0.9 vs. M = 1.9, SD = 0.9) as was the total number of medications (M = 11.0, SD = 5.2 vs. M = 15.1, SD = 5.8).

Conclusions:
Medication-related fall risk was increased during admission due to fall-related trauma. Patients were discharged with a higher sedating and anticholinergic burden than on admission, which increases risk for future falls.
Navigating an American College of Surgeons Virtual Verification Review Committee Visit: A Health System Perspective
Authors: Marden Edie , Christopherson Nathan 
Published: November 2021

Background:
Faced with a global pandemic at the beginning of 2020, the American College of Surgeons Committee on Trauma (ACS-COT) canceled in-person site visits. Late in 2020, the focus shifted to recovery and returning to a “new normal,” and the ACS transitioned to virtual visits.

Objective:
This article provides insight from a health system perspective on how we developed a virtual platform, prepared our system and staff, organized our teams, and lessons learned during virtual ACS visits.

Methods:
The Northwell Health Trauma Institute, a member of the largest health system in New York State, oversees seven centers ranging from Level I to Level III, including two pediatric centers. Preparations for virtual visits began with standardizing processes to ensure a smooth transition for our centers. We utilized the ACS virtual agenda as a framework. The methods we used will be divided into categories, including technology, personnel, and preparations.

Results:
Having multiple sites engage in the virtual visit enabled us to gain insight as we completed each visit. We standardized processes and created a team site for uploading documents. As a result, we established best practices.

Conclusion:
Shifting focus from an in-person visit to a virtual visit provided us with an opportunity to assess our preparations and to determine the most effective and efficient ways to navigate this new process. Having multiple sites allowed us to critique our process and make changes as we proceeded with subsequent sites.
Bimodal Hearing with Pediatric Cochlear Implant Recipients: Effect of Acoustic Bandwidth
Authors: Gifford René H. , Sunderhaus Linsey , Sheffield Sterling 
Published: November 2021

Objective:
The primary purpose of this study was to examine the effect of acoustic bandwidth on bimodal benefit for speech understanding in pediatric cochlear implant (CI) recipients.

Study Design:
Ten children (6–13 years) with CIs utilizing a bimodal hearing configuration participated in this study. Speech understanding was assessed via recorded Pediatric AzBio sentences presented in a 10-talker babble. The CI stimulus was always unprocessed and the low-pass filtered acoustic stimuli were delivered to the non-CI ear with the following cutoff frequencies: 250, 500, 750, 1000, and 1500 Hz.

Setting:
Tertiary referral center.

Main Outcome Measures:
Sentence recognition in noise for the acoustic-alone, CI-alone, and bimodal listening conditions.

Results:
The primary findings were: (1) children gained significant bimodal benefit with 250 Hz, and (2) children demonstrated no statistically significant additional bimodal benefit with increasing acoustic bandwidth.

Conclusions:
Acoustic bandwidth effects for pediatric CI recipients were significantly different than those documented in the literature for adult CI recipients. Specifically, this group of pediatric CI recipients demonstrated no increases in bimodal benefit with increases in acoustic bandwidth, primarily consistent with a segregation theory of bimodal integration.
Transcanal Endoscopic Ear Surgery for Advanced External Auditory Canal Cholesteatoma in Naim Stage III and IV
Authors: Li Yang , Sheng Ying , Xia Cui , Yan Jing , Guo Li , Ren XiaoYong , Wu BaoJun 
Published: November 2021

Objective:
To report the clinical characteristics and treatment outcomes, as well as endoscopic-assisted ear surgery techniques used in patients with advanced external auditory canal cholesteatoma (EACC).

Study Design:
Retrospective case series.

Setting:
University hospital.

Methods:
From October 2014 to September 2017, adult patients (age > 18) with advanced EACC (Naim's classification: stage III or IV) who underwent transcanal endoscopic ear surgery (TEES) were enrolled. The presenting features, extent of the lesion, and reconstruction techniques used were assessed. The healing time which was defined as the time required to develop a dry, re-epithelialized, and self-cleaning external auditory canal, was compared between stage III and IV.

Results:
Twenty-three patients were included. EACC was categorized as stage III in 11 ears and stage IV in 12 ears. Cholesteatoma involved the mastoid (30%), middle ear (26%), chorda tympani (22%), temporomandibular joint, antrum, and facial nerve (17% for each). In 96% of patients, a dry and self-cleaning external auditory canal (EAC) was maintained after a mean follow-up of 15 months. The median healing time was 8 weeks in stage III, which was significantly shorter than the 12 weeks required for stage IV (p < 0.05). There was no significant difference in the median healing time between TEES and the canal wall up mastoidectomy for stage IV EACC (14 weeks) performed by the same surgeon over the same period (p > 0.05).

Conclusions:
TEES is a feasible and safe technique for the exposure and eradication of advanced EACC. Some critical endoscopic techniques for resecting disease and reconstructing the defect in the EAC and middle ear should be mastered before performing this operation.
Assessing Self-reported Recovery in a Community Psychiatry Setting
Authors: Rodriguez Katrina M. , Von Mach Tara , Spivak Stanislav , Mojtabai Ramin , Cullen Bernadette A. 
Published: November 2021

Objective:
This study examined demographic and diagnostic characteristics associated with self-reported recovery in patients with serious mental illness.

Methods:
Patient demographics and diagnoses were obtained from a retrospective review of charts from 981 patients attending a community psychiatry outpatient program between January 2015 and December 2016. All patients completed the Recovery Assessment Scale-Revised (RAS-R), a self-report recovery questionnaire consisting of 5 subscales, approximately every 6 months. Generalized estimating equation models were used to assess change in RAS-R scores over time and to test for associations with demographic characteristics, clinical diagnoses, and appointment adherence.

Results:
RAS-R scores increased among all demographic and diagnostic groups during the study period. A primary diagnosis of a psychotic disorder (including schizophrenia) was associated with higher 2-year average RAS-R total scores and scores on the Personal Confidence and Hope, Goal and Success Orientation, and Not Dominated by Symptoms subscales. African American race was associated with higher 2-year average scores on the Personal Confidence and Hope subscale. Increasing age was associated with higher total RAS-R scores and multiple subscale scores. No significant associations were found between sex or appointment adherence and RAS-R total scores or any of the subscale scores.

Conclusions:
While certain demographic and diagnostic groups were associated with higher RAS-R scores, study results suggest that time in treatment is itself associated with higher self-reported recovery among all demographic groups. Age, race, and diagnosis were all associated with higher scores on the Personal Confidence and Hope subscale, highlighting the need for individualized treatment that takes multiple patient characteristics into account.
A Case Series of Very Late-onset Schizophrenia-like Psychosis: Is It a Dimension of Dementia?
Authors: Zazaian Danielle , Gifford Lindsey , Rath Swapnil 
Published: November 2021

Background:
Emerging research has shown that there may be a subset of patients who develop a first-break psychosis later in life when they are over 60 years of age. Very late-onset schizophrenia-like psychosis (VLOSLP) differs from early-onset schizophrenia in a few very important ways that lead us to believe that there may be a distinct pathologic process involved.

Methods:
We present 4 cases of females with psychotic symptoms that first appeared after the patients were 60 years of age. We conducted a literature review and found that our older adult psychiatric unit is not alone in struggling with diagnoses for these individuals.

Results:
Some of these patients have a disease that will progress to a neurocognitive disorder, but a large group of others will remain cognitively intact. Fortunately, the treatment for both processes is very similar, but studies have shown that patients with VLOSLP will need significantly lower doses of antipsychotics compared with those with early-onset schizophrenia.

Conclusions:
It remains unclear if VLOSLP is a unique disorder, a prodrome to dementia, or a different condition that is not yet understood. Further research is needed to develop comprehensive treatment for patients with VLOSLP.
Transgenerational impact of aberrant inflammation in rat pregnancy
Authors: Ushida Takafumi , Cotechini Tiziana , Protopappas Nicole , Atallah Aline , Collyer Charlotte , Macdonald-Goodfellow Shannyn K. , Tse M. Yat , Winn Louise M. , Pang Stephen C. , Adams Michael A. , Othman Maha , Kotani Tomomi , Kajiyama Hiroaki , Graham Charles H. 
Published: November 2021

AbstractChildren of women with pre-eclampsia have increased risk of cardiovascular (CV) and metabolic disease in adult life. Furthermore, the risk of pregnancy complications is higher in daughters born to women affected by pre-eclampsia than in daughters born after uncomplicated pregnancies. While aberrant inflammation contributes to the pathophysiology of pregnancy complications, including pre-eclampsia, the contribution of maternal inflammation to subsequent risk of CV and metabolic disease as well as pregnancy complications in the offspring remains unclear. Here we demonstrate that 24-week-old female rats (F1) born to dams (F0) exposed to lipopolysaccharide (LPS) during pregnancy (to induce inflammation) exhibited mild systolic dysfunction, increased cardiac growth-related gene expression, abnormal glucose tolerance and coagulopathy; whereas male F1 offspring exhibited abnormal glucose tolerance and increased visceral fat accumulation compared with F1 sex-matched offspring born to saline-treated dams. Both male and female F1 offspring born to LPS-treated dams had evidence of anemia. Fetuses (F2) from F1 females born to LPS-treated dams were growth restricted, and this reduction in fetal growth was associated with increased CD68 positivity and decreased expression of glucose transporter-1 in their utero-placental units. These results indicate that abnormal maternal inflammation can contribute to increased risk of CV and metabolic disease in offspring, and that the effects of inflammation may be transgenerational. This study provides evidence in support of early screening for CV and metabolic disease, as well as pregnancy complications in offspring affected by pre-eclampsia or other pregnancy complications associated with aberrant inflammation.
Computation of transcranial magnetic stimulation electric fields using self-supervised deep learning
Authors: Li Hongming , Deng Zhi-De , Oathes Desmond , Fan Yong 
Published: November 2021

AbstractElectric fields (E-fields) induced by transcranial magnetic stimulation (TMS) can be modeled using partial differential equations (PDEs). Using state-of-the-art finite-element methods (FEM), it often takes tens of seconds to solve the PDEs for computing a high-resolution E-field, hampering the wide application of the E-field modeling in practice and research. To improve the E-field modeling’s computational efficiency, we developed a self-supervised deep learning (DL) method to compute precise TMS E-fields. Given a head model and the primary E-field generated by TMS coils, a DL model was built to generate a E-field by minimizing a loss function that measures how well the generated E-field fits the governing PDE. The DL model was trained in a self-supervised manner, which does not require any external supervision. We evaluated the DL model using both a simulated sphere head model and realistic head models of 125 individuals and compared the accuracy and computational speed of the DL model with a state-of-the-art FEM. In realistic head models, the DL model obtained accurate E-fields that were significantly correlated with the FEM solutions. The DL model could obtain precise E-fields within seconds for whole head models at a high spatial resolution, faster than the FEM. The DL model built for the simulated sphere head model also obtained an accurate E-field whose average difference from the analytical E-fields was 0.0054, comparable to the FEM solution. These results demonstrated that the self-supervised DL method could obtain precise E-fields comparable to the FEM solutions with improved computational speed.
Notch-dependent DNA cis-regulatory elements and their dose-dependent control of C. elegans stem cell self-renewal
Authors: Lynch Tina R , Xue Mingyu , Czerniak Cazza W. , Lee ChangHwan , Kimble Judith 
Published: November 2021

AbstractA long-standing biological question is how DNA cis-regulatory elements shape transcriptional patterns during metazoan development. The use of reporter constructs, cell culture and computational modeling has made enormous contributions to understanding this fundamental question, but analysis of regulatory elements in their natural developmental context is an essential but rarely used complement. Here, we edited Notch-dependent cis-regulatory elements in the endogenous C. elegans sygl-1 gene, which encodes a key stem cell regulator. We then analyzed the in vivo consequences of those mutations – on both gene expression (nascent transcripts, mRNA, protein) and stem cell maintenance. Mutation of a single element in a three-element homotypic cluster reduced expression as well as stem cell pool size by about half, while mutation of two elements essentially abolished them. We find that LBS number and LBS neighborhood are both important to activity: elements on separate chromosomes function additively, while elements in the same cluster act synergistically. Our approach of precise CRISPR/Cas9 gene editing coupled with quantitation of both molecular and biological readouts establishes a powerful model for in vivo functional analyses of DNA cis-regulatory elements.Summary statementNotch-dependent DNA cis-regulatory elements work together in their developmental context to shape a transcriptional gradient, control stem cell pool size, and govern differentiation onset.
Effective cell membrane tension is independent of polyacrylamide substrate stiffness
Authors: Kreysing Eva , Mc Hugh Jeffrey , Foster Sarah K. , Andresen Kurt , Greenhalgh Ryan D. , Pillai Eva K. , Dimitracopoulos Andrea , Keyser Ulrich F. , Franze Kristian 
Published: November 2021

AbstractMost animal cells are surrounded by a cell membrane and an underlying actomyosin cortex. Both structures are linked, and they are under tension. In-plane membrane tension and cortical tension both influence many cellular processes, including cell migration, division, and endocytosis. However, while actomyosin tension is regulated by substrate stiffness, how membrane tension responds to mechanical substrate properties is currently poorly understood. Here, we probed the effective membrane tension of neurons and fibroblasts cultured on glass and polyacrylamide substrates of varying stiffness using optical tweezers. In contrast to actomyosin-based traction forces, both peak forces and steady state tether forces of cells cultured on hydrogels were independent of substrate stiffness and did not change after blocking myosin II activity using blebbistatin, indicating that tether and traction forces are not directly linked. Peak forces in fibroblasts on hydrogels were about twice as high as those in neurons, indicating stronger membrane-cortex adhesion in fibroblasts. Steady state tether forces were generally higher in cells cultured on hydrogels than on glass, which we explain by a mechanical model. Our results provide new insights into the complex regulation of effective membrane tension and pave the way for a deeper understanding of the biological processes it instructs.
International impact of large multi-centre surgical trials of arthroscopic subacromial decompression
Authors: Smith James A. , Kostka Kristin , Beard David J. , Carr Andrew J. , Rees Jonathan L. , Prieto-Alhambra Daniel 
Published: November 2021

AbstractObjectivesTo examine temporal trends in incidence of arthroscopic subacromial decompression (ASAD) surgery internationally during conduct and after publication of placebo controlled trials finding no evidence of meaningful benefit of ASAD for shoulder impingement.DesignObservational study of incidence rates.SettingLarge routinely collected datasets were used: outpatient data from Belgium and UK, and insurance claims and outpatient data from US. UK data were from Clinical Practice Research Datalink and Belgium and US data were from IQVIA. US and UK data spanned 2005 – 2019 and Belgium data 2011 – 2019.ParticipantsPatients were eligible for inclusion in the study if they had at least one visit recorded in the database in a given year and cases were defined as patients undergoing ASAD for the first time in their records in a given year.Outcome measuresWe calculated incidence of ASAD over time, overall and stratified by age and sex. Characteristics of patients undergoing ASAD were also assessed over time.ResultsUK incidence has fallen since a peak of 4.7 per 10,000 person years in 2011 (when the CSAW trial began) to 1.8 in 2019. US incidence shows no clear pattern and remains consistently higher than the UK, at 11.5 per 100,000 person years in 2019. Changes in incidence patterns were similar across different age groups and sexes. The number of cases in Belgium was too small for meaningful conclusions.ConclusionsWe found ASAD rates have fallen in the UK during conduct and after publication of two large surgical RCTs from the UK and Finland that questioned the effectiveness of ASAD for shoulder impingement. A similar impact on clinical practice has not been seen in US. Further work to understand the barriers or concerns preventing international uptake of high quality evidence into clinical practice is needed.Strengths and limitations of this studyThis is the most comprehensive study of ASAD incidence we are aware of. Routinely collected datasets were used to assess proportions of the patients undergoing this procedure in several countriesStandardised case definitions were used across databases to increase comparability of findingsTemporal changes in database coverage and quality of reporting can influence findings. The observed variation in ASAD incidence may not be entirely attributable to changes in ASAD surgery rates.
Base editing in bovine embryos reveals a species-specific role of SOX2 in regulation of pluripotency
Authors: Luo Lei , Shi Yan , Wang Huanan , Wang Zizengchen , Dang Yanna , Li Shuang , Wang Shaohua , Zhang Kun 
Published: November 2021

AbstractThe emergence of the first three lineages during development are orchestrated by a network of transcription factors, which are best characterized in mice. However, the role and regulation of these factors are not completely conserved in other mammals, including human and cattle. Here, we establish a gene inactivation system by introducing premature codon with cytosine base editor in bovine embryos with a robust efficiency. Of interest, SOX2 is universally localized in early blastocysts but gradually restricted into the inner cell mass in cattle. SOX2 knockout results in a failure of the establishment of pluripotency. Indeed, OCT4 level is significantly reduced and NANOG was barely detectable. Furthermore, the formation of primitive endoderm is compromised with few SOX17 positive cells. Single embryo RNA-seq reveals a dysregulation of 2074 genes, among which 90% are up-regulated in SOX2-null blastocysts. Intriguingly, more than a dozen lineage-specific genes, including OCT4 and NANOG, are down-regulated. Moreover, SOX2 expression is sustained in the trophectoderm in absence of CDX2 in bovine late blastocysts. Overall, we propose that SOX2 is dispensable for OCT4 and NANOG expression and disappearance of SOX2 in the trophectoderm depends on CDX2 in cattle, which are all in sharp contrast with results in mice.SignificanceThe first and second cell fate decisions of a new life are important for subsequent embryonic and plancental development. These events are finely controlled by a network of transcriptional factors, which are extensively characterized in mice. Species-specific roles of these proteins are emerging in mammals. Here, we develop a gene loss-of-function system by using cytosine base editors in bovine embryos. We find that expression pattern, functional roles, and regulation of SOX2 are all different between mouse and bovine embryos. Remarkbly, SOX2 is required for OCT4 and NANOG, two well established pluripoteny genes. Furthermore, CDX2 is required to shut down SOX2 in the trophectoderm. Given similar expression pattern of SOX2 between human and bovine blastocysts, bovine embryos represents a putative model to investigate human pluripotency regulation in vivo.
A synthetic distributed genetic multi-bit counter
Authors: Chen Tianchi , Al-Radhawi M. Ali , Voigt Christopher A. , Sontag Eduardo D. 
Published: November 2021

SummaryA design for genetically-encoded counters is proposed via repressor-based circuits. An N -bit counter reads sequences of input pulses and displays the total number of pulses, modulo 2N .The design is based on distributed computation, with specialized cell types allocated to specific tasks. This allows scalability and bypasses constraints on the maximal number of circuit genes per cell due to toxicity or failures due to resource limitations.The design starts with a single-bit counter. The N -bit counter is then obtained by interconnecting (using diffusible chemicals) a set of N single-bit counters and connector modules.An optimization framework is used to determine appropriate gate parameters and to compute bounds on admissible pulse widths and relaxation (inter-pulse) times, as well as to guide the construction of novel gates.This work can be viewed as a step toward obtaining circuits that are capable of finite-automaton computation, in analogy to digital central processing units.Graphical Abstract