bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain control and reduction of opioid use associated with intracameral phenylephrine1.0%–ketorolac 0.3% administered during cataract surgery
Authors: Donnenfeld Eric D. , Mychajlyszyn Daniel , Mychajlyszyn Andrey , Stein Rebecca 
Published: November 2021

Purpose:
To compare pain and the need for the opioid fentanyl use associated with the administration of phenylephrine 1.0%–ketorolac 0.3% (P/K) with those of epinephrine administration during cataract surgery.

Setting:
Ambulatory surgery center.

Design:
Single-center, prospective, randomized, double-masked, self-controlled trial.

Methods:
Patients undergoing bilateral, topical anesthetic cataract surgery were randomized to receive either intracameral P/K or epinephrine in their balanced salt solution for the first eye and the other for the second eye, 2 weeks later. Fentanyl was used to manage intraoperative pain. The primary end point was the need for fentanyl administration intraoperatively. Secondary outcomes included pain measurements; surgery duration; effective phacoemulsification time; pupil size; and complications.

Results:
112 eyes of 56 patients were enrolled. Significantly fewer eyes in the P/K group (7 [12.5%]) than in the epinephrine group (19 [33.9%]; P = .013) required intraoperative fentanyl administration. Mean pain scores were lower in the P/K group than those in the control group at all timepoints. For patients with no pain to mild pain (pain scores ≤ 3), 85.7% (n = 48) of the P/K group and 58.9% (n = 33) of the epinephrine group met this benchmark (P = .003) intraoperatively. The combined outcome, the number of patients not receiving intravenous fentanyl and experiencing no pain to mild pain, was significantly higher in the study (82.1%, n = 46) than in the control group (58.9%, n = 33; P = .013).

Conclusions:
P/K administration significantly reduced pain and the need for fentanyl use. Using P/K is a practical way for cataract surgeons to provide better patient care and reduce the need for intraoperative opioids.
Eight-year follow-up of excimer laser trabeculostomy alone and combined with phacoemulsification in patients with open-angle glaucoma
Authors: Berlin Michael S. , Shakibkhou Jonathan , Tilakaratna Nirosha , Giers Ulrich , Groth Sylvia Linner 
Published: November 2021

Purpose:
To describe the 8-year results of excimer laser trabeculostomy (ELT) alone and ELT in conjunction with phacoemulsification (phaco).

Setting:
University hospital.

Design:
Retrospective review.

Methods:
308 nm excimer laser energy delivered through an intraocular fiber-optic probe created channels through the inner wall of Schlemm canal. 2 groups were studied: ELT alone and ELT + phaco. Inclusion criteria were adult patients with open-angle glaucoma or ocular hypertension on 1 or more intraocular pressure (IOP)-lowering medications and, in the ELT + phaco group, presence of visually significant cataract. Primary outcome measures were change of IOP from baseline and number of IOP-lowering medications.

Results:
164 eyes in 2 groups, ELT alone (n = 90) and ELT + phaco (n = 74), were followed up for 8 years. Baseline IOP was 22.17 ± 7.0 mm Hg and 21.9 ± 6.44 mm Hg in the ELT alone and the ELT + phaco groups, respectively. IOP in the ELT alone group decreased to 16.84 ± 5.2 mm Hg at 1 year (n = 69) and remained at 15.9 ± 3.5 (n = 19) at 8 years. IOP in the ELT + phaco group was 14.04 ± 4.1 mm Hg at 1 year (n = 63) and 13.7 ± 2.8 mm Hg at 8 years (n = 13). The number of IOP-lowering medications at baseline in the ELT alone group was 1.85 ± 0.8 and decreased to 1.19 ± 1.10 at 1 year and 1.4 ± 1.4 at 8 years. In the ELT + phaco group, it was 1.58 ± 0.8 at baseline and decreased to 0.97 ± 0.95 at 1 year and 1.85 ± 0.7 at 8 years.

Conclusions:
ELT demonstrated long-term IOP lowering and decrease in the number of IOP-lowering medications. Benefits of this laser-based implant-free microinvasive glaucoma surgery procedure included a high safety profile and long-term efficacy.
Effect of a Flipped Classroom Compared With a Traditional Lecture on Physician Assistant Students' Exam Performance
Authors: Wright Matthew , Jia Yuane , Vidal Erich , O'Connell Claire Babcock , Palfreyman Lori , Parrott J. Scott 
Published: November 2021

Purpose
The purpose of this study was to retrospectively compare the exam performance of physician assistant (PA) students given asthma instruction in a flipped classroom with PA students in a traditional lecture setting while controlling for students' previous academic performance and clinical asthma experience.

Methods
Three cohorts of PA students (n = 146) from the years 2017 (traditional-lecture setting) and 2018 and 2019 (flipped-classroom setting) were included in the study. Academic performance across cohorts was compared using answers to 11 exam questions reflective of the asthma content.

Results
Findings demonstrated significantly greater performance in the flipped classroom compared with traditional lecture. The 2018 and 2019 cohorts scored 9.4% and 13.2% higher, respectively, compared with the 2017 cohort. Exam performance of students with a low likelihood of clinical exposure to asthmatic patients before PA school was similar to those with a high likelihood.

Conclusion
This study found improved exam performance with a flipped classroom. The flipped classroom represents a potential opportunity to maximize similar performances by both less experienced students and more experienced students.
Projecting the Supply and Demand of Prosthetists and Orthotists in Singapore
Authors: Asano Miho , Ng Yu Li , Anuar Khalid , Yeo Yi Tian Felicity , Koh Gerald Choon Huat , Tan Kelvin Bryan 
Published: November 2021

ABSTRACT

Introduction
Singapore's aging population and prevalence of chronic diseases and conditions continue to grow along with the need for prosthetic and orthotic services. We need to understand the supply of prosthetic and orthotic services and prosthetists and orthotists (P&Os) to optimize care. Therefore, the objective of this study was to estimate the recent and the future supply and demand for P&Os in Singapore.

Methods
This was a retrospective medical record review. We identified the seven conditions requiring prosthetic and orthotic services and applied condition-specific admission rates on the projected population of Singapore through 2060 to obtain the number of inpatient admissions requiring the services. We then converted these numbers to prosthetist/orthotist hours by multiplying by prosthetist/orthotist workload for each condition. Finally, we applied two supply scenarios to examine potential P&O shortfall.

Results
The shortfall was estimated to be 9.4 and 5.4 in 2016 under the respective scenarios. These gaps increase to 18.4 and 5.8, respectively, in 2030, and 28.1 and 6.2, respectively, in 2060.

Conclusions
The existing shortfall of P&Os in Singapore will continue to grow from 2016 to 2060. Appropriate strategies should be considered and implemented in a timely manner to manage the potential shortfall.

Clinical Relevance
Projecting the demand for future prosthetist/orthotist manpower through a specific condition-driven and time-based utility approach provides an alternative model to only a linear population growth. This may provide a more accurate predictability and selection of precise strategies to manage future manpower demands.
Transcranial Direct Current Stimulation and Yoga for Functional Movement Disorders
Authors: Park Jung E. , Hong Ji-Yi , Lee Su-Young 
Published: November 2021

Background:
Functional movement disorder (FMD), a conversion disorder characterized by involuntary movements, is difficult to treat.

Methods:
We aimed to assess the effects of anodal transcranial direct current stimulation (tDCS) and yoga in FMD patients (n=5). TDCS of the right temporoparietal junction, a brain region relevant in the sense of self-agency, was conducted. Subjects underwent both sham and anodal tDCS with a washout period of 3 weeks. Yoga was used as a mode of exercise, as well as in conjunction with stimulation to sustain potential changes in neural plasticity.

Results:
A total of 5 subjects completed the study [mean age: 52 (SE: 4) y, disease duration: 5 (SE: 1.6) y], undergoing both sham and anodal tDCS. Anodal tDCS does not appear to be superior to sham tDCS in alleviating symptoms and disability, but combining tDCS and yoga appears to lead to mild improvement noted on clinical observation, based on the change in the efficacy index of Clinical Global Impression found in 4 subjects.

Conclusion:
Our study results suggest that anodal tDCS is not superior to sham tDCS in alleviating subjective symptoms and disability in FMD. However, interpretation of these results is limited due to the small number of stimulation sessions and number of subjects. Future studies using more frequent stimulation sessions are needed to further determine whether anodal tDCS may have a therapeutic effect in this patient group compared with sham tDCS.
Association of Poor Sleep With Depressive and Anxiety Symptoms by HIV Disease Status: Women's Interagency HIV Study
Authors: Daubert Elizabeth , French Audrey L. , Burgess Helen J. , Sharma Anjali , Gustafson Deborah , Cribbs Sushma K. , Weiss Deborah Jones , Ramirez Catalina , Konkle-Parker Deborah , Kassaye Seble , Weber Kathleen M. 
Published: November 2021

Background:
Sleep disturbances are prevalent in women living with HIV (WLWH) and can affect mental health and overall quality of life. We examined the prevalence and predictors of poor sleep quality in a US cohort of WLWH and HIV-uninfected controls and the relationship between sleep quality and mental health symptom burden stratified by HIV disease status (viremic WLWH, aviremic WLWH, and HIV-uninfected women).

Methods:
Sleep quality was assessed using the Pittsburgh Sleep Quality Index in 1583 (400 viremic WLWH, 723 aviremic WLWH, and 460 HIV-uninfected women) Women's Interagency HIV Study participants. Depressive and anxiety symptoms were concurrently assessed using the Center for Epidemiological Studies-Depression (CES-D) scale and General Anxiety Disorder (GAD-7) scale. Associations between poor sleep quality (global Pittsburgh Sleep Quality Index >5) and both high depressive (CES-D ≥16) and anxiety (GAD-7 ≥10) symptoms were each assessed by HIV disease status using multivariable logistic regression models.

Results:
Prevalence of poor sleep quality in the overall sample was 52%, differed by HIV disease status (P = 0.045), and was significantly associated with high depressive and anxiety symptoms in (1) viremic WLWH, (2) aviremic WLWH, and (3) HIV-uninfected women [CES-D: (1) adjusted odds ratio (aOR) = 7.50, 95% confidence interval (CI): 4.10 to 13.7; (2) aOR = 4.54, 95% CI: 3.07 to 6.73; and (3) aOR = 6.03, 95% CI: 3.50 to 10.4; GAD-7: (1) aOR = 5.20; 95% CI: 2.60 to 10.4, (2) aOR = 6.03; 95% CI: 3.67 to 9.91, and (3) aOR = 6.24; 95% CI: 3.11 to 12.6].

Conclusions:
Poor sleep quality is highly prevalent, as is mental health symptom burden, among WLWH and HIV-uninfected controls. Future longitudinal studies are necessary to clarify the directionality of the relationship.
Administration of Intravenous Dexmedetomidine and Acetaminophen for Improved Postoperative Pain Management in Primary Palatoplasty
Authors: Ichiuji Brynne , Mantilla-Rivas Esperanza , Rana Md Sohel , Mamidi Ishwarya , Manrique Monica , Stein Jason , Aivaz Marudeen , McGrath Jennifer , Rogers Gary F. , Oh Albert K. 
Published: November 2021

Objective:
Suboptimal pain management after primary palatoplasty (PP) may lead to complications such as hypoxemia, and increased hospital length of stay. Opioids are the first option for postoperative acute pain control after PP; however, adverse effects include excessive sedation, respiratory depression, and death, among others. Thus, optimizing postoperative pain control using opioid-sparing techniques is critically important. This paper aims to analyze efficacy and safety of combined intravenous (IV), dexmedetomidine, and IV acetaminophen during PP.

Methods:
Review of a cohort of patients who underwent PP from April 2009 to July 2018 at a large free-standing children's hospital was performed, comparing patients who received combined IV dexmedetomidine and acetaminophen with those who did not receive either of the 2 medications. Efficacy was measured through opioid and nonopioid analgesic dose and timing, pain scores, duration to oral intake, and length of stay. Safety was measured by 30-day complication rates including readmission for bleeding and need for supplementary oxygen.

Results:
Total postoperative acetaminophen (P = 0.01) and recovery room fentanyl (P < 0.001) requirements were significantly lower in the study group compared with the control group. Length of stay, oral intake duration, pain scores, total postoperative opioid requirements, and complications rates trended favorably in the study group, though differences did not reach statistical significance.

Conclusions:
Intraoperative IV dexmedetomidine and acetaminophen during PP provides safe and effective perioperative pain control, resulting in statistically significant decreased need for postoperative acetaminophen and fentanyl. Larger studies are necessary to determine if other trends identified in this study may be significant.
Synthetic Biology Tool Development Advances Predictable Gene Expression in the Metabolically Versatile Soil Bacterium Rhodopseudomonas palustris
Authors: Immethun Cheryl , Kathol Mark , Changa Taity , Saha Rajib 
Published: November 2021

AbstractHarnessing the unique biochemical capabilities of non-model microorganisms would expand the array of biomanufacturing substrates, process conditions, and products. There are non-model microorganisms that fix nitrogen and carbon dioxide, derive energy from light, catabolize methane and lignin-derived aromatics, are tolerant to physiochemical stresses and harsh environmental conditions, store lipids in large quantities, and produce hydrogen. Model microorganisms often only break down simple sugars and require low stress conditions, but they have been engineered for the sustainable manufacture of numerous products, such as fragrances, pharmaceuticals, cosmetics, surfactants, and specialty chemicals, often by using tools from synthetic biology. Transferring complex pathways with all of the needed cofactors, energy sources, and cellular conditions from a non-model microorganism to a common chassis has proven to be exceedingly difficult. Utilization of unique biochemical capabilities could also be achieved by engineering the host; although, synthetic biology tools developed for model microbes often do not perform as designed in other microorganisms. The metabolically versatile Rhodopseudomonas palustris CGA009, a purple non-sulfur bacterium, catabolizes aromatic compounds derived from lignin in both aerobic and anaerobic conditions and can use light, inorganic, and organic compounds for its source of energy. R. palustris utilizes three nitrogenase isozymes to fulfill its nitrogen requirements while also generating hydrogen. Furthermore, the bacterium produces two forms of RuBisCo in response to carbon dioxide/bicarbonate availability. While this potential chassis harbors many beneficial traits, stable heterologous gene expression has been problematic due to its intrinsic resistance to many antibiotics and the lack of synthetic biology parts investigated in this microbe. To address these problems, we have characterized gene expression and plasmid maintenance for different selection markers, started a synthetic biology toolbox specifically for the photosynthetic R. palustris, including origins of replication, fluorescent reporters, terminators, and 5’ untranslated regions, and employed the microbe’s endogenous plasmid for exogenous protein production. This work provides essential synthetic biology tools for engineering R. palustris’ many unique biochemical processes and has helped define the principles for expressing heterologous genes in this promising microbe through a methodology that could be applied to other non-model microorganisms.
Prioritising Autoimmunity Risk Variants for Functional Analyses by Fine-Mapping Mutations Under Natural Selection
Authors: Pankratov Vasili , Yunusbaeva Milyausha , Ryakhovsky Sergei , Zarodniuk Maksym ,   Estonian Biobank Research Team, Yunusbayev Bayazit 
Published: November 2021

ABSTRACTPathogens imposed selective pressure on humans and shaped genetic variation in immunity genes. This can also be true for a fraction of causal variants implicated in chronic inflammatory disorders. Hence, locating adaptive mutations among candidate variants for these disorders can be a promising way to prioritize and decipher their functional response to microbial stimuli and contribution to pathogenesis. This idea has been discussed for decades, but challenges in locating adaptive SNPs hindered its application in practice. Our study addresses this issue and shows that a fraction of candidate variants for inflammatory conditions evolved under moderate and weak selection regimes (sweeps), and such variants are mappable. Using a novel powerful local-tree-based methodology, we show that 204 out of 593 risk loci for 21 autoimmune disorders contain at least one candidate SNP with strong evidence of selection. More importantly, in 28% of cases, these candidates for causal variants colocalize with SNPs under natural selection that we fine-mapped in this study. Causal SNPs under selection represent promising targets for functional experiments. Such experiments will help decipher molecular events triggered by infectious agents, a likely early event in autoimmunity. Finally, we show that a large fraction (60%) of candidate variants are either hitchhikers or linked with the selected mutation. Our findings, thus, support both hitchhiking and natural selection models, with the latter having important practical implications in medicine.
Surprise: a unified theory and experimental predictions
Authors: Modirshanechi Alireza , Brea Johanni , Gerstner Wulfram 
Published: November 2021

AbstractSurprising events trigger measurable brain activity and influence human behavior by affecting learning, memory, and decision-making. Currently there is, however, no consensus on the definition of surprise. Here we identify 16 mathematical definitions of surprise in a unifying framework, show how these definitions relate to each other, and prove under what conditions they are indistinguishable. We classify these surprise measures into four main categories: (i) change-point detection surprise, (ii) information gain surprise, (iii) prediction surprise, and (iv) confidence-correction surprise. We design experimental paradigms where different categories make different predictions: we show that surprise-modulation of the speed of learning leads to sensible adaptive behavior only for change-point detection surprise whereas surprise-seeking leads to sensible exploration strategies only for information gain surprise. However, since neither change-point detection surprise nor information gain surprise perfectly reflect the definition of ‘surprise’ in natural language, a combination of prediction surprise and confidence-correction surprise is needed to capture intuitive aspects of surprise perception. We formalize this combination in a new definition of surprise with testable experimental predictions. We conclude that there cannot be a single surprise measure with all functions and properties previously attributed to surprise. Consequently, we postulate that multiple neural mechanisms exist to detect and signal different aspects of surprise.Author noteAM is grateful to Vasiliki Liakoni, Martin Barry, and Valentin Schmutz for many useful discussions in the course of the last few years, and to Andrew Barto for insightful discussions through and after EPFL Neuro Symposium 2021 on “Surprise, Curiosity and Reward: from Neuroscience to AI”. We thank K. Robbins and collaborators for their publicly available experimental data (Robbins et al., 2018). All code needed to reproduce the results reported here will be made publicly available after publication acceptance. This research was supported by Swiss National Science Foundation (no. 200020_184615). Correspondence concerning this article should be addressed to Alireza Modirshanechi, School of Computer and Communication Sciences and School of Life Sciences, EPFL, Lausanne, Switzerland. E-mail: alireza.modirshanechi@epfl.ch.
Base-resolution prediction of transcription factor binding signals by a deep learning framework
Authors: Zhang Qinhu , He Ying , Wang Siguo , Chen Zhanheng , Guo Zhenhao , Cui Zhen , Huang De-Shuang 
Published: November 2021

AbstractTranscription factors (TFs) play an important role in regulating gene expression, thus the identification of the sites bound by them has become a fundamental step for molecular and cellular biology. In this paper, we developed a deep learning framework leveraging existing fully convolutional neural networks (FCN) to predict TF-DNA binding signals at the base-resolution level, called FCNsignal. The proposed FCNsignal can simultaneously achieve the following tasks: (i) modeling the base-resolution signals of binding regions; (ii) discriminating binding or non-binding regions; (iii) locating TF-DNA binding regions; (iv) predicting binding motifs. The experimental results on 53 TF ChIP-seq datasets and 6 chromatin accessibility ATAC-seq datasets show that our proposed framework outperforms some existing state-of-the-art methods. In addition, we explored to use the trained FCNsignal to locate all potential TF-DNA binding regions on a whole chromosome and predict DNA sequences of arbitrary length, and the results show that our framework can find most of the known binding regions and accept sequences of arbitrary length. Furthermore, we demonstrated the potential ability of our framework in discovering causal disease-associated single-nucleotide polymorphisms (SNPs) through a series of experiments.Author summaryIdentification of transcription factor binding sites (TFBSs) is fundamental to study gene regulatory networks in biological systems, as TFs activate or suppress the transcription of genes by binding to specific TFBSs. With the development of high-throughput sequencing technologies and deep learning (DL), several DL-based approaches have been developed for systematically studying TFBSs, achieving impressive performance. Nevertheless, these methods either excessively focus on discriminating binding or non-binding sequences or individually accomplish multiple TFBSs-associated tasks. In this work, we provide an integrated framework, which utilizes the FCN architecture to predict TF-DNA binding signals at the base-resolution level, to simultaneously study multiple TFBSs-associated tasks. More importantly, we also demonstrate that our proposed framework has the ability to locate all potential TF-DNA binding regions from DNA sequences of arbitrary length. We hope that our framework can provide a new perspective on studying the mechanism of TF-DNA binding and its related tasks.