bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial
Authors: Morreel Stefan , Philips Hilde , De Graeve Diana , Monsieurs Koenraad G. , Kampen Jarl K. , Meysman Jasmine , Lefevre Eva , Verhoeven Veronique 
Published: November 2021

Objectives
To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC).

Methods
Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard).

Results
In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised.

Conclusions
ED nurses using a new tool safely diverted 9.5% of the included patients to primary care.

Trial registration
ClinicalTrials.gov Identifier: NCT03793972
Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study
Authors: Mandai Shintaro , Ando Fumiaki , Mori Takayasu , Susa Koichiro , Iimori Soichiro , Naito Shotaro , Sohara Eisei , Uchida Shinichi , Fushimi Kiyohide , Rai Tatemitsu 
Published: November 2021

Background
Physicians have long noted a substantial discrepancy between the reasons for hospital admission and ultimate causes of death, particularly among older adults or patients with complex underlying diseases. However, objective data on this phenomenon are lacking. We aimed to examine the risk of in-hospital death caused by a reason other than the original reason for hospitalization and its association with underlying kidney disease in a nationwide inpatient database.

Methods
In this retrospective cohort study, we studied 639,556 Japanese adults who died in the hospital from 2012 to 2015, using data from Japan’s Diagnosis Procedure Combination database. We analyzed the discrepancy rate between reasons for hospital admission and death and associated factors using the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes and seven related categories.

Results
Among non-chronic kidney disease (CKD) (590,551), CKD (24,708), and end-stage kidney disease (ESKD) (24,297) patients, the median age was 77 years (interquartile range [IQR]: 67–84 years), 83 years (IQR: 75–88), and 75 years (IQR: 67–81), and 25.7%, 30.3%, and 41.6% died from a reason other than the original reason for hospitalization, respectively. Multivariate logistic regression analyses determined CKD/ESKD as the predominant risk factor for this discrepancy, rather than older age, male sex, obesity, and other comorbidities. Sankey diagrams that presented diagnostic changes from hospital admission to death revealed multiple wider segments connecting to different disease classifications, particularly to congestive and septic death in CKD and ESKD patients, respectively. Death owing to another disease classification led to an increase in the median length of hospital stay by 5–7 days and to a 1.3-–1.4-fold increase in medical costs across the populations.

Conclusions
A substantial proportion of patients with CKD and ESKD died during hospitalization for a reason other than their original reason for admission, leading to increased length of hospital stay and cost.
Trends in the quality and cost of inpatient surgical procedures in the United States, 2002–2015
Authors: Ning Ning , Haynes Alex , Romley John 
Published: November 2021

Objectives
This study documents trends in risk-adjusted quality and cost for a variety of inpatient surgical procedures among Medicare beneficiaries from 2002 through 2015, which can provide valuable insight on future strategies to improve public health and health care.

Methods
We focused on 11 classes of inpatient surgery, defined by the Agency for Health Research and Quality’s (AHRQ’s) Clinical Classification System. The surgical classes studied included a wide range of surgeries, including tracheostomy, heart valve procedures, colorectal resection, and wound debridement, among others. For each surgical class, we assessed trends in treatment costs and quality outcomes, as defined by 30-day survival without unplanned readmissions, among Medicare beneficiaries receiving these procedures during hospital stays. Quality and costs were adjusted for patient severity based on demographics, comorbidities, and community context. We also explored surgical innovations of these 11 classes of inpatient surgery from 2002–2015.

Results
We found significant improvements in quality for 7 surgical classes, ranging from 0.08% (percutaneous transluminal coronary angioplasty) to 0.74% (heart valve procedures) per year. Changes in cost varied by surgery, the significant decrease in cost ranged from -2.59% (tracheostomy) to -0.34% (colorectal resection) per year. Treatment innovation occurred with respect to surgical procedures utilized for heart valve procedures and colorectal resection, which may be associated with the decrease in surgical cost.

Conclusions
Our results suggest that there was significant quality improvement for 7 surgery categories over the 14-year study period. Costs decreased significantly for 6 surgery categories, and increased significantly for 3 other categories.
Estimating the infant mortality rate from DHS birth histories in the presence of age heaping
Authors: Romero Prieto Julio , Verhulst Andrea , Guillot Michel 
Published: November 2021

Background
The infant mortality rate (IMR) is a critical indicator of population health, but its measurement is subject to response bias in countries without complete vital registration systems who rely instead on birth histories collected via sample surveys. One of the most salient bias is the fact that child deaths in these birth histories tend to be reported with a large amount of heaping at age 12 months. Because of this issue, analysts and international agencies do not directly use IMR estimates based on surveys such as Demographic and Health Surveys (DHS); they rely instead on mortality models such as model life tables. The use of model life tables in this context, however, is arbitrary, and the extent to which this approach appropriately addresses bias in DHS-based IMR estimates remains unclear. This hinders our ability to monitor IMR levels and trends in low-and middle-income countries. The objective of this study is to evaluate age heaping bias in DHS-based IMR estimates and propose an improved method for adjusting this bias.

Methods and findings
Our method relies on a recently-developed log-quadratic model that can predict age-specific mortality by detailed age between 0 and 5. The model’s coefficients were derived from a newly constituted database, the Under-5 Mortality Database (U5MD), that represents the mortality experience of countries with high-quality vital registration data. We applied this model to 204 DHS surveys, and compared unadjusted IMR values to IMR values adjusted with the log-quadratic model as well as with the classic model life table approach. Results show that contrary to existing knowledge, age heaping at age 12 months rarely generates a large amount of bias in IMR estimates. In most cases, the unadjusted IMR values were not deviating by more than +/- 5% from the adjusted values. The model life table approach, by contrast, introduced an unwarranted, downward bias in adjusted IMR values. We also found that two regions, Sub-Saharan Africa and South Asia, present age patterns of under-5 mortality that strongly depart from the experience represented in the U5MD. For these countries, neither the existing model life tables nor the log-quadratic model can produce empirically-supported IMR adjustments.

Conclusions
Age heaping at age 12 months produces a smaller amount of bias in DHS-based IMR estimates than previously thought. If a large amount of age heaping is present in a survey, the log-quadratic model allows users to evaluate, and whenever necessary, adjust IMR estimates in a way that is more informed by the local mortality pattern than existing approaches. Future research should be devoted to understanding why Sub-Saharan African and South Asian countries have such distinct age patterns of under-five mortality.
Immunization with desmoglein 3 induces non-pathogenic autoantibodies in mice
Authors: Boch Katharina , Dräger Sören , Zillikens Detlef , Hudemann Christoph , Hammers Christoph M. , Patzelt Sabrina , Schmidt Enno , Langan Ewan A. , Eming Rüdiger , Ludwig Ralf J. , Bieber Katja 
Published: November 2021

Background
Pemphigus vulgaris (PV) is a rare autoimmune blistering disease characterized by the development of autoantibodies targeting desmoglein (Dsg) 3, but also against Dsg1 in mucocutaneous disease. Given that existing PV animal models only recapitulate aspects of the disease, we aimed to establish a more comprehensive disease model based on the immunization of mice with PV autoantigen(s).

Methods
The following immunization strategies were tested: (i) C57Bl/6J, B6.SJL-H2s C3c/1CyJ, DBA2/J, or SJL/J mice were immunized with recombinant murine Dsg3 (mDsg3), (ii) DBA2/J and SJL/J mice were immunized with mDsg3 and additionally injected a single non-blister inducing dose of exfoliative toxin A (ETA), and (iii) DBA2/J and SJL/J mice were immunized with human Dsg (hDsg) 1 and 3.

Results
Despite the induction of autoantibodies in each immunization protocol, the mice did not develop a clinical phenotype. Tissue-bound autoantibodies were not detected in the skin or mucosa. Circulating autoantibodies did not bind to the native antigen in indirect immunofluorescence microscopy using monkey esophagus as a substrate.

Conclusion
Immunization with PV autoantigens induced non-pathogenic Dsg1/3 antibodies, but did not cause skin/mucous membrane disease in mice. These findings, confirmed by failure of binding of the induced autoantibodies to their target in the skin, suggest that the autoantibodies which were formed were unable to bind to the conformational epitope present in vivo.
Health Economic Impact of a Multicenter Quality-of-Care Initiative for Reducing Unplanned Healthcare Utilization Among Patients With Inflammatory Bowel Disease
Authors: Almario Christopher V. , Kogan Lawrence , van Deen Welmoed K. , Scott Frank I. , Singh Siddharth , Hou Jason K. , Lum Donald , Aguilar Humberto , Betteridge John , Flynn Ann , Gerich Mark , Kaufman Lia , Mattar Mark C. , Mize Carrie , Ostrov Arthur , Shah Samir A. , Younes Ziad , Weaver S. Alandra , Heller Caren , Siegel Corey A. , Melmed Gil Y. 
Published: November 2021

INTRODUCTION:
A multicenter adult inflammatory bowel disease learning health system (IBD Qorus) implemented clinical care process changes for reducing unplanned emergency department visits and hospitalizations using a Breakthrough Series Collaborative approach.

METHODS:
Using Markov decision models, we determined the health economic impact of participating in the Collaborative from the third-party payer perspective.

RESULTS:
Across all 23 sites, participation in the Collaborative was associated with lower annual costs by an average of $2,528 ± $233 per patient when compared with the baseline period.

DISCUSSION:
Implementing clinical care process changes using a Collaborative approach was associated with overall cost savings. Future work should examine which specific interventions are most effective and whether such cost savings are sustainable.
Ischemic Colitis From Idiopathic Myointimal Hyperplasia of the Mesenteric Veins in a Post–Liver Transplant Patient
Authors: Wong Rochelle , Westerveld Donevan , Yeo Heather , Jessurun Jose , Jesudian Arun 
Published: November 2021

ABSTRACT
Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare cause of nonthrombotic, noninflammatory ischemic colitis. IMHMV classically presents in men with abdominal pain and bloody diarrhea and is frequently misdiagnosed as inflammatory bowel disease. However, IMHMV causes a more protracted, relapsing course of abdominal pain that does not respond to medical therapy. The diagnosis can be secured by colonoscopic biopsy. Surgical resection is curative and should be considered even in high-risk patients. Here, we describe a case of IMHMV diagnosed preoperatively in a post–liver transplant patient with residual portal hypertension who ultimately underwent successful surgical resection.
The molecular mechanisms underlying arecoline-induced cardiac fibrosis in rats
Authors: Ku Chang-Wen , Day Cecilia Hsuan , Ou Hsiu-Chung , Ho Tsung-Jung , Chen Ray-Jade , Kumar Velmurugan Bharath , Lin Wen-Yuan , Huang Chih-Yang 
Published: November 2021

Abstract
The areca nut is one of the most commonly consumed psychoactive substances worldwide, with an estimated consumption by approximately 10% of the world’s population, especially in some regions of South Asia, East Africa, and the tropical Pacific. Arecoline, the major areca nut alkaloid, has been classified as carcinogenic to humans as it adversely affects various organs, including the brain, heart, lungs, gastrointestinal tract, and reproductive organs. Earlier studies have established a link between areca nut chewing and cardiac arrhythmias, and yet research pertaining to the mechanisms underlying cardiotoxicity caused by arecoline is still preliminary. The main purpose of this study is to test the hypothesis that arecoline causes cardiac fibrosis through transforming growth factor-β (TGF-β)/Smad-mediated signaling pathways. Male Wistar rats were injected intraperitoneally with low (5 mg/kg/day) or high (50 mg/kg/day) doses of arecoline for 3 weeks. Results from Masson’s trichrome staining indicated that arecoline could induce cardiac fibrosis through collagen accumulation. Western blot analysis showed that TGF-β and p-Smad2/3 protein expression levels were markedly higher in the arecoline-injected rat hearts than in those of the control rats. Moreover, arecoline upregulated other fibrotic-related proteins, including SP1-mediated connective tissue growth factor expression. Tissue-type plasminogen activator and its inhibitor, plasminogen activator inhibitor, and matrix metalloproteinase (MMP) 9 were upregulated, and the inhibitor of MMP9 was downregulated. This study provides novel insight into the molecular mechanisms underlying arecoline-induced cardiac fibrosis. Taken together, the areca nut is a harmful substance, and the detrimental effects of arecoline on the heart are similar to that caused by oral submucous fibrosis.
TGF-β1-overexpressing mesenchymal stem cells reciprocally regulate Th17/Treg cells by regulating the expression of IFN-γ
Authors: Li Ruixue , Wang Renyong , Zhong Shijie , Asghar Farhan , Li Tiehan , Zhu Lei , Zhu Hong 
Published: November 2021

Abstract
Transforming growth factor (TGF)-β1 and mesenchymal stromal cells (MSCs) are two effective immunosuppressive agents for organ transplantation technology. This study aims to explore the molecular mechanism of TGF-β1-overexpressed MSCs on T cell immunosuppression. To achieve that, BM-MSCs were isolated from canine bone marrow, and their osteogenic differentiation and surface markers were detected. The TGF-β1 gene was transferred into lentivirus and modified MSCs (TGF-β1/MSCs) by lentivirus transfection. Furthermore, TGF-β1/MSCs were co-cultured with T cells to investigate their effect on differentiation and immune regulation. Results showed that TGF-β1/MSCs significantly downregulated the proportion of CD4+ CD8+ T cells in lymphocytes and significantly upregulated the proportion of CD4+ CD25+ T cells. Moreover, TGF-β1/MSCs significantly upregulated the expression of IL-10 in CD4+ T cells and downregulated the expression of IL-17A, IL-21, and IL-22. Meanwhile, interferon-γ (IFN-γ) neutralizing antibody blocked the effects of TGF-β1/MSCs on the differentiation inhibition of Th17. Overall, our results confirm the strong immunosuppressive effect of TGF-β1/MSCs in vitro and demonstrate that IFN-γ mediates the immunosuppressive effect of TGF-β1/MSC.
Baeyer–Villiger co-oxidation of cyclohexanone with Fe–Sn–O catalysts in an O2/benzaldehyde system
Authors: Sun Jingjing , Zhu Qianqian , Guo Xiaoyan , Jin Haibo , He Guangxiang , Ma Lei , Zhang Rongyue , Gu Qingyang , Yang Suohe 
Published: November 2021

Abstract
Baeyer–Villiger (BV) oxidation of cyclohexanone to ε-caprolactone was studied by a co-precipitation method using Fe–Sn–O catalysts in an O2/benzaldehyde system. The effects of the Fe:Sn ratio, calcination temperature, calcination time, and reaction conditions on the catalytic performance were investigated. The catalysts present the best activity when it is prepared at a Fe:Sn ratio of 1:1, calcination temperature of 850°C, and calcination time of 5 h. Under these conditions, catalysts form a large number of small prisms, which result in a larger specific surface area and enhanced catalytic activity. The optimum reaction conditions for the synthesis of ε-caprolactone in the presence of the Fe–Sn–O catalyst are as follows: catalyst (0.12 g), 1,2-dichloroethane (30 mL), O2 flow rate of 25 mL min−1, cyclohexanone to benzophenone of 3:1, reaction temperature of 60°C, and reaction time of 5 h. The conversion of cyclohexanone and the average yield of ε-caprolactone are determined at 98.96% and 83.36%, respectively.
Increased flexibility to improve the catalytic performance of carbon-based solid acid catalysts
Authors: Hu Shuanglan , Huang Junsheng , Huang Dongting , Li Peng , Tang Jingjie , Meng Fei 
Published: November 2021

AbstractThe correlation between catalytic performance and the structure of a carbon-based solid acid (G/F-1/x), an amorphous carbon-bearing SO3H group, was investigated. Concentrated sulfuric acid was used to carbonize and sulfonate the mixed graphene and fructose powder for the preparation of carbon-based solid acid catalysts with different cross-linked structures. The results showed that the catalyst with a higher fructose loading amount presented higher catalytic performance. The catalytic performance improvement could be attributed to a high density of SO3H groups and the fast diffusion of reactants and products enabled by a flexible carbon network. The best furfural yield was obtained up to 69.4% when the weight of graphene and the fructose loading ratio was 1:4.
Which Factors Determine the Adoption of the Internet of Things? Impacts and Benefits
Authors: Miruna Sarbu  
Published: November 2021

Abstract
This paper provides first econometric evidence on the determinants of the Internet of Things among firms and on potential performance impacts. The analysis is based on representative firm-level data from 874 German firms. A probit model and an instrumental variable regression serve as econometric approach. The results reveal that especially collaboration platforms and B2B e-commerce increase the propensity to use the Internet of Things. The results further indicate that product innovation is highest for firms jointly using the Internet of Things and collaboration platforms while a reduction of the workforce is also highest in this case. In contrast, there is no evidence for a potential impact on sales development.
The Regional Rootedness of China’s Film Industry: Cluster Development and Attempts at Cross-Location Integration
Authors: Fan Zhizhong , Yu Xi 
Published: November 2021

Abstract
China’s film industry has its historical roots across the four geographical divisions of northern, eastern, western, and southern China. Each of these four film-producing regions has their own characteristics with divergent historical heritages and cultural resources. After the founding of the People’s Republic of China (PRC) the division of administrative regions included a territorially divided management policy of film enterprises. Such policies promoted the regional development of China’s film industry while simultaneously exacerbated the complex contradictions between and among the clusters produced. In the 1950s, four major state-owned film studios were established in Beijing, Shanghai, and Changchun. Under the planned economy model, films were purchased and sold exclusively by the state through these studios. Since the 1990s, China’s film industry has undergone deep institutional reform, with film distribution and exhibition gradually moving towards the market and private enterprises beginning to actively participate in film production and distribution. The film industry has since begun to actively explore the generative potential of the existing industrial clusters, experimenting with film co-production and cross-regional business operations across the regions. With the goal of constructing a film and television alliance, the film industry has sought to maximize the advantages of different regions to promote the integration of these historically and regionally distinct sectors in an open and tolerant manner, laying the foundation for Chinese films to leapfrog into the global film market.
Antidiarrheal activity of Bridelia ferruginea bark methanolic extract involves modulation ATPases in mice and inhibition of muscarinic acetylcholine receptor (M3) and prostaglandin E2 receptor 3 (EP3) in silico
Authors: Omolaso Blessing Olugbamila , Adesanwo Julius Kolawole , Ishola Ahmed Adebayo , Adegoke Adeoti Gbemisola , Akingbule Francis O. , Ipadeola Yetunde Ayoka , Adewole Kayode Ezekiel 
Published: November 2021

Abstract

Objectives
Diarrhea, an abnormal state in which the individual has about three or more daily bowel movements, is now considered one of the most challenging global public health problems. Using plant products, such as Bridelia ferruginea is an alternative treatment option. The objective of this study was to investigate the antidiarrheal activity of B. ferruginea bark methanolic extract (BfME) and the mechanisms involved.

Methods
BfME antidiarrheal activity was evaluated in mice model of castor oil-induced diarrhea and enteropooling. To evaluate motility, gastrointestinal transit time was carried out using phenol red meal, while intestinal activities of selected ATPases were also evaluated. Furthermore, the active components in BfME were detected by GC-MS analysis, while molecular docking of the most abundant compounds with muscarinic acetylcholine receptor (M3) and prostaglandin E2 receptor 3 (EP3) were conducted.

Results
BfME at 400 and 800 mg/kg showed antidiarrheal activity by delaying onset of diarrhea, reduced gastrointestinal transit and increased intestinal activities of Na+ K+-ATPase, Ca2+ Mg2+-ATPase and Mg2+-ATPase. Molecular docking revealed that γ-sitosterol, α-amyrin, and stigmasterol have outstanding binding affinity for M3 and EP3.

Conclusions
In view of these results, the observed antidiarrheal activity possibly occurs via the activation of ATPases activities and inhibition of M3 and EP3.