bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variables Affecting 90-Day Overall Reimbursement After Anterior Cruciate Ligament Reconstruction: Analysis of Nearly 250,000 Patients in the United States
Authors: Halperin Scott J. , Prenner Sofia , Dhodapkar Meera M. , Santos Estevao , Medvecky Michael J. , Grauer Jonathan N. 
Published: December 2024

Background: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed orthopaedic procedure. As the number of ACLRs continues to increase in incidence, understanding the variability and drivers of cost to the health care system may help target cost-saving measures. Purposes: To examine the variability in overall 90-day reimbursements (amount paid for health care services) for ACLR using a national, multi-insurance, administrative database and to assess factors associated with variability. Study Design: Cross-sectional study. Methods: Using the M151 PearlDiver data set (data from 2010 to April 30, 2021), the authors identified the 90-day total reimbursements in patients who underwent ACLR. Patient age, sex, and comorbidity burden; insurance type; inpatient versus outpatient surgery status; and 90-day postoperative adverse events were determined and were correlated with overall reimbursements using multivariable logistic regression. Results: A total of 249,484 patients who underwent ACLR during the study period were identified. The mean patient age was 31.6 ± 13.58 years, 50.3% were female, the mean Elixhauser Comorbidity Index (ECI) was 1.4 ± 1.8, and procedures were performed on an outpatient basis for 245,507 patients (98.4%). Insurance type was commercial for 220,284 patients (88.3%), Medicaid for 17,660 (7.1%), and Medicare for 3500 (1.4%). The mean overall 90-day reimbursement was $4281.91 ± $4982.61 (median [interquartile range], $3032 [$1681-5142]), and the total reimbursement for the patient cohort was $1,049,250,747. On multivariable linear regression, the variables independently associated with the greatest changes in overall reimbursement were (in decreasing order) hospital readmission (+$17,675.23), adverse events (+$1554.14), inpatient procedure (+$1246.51), and emergency department visits (+$784.06). Lesser but significant associations were found with greater ECI (+$252.30) and female sex (+$101.01). Decreased overall reimbursement was associated with older age (−$12.19) and Medicare (−$883.48)/Medicaid (−$493.18) relative to commercial insurance. Conclusion: In the current study, large variability was found in overall ACLR reimbursement/cost within the health care system. Hospital admissions (inpatient surgery and readmission) and adverse events were associated with the greatest increase in costs and emphasize the need to optimize these metrics above and beyond patient experience.
The potential carcinogenicity of orthopaedic implants – a scoping review
Authors: Sun Cherry W.Y. , Lau Lawrence C.M. , Cheung Jason P.Y. , Choi Siu-Wai 
Published: December 2024

Abstract
Background
Every year, hundreds of thousands of patients receive an orthopaedic or dental implant containing metals such as cobalt, chromium and titanium. Since the European Chemicals Agency (2020) classified pure cobalt metal as a Category 1B carcinogen, manufacturers of products containing ≥ 0.1% of this metal must perform a risk assessment and justify that there are no viable alternatives. The up-classification of cobalt metal to a carcinogen without good evidence that its use in implants is carcinogenic may cause unnecessary concern to the many patients who have, or may require such implants. Although in vitro and animal studies have shown such metals to be carcinogenic, human epidemiological studies have not been definitive. In addition, although many advances have been made in the past few decades with regard to the materials used in implant metals, no recent review of their carcinogenic effects have been published.

Methods
This scoping review aims to summarise epidemiological studies conducted in recent years (from 2010 to present) to outline the carcinogenic effects of orthopaedic metal implants that have been published. This encompasses implants of different materials and surfaces, including metal, polyethylene and ceramic orthopaedic implants, cemented and cementless joint replacement surgeries, and surgical techniques such as resurfacing and total joint replacements that are currently in use and the potential carcinogenicity related to their use. Research papers with various study designs published in the English language were included. Studies were excluded if participants had a prior history of cancer before receiving orthopaedic implants and if they focused solely on the carcinogenicity of metals or materials not related to orthopaedic implants.

Results
A total of 16 studies, encompassing over 700,000 implant patients, were identified through PubMed and have been included in this review. In long term follow-up of up to 17.9 years, no increased risk of all-site cancer was seen in these patients. However, an increase in site-specific cancers, namely prostate, melanoma and haematological cancers have been identified. Specifically, an increase in prostate cancer was identified in three studies.

Conclusion
Based on the summarised evidence, there is no consistent evidence to show that patients with any type of orthopaedic implant has an increased risk of cancer, although slight (non-statistically significant) increases in prostate cancer was observed and this, in particular, deserves longer-term surveillance.
A pilot study of a gratitude journaling intervention to enhance spiritual well-being and exercise self-efficacy in Black breast cancer survivors
Authors: Cousin Lakeshia , Braithwaite Dejana , Anton Stephen , Zhang Zhongyue , Lee Ji-Hyun , Leewenburgh Christiaan , Lyon Debra 
Published: December 2024

Abstract
Background
Breast cancer (BC) survivorship presents significant health disparities, particularly affecting Black women, who experience a 40% higher BC death rate compared to White women. These disparities are exacerbated by comorbidities, which contribute to poorer overall health outcomes. Additionally, Black BC survivors often face psychosocial challenges, including increased stress and lower well-being, which can lead to adverse physical health effects. This pilot study aims to assess the feasibility and efficacy of a culturally sensitive gratitude journaling intervention designed to enhance spiritual well-being, exercise self-efficacy, and reduce inflammation among Black BC survivors.

Methods
This pilot study employed a two-group, parallel random-assignment experimental design to compare a gratitude journaling intervention with a general memory journaling control group. Twenty-six Black women aged 40 to 70 years with a history of BC were randomly assigned to either the gratitude journaling intervention group (n = 13) or the control group (n = 13). The gratitude intervention group engaged in gratitude journaling twice weekly for eight weeks, while the control group documented daily memories. Outcomes measured included Gratitude Questionnaire-6, FACIT-Spiritual Well-Being 12 Item Scale, Perceived Stress Scale, Giscombe Superwoman Schema Questionnaire, and the Stage of Motivational Readiness for Physical Activity questionnaire and inflammatory biomarkers. Statistical analyses included the Wilcoxon rank sum test and Fisher’s exact test.

Results
Twenty-six participants were enrolled, with 73% completing baseline and post-intervention assessments. The intervention group showed a significant improvement in spiritual well-being (p = 0.014) with a large effect size (ES = 0.57). Marginal improvements in exercise self-efficacy were also observed (ES = 0.39). Although there were no significant differences in dispositional gratitude and perceived stress between groups, the intervention group exhibited trends toward increased gratitude and reduced stress. Inflammatory biomarker analysis indicated non-significant changes, though IL-6 levels increased in the intervention group.

Conclusion
This study demonstrates the feasibility and acceptability of a gratitude journaling intervention among Black BC survivors. The intervention significantly enhanced spiritual well-being and showed promise in improving exercise self-efficacy, suggesting its potential for promoting holistic wellness in this population. These findings provide a foundation for future larger-scale randomized controlled trials to further evaluate the efficacy of gratitude-based interventions for Black BC survivors.

Trial registration
This study was registered prospectively at ClinicalTrials.gov (NCT05473026) on 07-13-2022.
Characterising the activity, lifestyle behaviours and health outcomes of UK university students: an observational cohort study with a focus on gender and ethnicity
Authors: Savage Matthew J. , Procter Eleanor L. , Magistro Daniele , Hennis Philip J. , Donaldson James , Leslie-Walker Anika , Jones Bethany A. , James Ruth M. 
Published: December 2024

Abstract
Background
Health-related outcomes and behaviours in university students are known to be poor relative to the general population. The substantial contextual shifts related to the COVID-19 pandemic, combined with increased numbers of students from minoritised ethnicity backgrounds and presenting as trans and gender diverse (TGD), means that up-to-date information is unavailable. The primary aim of this study was therefore to characterise the current movement, dietary and lifestyle behaviours, mental health, and Body Mass Index (BMI) of UK university students and assess differences between genders and ethnic groups.

Methods
An online, self-report survey was administered across three years (2021–2023). Three independent cohorts of university students’ (n = 6,327) completed the survey on four key topic areas. One-way ANOVAs were used to assess differences between genders (men, women, TGD), and independent samples t-tests were used to assess differences between ethnic groups (White, Minoritised Ethnicity).

Results
30% of students were not meeting physical activity guidelines, 54% were sedentary for ≥ 6 h·d− 1, 83% had poor diet quality, 51% were in high or increased risk groups for alcohol consumption, 18% experienced terrible or poor sleep quality, and 32% were overweight or obese. Gender differences were present for all variables other than walking physical activity (WPA) (P < 0.05), with men having better mental health and engaging in healthier movement and sleeping behaviours, whereas women had more healthful dietary and drinking behaviours, and TGD students had poorer outcomes compared to cis-gender students in most domains. Differences between White and minoritised ethnicity students were present for all variables other than sedentary behaviour, diet quality, WPA and BMI (P < 0.05); students of minoritised ethnicity engaged in better movement, drinking and sleep behaviours in addition to having more positive mental health than White students.

Conclusion
The findings of the current study provide an update on the landscape of UK university students’ health and health-related behaviours. Overall, health-related outcomes and behaviours are poor in this population and these data suggest that gender and ethnicity play a role in determining students’ health and health-related behaviours. Therefore, these factors should be considered when developing strategies to promote healthy living in the context of higher education.
Evaluating maternal death surveillance and response system in Sunyani Municipality of Bono region in Ghana from 2017-2021
Authors: Ngegbai Amara S. , Kuma George Khumalo , Noora Charles L. , Maya Ernest Tei , Guure Chris 
Published: December 2024

Abstract
Introduction
Maternal death rates in Ghana have decreased overall but remain high in rural areas. The Maternal Death Surveillance and Response System (MDSR) aims to eliminate preventable maternal deaths effectively. However, its effectiveness is less pronounced at district and subdistrict levels than at national and regional levels. Despite the requirement for periodic evaluation, there is a lack of evidence supporting these assessments. This study focuses on evaluating the MDSR in Sunyani Municipal.

Methods
The evaluation was conducted using a cross-sectional design, using both qualitative and quantitative approaches. Data from the District Health Information Management Systems (DHIMS) and the maternal death line list from January 2017 to December 2021 on maternal deaths were reviewed. Stakeholders, including health professionals, were interviewed. The means, proportions, and other statistical measures were calculated using Epi Info Version 7. Qualitative data underwent content analysis, and the results were visually presented in tables and flowcharts to illustrate the flow of surveillance information.

Results
Most respondents were female, constituting 51.4% (19/37), with midwives comprising the largest group at 32.4% (12/37). Approximately 75.7% (28/37) were able to explain how the surveillance data has been used for public health action. The notification and reporting process was clear to 85% (17/20) of respondents. Although 94.6% (35/37) expressed willingness to notify and participate in audits at facility and community levels, the audits remained facility-based. All facilities consistently reported maternal deaths, but data storage equipment was lacking. Approximately 80% (20/25) of forms were reported within 24 h, and 88% (22/25) were investigated within seven days. Only 68% (17/25) of forms were filled out correctly, with no municipal and facility-level line list. All reported deaths came from healthcare facilities, with no community-reported maternal deaths.

Conclusions
The MDSR system in Sunyani Municipal demonstrates high awareness and willingness to participate among healthcare providers but faces challenges in data accuracy and community engagement. Death audits remain facility-based, and the lack of community-reported maternal deaths and municipal-level line lists indicates gaps in comprehensive reporting and data management. To improve the system, it is recommended that community case searches be enhanced for better reporting and to address data management issues by ensuring proper data quality assessment.
Relationships between neurodivergence status and adverse childhood experiences, and impacts on health, wellbeing, and criminal justice outcomes: findings from a regional household survey study in England
Authors: Wilson Charley , Butler Nadia , Quigg Zara , Moore David , Bellis Mark 
Published: December 2024

Abstract
Background
Evidence indicates that neurodivergent (ND) populations may be more at risk of experiencing adverse childhood experiences (ACEs), compared to neurotypical (NT) populations. However, this evidence has typically not examined a comprehensive set of ACEs and has only included ND individuals on the basis that they have a diagnosis. Very little research has examined the impacts of ACEs on negative adulthood outcomes for ND populations. The current study aimed to examine the associations between neurodivergence and experiences of ACEs, and the impact of being ND and experiencing ACEs on health, wellbeing, and criminal justice outcomes.

Methods
From November 2023 to April 2024, a household survey using representative sampling was undertaken with 5395 residents of an English region aged 18 + years. Neurodivergence status was measured using one self-report item. Nine ACEs were measured using validated self-report items. Outcome measures included: poor general health, low mental wellbeing, ever being arrested, and ever being incarcerated. Multinomial regression models were used to examine relationships between neurodivergence status and ACEs. Binary logistic regression models were used to examine independent relationships between neurodivergence status and ACE count and each outcome measure. Generalised linear models with an estimated marginal means function were used to estimate the increased risk of each outcome for different combinations of neurodivergence and ACE count status (NT less than four ACEs (reference group), NT 4 + ACEs, ND less than four ACEs, ND 4 + ACEs).

Results
A higher proportion of ND individuals experienced each ACE type than NT individuals. While controlling for sociodemographics, ND individuals were more likely to experience a greater number of ACEs than their NT peers. While controlling for sociodemographics, each outcome measure was more likely amongst those who were ND, and each outcome measure except for poor general health was more likely amongst those with higher ACE counts.

Conclusions
The combination of being ND and experiencing ACEs could additively increase risks of experiencing poor wellbeing and criminal justice outcomes by a greater extent than expected. Preventing and responding to ACEs in ND populations should be a priority to reduce risks of poor health, wellbeing, and criminal justice outcomes in this population.
Unravelling the cardio-renal-metabolic-foot connection in people with diabetes-related foot ulceration: a narrative review
Authors: Lan Nick S. R. , Dwivedi Girish , Fegan P. Gerry , Game Fran , Hamilton Emma J. 
Published: December 2024

AbstractDiabetes-related foot ulceration (DFU), a serious but preventable complication of diabetes, is a leading cause of hospitalisation, lower extremity amputation and disability worldwide. People with DFU have a greater burden of cardiovascular risk factors, heart failure and chronic kidney disease, resulting in over two-fold higher risk of cardiovascular death compared with people with diabetes without DFU. Here, we propose a “cardio-renal-metabolic-foot” connection in people with diabetes based on shared pathophysiological mechanisms linking DFU with cardiovascular and renal disease. Whilst these mechanistic links remain to be fully elucidated, systemic inflammation and infection in the context of DFU are postulated as key mediators in the development, and progression of, cardiovascular and renal disease. However, cardiovascular and renal disease are also implicated in the pathogenesis of DFU, highlighting the multi-directional interplay between conditions. The impact of screening, prevention, and early management of cardiovascular complications associated with DFU requires further research. Multi-modality cardiac imaging could play a role in unravelling disease mechanisms leading to novel therapeutic strategies, as well as facilitating personalised risk assessment and management. Recent clinical trials have transformed the therapeutic landscape for people with type 2 diabetes, by demonstrating that sodium glucose co-transporter 2 inhibitors, glucagon-like peptide-1 agonists and non-steroidal mineralocorticoid receptor antagonists improve cardiovascular and renal outcomes. Although dedicated research in people with DFU is warranted, these therapies could target multiple facets of the “cardio-renal-metabolic-foot” connection. The holistic, person-centred approach to managing DFU should incorporate new multidisciplinary models of care focusing on the prevention and management of cardiovascular and kidney disease.
Graphical abstract
The cardio-renal-metabolic-foot connection in people with diabetes. There is a critical need for (1) a better understanding of mechanisms connecting DFU with cardiovascular and kidney disease, perhaps guided by cardiac imaging, novel biomarkers, multi-omics and artificial intelligence to facilitate current treatments and the development of novel therapeutic strategies, (2) more data from clinical trials, registries and biobanks to inform clinical guidelines and evidence-based medicine, and (3) health system-wide integration of structured models of care with a contemporary emphasis on cardio-renal-metabolic-foot health to improve patient outcomes. DFU diabetes-related foot ulceration. Created with BioRender.com
Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction
Authors: Chen Yang , Yang Zhenkun , Liu Yang , Li Yuanjie , Zhong Ziyi , McDowell Garry , Ditchfield Coleen , Guo Taipu , Yang Mingjuan , Zhang Rui , Huang Bi , Gue Ying , Lip Gregory Y. H. 
Published: December 2024

Abstract
Background
The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.

Methods
We included first-ever stroke patients from the eICU Collaborative Research Database in 2014–2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital’s ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.

Results
The primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0–68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0–77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38–2.66) and hospital (HR 1.69, 95% CI 1.32–2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).

Conclusion
TyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.
Tension at the gate: sensing mechanical forces at the blood–brain barrier in health and disease
Authors: Hansen Cathrin E. , Hollaus David , Kamermans Alwin , de Vries Helga E. 
Published: December 2024

AbstractMicrovascular brain endothelial cells tightly limit the entry of blood components and peripheral cells into the brain by forming the blood–brain barrier (BBB). The BBB is regulated by a cascade of mechanical and chemical signals including shear stress and elasticity of the adjacent endothelial basement membrane (BM). During physiological aging, but especially in neurological diseases including multiple sclerosis (MS), stroke, small vessel disease, and Alzheimer’s disease (AD), the BBB is exposed to inflammation, rigidity changes of the BM, and disturbed cerebral blood flow (CBF). These altered forces lead to increased vascular permeability, reduced endothelial reactivity to vasoactive mediators, and promote leukocyte transmigration. Whereas the molecular players involved in leukocyte infiltration have been described in detail, the importance of mechanical signalling throughout this process has only recently been recognized. Here, we review relevant features of mechanical forces acting on the BBB under healthy and pathological conditions, as well as the endothelial mechanosensory elements detecting and responding to altered forces. We demonstrate the underlying complexity by focussing on the family of transient receptor potential (TRP) ion channels. A better understanding of these processes will provide insights into the pathogenesis of several neurological disorders and new potential leads for treatment.