bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolving role of the health system CIO: perspectives from 33 health systems
Authors: Kim Dae Hyun , Lemak Christy , Jones Douglas , Pena Dalton 
Published: August 2024

ObjectivesThis study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success.MethodsAn advisory board of industry executives and system leaders guided the study. Purposeful sampling was used to invite chief executive officer and CIOs from 65 not-for-profit US health systems to participate. Interviews were conducted with 51 executives from 33 different systems, using a comprehensive interview topic guide. Interview transcripts were analysed using NVivo software, focusing on themes related to the evolving role of the health system CIO.ResultsAnalyses revealed three main themes, with the CIO as (1) enabler of strategic change and transformation, (2) strategic developer of technology and leadership talent and (3) driver of organisational culture.DiscussionThe role of CIO has undergone transformation from technology and information system management to strategic leadership within the broader health system context. It highlights the importance of comprehensive business knowledge for CIOs and the need for other C-suite executives to have a deeper understanding of information and technology.ConclusionAs healthcare continues to evolve, the role of the CIO is expected to expand further, requiring a blend of technical and strategic business skills. This evolution presents opportunities for health systems to enhance their leadership development programmes, preparing leaders for the complexities of the contemporary health system sector.
Delayed development of spinal stenosis at the spinal cord stimulator percutaneous lead entry point: case report and literature review
Authors: Leech Hunter Xavier , Provenzano David Anthony , DeRiggi Leonard , Oliver-Smith David 
Published: August 2024

Background
Spinal cord stimulation (SCS) is an efficacious treatment for various refractory chronic pain syndromes. Serious complications including spinal cord compression (SCC) are rare with 19 previous reports which are mainly attributed to fibrotic scar tissue formation at the distal end of the leads at the location of the contacts. We report a case of SCC following SCS implantation at the lead entry location secondary to a delayed progression of spinal canal stenosis.

Case presentation
A patient in her early 70s underwent SCS implantation with adequate therapeutic benefit for approximately 2 years before citing complaints of increasing lower back pain and lower extremity radicular pain. Lumbar spine X-rays excluded lead migration as a causative factor. An MRI of the lumbar spine obtained 30 months following SCS implantation demonstrated a marked interval progression of central canal stenosis secondary to facet and ligamentous hypertrophy manifesting in compression of the spinal cord at the lead entry location. An L1–L2 decompressive laminectomy with hardware removal resulted in the resolution of her symptoms. A literature search conducted with the PubMed database identified previously published cases of SCC following SCS implantation which highlighted the rarity of this complication.

Conclusion
Our case report urges physicians of SCS patients, noting a loss of therapeutic benefit with their device, to investigate new pathologies including SCC. Furthermore, our case highlights clinical symptoms and surgical treatments of SCC. Paddle leads are more commonly implicated in published cases of SCC than percutaneous leads. Lastly, MRI conditionality is critical to identifying cases of SCC.
Building risk assessment methodology for explosive and non-conventional terrorist attacks
Authors: Carbonelli Marco , Quaranta Riccardo , Gaudio Pasquale , Di Giovanni Daniele , Xerri Grace P. , Malizia Andrea , Gratta Laura 
Published: August 2024

AbstractAn original methodology suitable for the assessment of the risk of a terrorist attack in a given site/building is proposed and illustrated for the case of an explosive or non-conventional (Chemical, Biological, Radiological, Nuclear and explosive—CBRNe) attack. The Building Risk Assessment Methodology discussed in this paper represents the arrival point of a detailed analysis and research carried out during the past 5 years and provides the synthesis of different results obtained for the assessment of Building Threats and Building Vulnerabilities. These two assessments were discussed in detail in other already published papers. The effort presented in this work is to deploy a risk and impact assessment technique for buildings that can be adopted in any operating scenario in the presence of explosive or non-conventional threats. The main target of the methodology is to provide a sufficiently accurate estimate of the risk in a simple fashion. The methodology allows to manage the different kinds of risk related to the explosive and non-conventional threats, and it is useful for identifying a ranking of risks for different buildings in different portions of territory and for prioritizing actions and investments in preparedness, protection and resilience of critical areas and critical infrastructures. In the paper, the results of two different case studies for three different threats will be considered, analyzed and compared.
Identification of Hub Genes and Potential Drugs in Neurofibromatosis 1: An Integrated Bioinformatics Analysis
Authors: Adnan Zoha , Rasheed Muhammad Asif , Khan Sami Ullah , Irfan Areeba , Awwad Fuad A. , Ismail Emad A. A. , Ijaz Khan M. , Kamolova Nargiza 
Published: August 2024

Background: Neurofibromatosis Type 1 (NF1) is an autosomal dominant benign tumor predisposition syndrome. Till date very little is known about the pathogenesis and underlying mechanisms of NF1. Objective: The aim of this study is to use integrated bioinformatics approaches to explore the pathways involved in NF1 onset by identifying hub genes and potential drugs. Methods: Microarray profiling datasets were used to obtain Differentially Expressed Genes (DEGs) by analyzing in GEO2R. 1730 DEGs were found and STRING analysis revealed Protein–Protein Interaction (PPI) network of these DEGs. Molecular Complex was detected using MCODE plugin of Cytoscape. CytoHubba plugin of Cytoscape was used to declare hub genes based on their degree of connectivity. Lastly, Drug–Gene Interaction Database (DGIdb) and Gene Expression Profiling Interactive Analysis (GEPIA) servers were used to find potential drugs and survival analysis of hub gene, respectively. Results: Degree of connectivity revealed 10 hub genes out of 1730 DEGs. The survival analysis of these hub genes resulted in three specific genes that are altered in NF1 patients. These three genes are named as BRCA1, KIF11 and LAMA1. Furthermore, 13 potential drugs were also predicted to influence BRCA1, KIF11 and LAMA1 and have therapeutic potential against NF1. Conclusion: This research opens ways to understanding the pathogenesis of NF1. All three genes are key biological markers and potential drug targets that can be confirmed by further experiments. Moreover, 13 potential drugs were found to work against the disease.
Using Generative AI in Finance, and the Lack of Emergent Behavior in LLMs
Authors: Bhattacharya Ranjeeta , Aoun Mario Antoine 
Published: August 2024

In each issue of
Communications
, we publish selected posts or excerpts from the many blogs on our website. The views expressed by bloggers are their own and not necessarily held by
Communications
or the Association for Computing Machinery.

Read more blogs and join the discussion at https://cacm.acm.org/blog.
https://cacm.acm.org/blog
Ranjeeta Bhattacharya on using generative AI to navigate complex regulations, and Mario Antoine Aoun on why there are no emergent properties in large language models.
Relationship Between Glycosylated Hemoglobin Variability and the Severity of Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus
Authors: Liu Xinyan , Yang Xiyao , Wu Na 
Published: August 2024

Background: Glycosylated hemoglobin (HbA1c) variability is a risk factor for cardiovascular complications in patients with Type 2 diabetes mellitus (T2DM), but its relationship with the severity of coronary artery disease (CAD) is unclear.Methods: Patients with T2DM who underwent coronary angiography due to angina were enrolled. HbA1c variability was expressed as coefficient of variation (CV), standard deviation (SD), variability independent of mean (VIM), and time in range (TIR). The severity of CAD was expressed by the number of involved vessels and Gensini score. Multivariate regression models were constructed to test the relationship between HbA1c variability, number of involved vessels, and the Gensini score, followed by linear regression analysis.Results: A total of 147 patients were included. In multivariate analysis, VIM‐HbA1c (OR = 2.604; IQR: 1.15, 5.90; r = 0.026) and HbA1cTIR (OR = 0.13; IQR: 0.04, 0.41; r < 0.001) were independent risk factors for the number of involved vessels. After adjustment, HbA1cTIR (OR = 0.01; IQR: 0.002, 0.04; r < 0.001), SD‐HbA1c (OR = 4.12, IQR: 1.64, 10.35; r = 0.001), CV‐HbA1c (OR = 1.41, IQR: 1.04, 1.92; r = 0.007), and VIM‐HbA1c (OR = 3.26; IQR: 1.43, 7.47; r = 0.003) were independent risk factors for the Gensini score. In the linear analysis, the Gensini score was negatively correlated with HbA1cTIR (β = −0.629; r < 0.001) and positively correlated with SD‐HbA1c (β = 0.271; r = 0.001) and CV‐HbA1c (β = 0.176; r = 0.033). After subgroup analysis, HbA1cTIR was a risk factor for the number of involved vessels. The Gensini score was negatively correlated with HbA1cTIR and positively correlated with SD‐HbA1c at subgroups of subjects with a mean HbA1c ≤ 7%.Conclusions: Our analysis indicates that HbA1c variability, especially HbA1cTIR, plays a role for the severity of CAD in patients with T2DM. HbA1c variability may provide additional information and require management even at the glycemic target.Translational Aspects: Studies have shown that HbA1c variability is related to cardiovascular complications. Further, we explore the correlation between HbA1c variability and the severity of CAD. HbA1c variability is a risk factor for coronary stenosis in T2DM. It may be a potential indicator reflecting glycemic control for the prevention and treatment of cardiovascular complications.
Promise and Perils of Primary HPV Testing
Authors: Spencer Jennifer C. , Wheeler Cosette M. 
Published: August 2024

Abstract
Cervical cancer screening has reduced morbidity and mortality in many countries, but efforts to optimize screening modalities and schedules are ongoing. Using data from a randomized trial conducted in British Columbia, Canada, in conjunction with a provincial screening registry, Gottschlich and colleagues demonstrated that the estimated risk for precancerous disease (cervical intraepithelial neoplasia grades 2 or worse) at 8 years following a negative human papillomavirus (HPV) test was similar to the current standard of care (Pap testing after 3 years). The study supports extending screening intervals for those with a negative HPV test beyond currently recommended 5-year intervals. In an ideal world, the resources saved through less frequent routine cervical screening could be redirected to increasing screening uptake and follow-up of abnormalities to improve equity in cervical cancer prevention. However, implementation of extending screening intervals remains less than straightforward in settings with fragmented healthcare systems that lack information systems to support patient call/recall, such as the United States. To achieve the full promise of primary HPV testing, stakeholders at every level must commit to identifying and addressing the diverse spectrum of barriers that undergird existing inequities in care access, appropriately resource implementation strategies, and improve health information systems.
See related article by Gottschlich et al., p. 904
Dendritic Cell Plasticity, Radiation, and Newton's Third Law
Authors: Kalinski Pawel , Gandhi Shipra , Kokolus Kathleen M. 
Published: August 2024

SummaryRegulatory T cells protect damaged tissues but can undermine the effects of cancer treatments, including radiotherapy (RTx). Intratumoral immunostimulatory dendritic cells (type 1 conventional dendritic cells) respond to RTx with the production of regulatory T cell–attracting MDC/CCL22, undermining RTx effects. That effect can be reversed by EGFR-targeted IFNα, highlighting cDC1 plasticity and relevance as therapeutic targets.See related article by Bugno et al., p. 4450
Thrombin Generation Is Associated With Extracellular Vesicle and Leukocyte Lipid Membranes in Atherosclerotic Cardiovascular Disease
Authors: Protty Majd B. , Tyrrell Victoria J. , Allen-Redpath Keith , Soyama Shin , Hajeyah Ali A. , Costa Daniela , Choudhury Anirban , Mitra Rito , Sharman Amal , Yaqoob Parveen , Jenkins P. Vince , Yousef Zaheer , Collins Peter W. , O’Donnell Valerie B. 
Published: August 2024

BACKGROUND:
Clotting, leading to thrombosis, requires interactions of coagulation factors with the membrane aminophospholipids (aPLs) phosphatidylserine and phosphatidylethanolamine. Atherosclerotic cardiovascular disease (ASCVD) is associated with elevated thrombotic risk, which is not fully preventable using current therapies. Currently, the contribution of aPL to thrombotic risk in ASCVD is not known. Here, the aPL composition of circulating membranes in ASCVD of varying severity will be characterized along with the contribution of external facing aPL to plasma thrombin generation in patient samples.

METHODS:
Thrombin generation was measured using a purified factor assay on platelet, leukocyte, and extracellular vesicles (EVs) from patients with acute coronary syndrome (n=24), stable coronary artery disease (n=18), and positive risk factor (n=23) and compared with healthy controls (n=24). aPL composition of resting/activated platelet and leukocytes and EV membranes was determined using lipidomics.

RESULTS:
External facing aPLs were detected on EVs, platelets, and leukocytes, elevating significantly following cell activation. Thrombin generation was higher on the surface of EVs from patients with acute coronary syndrome than healthy controls, along with increased circulating EV counts. Thrombin generation correlated significantly with externalized EV phosphatidylserine, plasma EV counts, and total EV membrane surface area. In contrast, aPL levels and thrombin generation from leukocytes and platelets were not impacted by disease, although circulating leukocyte counts were higher in patients.

CONCLUSIONS:
The aPL membrane of EV supports an elevated level of thrombin generation in patient plasma in ASCVD. Leukocytes may also play a role although the platelet membrane did not seem to contribute. Targeting EV formation/clearance and developing strategies to prevent the aPL surface of EV interacting with coagulation factors represents a novel antithrombotic target in ASCVD.
Leisure Sedentary Behavior, Physical Activities, and Cardiovascular Disease Among Individuals With Metabolic Dysfunction–Associated Fatty Liver Disease
Authors: Wu Hanzhang , Wei Jiahe , Chen Wenjuan , Chen Liangkai , Zhang Jihui , Wang Ningjian , Wang Shuai , Tan Xiao 
Published: August 2024

BACKGROUND:
Metabolic dysfunction–associated fatty liver disease is a significant risk factor for cardiovascular disease (CVD). This study assesses the association between leisure-time physical activity, sedentary behavior, and CVD risk among patients with metabolic dysfunction–associated fatty liver disease, considering genetic predisposition to CVD.

METHODS:
This cohort study included 157 794 participants with metabolic dysfunction–associated fatty liver disease from the UK Biobank who were free of CVD at baseline. The study measured leisure-time sedentary behaviors (watching TV, using a computer, and driving) and physical activities (walking for pleasure, light and heavy do-it-yourself activities, strenuous sports, and other exercises) in terms of frequency and duration over the 4 weeks before assessment. Both a Cox proportional hazard model and an isotemporal substitution model were utilized in the study to assess the association between leisure sedentary behavior, physical activities, and CVD risk.

RESULTS:
During a median 12.5 years of follow-up, 26 355 CVD cases were reported, including 19 746 coronary heart disease, 4836 stroke, and 7398 heart failure cases. High physical activity levels were linked to a significantly lower risk of CVD (21%), coronary heart disease (20%), stroke (15%), and heart failure (31%). In contrast, individuals with >6.5 h/d of sedentary behavior faced a 16% to 21% higher risk of these conditions compared with those with ≤3.5 h/d. Notably, replacing 30 minutes of inactivity with physical activity reduced CVD risks by 3% to 16%, particularly with strenuous sports. A significant interaction was observed between physical activity, sedentary behavior, and genetic predisposition in relation to stroke risk.

CONCLUSIONS:
Among patients with metabolic dysfunction–associated fatty liver disease, higher leisure-time physical activity levels correlate with reduced CVD risks, while increased sedentary behavior is linked to higher CVD risks. Replacing sedentary time with physical activity consistently shows benefits in reducing CVD outcomes, irrespective of genetic predisposition.
Quality of Life and Exercise Capacity in Early Stage and Subclinical Hypertrophic Cardiomyopathy: A Secondary Analysis of the VANISH Trial
Authors: Ireland Catherine G. , Burstein Danielle S. , Day Sharlene M. , Axelsson Raja Anna , Russell Mark W. , Zahka Kenneth G. , Pereira Alexandre , Canter Charles E. , Bach Richard G. , Wheeler Matthew T. , Rossano Joseph W. , Owens Anjali T. , Bundgaard Henning , Mestroni Luisa , Taylor Matthew R.G. , Patel Amit R. , Wilmot Ivan , Soslow Jonathan H. , Becker Jason R. , Giverts Ilya , Orav E. John , Claggett Brian , Lin Kimberly Y. , Ho Carolyn Y. 
Published: August 2024

BACKGROUND:
The health-related quality of life (HRQOL) and cardiopulmonary exercise testing (CPET) performance of individuals with subclinical and early stage hypertrophic cardiomyopathy (HCM) have not been systematically studied. Improved understanding will inform the natural history of HCM and factors influencing well-being.

METHODS:
VANISH trial (Valsartan for Attenuating Disease Evolution in Early Sarcomeric HCM) participants with early stage sarcomeric HCM (primary analysis cohort) and subclinical HCM (sarcomere variant without left ventricular hypertrophy comprising the exploratory cohort) who completed baseline and year 2 HRQOL assessment via the pediatric quality of life inventory and CPET were studied. Metrics correlating with baseline HRQOL and CPET performance were identified. The impact of valsartan treatment on these measures was analyzed in the early stage cohort.

RESULTS:

Two hundred participants were included: 166 with early stage HCM (mean age, 23±10 years; 40% female; 97% White; and 92% New York Heart Association class I) and 34 subclinical sarcomere variant carriers (mean age, 16±5 years; 50% female; and 100% White). Baseline HRQOL was good in both cohorts, although slightly better in subclinical HCM (composite pediatric quality of life score 84.6±10.6 versus 90.2±9.8;
P
=0.005). Both cohorts demonstrated mildly reduced functional status (mean percent predicted peak oxygen uptake 73±16 versus 78±12 mL/kg per minute;
P
=0.18). Percent predicted peak oxygen uptake and peak oxygen pulse correlated with HRQOL. Valsartan improved physical HRQOL in early stage HCM (adjusted mean change in pediatric quality of life score +4.1 versus placebo;
P
=0.01) but did not significantly impact CPET performance.

CONCLUSIONS:
Functional capacity can be impaired in young, healthy people with early stage HCM, despite New York Heart Association class I status and good HRQOL. Peak oxygen uptake was similarly decreased in subclinical HCM despite normal left ventricular wall thickness and excellent HRQOL. Valsartan improved physical pediatric quality of life scores but did not significantly impact CPET performance. Further studies are needed for validation and to understand how to improve patient experience.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01912534.
Epigenetic Clock at Birth and Childhood Blood Pressure Trajectory: A Prospective Birth Cohort Study
Authors: Hu Jie , Yaskolka Meir Anat , Hong Xiumei , Wang Guoying , Hu Frank B. , Wang Xiaobin , Liang Liming 
Published: August 2024

BACKGROUND:
The impact of methylation gestational age (GAmAge; a biomarker of fetal maturity) at birth on childhood blood pressure (BP) trajectories is unknown.

METHODS:
This cohort study included 500 boys and 440 girls with data on cord blood DNA methylation and BP at 3 to 15 years of age. Systolic BP (SBP) and diastolic BP percentiles were calculated based on clinical guidelines. Time-series K-means clustering identified 4 distinct SBP and diastolic BP percentile trajectories: high-steady, high-decrease, normal-increase, and normal-steady. GAmAge was estimated using an existing pediatric epigenetic clock. Extrinsic age acceleration was calculated as residuals of associations between GAmAge and chronological gestational age. Intrinsic age acceleration was calculated using the same method adjusting for cord blood cell compositions.

RESULTS:

Extrinsic age acceleration and intrinsic age acceleration were inversely associated with repeated measures of BP percentiles. Significant inverse associations were observed between extrinsic age acceleration and SBP percentiles in boys (β=−2.02;
P
=0.02) but not in girls (β=−0.49;
P
=0.58). Both extrinsic age acceleration and intrinsic age acceleration were inversely associated with SBP percentiles in girls born preterm (<37 weeks; β
EAA
=−2.95; β
IAA
=−3.00;
P
<0.05). Compared with the normal-steady SBP trajectory, significant inverse associations were observed between intrinsic age acceleration and high-steady, high-decrease, and normal-increase SBP trajectories in boys (odds ratio, 0.73–0.81;
P
<0.03), and significant positive associations were observed for high-decrease and normal-increase SBP trajectories in girls (odds ratio, 1.26–1.38;
P
<0.01). Significant sex differences were observed (
P
sex-interaction
<2×10
−16
).

CONCLUSIONS:
GAmAge acceleration at birth was inversely associated with child BP, and such association was more pronounced in boys than in girls. Our findings may shed new light on the developmental origins of high BP and sex differences in cardiovascular risk.