Validation of a Major and Clinically Relevant Nonmajor Bleeding Phenotyping Algorithm on Electronic Health Records.

PURPOSE: Bleeding is an important health outcome of interest in epidemiological studies. We aimed to develop and validate rule-based algorithms to identify (1) major bleeding and (2) all clinically relevant bleeding (CRB) (composite of major and all clinically relevant nonmajor bleeding) within real-world electronic healthcare data. METHODS: We took a random sample (n = 1630) of inpatient admissions to Singapore public healthcare institutions in 2019 and 2020, stratifying by hospital and year. We included patients of all age groups, sex, and ethnicities. Presence of major bleeding and CRB were ascertained by two annotators through chart review. A total of 630 and 1000 records were used for algorithm development and validation, respectively. We formulated two algorithms: sensitivity- and positive predictive value (PPV)-optimized algorithms. A combination of hemoglobin test patterns and diagnosis codes were used in the final algorithms. RESULTS: During validation, diagnosis codes alone yielded low sensitivities for major bleeding (0.16) and CRB (0.24), although specificities and PPV were high (>0.97). For major bleeding, the sensitivity-optimized algorithm had much higher sensitivity and negative predictive values (NPVs) (sensitivity = 0.94, NPV = 1.00), however false positive rates were also relatively high (specificity = 0.90, PPV = 0.34). PPV-optimized algorithm had improved specificity and PPV (specificity = 0.96, PPV = 0.52), with little reduction in sensitivity and NPV (sensitivity = 0.88, NPV = 0.99). For CRB events, our algorithms had lower sensitivities (0.50-0.56). CONCLUSIONS: The use of diagnosis codes alone misses many genuine major bleeding events. We have developed major bleeding algorithms with high sensitivities, which can ascertain events within populations of interest.

A Lifeact-EGFP quail for studying actin dynamics in vivo.

Here, we report the generation of a transgenic Lifeact-EGFP quail line for the investigation of actin organization and dynamics during morphogenesis in vivo. This transgenic avian line allows for the high-resolution visualization of actin structures within the living embryo, from the subcellular filaments that guide cell shape to the supracellular assemblies that coordinate movements across tissues. The unique suitability of avian embryos to live imaging facilitates the investigation of previously intractable processes during embryogenesis. Using high-resolution live imaging approaches, we present the dynamic behaviors and morphologies of cellular protrusions in different tissue contexts. Furthermore, through the integration of live imaging with computational segmentation, we visualize cells undergoing apical constriction and large-scale actin structures such as multicellular rosettes within the neuroepithelium. These findings not only enhance our understanding of tissue morphogenesis but also demonstrate the utility of the Lifeact-EGFP transgenic quail as a new model system for live in vivo investigations of the actin cytoskeleton.

An insight into viscosity and conductivity in the formulation of co-axial electrospun Carica papaya leaf extract.

Objective: This research aimed to investigate the application of the coaxial electrospun method for the production of natural extracts (papaya leaf extract) fibre films. This was achieved through utilising different polymers and with a focus on the conductivity and the viscosity of polymer solutions as critical parameters to generate successful fibres.Significance: Electrospinning is a promising trending manufacturing method for incorporating thermolabile herbal extracts using coaxial electrospun features. However, the complexity of the electrospinning process and the feasibility of the product required precise scrutiny.Methods: The electrospinning solution parameters (conductivity and viscosity) were evaluated by employing various ratios of Eudragit L100 (EL100) and Eudragit L100-55 (EL100-55) pre-spinning polymeric blend solutions. The electrospinning process and ambient parameters were optimised. Following that, the in-silico physicochemical properties of phytochemical marker, rutin, were illustrated using SwissADME web tool. Both freeze-dried Carica papaya leaf extract and its produced films were characterised using Scanning Electron Microscopy (SEM), Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR), polarised light microscopy, and X-ray Powder Diffraction (XRPD).Results: The optimal values of conductivity (≈40-44 × 10-4 S/m) and viscosity (≈32-42 × 10-3 Pa·s) were determined for producing evenly distributed and small fibre diameters in SEM images. These parameters significance was highlighted in acquiring and maintaining adequate tangential stress for fibre elongation, which would consequently affect the morphology and diameter of the fibres formed.Conclusion: In conclusion, the solution, process, and ambient parameters are significant in developing natural extracts into films via electrospinning technology, and this includes the promising Carica papaya leaf extract films produced by coaxial electrospinning.

Wnt dose escalation during the exit from pluripotency identifies tranilast as a regulator of cardiac mesoderm.

Wnt signaling is a critical determinant of cell lineage development. This study used Wnt dose-dependent induction programs to gain insights into molecular regulation of stem cell differentiation. We performed single-cell RNA sequencing of hiPSCs responding to a dose escalation protocol with Wnt agonist CHIR-99021 during the exit from pluripotency to identify cell types and genetic activity driven by Wnt stimulation. Results of activated gene sets and cell types were used to build a multiple regression model that predicts the efficiency of cardiomyocyte differentiation. Cross-referencing Wnt-associated gene expression profiles to the Connectivity Map database, we identified the small-molecule drug, tranilast. We found that tranilast synergistically activates Wnt signaling to promote cardiac lineage differentiation, which we validate by in vitro analysis of hiPSC differentiation and in vivo analysis of developing quail embryos. Our study provides an integrated workflow that links experimental datasets, prediction models, and small-molecule databases to identify drug-like compounds that control cell differentiation.

Quantitative muscle ultrasound as a disease biomarker in hereditary transthyretin amyloidosis with polyneuropathy.

INTRODUCTION: There is an increasing need for a reproducible and sensitive outcome measure in patients with hereditary transthyretin amyloidosis (ATTRv) with polyneuropathy (PN) due to the emergence of disease modifying therapies. In the current study, we aimed to investigate the role of quantitative muscle ultrasound (QMUS) as a disease biomarker in ATTRv-PN. METHODS: Twenty genetically confirmed ATTRv amyloidosis patients (nine symptomatic, 11 pre-symptomatic) were enrolled prospectively between January to March 2023. Muscle ultrasound was performed on six muscles at standardized locations. QMUS parameters included muscle thickness (MT) and muscle echo intensity (EI). Twenty-five age- and sex-matched healthy controls were recruited for comparison. Significant QMUS parameters were correlated with clinical outcome measures. RESULTS: Muscle volume of first dorsal interosseus (FDI) muscle [measured as cross-sectional area (CSA)] was significantly lower in symptomatic patients compared to healthy controls and pre-symptomatic carriers (98.3 ± 58.0 vs. 184.4 ± 42.5 vs. 198.3 ± 56.8, p < 0.001). EI of biceps and FDI for symptomatic ATTRv-PN patients were significantly higher compared to the other two groups (biceps: 76.4 ± 10.8 vs. 63.2 ± 11.5 vs. 59.2 ± 9.0, p = 0.002; FDI: 48.2 ± 7.5 vs. 38.8 ± 7.5 vs. 33.0 ± 5.3, p < 0.001). CSA of FDI and EI of biceps and FDI correlated with previous validated outcome measures [polyneuropathy disability score, neuropathy impairment score, Karnofsky performance scale, Rasch-built overall disability scale, European quality of life (QoL)-5 dimensions and Norfolk QoL questionnaire-diabetic neuropathy]. CONCLUSION: QMUS revealed significant difference between ATTRv amyloidosis patients and healthy controls and showed strong correlation with clinical outcome measures. QMUS serves as a sensitive and reliable biomarker of disease severity in ATTRv-PN.

Breaking barriers: bilosomes gel potentials to pave the way for transdermal breast cancer treatment with Tamoxifen.

OBJECTIVE: Breast cancer affects women globally, regardless of age or location. On the other hand, Tamoxifen (TXN), a class II biopharmaceutical drug is acting as a prophylactic/treating agent for women at risk of and/or with hormone receptor-positive breast cancer. However, its oral administration has life-threatening side effects, which have led researchers to investigate alternative delivery methods. One such method is transdermal drug delivery utilizing bile salts as penetration enhancers, aka Bilosomes. METHODS: Bilosomes formulations were optimized statistically for the outcome of vesicle shape, size, and entrapment efficiency using two types of bile, i.e. sodium taurocholate and sodium cholate. These bilosomes were then loaded into HPMC base gel and further characterized for their morphology, drug content, pH, viscosity, spreadability and eventually ex-vivo skin penetration and deposition studies. RESULTS: Findings showed that sodium cholate has superiority as a penetration enhancer over sodium taurocholate in terms of morphological characterizes, zeta potential, and cumulative amounts of tamoxifen permeated per unit area (15.13 ± 0.71 µg/cm2 and 6.51 ± 0.6 µg/cm2 respectively). In fact, bilosomes designed with sodium cholate provided around 9 folds of skin deposition compared to TXN non-bilosomal gel. CONCLUSION: Bilosomes gels could be a promising option for locally delivering tamoxifen to the breast through the skin, offering an encouraging transdermal solution.

Machine learning analysis of wing venation patterns accurately identifies Sarcophagidae, Calliphoridae and Muscidae fly species.

In medical, veterinary and forensic entomology, the ease and affordability of image data acquisition have resulted in whole-image analysis becoming an invaluable approach for species identification. Krawtchouk moment invariants are a classical mathematical transformation that can extract local features from an image, thus allowing subtle species-specific biological variations to be accentuated for subsequent analyses. We extracted Krawtchouk moment invariant features from binarised wing images of 759 male fly specimens from the Calliphoridae, Sarcophagidae and Muscidae families (13 species and a species variant). Subsequently, we trained the Generalized, Unbiased, Interaction Detection and Estimation random forests classifier using linear discriminants derived from these features and inferred the species identity of specimens from the test samples. Fivefold cross-validation results show a 98.56 ± 0.38% (standard error) mean identification accuracy at the family level and a 91.04 ± 1.33% mean identification accuracy at the species level. The mean F1-score of 0.89 ± 0.02 reflects good balance of precision and recall properties of the model. The present study consolidates findings from previous small pilot studies of the usefulness of wing venation patterns for inferring species identities. Thus, the stage is set for the development of a mature data analytic ecosystem for routine computer image-based identification of fly species that are of medical, veterinary and forensic importance.

The Study of Forensically Important Insects Recovered from Human Corpses in Taiwan.

A study of entomological specimens recovered from 117 human corpses in 114 forensic cases was conducted in Taiwan between 2011 and 2018. The comparisons and discussions of the entomological data were based on the locations (indoor vs. outdoor), environments (urban vs. suburban), season and decomposition stages of corpses. In the study, both morphology and DNA-based comparison methods were used to facilitate species identification. In total, nine families and twenty-two species were thus identified. The two most abundant fly species recovered from human corpses were Chrysomya megacephala (35.1%, 1735 out of 4949) and Chrysomya rufifacies (21.7%, 1072 out of 4949). As for case frequency, both the two were also the most common fly species (both 40%, 46 out of 114), particularly in outdoor cases (also both 74%, 25 out of 34). We found that Chrysomya pinguis and Lucilia porphyrina appeared in low temperature scenes in this study. Synthesiomyia nudiseta was the most common species detected on indoor (36%, 29 out of 80 cases) and urban (41%, 22 out of 54 cases) corpses. Sarcophagidae were strongly associated with urban environments (35%, 19 out of 54 cases), and Parasarcophaga (Liosarcophaga) dux, Liopygia ruficornis and Boettcherisca peregrina were the most frequent sarcophagid species collected from corpses. Hydrotaea spinigera was often found on corpses immersed in water (60%, three out of five cases) with advanced decay or remains stages. Megaselia scalaris was closely correlated with indoor cases (24%, 19 out of 80). In addition, Piophila megastigmata was collected from a corpse in the remains stage and the data represent the first report in Taiwan.

Using the consolidated framework for implementation research to guide a pilot of implementing an institution level patient informed consent process for clinical research at an outpatient setting.

BACKGROUND: In Singapore, research teams seek informed patient consent on an ad hoc basis for specific clinical studies and there is typically a role separation between operational and research staff. With the enactment of the Human Biomedical Research Act, there is increased emphasis on compliance with consent-taking processes and research documentation. To optimize resource use and facilitate long-term research sustainability at our institution, this study aimed to design and pilot an institution level informed consent workflow (the "intervention") that is integrated with clinic operations. METHODS: We used the Consolidated Framework for Implementation Research (CFIR) as the underpinning theoretical framework and conducted the study in three stages: Stage 1, CFIR constructs were used to systematically identify barriers and facilitators of intervention implementation, and a simple time-and-motion study of the patient journey was used to inform the design of the intervention; Stage 2, implementation strategies were selected and mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy; Stage 3, we piloted and adapted the implementation process at two outpatient clinics and evaluated implementation effectiveness through patient participation rates. RESULTS: We identified 15 relevant CFIR constructs. Implementation strategies selected to address these constructs were targeted at three groups of stakeholders: institution leadership (develop relationships, involve executive boards, identify and prepare champions), clinic management team (develop relationships, identify and prepare champions, obtain support and commitment, educate stakeholders), and clinic operations staff (develop relationships, assess readiness, conduct training, cyclical tests of change, model and simulate change, capture and share local knowledge, obtain and use feedback). Time-and-motion study in clinics identified the pre-consultation timepoint as the most appropriate for the intervention. The implementation process was adapted according to clinic operations staff and service needs. At the conclusion of the pilot, 78.3% of eligible patients provided institution level informed consent via the integrated workflow implemented. CONCLUSIONS: Our findings support the feasibility of implementing an institution level informed consent workflow that integrates with service operations at the outpatient setting to optimize healthcare resources for research. The CFIR provided a useful framework to identify barriers and facilitators in the design of the intervention and its implementation process.

Comparison of Digital Interactive Case-Based Educational Resource with Virtual Role Play in Dental Undergraduates in Clinical Oral Medicine/Oral Pathology Education.

Case-based learning has always been a key element of dental education and the incorporation of technology into the concept became increasingly important during the COVID-19 pandemic. This study aimed to compare the effectiveness of a virtual interactive case resource in oral medicine/oral pathology, Virtual Oral Medicine Clinic (VOMC), with the virtual role play among third-year dental undergraduates. Fifty-one students were randomly assigned into two groups and the control group was subjected to a role play activity, whereas the experimental group was provided with VOMC. Both groups were assessed with an objective structured clinical examination (OSCE) before and after the intervention. Students' self-perceived usefulness of the interventions was evaluated by a questionnaire and randomly selected students were invited for focus group discussions. Data were analysed using the Wilcoxon signed-rank test and the Mann−Whitney U test. Descriptive statistics were used to analyse student responses. Students in both groups demonstrated significant improvement (p < 0.001) in the post-test compared to the pre-test. Students in the experimental group demonstrated higher overall scores (p < 0.001) when compared to the control group. Though both methods were received favourably by the students, role play was more positively perceived when compared to digital resource. Though VOMC was shown to improve student scores, the perception of VOMC was not quantitatively superior to the role play activity. Hence VOMC can be recommended as an adjunct tool to enhance learning in oral medicine in undergraduate dental students.

Combining Machine Learning with a Rule-Based Algorithm to Detect and Identify Related Entities of Documented Adverse Drug Reactions on Hospital Discharge Summaries.

INTRODUCTION: Discharge summaries contain valuable information about adverse drug reactions, but their unstructured nature makes them challenging to analyse and use as a signal source for pharmacovigilance. Machine learning has shown promise in identifying discharge summaries that contain related drug-adverse event pairs but has fared relatively poorer in entity extraction. METHODS: A hybrid model is developed combining rule-based and machine learning algorithms using discharge summaries with the aim of maximising capture of related drug-adverse event pairs. The rule first identifies segments containing adverse event entities within a 100-character distance from a drug term; machine learning subsequently estimates the relatedness of the drug and adverse event entities contained. The approach is validated on four independent datasets that are temporally and geographically separated from model development data. The impact of restricted drug-adverse event pair detection on recall is evaluated by using two of the four validation datasets that do not impose rule-based restrictions to annotations. RESULTS: The hybrid model achieves a recall of 0.80 (fivefold cross validation), 0.80 (temporal) and 0.76 (geographical) on validation using datasets containing only pre-identified target text segments that fulfil the rule-based algorithm criteria. When tested on datasets that additionally contained drug-adverse event pairs not restricted by the rule-based criteria, recall of the model declines to 0.68 and 0.62 on temporally and geographically separated datasets, respectively. CONCLUSIONS: The proposed hybrid model demonstrates reasonable generalisability on external validation. Rule-based restriction of the detection space results in an approximately 12-14% reduction in recall but improves identification of the related drug and adverse event terms.

Conjugated Polymers for Microwave Applications: Untethered Sensing Platforms and Multifunctional Devices.

In the past two decades, organic electronic materials have enabled and accelerated a large and diverse set of technologies, from energy-harvesting devices and electromechanical actuators, to flexible and printed (opto)electronic circuitry. Among organic (semi)conductors, organic mixed ion-electronic conductors (OMIECs) are now at the center of renewed interest in organic electronics, as they are key drivers of recent developments in the fields of bioelectronics, energy storage, and neuromorphic computing. However, due to the relatively slow switching dynamics of organic electronics, their application in microwave technology, until recently, has been overlooked. Nonetheless, other unique properties of OMIECs, such as their substantial electrochemical tunability, charge-modulation range, and processability, make this field of use ripe with opportunities. In this work, the use of a series of solution-processed intrinsic OMIECs is demonstrated to actively tune the properties of metamaterial-inspired microwave devices, including an untethered bioelectrochemical sensing platform that requires no external power, and a tunable resonating structure with independent amplitude- and frequency-modulation. These devices showcase the considerable potential of OMIEC-based metadevices in autonomous bioelectronics and reconfigurable microwave optics.

Tuning Organic Electrochemical Transistor Threshold Voltage using Chemically Doped Polymer Gates.

Organic electrochemical transistors (OECTs) have shown promise as transducers and amplifiers of minute electronic potentials due to their large transconductances. Tuning the OECT threshold voltage is important to achieve low-powered devices with amplification properties within the desired operational voltage range. However, traditional design approaches have struggled to decouple channel and materials properties from threshold voltage, thereby compromising on several other OECT performance metrics, such as electrochemical stability, transconductance, and dynamic range. In this work, simple solution-processing methods are utilized to chemically dope polymer gate electrodes, thereby controlling their work function, which in turn tunes the operation voltage range of the OECTs without perturbing their channel properties. Chemical doping of initially air-sensitive polymer electrodes further improves their electrochemical stability in ambient conditions. Thus, OECTs that are simultaneously low-powered and electrochemically resistant to oxidative side reactions under ambient conditions are demonstrated. This approach shows that threshold voltage, which is once interwoven with other OECT properties, can in fact be an independent design parameter, expanding the design space of OECTs.

Mixed Ionic-Electronic Conduction, a Multifunctional Property in Organic Conductors.

Organic mixed ionic-electronic conductors (OMIECs) have gained recent interest and rapid development due to their versatility in diverse applications ranging from sensing, actuation and computation to energy harvesting/storage, and information transfer. Their multifunctional properties arise from their ability to simultaneously participate in redox reactions as well as modulation of ionic and electronic charge density throughout the bulk of the material. Most importantly, the ability to access charge states with deep modulation through a large extent of its density of states and physical volume of the material enables OMIEC-based devices to display exciting new characteristics and opens up new degrees of freedom in device design. Leveraging the infinite possibilities of the organic synthetic toolbox, this perspective highlights several chemical and structural design approaches to modify OMIECs' properties important in device applications such as electronic and ionic conductivity, color, modulus, etc. Additionally, the ability for OMIECs to respond to external stimuli and transduce signals to myriad types of outputs has accelerated their development in smart systems. This perspective further illustrates how various stimuli such as electrical, chemical, and optical inputs fundamentally change OMIECs' properties dynamically and how these changes can be utilized in device applications.

Synthesis of Capsaicin Loaded Silver Nanoparticles Using Green Approach and Its Anti-Bacterial Activity Against Human Pathogens.

Nanotechnology is drawing attention nowadays due to its ability to regulate metals into nanosize, ultimately changing metal's physical, chemical, and optical properties. Silver nanoparticles are known for their potential impact as antimicrobial agents due to their inherent property penetrating the cell wall. The present study aimed to develop and statistically optimise using a novel combination of capsaicin loaded silver nanoparticles (AgCNPs) as an effective anti-bacterial agent to treat psoriasis using a green approach. Ascorbic acid was used as a reducing agent to fabricate silver nanoparticles. The formulation parameters optimisation was conducted using Box-Behnken Design (3×3 factorial design). The loading of capsaicin was confirmed by attenuated total reflectance-fourier transform infrared spectroscopy. Energy-dispersive X-ray spectroscopy-scanning electron microscopy (EDX-SEM) confirmed the existence of silver; net-like structure revealed in SEM and high-resolution transmission electron microscopy further confirmed the nano size of the formulation. Differential scanning calorimetry and X-ray diffraction demonstrated the capsaicin transformed into amorphous after encapsulated. An in-vitro microbial study showed that the 0.10 M formulation of AgCNPs exerted potent anti-bacterial activity, which can be considered an alternative anti-bacterial agent. It also displayed that the zone of inhibition was significantly high in gram-negative bacteria (E. coli) than gram-positive bacteria (S. aureus). Green synthesised AgCNPs showed highly significant anti-bacterial activity, which indicates that this formulation can be very promising for treating psoriasis.

A Barium Titanate-on-Oxide Insulator Optoelectronics Platform.

Electro-optic modulators are among the most important building blocks in optical communication networks. Lithium niobate, for example, has traditionally been widely used to fabricate high-speed optical modulators due to its large Pockels effect. Another material, barium titanate, nominally has a 50 times stronger r-parameter and would ordinarily be a more attractive material choice for such modulators or other applications. In practice, barium titanate thin films for optical waveguide devices are usually grown on magnesium oxide due to its low refractive index, allowing vertical mode confinement. However, the crystal quality is normally degraded. Here, a group of scandate-based substrates with small lattice mismatch and low refractive index compared to that of barium titanate is identified, thus concurrently satisfying high crystal quality and vertical optical mode confinement. This work provides a platform for nonlinear on-chip optoelectronics and can be promising for waveguide-based optical devices such as Mach-Zehnder modulators, wavelength division multiplexing, and quantum optics-on-chip.

Singapore Basic Cardiac Life Support and Automated External Defibrillation Guidelines 2021.

Basic Cardiac Life Support and Automated External Defibrillation (BCLS+AED) refers to the skills required in resuscitating cardiac arrest casualties. On recognising cardiac arrest, the rescuer should call for '995' for Emergency Ambulance and immediately initiate chest compressions. Good-quality chest compressions are performed with arms extended, elbows locked, shoulders directly perpendicular over the casualty's chest, and the heel of the palm placed on the lower half of the sternum. The rescuer compresses hard and fast at 4-6 cm depth for adults at a compression rate of 100-120 per minute, with complete chest recoil after each compression. Two quick ventilations of 400-600 mL each can be delivered via a bag-valve-mask after every 30 chest compressions. Alternatively, a trained, able and willing rescuer can provide mouth-to-mouth ventilation. Cardiopulmonary resuscitation should be stopped only when the casualty wakes up, the emergency team takes over care, or when an automated external defibrillator prompts for heart rhythm analysis or delivery of a shock.

A variant e13a3 BCR-ABL1 fusion transcript in refractory adult B-cell acute lymphoblastic leukemia achieving complete remission with CAR-Tcell therapy.

Acute lymphoblastic leukemia (ALL) cases with e13a3 fusion transcripts are extremely rare. We report a 24-year-old male with Ph-positive (Ph+) ALL with an aberrant e13a3 fusion transcript treated with CD19-specific chimeric antigen receptor T-cell (CAR-T) therapy. He developed refractory disease post-chemotherapy induction, andreceived allogeneic hematopoietic stem cell transplantation (allo-HSCT) after salvage with imatinib in combination with chemotherapy regimen. Unfortunately, the patient relapsed after +90 days post-transplant. He was consented to CAR-T therapy trial and achieved complete remission, highlighting the efficacy of CAR-T treatment in relapsed-refractory B-ALL irrespective of the underlying genetic drivers in leukemia cells .

Deep conservation of the enhancer regulatory code in animals.

Interactions of transcription factors (TFs) with DNA regulatory sequences, known as enhancers, specify cell identity during animal development. Unlike TFs, the origin and evolution of enhancers has been difficult to trace. We drove zebrafish and mouse developmental transcription using enhancers from an evolutionarily distant marine sponge. Some of these sponge enhancers are located in highly conserved microsyntenic regions, including an Islet enhancer in the Islet-Scaper region. We found that Islet enhancers in humans and mice share a suite of TF binding motifs with sponges, and that they drive gene expression patterns similar to those of sponge and endogenous Islet enhancers in zebrafish. Our results suggest the existence of an ancient and conserved, yet flexible, genomic regulatory syntax that has been repeatedly co-opted into cell type-specific gene regulatory networks across the animal kingdom.