bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case management in emergency care: impact evaluation of the CARED Program
Authors: Ong Colin Eng Choon , Yap Joanne Yan Ting , Velu Kamala , Wu Christine Xia , Yap Adrian Ujin , Ng Kai Xin , Chu Michael Yat Sen , Dan Yock Young , Choa Peng Hui , Phan Phillip Hin Choi 
Published: January 2025

Abstract

Background
Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and emergency department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge.

Methods
A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients, i.e. frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage.

Results
Nearest-neighbour 1:1 propensity score matching matched 1615 intervention group to 1615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71–5.23%) and 60-day (6.69%; 95% CI 5.47–7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83–5.95%) and 60-day (6.50%; 95% CI 5.28–7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance [$1 553 548.96 (69.86%); 95% CI $1 525 827.76 to $1 581 270.15; P = .006; and $1 400 047.07 (32.56%); 95% CI $1 365 484.79 to $1434 609.37; P = .048, respectively], ED attendance costs avoidance [$25 849.92 (23.70%); 95% CI $25 091.93 to $26 607.89; P = .096; and $37 538.39 (18.09%); 95% CI $36 470.27 to $38 606.53; P = .086, respectively] and bed occupancy days saved (1212 days; 95% CI 1191.80 days to 1232.20 days; P = .003; and 1267 days; 95% CI 1242.58 days to 1291.42 days; P = .011, respectively)

Conclusion
CARED program effectively reduced unplanned hospital use within 30- and 60 days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.
The hidden pharmacokinetic challenge: diarrhea’s influence on cyclosporine therapy: a case series
Authors: Richard Riya Mary , G Jefry Winner , Shaibu Ann Mary , Pandey Bimal Raj , Thapa Praveen 
Published: January 2025

Background:
Cyclosporine is used as an immunosuppressive drug to improve graft survival rates in the field of organ transplantation. Therapeutic drug monitoring [TDM] of cyclosporine in transplant patients is crucial for optimizing drug dosage and minimizing the risks. Diarrhea is a common gastrointestinal condition, resulting in pharmacokinetic, malabsorption, and clinical consequences for people who rely on cyclosporine medication.

Case presentations:
The case series discusses three pediatric patients who underwent therapeutic drug monitoring of cyclosporine to guide their treatment. The first two cases involved post-renal transplant patients with glomerulonephritis, while the third case involved a patient with tubulointerstitial kidney disease. TDM was employed to guide dose adjustments. The first patient initially received 15 mg/kg but showed high trough concentration. The dosage was gradually reduced, while diarrhea was managed. The second and third patients exhibited a similar trend which also necessitated dose adjustments.

Clinical discussion:
Diarrhea was identified as a factor impacting cyclosporine levels. This case series evaluated the impact of diarrhea on cyclosporine therapeutic levels in three pediatric renal transplant patients. TDM in cyclosporine therapy is significant due to its narrow therapeutic index and variable pharmacokinetics. Elevated trough concentrations led to a gradual dose reduction to achieve the target levels.

Conclusion:
This case series highlights the importance of TDM-guided dosing of cyclosporine, particularly in patients with diarrhea, to maintain target trough concentrations.
Deciphering extracranial metastasis in high-grade meningiomas: insights from a case study and literature review
Authors: Ahmed Nazmin , Chaurasia Bipin 
Published: January 2025

Introduction and importance:
These high-grade meningiomas have higher recurrence rates and poorer survival outcomes compared to benign variants. This study presents a case of metastasis in a high-grade meningioma and a comprehensive analysis of the literature published between 2000 and 2023, including only original studies focused on extracranial metastasis.

Case presentation:
We report the case of a 45-year-old female who presented with progressive left-sided weakness and partial seizures. Imaging revealed a large, lobulated extra-axial mass in the right parietal parasagittal region, which was surgically resected and diagnosed as an anaplastic meningioma (WHO grade III). Despite an initial recovery, the patient experienced tumor recurrence with local invasion, multiple metastases to the contralateral brain, liver, lung, spine, and long bone. Various treatments, including radiotherapy, chemotherapy, and surgery, were employed, but the disease progressed, leaving the patient bed-bound at 8 years follow up.

Clinical discussion:
In our literature review, encompassing 247 patients with extracranial metastasis of meningiomas from seven studies, the lungs and bones were the most common metastatic sites. Patients with grade III meningiomas had poorer survival outcomes than those with grade II. Gross total resection (GTR) was associated with improved progression-free survival, while recurrence markedly reduced overall survival, underscoring the aggressive nature of metastatic meningiomas and the importance of early, comprehensive treatment strategies.

Conclusion:
Extracranial metastasis in high-grade meningiomas poses significant diagnostic and therapeutic challenges. Our analysis underscores the complexity of managing these cases and highlights the critical need for early identification of high-risk patients and tailored treatment protocols to improve long-term outcomes.
Sacrococcygeal teratoma in a 10-year-old-female: a rare case report from Nepal
Authors: Kumar Yadav Kundan , Pokhrel Milan , Dhenga Sonam , Kumari Yadav Srijana , Basnyat Sameer , Yadav Krishna 
Published: January 2025

Introduction:
Sacrococcygeal teratoma is commonly a benign tumor that arises in the sacrum and base of the coccyx. It has an incidence of 1 in 40 000 and a female-to-male ratio of 4:1. Computed tomography scan and magnetic resonance imaging (MRI) are key to diagnosis and surgical resection is the definite treatment.

Case presentation:
A 10-year-old female presented with a gradually progressive sacral swelling since birth associated with fever, pain, and discharge from the swelling for 2 weeks. On examination, there was an approx. 10 × 11 cm mass in the sacral region with a pus point and signs of inflammation were present. On palpation the mass was tender. MRI lumbosacral spine showed a complex mass in the infra-coccygeal region with features suggestive of sacrococcygeal teratoma. Surgical resection of the tumor was performed.

Discussion:
Sacrococcygeal teratoma arises from totipotent cells from Hensen’s node at the coccygeal region. Clinical presentation varies according to type with common manifestations being progressive swelling at the coccygeal region and features of mass effect such as low back pain, and bowel or bladder symptoms. Imaging helps in diagnosis as well as detecting the size, and extent of the tumor as well as its relation to nearby structures. Surgery via transabdominal or trans-sacral approach is the curative treatment.

Conclusion:
Diagnosis of sacrococcygeal teratoma should be considered if a patient presents with gradually progressive swelling of the sacral region.
Application of structural equation modelling (SEM) to evaluate reworks in sustainable buildings
Authors: Olanrewaju AbdulLateef 
Published: January 2025

PurposeSustainable buildings are designed to minimise the adverse impacts of buildings on users, occupants, communities and the environment while enhancing client investment, contractors’ productivity and profit margins. However, sustainable buildings often experience significant rework. This research aims to evaluate the complex interrelationships among the causes of rework in sustainable buildings using structural equation modeling (SEM) techniques. By testing the theory and validating a framework addressing the causes of rework in sustainable buildings, the construction sector can make a meaningful contribution towards a sustainable future.Design/methodology/approachThe study developed a questionnaire comprising 24 identified causes of rework in sustainable buildings, derived from an extensive literature review and field observations. The causes were evaluated using a 4-point Likert scale, ranging from less occurrence to very high occurrence. The survey was administered to construction professionals via online platforms and direct hand delivery.FindingsThe identified causes of rework were grouped into four components through exploratory factor analysis (EFA) and subsequently validated using SEM. These components are competency, information, framework and plan. While the measurement model demonstrated robustness, the structural model indicated the need for further refinement. The study provides actionable strategies to mitigate rework, supporting the advancement of sustainable practices within the construction sector.Originality/valueThe findings of this research carry substantial theoretical and practical significance for advancing knowledge and practices in the sustainable buildings market. Theoretically, the study enriches the understanding of rework causes and their interrelationships, providing a foundation for future research. Practically, the results serve as a vital resource for stakeholders in the construction sector and offer actionable insights to enhance decision-making, improve project outcomes and foster sustainable building practices.
How do foreign and domestic institutional investors drive the market value? The influence of family ownership
Authors: Panda Brahmadev , Tripathy Sasikanta , Tiwari Aviral Kumar , Yarovaya Larisa 
Published: January 2025

PurposeThis paper aims to investigate and compare the impact of foreign and domestic institutional investors on the market value of family and non-family companies. Subsequently, it examines how different degrees of family ownership influence foreign and domestic institutional investors and their value impacts.Design/methodology/approachThe sample of this study includes 339 non-financial firms from NIFTY-500 for 11 years from 2011 to 2020, which contains 128 family and 211 non-family companies. Both static (fixed-effect model) and dynamic (two-step system generalized method of moments) models are employed to test the hypotheses.FindingsFindings suggest that foreign institutional investors outshine domestic institutions regarding value creation. Meanwhile, higher (>50%) family holdings are detrimental to foreign institutional investors, while moderate holdings (26–49%) improve domestic institutional investments. The favorable effect of foreign players gets diluted with the higher (>50%) family holdings, while the adverse impact of domestic players improves with the moderate (26–49%) family holdings. Overall, partial family control is beneficial, while low and absolute family control is detrimental to market value. These findings indicate that institutional investors are family control-dependent, where the family control effect is not static.Originality/valueThis paper offers a novel perspective by addressing the effect of costs and benefits realized at three distinctive levels of family holdings on foreign and domestic institutional investors and their value impacts to witness differences caused by varying family control, which is not done earlier as per the best of our knowledge.
Post‐colonoscopy cancer rates in Scotland from 2012 to 2018: A population‐based cohort study
Authors: Winter Jack , Clark Gavin , Steele Robert , Thornton Michelle 
Published: January 2025

AbstractAimThe aim of this work was to quantify post‐colonoscopy colorectal cancer (PCCRC) rates in National Health Service (NHS) Scotland using World Endoscopy Association guidelines, compare incidence between health boards and referral streams and explore comparisons in results with published data from other healthcare systems.MethodThis is a population‐based cohort study using NHS Scotland data between 2012 and 2018. All people undergoing colonoscopy between 2012 and 2018 and subsequently diagnosed as having bowel cancer up to 3 years after their investigation were included. The main outcome measures are national trends in the PCCRC rate at 3 years (PCCRC‐3yr). with comparison between bowel screening and non‐screening referral routes, board of referral and analysis of factors associated with occurrence.ResultsThe overall unadjusted PCCRC‐3yr was 7.9% (7.4%–8.3%). There was no change in the annual rate over the 7‐year study period. The PCCRC rate was lower for the Scottish Bowel Cancer Screening Programme (6.7% vs. 8.3%), but compared unfavourably with rates reported by the NHS England Bowel Cancer Screening Programme from an earlier time period. There was wide variation in rates between health boards of similar population size. Rates were higher in women, with increasing age and in patients with a history of inflammatory bowel disease or diverticular disease.ConclusionDespite advances in technology, there has been no improvement in the PCCRC rate in Scotland between 2012 and 2018. Rates in bowel screening colonoscopy are better than in nonscreening colonoscopy but compare unfavourably with NHS England, possibly as a result of less robust endoscopist selection and training. Quality improvement is required in colonoscopy in order to improve patient outcomes nationally, and to allow equitable access to higher‐quality colonoscopy in different regions of the country.
The transmembrane protein TMEM196 controls cell proliferation and determines the floor plate cell lineage
Authors: Matsumoto Yumi , Tamaru Seiichi , Chen Xing , Shinozuka Takuma , Sakumura Yuichi , Sasai Noriaki 
Published: January 2025

AbstractThe neural tube, the embryonic precursor to the vertebrate central nervous system, comprises distinct progenitor and neuronal domains, each with specific proliferation programs. In this study, we identified TMEM196, a novel transmembrane protein that plays a crucial role in regulating cell proliferation in the floor plate in chick embryos. TMEM196 is expressed in the floor plate, and its overexpression leads to reduced cell proliferation without affecting the pattern formation of the neural tube. We also established the floor plate differentiation protocol of the mouse embryonic stem cells, and analyzed the function of TMEM196 with this system. Mutating the Tmem196 gene does not alter cell division and overall differentiation remains unchanged within the neural cells. However, TMEM196 inhibits Wnt signaling, and Tmem196 mutant cells exhibit aberrant paraxial mesoderm differentiation, suggesting that TMEM196 selects the floor plate cell fate at the binary decision of the neuromesodermal cells. These findings highlight TMEM196 as a key regulator of both cell proliferation and floor plate determination, contributing to proper regionalization during embryogenesis.
A Global Relationship Between Genome Size and Encoded Carbon Metabolic Strategies of Soil Bacteria
Authors: Wu Xingjie , Peng Jingjing , Malik Ashish Anil , Peng Ziheng , Luo Yu , Fan Fenliang , Lu Yahai , Wei Gehong , Delgado‐Baquerizo Manuel , Liesack Werner , Jiao Shuo 
Published: January 2025

ABSTRACTMicrobial traits are critical for carbon sequestration and degradation in terrestrial ecosystems. Yet, our understanding of the relationship between carbon metabolic strategies and genomic traits like genome size remains limited. To address this knowledge gap, we conducted a global‐scale meta‐analysis of 2650 genomes, integrated whole‐genome sequencing data, and performed a continental‐scale metagenomic field study. We found that genome size was tightly associated with an increase in the ratio between genes encoding for polysaccharide decomposition and biomass synthesis that we defined as the carbon acquisition‐to‐biomass yield ratio (A/Y). We also show that horizontal gene transfer played a major evolutionary role in the expanded bacterial capacities in carbon acquisition. Our continental‐scale field study further revealed a significantly negative relationship between the A/Y ratio and soil organic carbon stocks. Our work demonstrates a global relationship between genome size and the encoded carbon metabolic strategies of soil bacteria across terrestrial microbiomes.
Multicentric Epidemiological Analysis on Medial Wall Fractures of the Orbit: 10‐Year Retrospective Study Between the Centres of Perugia and Ancona
Authors: Committeri Umberto , Monarchi Gabriele , Consorti Giuseppe , Giovacchini Francesco , Balercia Paolo , Tullio Antonio 
Published: January 2025

ABSTRACTStudy Design and ObjectivesThe incidence of isolated fractures of the orbital medial wall is moderate because of the low bone thickness. Our study aimed to investigate demographic variables, fracture features and statistical correlations associated with these fractures retrospectively.Materials and MethodsA total of 57 patients with isolated orbital medial wall fracture, admitted at the Maxillofacial Surgery Unit of Perugia University Hospital and Maxillofacial Surgery Unit of Ospedali Riuniti di Ancona, from 2014 to 2023 were enrolled in the study.Age, sex, comorbidities, post‐traumatic clinical manifestations and defect size and side were all evaluated in patients. Pearson's regression coefficient (r) was used for statistical analysis.ResultsThe fractures were more frequent in men (male to female ratio 2.16:1) primarily as a result of motor vehicle accidents (30% of cases); the average age was 48 years; enophthalmos, diplopia and ocular motility abnormalities were observed in 31%, 23% and 21%, respectively.According to statistical analysis, fracture area was significantly correlated with age, with older patients having larger fractures (p < 0.001); interpersonal violence and traffic accidents were related to younger age (p < 0.001). In a recent analysis of the data, it was found that isolated orbital medial wall fractures occur more frequently in young men (< 40 years) due to road accidents or interpersonal violence. Patients' age is statistically correlated with fracture area, with older patients having larger defects.ConclusionsThis research assesses both the demographic and fracture characteristics of pure medial orbital wall fractures, aiming to enhance the understanding of this clinical scenario and to evaluate optimal treatment strategies.
Magnetic Resonance Cholangiopancreatography for Cholangiopancreatic Duct Imaging in Dogs
Authors: Fujiwara Reina , Yamamoto Kie , Yamasaki Masahiro , Ohno Koichi 
Published: January 2025

ABSTRACTUltrasonography is often used to diagnose biliary diseases in dogs; however, it is difficult to delineate the entire bile and pancreatic ducts. Various imaging techniques for bile and pancreatic ducts have been attempted to overcome this problem. Magnetic resonance cholangiopancreatography (MRCP) is often used to evaluate the bile and pancreatic ducts in humans with obstructive jaundice, but very few reports exist on its usage in dogs. This study was designed as a prospective observational study to assess the feasibility and effectiveness of MRCP for visualizing the bile and pancreatic ducts in nondiseased dogs. Therefore, this study aimed to evaluate the visibility of the bile and pancreatic ducts through MRCP imaging using a 3.0 T‐MRI system in dogs with no signs of hepatic, biliary, and pancreatic diseases. The detection rate for each anatomical structure was evaluated, with the highest observed in the gallbladder (100%), followed by the common bile duct (80%), cystic duct (70%), pancreatic ducts in the left and right lobe of the pancreas (70%), left and right hepatic ducts (60%), accessory pancreatic ducts (60%), and major pancreatic duct (40%). MRCP is a promising noninvasive imaging technique that can promptly and accurately visualize bile and pancreatic ducts in dogs without being influenced by the skill of the operator.
Bridging Therapies—Ex Vivo Liver Xenoperfusion and the Role of Machine Perfusion: An Update
Authors: Czigany Zoltan , Shirini Kasra , Putri Aghnia J. , Longchamp Alban E. , Bhusal Subarna , Kamberi Shani , Meier Raphael P. H. 
Published: January 2025

ABSTRACTAdvancements in xenotransplantation intersecting with modern machine perfusion technology offer promising solutions to patients with liver failure providing a valuable bridge to transplantation and extending graft viability beyond current limitations. Patients facing acute or acute chronic liver failure, post‐hepatectomy liver failure, or fulminant hepatic failure often require urgent liver transplants which are severely limited by organ shortage, emphasizing the importance of effective bridging approaches. Machine perfusion is now increasingly used to test and use genetically engineered porcine livers in translational studies, addressing the limitations and costs of non‐human primate models. Current reports about artificial and bioartificial liver support combined with xenografts showcase the potential in ex vivo xenogeneic perfusion. Breakthroughs, such as the perfusion of genetically modified porcine liver with FDA‐approved machine perfusion systems connected to human blood circulation, underscore the interest and potential feasibility of a “liver dialysis” bridge to allotransplantation or recovery. This review provides an overview of the past and current research in the field of ex vivo pig liver xenoperfusion.