Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Comparing the emotional and cognitive components of initial trust formation in air traffic controller-autonomy teams

The use of intelligent decision aids in Air Traffic Management is recommended to manage the exponential rise in global air traffic. Consequently, trust, which is one of the main drivers of how Air Traffic Controllers use such decision aids, has become an important area of research. It has been suggested that there is a strong emotional influence in the formation of Human-Human Trust, and it is unclear if this paradigm is valid for Human-Autonomy Trust. The extent of the cognitive and emotional components in the initial trust relationship between Air Traffic Controllers and a simulated conflict detection autonomous decision aid was examined with the use of functional Magnetic Resonance Imaging. The results confirmed that the emotional component showed higher activation than the cognitive component for the initial formation of trust between Air Traffic Controllers and autonomous decision aids.Civil Aviation Authority of Singapore (CAAS)Nanyang Technological UniversityNational Research Foundation (NRF)Submitted/Accepted versionThis research is supported by the National Research Foundation, Singapore, and the Civil Aviation Authority of Singapore, under the Aviation Transformation Programme, with Research Grant 04SBS000704C160. IRB approval for this study was granted by the Nanyang Technological University Institutional Review Board (IRB) (NTU IRBIRB-2018-12-002)

Molecular Imaging Investigations of Polymer-Coated Cerium Oxide Nanoparticles as a Radioprotective Therapeutic Candidate

Cerium oxide nanoparticles (CONPs) have a unique surface redox chemistry that appears to selectively protect normal tissues from radiation induced damage. Our prior research exploring the biocompatibility of polymer-coated CONPs found further study of poly-acrylic acid (PAA)-coated CONPs was warranted due to improved systemic biodistribution and rapid renal clearance. This work further explores PAA-CONPs’ radioprotective efficacy and mechanism of action related to tumor microenvironment pH. An ex vivo TUNEL assay was used to measure PAA-CONPs’ protection of the irradiated mouse colon in comparison to the established radioprotector amifostine. [18F]FDG PET imaging of spontaneous colon tumors was utilized to determine the effects of PAA-CONPs on tumor radiation response. In vivo MRI and an ex vivo clonogenic assay were used to determine pH effects on PAA-CONPs’ radioprotection in irradiated tumor-bearing mice. PAA-CONPs showed excellent radioprotective efficacy in the normal colon that was equivalent to uncoated CONPs and amifostine. [18F]FDG PET imaging showed PAA-CONPs do not affect tumor response to radiation. Normalization of tumor pH allowed some radioprotection of tumors by PAA-CONPs, which may explain their lack of tumor radioprotection in the acidic tumor microenvironment. Overall, PAA-CONPs meet the criteria for clinical application as a radioprotective therapeutic agent and are an excellent candidate for further study

Tuning sub-10 nm single-phase NaMnF3 nanocrystals as ultrasensitive hosts for pure intense fluorescence and excellent T1 magnetic resonance imaging

We report ultrasensitive sub-10 nm NaMnF3 nanocrystals codoped with Yb3+, Er3+/Tm3+ ions, and their intense pure red and near-infrared upconversion emissions in the presence of Mn2+. The nanocrystals showed excellent T1 contrast in 7 T MRI, implying their potential as single-phase contrast agents for fluorescent deep tissue and MR imaging

Single-phase NaDyF4:Tb3+ nanocrystals as multifunctional contrast agents in high-field magnetic resonance and optical imaging

The current work reports single-phase, terbium-doped sodium dysprosium fluoride (NaDyF4:Tb3+) nanocrystals with green luminescence and good T2 contrast in 7.0-T MRI phantom and animal imaging. The current nanocrystals demonstrate good potential as a dual modal contrast agent for high-field magnetic resonance (MR) and fluorescence imaging

Stejskal-tanner equation derived in full

The pulsed field gradient spin-echo nuclear magnetic resonance method is used to measure the translational diffusion of solvents and solutes in homogeneous and heterogeneous systems. It is widely used in the characterization of molecules and materials in general, via phenomena such as 'diffusion interference'. It is also the basis of tissue discrimination in magnetic resonance imaging, via diffusion tensor imaging. The mathematical equation used to analyze data from a simple noninteracting solute (using a pair of magnetic field gradient pulses that are applied in the experiment) was first derived by Stejskal and Tanner. However, in the article and in subsequent presentations the basic derivation, which we call the the "theoretical physics" of the theory, is not presented in extenso. Conversely, many papers in which the exploration of the effects of magnetic field gradient pulses of shapes other than simple rectangles generally begin with the time-dependent integral that emerges from the original theoretical physics. To fill this "pedagogical gap" we use here a rigorous step-by-step approach to the theoretical physics of the Stejskal-Tanner equation and indicate how it was based on earlier theories. We also take the opportunity to indicate a contemporary approach to deriving new relationships between user-defined magnetic field gradient pulse shapes and the diffusion coefficient; and we show how these can be rapidly and accurately derived using symbolic computation

A quantum-inspired model for human-automation trust in air traffic control derived from functional magnetic resonance imaging

With a greater proliferation of automation tools in the domain of Air Traffic Management due to exponential growth in air traffic, human factors, and more specifically, trust, becomes a crucial component of Air Traffic Controller (ATCO)-automation teams. An attempt to better represent trust behaviours in ATCOs was made by juxtaposing two philosophies of trust using the principles of superposition and complementarity from quantum mechanics. Neuroimaging evidence of this simultaneous concurrence was demonstrated with use of functional Magnetic Resonance Imaging (fMRI) data. The robustness in this proposed model is higher due to the use of objective data to explain ATCO trusting behaviour under uncertainty. This is an improvement on current models that are context-dependent and based on subjective data.Civil Aviation Authority of Singapore (CAAS)Published versionThis work is partially supported by NTU-CAAS Research Grant M4062429.052 by Air Traffic Management Research Institute, School of MAE, NTU, Singapore. Ethics approval for this research was granted by the Nanyang Technological University (NTU) institutional review board (IRB) (NTU IRBIRB-2018-12-002). A participant information sheet was provided and signed consent form was collected. At no point were participants asked to reveal names or other identifiable information, and only anonymised data was collected

Stronger brain activation for own baby but similar activation toward babies of own and different ethnicities in parents living in a multicultural environment

Specific facial features in infants automatically elicit attention, affection, and nurturing behaviour of adults, known as the baby schema effect. There is also an innate tendency to categorize people into in-group and out-group members based on salient features such as ethnicity. Societies are becoming increasingly multi-cultural and multi-ethnic, and there are limited investigations into the underlying neural mechanism of the baby schema effect in a multi-ethnic context. Functional magnetic resonance imaging (fMRI) was used to examine parents' (N = 27) neural responses to (a) non-own ethnic in-group and out-group infants, (b) non-own in-group and own infants, and (c) non-own out-group and own infants. Parents showed similar brain activations, regardless of ethnicity and kinship, in regions associated with attention, reward processing, empathy, memory, goal-directed action planning, and social cognition. The same regions were activated to a higher degree when viewing the parents' own infant. These findings contribute further understanding to the dynamics of baby schema effect in an increasingly interconnected social world.Ministry of Education (MOE)Published versionThis research was supported by grants from the Ministry of Education, Singapore, under its Academic Research Fund Tier 1 (10/19)

“Smart” theranostic lanthanide nanoprobes with simultaneous up-conversion fluorescence and tunable T1–T2 magnetic resonance imaging contrast and near-infrared activated photodynamic therapy

The current work reports a type of “smart” lanthanide-based theranostic nanoprobe, NaDyF4:Yb3+/NaGdF4:Yb3+,Er3+, which is able to circumvent the up-converting poisoning effect of Dy3+ ions to give efficient near infrared (980 nm) triggered up-conversion fluorescence, and offers not only excellent dark T2-weighted MR contrast but also tunable bright and T1-weighted MR contrast properties. Due to the efficient up-converted energy transfer from the nanocrystals to chlorin e6 (Ce6) photosensitizers loaded onto the nanocrystals, cytotoxic singlet oxygen was generated and photodynamic therapy was demonstrated. Therefore, the current multifunctional nanocrystals could be potentially useful in various image-guided diagnoses where bright or dark MRI contrast could be selectively tuned to optimize image quality, but also as an efficient and more penetrative near-infrared activated photodynamic therapy agent.Published versio

A Brief Introduction to Magnetoencephalography (MEG) and Its Clinical Applications

Funding Information: Acknowledgments: S.W.K.J, V.V., P.P. and B.G. acknowledge the support from Lee Kong Chian School of Medicine and Data Science and AI Research (DSAIR) Centre of NTU (Project Number ADH‐11/2017‐DSAIR and the support from the Cognitive Neuroimaging Centre (CONIC) at Nan‐ yang Technological University, Singapore. Publisher Copyright: © 2022 by the author. Licensee MDPI, Basel, Switzerland.Magnetoencephalography (MEG) plays a pivotal role in the diagnosis of brain disorders. In this review, we have investigated potential MEG applications for analysing brain disorders. The signal‐to‐noise ratio (SNRMEG =2.2 db, SNREEG <1 db) and spatial resolution (SRMEG =2–3 mm, SREEG =7–10 mm) is higher for MEG than EEG, thus MEG potentially facilitates accurate monitoring of cortical activity. We found that the direct electrophysiological MEG signals reflected the physiological status of neurological disorders and play a vital role in disease diagnosis. Single‐channel con-nectivity, as well as brain network analysis, using MEG data acquired during resting state and a given task has been used for the diagnosis of neurological disorders such as epilepsy, Alzheimer’s, Parkinsonism, autism, and schizophrenia. The workflow of MEG and its potential applications in the diagnosis of disease and therapeutic planning are also discussed. We forecast that computer-aided algorithms will play a prominent role in the diagnosis and prediction of neurological diseases in the future. The outcome of this narrative review will aid researchers to utilise MEG in diagnostics.Peer reviewe