bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of digital skills on health: Evidence from the China General Social Survey
Authors: Qin Cheng , Zhu Yuchen , Li Donglin , Liu Can 
Published: December 2024

Objective The widespread penetration of the internet and digital technology have profoundly impacted the global economy and people's lives. Although the impact of digital skills on social development and personal lifestyles is well-documented, their influence on health and health inequalities remains underexplored. This study aims to analyze the impact of digital skills on health and health inequalities and to investigate the underlying mechanisms. Methods This study utilized cross-sectional data from the 2017 China General Social Survey ( N = 2195). We employed the Ordered Probit (O-Probit) model and ordinary least squares regression to examine the impact of digital skills on health and explore the underlying mechanisms. Health inequalities across different groups were measured using the health concentration index. Results Enhancing digital skills enhances population health by boosting economic status, increasing social participation, and improving access to information. However, the impact varies by age and residence. Digital skills have a stronger effect on the health of young and middle-aged individuals, as well as urban residents, compared to older adults and rural populations. Furthermore, digital skills exacerbate health inequalities, benefiting high-income groups and widening the gap between income levels. Conclusions Widespread promotion and continuous improvement of digital skills are key to enhancing public health. We need to focus on the popularization of digital skills and the construction of digital infrastructure for low-income disadvantaged groups and rural areas, as well as use various means to reduce group and regional differences in the impact of digital skills on health conditions.
Exploring the complexities of epigenetics in multiple sclerosis: A study involving meta-analysis of DNA methylation profiles, epigenetic drift, and rare epivariations
Authors: Baldrighi Giulia Nicole , Cavagnola Rebecca , Sacco Davide , Costantino Lucy , Bernardinelli Luisa , Gentilini Davide 
Published: December 2024

Background Multiple sclerosis (MS) is an autoimmune condition characterized by inflammatory and neurodegenerative traits. Recently, DNA methylation has emerged as a promising field of investigation for elucidating dynamics characterizing MS development and progression. Objectives This study aimed to comprehensively investigate the role of epigenetics in MS by analyzing the methylation profiles from blood and brain tissues from public datasets. Methods Employing a meta-analytical framework for differential methylation analyses, the study extended beyond conventional analyses to explore additional dimensions of epigenetic regulation, including epigenetic drift, age acceleration, and rare epivariations. Results Results of the differential methylation analysis were in line with previously reported findings. No significant differences were observed in age acceleration or global epigenetic drift between MS cases and controls. However, upon closer analysis at the gene level, distinctive patterns of epigenetic drift emerged, particularly within genes implicated in neural biological functions. Conclusions These findings underscore the role of epigenetic modifications in shaping MS pathology. Furthermore, the study unveiled the exclusive presence of rare epivariations within the MS cases, some of which involved genes previously linked to MS or other autoimmune diseases. This highlights the potential significance of rare genetic aberrations in driving MS susceptibility and progression.
Lumbar Spinal Fusion Outcomes in Patients With Cancer Compared to Matched Peers Without Cancer
Authors: Gallagher Ryan S. , Karsalia Ritesh , Xu Emily , Wathen Connor A. , Borja Austin J. , Na Jianbo , Collier Tara , McClintock Scott , Malhotra Neil R. 
Published: December 2024

Study Design Retrospective Matched Cohort Study. Objectives Optimization of medical comorbidities is an essential part of preoperative management. However, the isolated effects of individual comorbidities have not been evaluated within a homogenous spine surgery population. This exact matching study aims to assess the independent effects of cancer on outcomes following single-level lumbar fusions for non-cancer surgery. Methods 4680 consecutive patients undergoing single-level posterior-only lumbar fusion were retrospectively enrolled. Univariate statistics and coarsened exact matching (CEM) were computed to evaluate outcomes between cancer patients and those without comorbidities. Results By logistic regression, malignancy conferred a higher risk of surgical complication ( P = 0.016, OR = 2.64, CI = [1.200,5.790]), 30- and 90- day readmission ( P = 0.012, OR = 2.025, CI = [1.170-3.510]; P < 0.001, OR = 2.34, CI = [1.430, 3.830], respectively), 90-day reoperation ( P < 0.001, OR = 2.16, [1.110, 4.200]), and death at 90-days ( P = 0.032, OR = 8.27, CI = [1.200, 56.850]). After matching, malignancy was associated with increased odds of incidental durotomy (6 vs 0 cases, P = 0.048) and death at both 30 and 90 days (both: OR = 8.0, P = 0.020, CI = [1.00, 63.960]). No cases of durotomy occurred in cases with mortality in the matched sample, suggesting independent relationships. There were no differences in length of stay, non-home discharge, ED evaluation, readmission, or reoperations. Conclusion Among otherwise exact-matched patients undergoing single level lumbar fusion, history of malignancy conferred a higher risk of short-term mortality, but not other outcomes suggestive of surgical failure. Increased mortality after lumbar fusion should be studied further and may play a role in surgical decision-making and patient discussions.
Risk and Prognosis of Hamstring Injuries in the National Football League: A 12-Year Review
Authors: Jenkins Ryne , Bianchi John , Watson Jeremy , Shinners Jason , Jaisinghani Pooja , Spain Brett , Ruotolo Charles 
Published: December 2024

Background: Hamstring injuries can have a significant burden on a professional football player's career and performance. One in 4 players will suffer a lower extremity strain in their career, with the hamstring being the most common. These injuries are often fraught with extended periods of recovery and reinjury rates varying between 16% and 38%. Purpose: To determine the progression and duration of hamstring injury as well as risk factors and probability of reinjury in the National Football League (NFL). Study Design: Descriptive epidemiology study. Methods: Data were extracted from the official publicly accessible NFL database of injuries. NFL players suffering a hamstring injury during the study period of 2008-2020 were identified. Injuries were reported weekly as mandated by the NFL. Players were deemed cleared from injury when no longer listed in the injury report (IR). Reinjury was defined as any subsequent hamstring injury after a player's initial injury. The duration of injury and factors associated with injury were analyzed. Secondary objectives included team-specific injury rates and timing of injury. Results: A total of 2101 hamstring injuries occurred among 1354 players. The mean duration of the IR was 2.4 ± 2.1 weeks. A total of 442 (33%) players suffered subsequent reinjury, 27% of which occurred during the same season. The mean duration on the IR for reinjury was 2.4 ± 1.8 weeks, with no significant difference in duration compared with initial injury (2.4 ± 1.8 vs 2.2 ± 1.7; P = .138). Defensive skill players were most frequently injured (50.4%) followed by offensive skill players (37.7%). Of the 4812 total IR listings, 1806 (38%) did not participate in practice. A total of 1590 (33.5%) had limited participation in practice, and 1353 (28.5%) had full participation in practice. Injury rates among teams varied and ranged from 0.6% (Baltimore Ravens) to 5.7% (Houston Texans), with a median of 3.1% ( P < .0001). Conclusion: Hamstring injuries can have a lasting impact on a player's career with more than a third of players suffering subsequent reinjury. Although suffering a hamstring injury predisposes a player to reinjury, previous injury was not associated with longer recovery times. Rates of injury among organizational teams vary; thus, further research to understand the difference in preventive measures and treatment protocols may be warranted.
Comparison of Clinical Outcomes Between Arthroscopic Rotator Cuff Repair and Reverse Total Shoulder Arthroplasty in Patients With Massive Rotator Cuff Tears and High-Grade Fatty Atrophy Without Glenohumeral Osteoarthritis
Authors: Gonzalez-Morgado Diego , Hoffman Tammy R. , Ardebol Javier , Noble Matthew B. , Galasso Lisa A. , Nugent Matthew , Phillips Cameron , Denard Patrick J. 
Published: December 2024

Background: Despite the effectiveness of reverse total shoulder arthroplasty (RSA) and arthroscopic rotator cuff repair (ARCR) for treating massive rotator cuff tears (MRCTs), controversies remain in patients without glenohumeral osteoarthritis (GHOA). Purpose: To compare clinical outcomes of ARCR or RSA in patients with MRCT with high-grade fatty atrophy without GHOA. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective study on patients with MRCTs without GHOA and with grades 3 or 4 Goutallier muscle changes who underwent ARCR or RSA, with a minimum 2-year follow-up. Range of motion (ROM) and patient-reported outcomes (PROs) were collected—including visual analog scale for pain, American Shoulder and Elbow Surgeons score, Veterans Rand 12-Item Health survey, and Subjective Shoulder Value. Postoperative results were compared based on rotator cuff tendon healing in the ARCR group. Results: A total of 81 patients met the study criteria—56 underwent ARCR and 25 underwent RSA. Patients in the RSA (age, 71.7 ± 7.7 years) group were older than those in the ARCR (age, 66.7 ± 7.4 years) group ( P = .01) and more likely to have pseudoparalysis (52% vs 21.4%; P = .016). The mean follow-up for the ARCR and RSA groups was 56.5 ± 19 months and 36.1 ± 7.6 months, respectively ( P < .001). The rate of patients with ≥2 tendons with grade 3 or 4 changes was higher in the RSA group compared with the ARCR group: 96% versus 47% ( P < .001). PROs significantly improved after surgery in both groups ( P < .05). Postoperative forward flexion (FF) and internal rotation were higher after ARCR compared with RSA—144°± 22° versus 113°± 25° and L3 ± L4 versus S1 ± S2, respectively ( P <.001 and P = .002, respectively). Also, 31 of the rotator cuff repairs (55%) healed. PROs were similar between the healed and unhealed ARCR groups, with the only difference observed in postoperative FF—150°± 18° in the healed group versus 136°± 26° in the unhealed group ( P = .044). Conclusion: Both ARCR and RSA improved functional outcomes in patients with MRCT without GHOA. While healing was moderate after ARCR, the postoperative ROM was greater after ARCR compared with RSA in appropriately selected patients. Moreover, healed rotator cuffs demonstrated improved postoperative FF compared with unhealed repairs.
A conceptual framework for assessing implementation strategy integrity
Authors: Molfenter Todd , Ducharme Lori , Stein Lynda , Belenko Steven , Mitchell Shannon Gwin , Watson Dennis P. , Aalsma Matthew C. , Friedmann Peter D. , Becan Jennifer E. , Garner Bryan R. , Vechinski Jessica , Bouris Alida , Claypool Emily , Elkington Kate 
Published: December 2024

Background The outcomes of planned implementation efforts have been mixed, with some applications failing to achieve the desired change or impact. While reasons for mixed findings in implementation research are multifaceted (e.g., Damschroder et al., 2009, 2022), how the implementation strategy (IS) was deployed (i.e., integrity) and its impact on the implementation outcomes of evidence-based innovations (EBIs) is under-studied and warrants further clarification. Method This article builds on the IS fidelity and mechanisms of change literature to create the Implementation Strategy Integrity Framework (ISIF). The ISIF was developed by a set of implementation science researchers in the Justice Community Opioid Innovation Network seeking to document the role of implementation strategies in influencing EBI outcomes. Results The authors identified four areas of documentation and measurement to examine the role of IS integrity on EBI outcomes. (a) Implementation Strategy Rigor (i.e., adherence, dose, and quality) requires those implementing the strategy/strategies to specify them, document adherence to the planned strategies, quality of execution, and any adaptations made. (b) Target User Responsiveness documents the extent and quality of targeted users’ participation in IS activities and how well the target users perform their roles in conducting actions intended by the implementation strategies. (c) Target Mechanism Activation notes to what degree the implementation strategies achieved the intended impact(s) on targeted factors that facilitate EBI use. Finally, (d) these three areas are combined with selected Inner and Outer Context variables to explain IS integrity’s potential moderating and mediating effects on EBI outcomes. Conclusions A framework that can define the integrity of an IS and allow for its subsequent use as an explanatory variable in EBI outcomes is necessary for better elucidating mechanisms of action. The ISIF offers a structured approach to operationalize, measure, and evaluate the application and related impacts of implementation strategies.
Impact of Malnutrition on Patients with Sickle Cell Anemia Hospitalized with Vaso-Occlusive Crisis: A US Collaborative Network Cohort Study
Authors: Byfield Karecia , Jones Colton Frisco , Obomanu Elvis , Syal Arshi , Arya Yajur , Mayo Ryan J 
Published: December 2024

Background
Malnutrition is frequently seen in patients with sickle cell anemia (SCA). It is associated with a weakened immune system and reduced pain threshold, increasing the risk of vaso-occlusive pain crises (VOC). However, its impact on the clinical outcomes of patients hospitalized for vaso-occlusive crises remains unclear. Therefore, we conducted a national-level cohort study to elucidate these outcomes.
Methods
We used data from the US Collaborative Network-TriNetX to evaluate the impact of malnutrition on patients with SCA who were hospitalized for VOC. Patients were divided into two cohorts: those with malnutrition, identified by the relevant ICD-10 codes, and those without. The malnutrition cohort was propensity score matched with a control group based on age, sex, gender, and various comorbidities. They were followed for 30 days post-hospitalization to assess outcomes such as mortality, need for transfusion, splenic infarction, stroke, myocardial infarction, acute kidney injury, and readmission.
Results
After propensity score matching, each cohort consisted of 1,517 patients with similar baseline characteristics. The mean age for both cohorts was 32 years, with the malnutrition cohort being 51% female and the non-malnutrition cohort 53% female. The ethnic distribution was 67% Black, 12% White, and the remainder of unknown ethnicity. Our analysis found that within 30 days post-hospitalization, the cohort with malnutrition had a significantly higher risk of mortality (RR: 3.05, 95% CI: 1.93-4.81, P&lt;0.001), need for blood transfusion (RR: 2.17, 95% CI: 1.68-2.81, P&lt;0.001), ischemic stroke (RR: 1.98, 95% CI: 1.07-3.69, P&lt;0.001), and myocardial infarction (RR: 1.97, 95% CI: 1.12-3.46, P&lt;0.001). There was also an increased risk of acute kidney injury (RR: 2.57, 95% CI: 1.94-3.41, P&lt;0.001) and readmission (RR: 2.34, 95% CI: 2.00-2.74, P&lt;0.001). There was no significant difference in the occurrence of acute chest syndrome or splenic infarction.
Conclusion
Our study reveals that malnutrition in patients with SCA hospitalized for VOC is significantly associated with a heightened risk of adverse outcomes, including increased mortality, ischemic stroke, myocardial infarction, and acute kidney injury. A multidisciplinary approach to managing malnutrition in sickle cell anemia is essential to improving survival and outcomes in these patients.
Long-term safety and efficacy of fitusiran prophylaxis, and perioperative management, in people with hemophilia A or B
Authors: Pipe Steven W. , Lissitchkov Toshko , Georgiev Pencho , Mangles Sarah , Hegemann Inga , Trinchero Alice , Chowdary Pratima , Forbes Adam , Feng Liqi , Menapace Laurel A. , Kichou Salim , Andersson Shauna , Demissie Marek , Ragni Margaret V. 
Published: December 2024

Abstract
Fitusiran is an investigational small interfering RNA therapeutic that targets antithrombin (AT) to rebalance hemostasis in people with hemophilia. Here, we present the results of a completed phase 2 open-label extension study, which evaluated the long-term safety and efficacy of fitusiran in participants with moderate or severe hemophilia A or B, with or without inhibitors. Male participants who had completed the phase 1 study (ClinicalTrials.gov identifier: NCT02035605) were enrolled. Participants received monthly subcutaneous fitusiran (50 or 80 mg) under the original dose regimen until a voluntary dosing pause in 2020, after which the AT-based dose regimen was introduced, targeting the recommended AT activity levels of 15% to 35%. Thirty-four participants (hemophilia A, n = 27; hemophilia B, n = 7) were enrolled in the phase 2 study and treated with fitusiran for a median exposure of 4.1 years. Adverse events reported on the original and the AT-based dose regimen were consistent with the identified risks of fitusiran. After implementation of the AT-based dose regimen, there were no thrombotic events, and a reduction in the incidence of elevated transaminases and biliary events was reported. The observed median annualized bleed rate (ABR) on the AT-based dose regimen (0.87) was comparable with the ABR under the original dose regimen (0.70). Furthermore, fitusiran prophylaxis was associated with improved health-related quality of life compared with baseline and provided successful hemostatic control during surgical procedures and invasive interventions. Overall, fitusiran was well tolerated, and effective bleeding control was maintained on an AT-based dose regimen. This trial was registered at www.clinicaltrials.gov as #NCT02554773.
Targeting hardship: poverty as a modifiable risk factor in childhood leukemia and lymphoma treatment
Authors: Umaretiya Puja J. , Aziz-Bose Rahela , Kelly Colleen , Bona Kira 
Published: December 2024

Abstract
Racial, ethnic, and socioeconomic survival disparities have been well-demonstrated across population-based and clinical trial datasets in pediatric hematologic malignancies. To date, these analyses have relied on trial-collected data such as race, ethnicity, insurance, and zip code. These exposures serve as proxies for factors such as structural racism, genetic ancestry, and adverse social determinants of health (SDOH). Systematic measurement of SDOH and social needs—and interventions targeting these needs—are feasible in pediatric oncology. We use these data to present a roadmap for the next decade of health equity research to identify actionable mechanisms and develop a portfolio of interventions to advance equitable outcomes across pediatric hematologic malignancies.
Ph+ ALL: new approaches for upfront therapy
Authors: Luskin Marlise R. 
Published: December 2024

Abstract
Philadelphia chromosome-positive (Ph+) ALL is the most common genetic subtype of ALL and primarily affects adults. Ph+ ALL is characterized by the constitutively active ABL1 kinase and is resistant to conventional chemotherapy. Thus, Ph+ ALL was historically associated with a dismal prognosis, particularly among patients who did not undergo allogeneic hematopoietic stem cell transplantation (alloHCT) in first complete remission (CR). Imatinib, the first tyrosine kinase inhibitor (TKI) effective against ABL1, transformed the treatment and prognosis of Ph+ ALL, allowing more patients to achieve CR and become eligible for alloHCT, thereby improving outcomes. In recent years, there has been an improved understanding of the biology of Ph+ ALL, including recognition of distinct subtypes (multilineage and lymphoblast-only Ph+ ALL). There has also been a dramatic expansion of effective therapeutic and diagnostic tools for management of Ph+ ALL, including more potent TKIs, which have activity against ABL kinase–resistance mutations; refinement of the chemotherapy and alloHCT regimens that accompany TKI therapy; introduction of immunotherapy (blinatumomab); and better assays for measurable residual disease monitoring. This article reviews recent advancements and future directions for the initial treatment of Ph+ ALL in adults.
Late complications and long-term care of adult CAR T-cell patients
Authors: Bishop Michael R. 
Published: December 2024

Abstract
The success of chimeric antigen receptor (CAR) T-cell therapy in adult patients with hematologic malignancies has resulted in a large number of long-term survivors who may experience late complications distinct from those in the early CAR T-cell treatment period. These late complications, defined as occurring more than 90 days after CAR T-cell infusion, include cytopenias, infections, secondary malignancies, and delayed neurotoxicities. Late cytopenias may be from prolonged recovery after lymphodepleting (LD) chemotherapy or arise anew, raising concerns for recurrent primary disease or a secondary malignancy. Cytopenias are treated with supportive care, hematopoietic cytokines, and, occasionally, hematopoietic stem cell support. LD chemotherapy profoundly affects B, T, and natural killer cells. CD19 and B-cell maturation antigen are expressed on normal B cells and plasma cells, respectively, and the targeting of these structures by CAR T-cell products can result in prolonged lymphopenias and hypogammaglobulinemia, making infection an ongoing risk. Late infections are predominantly due to respiratory viruses, reactivation of herpes viruses, and Pneumocystis jirovecii. Patients may require ongoing prophylaxis and immunoglobulin replacement therapy. Although responses may be blunted, vaccinations are generally recommended for most adult CAR T-cell patients. Both hematologic and solid secondary malignancies are a known risk of CAR T-cell therapy; retroviruses used to produce CAR T-cell products have resulted in T-cell cancers secondary to insertional oncogenesis. It is essential to monitor for late complications in adult patients receiving CAR T-cells by using a multidisciplinary approach between referring hematologist oncologists and cell therapy centers to improve the outcomes and quality of life for these patients.
Common variable immunodeficiency: autoimmune cytopenias and advances in molecular diagnosis
Authors: Cunningham-Rundles Charlotte , Casanova Jean-Laurent , Boisson Bertrand 
Published: December 2024

Abstract
Common variable immunodeficiency (CVID) is one of the most common groups of human inborn errors of immunity. In addition to infections resulting from insufficient levels of immunoglobulins and antibodies, a significant proportion of patients develop autoimmune cytopenias, especially immune thrombocytopenia, hemolytic anemia, or neutropenia. They may be the initial manifestation of CVID in a patient who has not had significant infections, and similar episodes may recur at intervals over time. Treatment of these hematologic complications includes the use of corticosteroids or other medications, often including rituximab; splenectomy is discouraged. Here we outline the overall occurrence of these blood cytopenias in a cohort of 408 patients, as well as the clinical and genetic associations noted in these individuals.