bluuebunny/crossref_metadata_2025_split huggingface dataset:
How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy
Authors: Kilbourne Amy M. , Geng Elvin , Eshun-Wilson Ingrid , Sweeney Shannon , Shelley Donna , Cohen Deborah J. , Kirchner JoAnn E. , Fernandez Maria E. , Parchman Michael L. 
Published: May 2023

Abstract
Background
Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results in randomized implementation trials and has not been fully researched across different contexts.

Objective
Using mechanism mapping, which applies directed acyclic graphs that decompose an effect of interest into hypothesized causal steps and mechanisms, we propose a more concrete description of how healthcare facilitation works to inform its further study as a meta-implementation strategy.

Methods
Using a modified Delphi consensus process, co-authors developed the mechanistic map based on a three-step process. First, they developed an initial logic model by collectively reviewing the literature and identifying the most relevant studies of healthcare facilitation components and mechanisms to date. Second, they applied the logic model to write vignettes describing how facilitation worked (or did not) based on recent empirical trials that were selected via consensus for inclusion and diversity in contextual settings (US, international sites). Finally, the mechanistic map was created based on the collective findings from the vignettes.

Findings
Theory-based healthcare facilitation components informing the mechanistic map included staff engagement, role clarification, coalition-building through peer experiences and identifying champions, capacity-building through problem solving barriers, and organizational ownership of the implementation process. Across the vignettes, engagement of leaders and practitioners led to increased socialization of the facilitator’s role in the organization. This in turn led to clarifying of roles and responsibilities among practitioners and identifying peer experiences led to increased coherence and sense-making of the value of adopting effective innovations. Increased trust develops across leadership and practitioners through expanded capacity in adoption of the effective innovation by identifying opportunities that mitigated barriers to practice change. Finally, these mechanisms led to eventual normalization and ownership of the effective innovation and healthcare facilitation process.

Impact
Mapping methodology provides a novel perspective of mechanisms of healthcare facilitation, notably how sensemaking, trust, and normalization contribute to quality improvement. This method may also enable more efficient and impactful hypothesis-testing and application of complex implementation strategies, with high relevance for lower-resourced settings, to inform effective innovation uptake.
Pulmonary cavernous hemangioma combined with smooth muscle hyperplasia: a case report and review of the literature
Authors: Ibe Takashi , Kosaka Takayuki , Sugano Masayuki , Kakizaki Satoru , Shirabe Ken 
Published: May 2023

Abstract
Background
Cavernous hemangiomas are usually located in the liver, skin, and subcutaneous tissues. Although they can arise from any organ, cavernous hemangiomas rarely occur as a pulmonary tumor. We herein report a rare case of a pulmonary cavernous hemangioma that was surgically resected.

Case presentation
A woman in her 40s was found to have 2 well-defined nodules in the lower lobe of the left lung by computed tomography during following up of bladder cancer. She had a history of surgery for tetralogy of Fallot at 6 years old and pulmonary valve replacement for pulmonary valve insufficiency in her late 30s. She had also undergone surgery for bladder cancer. Although there was no accumulation of 18F-fluorodeoxyglucose on positron emission tomography (PET), the tumor slowly grows. Surgical resection was therefore performed to obtain a definitive diagnosis. The postoperative histological examination revealed an encapsulated nodule comprising large, dilated vessels lined with vascular endothelium and filled with blood, which led to the diagnosis of a pulmonary cavernous hemangioma.

Conclusion
We experienced a rare case of pulmonary cavernous hemangioma and reviewed the previous reports.
Unfolding a composed ensemble of energy spectra using singular value decomposition
Authors: Berkovits Richard 
Published: May 2023

Abstract
In comparing the behavior of an energy spectrum to the predictions of random matrix theory one must transform the spectrum such that the averaged level spacing is constant, a procedure known as unfolding. Once energy spectra belong to an ensemble where there are large realization-to-realization fluctuations the canonical methods for unfolding fail. Here we show that singular value decomposition can be used even for the challenging situations where the ensemble is composed out of realizations originating from a different range of parameters resulting in a non-monotonous local density of states. This can be useful in experimental situations for which the physical parameters cannot be tightly controlled, or for situations for which the local density of states is strongly fluctuating.
Association of Sarcopenia with a Poor Prognosis and Decreased Tumor-Infiltrating CD8-Positive T Cells in Pancreatic Ductal Adenocarcinoma: A Retrospective Analysis
Authors: Masuda Shigeto , Yamakawa Kohei , Masuda Atsuhiro , Toyama Hirochika , Sofue Keitaro , Nanno Yoshihide , Komatsu Shohei , Omiya Satoshi , Sakai Arata , Kobayashi Takashi , Tanaka Takeshi , Tsujimae Masahiro , Ashina Shigeto , Gonda Masanori , Abe Shohei , Uemura Hisahiro , Kohashi Shinya , Inomata Noriko , Nagao Kae , Harada Yoshiyuki , Miki Mika , Irie Yosuke , Juri Noriko , Kanzawa Maki , Itoh Tomoo , Fukumoto Takumi , Kodama Yuzo 
Published: May 2023

AbstractBackgroundSarcopenia, defined as a loss of skeletal muscle mass and quality, is found in 30–65% of patients with pancreatic ductal adenocarcinoma (PDAC) at diagnosis, and is a poor prognostic factor. However, it is yet to be evaluated why sarcopenia is associated with poor prognosis. Therefore, this study elucidated the tumor characteristics of PDAC with sarcopenia, including driver gene alterations and tumor microenvironment.Patients and MethodsWe retrospectively analyzed 162 patients with PDAC who underwent pancreatic surgery between 2008 and 2017. We defined sarcopenia by measuring the skeletal muscle mass at the L3 level using preoperative computed tomography images and evaluated driver gene alteration (KRAS,TP53,CDKN2A/p16, andSMAD4) and tumor immune (CD4+, CD8+, and FOXP3+) and fibrosis status (stromal collagen).ResultsIn localized-stage PDAC (stage ≤ IIa), overall survival (OS) and recurrence-free survival were significantly shorter in the sarcopenia group than in the non-sarcopenia group (2-year OS 89.7% versus 59.1%,P= 0.03; 2-year RFS 74.9% versus 50.0%,P= 0.02). Multivariate analysis revealed that sarcopenia was an independent poor prognostic factor in localized-stage PDAC. Additionally, tumor-infiltrating CD8+T cells in the sarcopenia group were significantly less than in the non-sarcopenia group (P= 0.02). However, no difference was observed in driver gene alteration and fib.rotic status. These findings were not observed in advanced-stage PDAC (stage ≥ IIb).ConclusionsSarcopenia was associated with a worse prognosis and decreased tumor-infiltrating CD8+T cells in localized-stage PDAC. Sarcopenia may worsen a patient’s prognosis by suppressing local tumor immunity.
The incremental value of CCTA-derived myocardial radiomics signature for ischemia diagnosis with reference to CT myocardial perfusion imaging
Authors: Zhu Meng-meng , Zhu Xiao-mei , Lin Shu-shen , Dong Si-ting , Liu Wang-yan , zhang Jia-yin , Xu Yi 
Published: May 2023

Objectives: To explore the incremental value of myocardial radiomics signature derived from static coronary computed tomography angiography (CCTA) for identifying myocardial ischemia based on stress dynamic CT myocardial perfusion imaging (CT-MPI). Methods: Patients who underwent CT-MPI and CCTA were retrospectively enrolled from two independent institutions, one used as training and the other as testing. Based on CT-MPI, coronary artery supplying area with relative myocardial blood flow (rMBF) value <0.8 was considered ischemia. Conventional imaging features of target plaques which caused the most severe narrowing of the vessel included area stenosis, lesion length (LL), total plaque burden, calcification burden, non-calcification burden, high-risk plaque (HRP) score, and CT fractional flow reserve (CT-FFR). Myocardial radiomics features were extracted at three vascular supply areas from CCTA images. The optimized radiomics signature was added to the conventional CCTA features to build the combined model (radiomics + conventional). Results: There were 168 vessels from 56 patients enrolled in the training set, and the testing set consisted of 135 vessels from 45 patients. From either cohort, HRP score, LL, stenosis ≥50% and CT-FFR ≤0.80 were associated with ischemia. The optimal myocardial radiomics signature consisted of nine features. The detection of ischemia using the combined model was significantly improved compared with conventional model in both training and testing set (AUC 0.789 vs 0.608, p < 0.001; 0.726 vs 0.637, p = 0.045). Conclusions: Myocardial radiomics signature extracted from static CCTA combining with conventional features could provide incremental value to diagnose specific ischemia. Advances in knowledge: Myocardial radiomics signature extracted from CCTA may capture myocardial characteristics and provide incremental value to detect specific ischemia when combined with conventional features.
The correlation of left atrial dysfunction and amyloid load in patients with immunoglobulin light-chain cardiac amyloidosis: a 3T cardiac magnetic resonance study
Authors: Lu Jianyao , Yang Zhaoxia , Tang Dazong , Luo Yi , Xiang Chunlin , Zhou Xiaoyue , Huang Lu , Xia Liming 
Published: May 2023

Objective: To investigate the left atrial (LA) changes in immunoglobulin light-chain cardiac amyloidosis (AL-CA) patients with different risk stratifications and to explore the correlation between LA function and the degree of amyloid load using cardiac magnetic resonance (CMR) imaging. Methods: Forty-three AL-CA patients were retrospectively enrolled and were divided into low-to-moderate-risk group (n = 16, increased NT-proBNP or troponin I, or both normal) and high-risk group (n = 27, increased NT-proBNP and troponin I). 20 healthy individuals matched for age and gender were included. The function, myocardial deformation of left heart, and left ventricular (LV) tissue characterization among the three groups were compared. The correlation between LA function and LV tissue characterization was investigated. Results: Compared with the controls, the AL-CA patients had a larger LA volume, lower left atrial emptying fraction (LAEF) and impaired left atrial strain (LAS). The high-risk group exhibited lower reservoir and booster function and increased LV extracellular volume (LV-ECV) than the low-to-moderate-risk group (p < 0.05). LV-ECV was significantly correlated with LAS and LAEF (all p < 0.05) but not LAEFconduit. The LAS and LAEF had a good diagnostic ability for risk stratification of AL-CA patients (area under the curve, 0.70 ~ 0.72). Conclusion: High-risk AL-CA patients showed more severe LA function impairment than low-to-moderate-risk AL-CA patients. LAS and LAEF were closely associated with LV-ECV in AL-CA patients, LAS and LAEF exhibited good capability to differentiate AL-CA patients of different risk stratifications. Advances in knowledge: CMR-derived LAS and LAEF were correlated with amyloid load, allowing for differentiation of AL-CA patients at different risk stages.
Comparing the Denver criteria sets for blunt trauma: a retrospective study of cases in Edmonton, Alberta
Authors: Wagner Mitchell J. , Hussein Imaan , Low Gavin , Samji Karim Bahadurali 
Published: May 2023

Objective: To determine whether a more conservative Denver criterion set could reduce unnecessary CT angiography (CTA) studies when screening for blunt cerebrovascular injury (BCVI) following blunt trauma. Methods: Following ethics approval, a retrospective chart review of 447 consecutive patients undergoing emergency CTA at two large teaching hospitals was conducted to determine the presence of risk factors for each Denver criterion set. Imaging studies of adults conducted between January 2016 and June 2020 containing sufficient clinical information for accurate classification were included in the study. Specificity, sensitivity, and predictive values were calculated. A two-sided Fisher exact test was used to evaluate the association between each iteration of the Denver criteria and the presence of BCVI. Results: The specificities of the Original, Modified, and Expanded Denver criteria were 43.58%, 34.32%, and 24.85%, respectively. Positive-predictive values (PPV) followed a different trend, with respective values of 2.77%, 3.06%, and 2.78%. Sensitivity and negative-predictive values (NPV) were found to be 100% for each criterion set. Being positive for a criterion set, and the presence of BCVI, was statistically significant for the original Denver criteria (p = 0.021, n = 443), but not the modified (p = 0.100, n = 345) or expanded Denver criteria (p = 0.202, n = 333). Conclusion: Use of the modified and expanded Denver criteria leads to the overuse of cerebrovascular imaging on patients suffering blunt force trauma. Advances in knowledge: The original Denver criteria may more appropriately identify subjects for further evaluation with CTA than the current standard, while retaining diagnostic efficacy for BCVI.
CT image-based biomarkers acquired by AI-based algorithms for the opportunistic prediction of falls
Authors: Liu Daniel , Binkley Neil C , Perez Alberto , Garrett John W , Zea Ryan , Summers Ronald M , Pickhardt Perry J 
Published: May 2023

Objective Evaluate whether biomarkers measured by automated artificial intelligence (AI)-based algorithms are suggestive of future fall risk. Methods In this retrospective age- and sex-matched case–control study, 9029 total patients underwent initial abdominal CT for a variety of indications over a 20-year interval at one institution. 3535 case patients (mean age at initial CT, 66.5 ± 9.6 years; 63.4% female) who went on to fall (mean interval to fall, 6.5 years) and 5494 controls (mean age at initial CT, 66.7 ± 9.8 years; 63.4% females; mean follow-up interval, 6.6 years) were included. Falls were identified by electronic health record review. Validated and fully automated quantitative CT algorithms for skeletal muscle, adipose tissue, and trabecular bone attenuation at the level of L1 were applied to all scans. Uni- and multivariate assessment included hazard ratios (HRs) and area under the receiver operating characteristic (AUROC) curve. Results Fall HRs (with 95% CI) for low muscle Hounsfield unit, high total adipose area, and low bone Hounsfield unit were 1.82 (1.65–2.00), 1.31 (1.19–1.44) and 1.91 (1.74–2.11), respectively, and the 10-year AUROC values for predicting falls were 0.619, 0.556, and 0.639, respectively. Combining all these CT biomarkers further improved the predictive value, including 10-year AUROC of 0.657. Conclusion Automated abdominal CT-based opportunistic measures of muscle, fat, and bone offer a novel approach to risk stratification for future falls, potentially by identifying patients with osteosarcopenic obesity. Advances in knowledge There are few well-established clinical tools to predict falls. We use novel AI-based body composition algorithms to leverage incidental CT data to help determine a patient’s future fall risk.
Are the severity of obstruction and the apnea–hypopnea index related to orofacial anatomy in children with obstructive sleep apnea? a kinetic MRI study
Authors: Savoldi Fabio , Fung Kevin KF , Mak Wing-Sze , Kan Elaine YL , Yang Yanqi , Kwok Ka-Li , Gu Min 
Published: May 2023

Objectives: The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea–hypopnea index (AHI) or the amount of upper airway obstruction. Methods: MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level α = 0.05). Results: As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI(p = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI (β = −0.512, p = 0.007) and obstruction severity (β = 0.625, p = 0.002); and the retropalatal width was related to AHI (β = −0.384, p = 0.024) and obstruction severity (β = 0.519, p = 0.006). Conclusions: In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
Health Related Quality of Life (HRQOL) in pediatric population after surgical intervention in traumatic lower limb injuries: A prospective cohort
Authors: Muhammad Mustafa Hashmi  , Muhammad Rehan Akram  , Naumeri Fatima , Muhammad Faizan Akram  
Published: May 2023

Objective: To assess health related quality of life (HRQOL) of children who had undergone surgical intervention after lower limb trauma.
Methods: A prospective observational study was conducted at KEMU and UCHS, from September 2021 to June 2022. Fifty children aged 5 to 12 years who had undergone surgical intervention for lower limb trauma were included. Patients whose parents couldn’t understand Urdu or English, or with polytrauma, needing amputation and/or comorbidities were excluded. Another fifty-school going, age matched children were enrolled as controls. After informed consent, two responses from participants and parents on PedsQL questionnaires were recorded, first one week after discharge and second after six months, assessing age specific quality of life in four domains (physical, emotional, social, school). Impaired HRQOL was defined as a score that was more than 1SD below the mean of healthy sample.
Results: Baseline HRQOL scores were significantly lower in patients and parents reported data taken at one week, overall difference of 39.13 in total HRQOL scores (effect size, d 2.76). Difference of 39.86 was observed between baseline and follow-up data taken from parents with the highest effect size (d=3.34) in physical functioning scores. There was a significant difference of 10.07 between the total HRQOL scores of patients on follow up and controls, and HRQOL patients’ scores were higher than controls across all domains. Parent reported scores were less than those reported by children in almost all cases.
Conclusion: HRQOL of children at discharge after management of lower limb trauma was lower than age-matched control group. It, however, significantly exceeded controls’ scores after six months showing complete recovery.
doi: https://doi.org/10.12669/pjms.39.4.7128
How to cite this: Hashmi MM, Akram MR, Naumeri F, Akram MF. Health Related Quality of Life (HRQOL) in pediatric population after surgical intervention in traumatic lower limb injuries: A prospective cohort. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7128
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A new promising biological agent for refractory lupus nephritis: Telitacicept
Authors: Liu Shuangyan , Yu Xiangyue , Li Xiaodong 
Published: May 2023

doi: https://doi.org/10.12669/pjms.39.4.7542
How to cite this: Liu S, Yu X, Li X. A new promising biological agent for refractory lupus nephritis: Telitacicept. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7542
Leveraging on digital technology for financial inclusion of women agripreneurs in Southern Nigeria
Authors: Vivian Chinelo Ugwuja , Peter Ayodeji Ekunwe 
Published: May 2023

Background Women are key players in agriculture, but they are under-resourced, particularly in terms of finance. Microfinance has long been recognized as the most effective method of financially empowering these women, but using the benefits of digital technology can help scale it up and ensure its long-term viability. Methods The study area was Southern Nigeria. Respondents were women agripreneurs (n=479), from six states. 239 women agripreneurs who accessed digital financial products and 240 women agripreneurs who did not access financial products participated in the survey in 2019. Results The tests for significant difference between income of participants and non-participants in digital finance indicated a T-value of 3.214 (P< 0.001), which implies that there was a significant difference in the income of those that are accessing digital financial products (DFPs) and those that are not accessing DFPs. The tests for significant difference between savings of participants and non-participants indicated a T-value of 2.479 (p<0.05), which also implies that there was a significant difference in the women agripreneurs’ savings for participants and non-participants in DFPs. Only 2.5% of women agripreneurs are participating in micro-insurance in Southern Nigeria. Conclusions Women agripreneurs who are accessing digital financial products earned more income and saved more than those who are not accessing digital financial products. This implies that you are more advantaged in using digital finance in business. Micro-insurance is poorly accessed in Nigeria, and awareness of insurance products is moderately low. This study recommends that Central Bank of Nigeria should engage in more outreach programmes to enable all women in Nigeria access digital financial products because of its convenience and contributions to success in business. Insurance companies should capitalize on business models that incorporate mobile technologies in order to increase insurance penetration in rural areas.