bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subjective Causes for Failure to Return to Sport After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis
Authors: Yensen Katie , Mayfield Cory K. , Bolia Ioanna K , Palmer Ryan A. , Brown Michael , Kim Daniel R. , Abu-Zahra Maya S. , Kotlier Jacob L. , Webb Thomas , Cleary Emmett , Saboori Nima , Petrigliano Frank A. , Weber Alexander E. 
Published: March 2024

Context: While current literature has explored the outcomes of athletes who return to sport (RTS) after anterior cruciate ligament (ACL) injuries, less is known about the outcomes of those who are unsuccessful in returning to sport. Objective: To determine the rate of athletes who did not RTS after primary ACL reconstruction (ACLR) and to identify the specific subjective reasons for failure to RTS. Data Sources: A comprehensive search of the PubMed/MEDLINE, Scopus, and Web of Science databases was conducted through April 2021. Study Selection: Eligible studies included those explicitly reporting the rate of failure for RTS after ACLR as well as providing details on reasons for athletes’ inability to return; 31 studies met the inclusion criteria. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2 to 4. Data Extraction: The reasons for failure to RTS referred to in our study are derived from those established previously in the studies included. Data were collected on the number of athletes, mean age, mean follow-up time, type of sport played, failure to RTS rate, and specific reasons for failure to return. Results: The weighted rate of failure to RTS after ACLR was 25.5% (95% CI, 19.88-31.66). The estimated proportion of psychosocial-related reasons cited for failure to RTS was significantly greater than knee-related reasons for failure RTS (55.4% vs 44.6%, P < 0.01). The most cited reason for failure to RTS was fear of reinjury (33.0%). Conclusion: This study estimates the rate of failure to RTS after ACLR to be 25.5%, with the majority of athletes citing fear of reinjury as the major deterrent for returning to sports. We highlight how factors independent of surgical outcomes may impact an athlete’s ability to return to play given that the predominant reason for no RTS after ACLR was unrelated to the knee.
A Longitudinal Assessment of Self-directed Learning Readiness and Development in Medical Students
Authors: Roberts Megan , Darden Alix , Wiskur Brandt , Hill Molly 
Published: March 2024

OBJECTIVES Self-directed learning (SDL) competency is important for physicians to stay abreast of advances in their field and to provide the best available evidence-based care to their patients. Therefore, an essential responsibility of medical educators is to ensure the development of SDL skills in their students. The first objective of this study was to investigate longitudinally the degree to which medical students were ready to engage in SDL. The second objective was to examine students’ perceptions of their SDL development throughout training. METHODS A 2-part study of preclinical and clinical medical students was carried out at a midwestern U.S. university. In Study A, a longitudinal assessment of preclinical medical students’ readiness to engage in SDL was conducted by administering an SDL readiness survey (SDLRS). In Study B, third- and fourth-year medical students were asked to reflect on their SDL development, in addition to completing the SDLRS. RESULTS After validating the Hendry and Ginns version of the SDLRS in preclinical medical students during Study A, we found that 3 of the 4 subscales remained constant over the 3 iterations of the survey while the self-determination subscale increased significantly between the first and third iteration of the survey. In Study B, an analysis of the clinical medical students’ comments indicated a perceived increase in their SDL abilities and a growing appreciation of SDL. However, the SDLRS scores of clinical students did not differ from the results observed in preclinical students in Study A. CONCLUSIONS The results of the SDLRS indicated that the experience of students in our medical school has a positive influence on self-determination by the end of the preclinical years. Furthermore, analysis of the reflections of clinical students indicated ongoing development of SDL skills throughout their medical school training that were influenced by a wide range of experiences.
The Effect of Biological Sex on a County Pre-hospital Stroke Initiative
Authors: Rynor Helen , Nguyen Kelly , Oliva Jadthiel , Nirvanie-Persaud Lisa , Belnap Starlie C. , Rosa Felipe De Los Rios La 
Published: March 2024

Background Females are disproportionately affected by strokes when compared to males. This may be attributed to non-traditional stroke symptoms in females and stroke care sex variance. This study explored sex and ethnicity discrepancies in the FAST-ED and stroke outcomes. Methods An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored patient outcomes. We assessed two cohorts, the 2017 cohort collected one year after FAST-ED implementation, and the 2019 cohort collected two years after FAST-ED implementation. Inclusion criteria included patients aged ≥18 years arriving via EMS as a stroke alert; walk-ins were excluded. EMS FAST-ED compliance, FAST-ED score, final diagnoses, door to needle time (DTN), door to puncture (DTP) time, and stroke treatment volumes were evaluated for sex differences. Results 1,156 cases were analyzed, 638 (55%) were female. EMS FAST-ED compliance decreased by 17%, but did not differ by sex or ethnicity. EMS FAST-ED score was similar for females and males. Despite the similarity in FAST-ED score, females scored higher on the initial NIHSS ( F(1) = 6.25, p < .05) and discharge NIHSS ( F(1) = 8.588, p < .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p < .01, 95% CI [1.07–1.80]). Treatment rates did not vary between sex or ethnicity and overall DTN decreased by 10 minutes (2017 cohort M = 36 minutes, SE = 1.96; 2019 cohort M = 26 minutes, SE = 1.69). Conclusions The FAST-ED demonstrated equitable implementation and scoring among a diverse population, regardless of sex or ethnicity. Additionally, patients were equally likely to receive treatment, while benefiting from a decrease in DTN times.
Fresh Osteochondral Allograft to Medial Femoral Condyle With Proximal Tibial Opening Wedge Osteotomy
Authors: Shoemaker Evan P. , Tollefson Luke V. , Olson Conner , Kennedy Nicholas I. , LaPrade Robert F. 
Published: March 2024

Background: Contributors to knee degeneration include mechanical axis malalignment, patellar maltracking, meniscal deficiency, and tibiofemoral instability. Full-thickness osteochondral defects in young, active patients can lead to significant pain and instability. The gold standard treatment for large (>2 cm2) osteochondral defects is an osteochondral allograft (OCA) which addresses the pathologic articular cartilage loss and underlying bone deficiency. While biologic failure of fresh OCAs is reported, the majority of early failures are attributed to unaddressed mechanical malalignment in the coronal plane. Proximal tibial osteotomy (PTO) corrects malalignment thereby unloading the affected medial compartment and the newly placed OCA, improving long-term survivability. Indications: OCAs are indicated for isolated osteochondral defects and lesions in active young patients. PTO is indicated for patients with varus malalignment who risk potential graft failure of the affected medial compartment. Technique Description: The articular cartilage defect is identified, and a guide pin is drilled in the center. The defect is templated and scored around the margins. A reamer is used to drill to a total depth of 7 to 8 mm. The recipient site is then dilated for graft insertion. On the donor graft, the harvest site is outlined and drilled to the proper diameter. Careful measurement is utilized to ensure graft depth measurements match the recipient site. Once sized, the graft is tapped into place obtaining an anatomic fit along its entire periphery. The osteotomy is performed by using guide pins to delineate the plane cutting the tibia. Fluoroscopy confirmed the osteotomy site and angle. A spacing plate was securely inserted with screws, with placement confirmed by fluoroscopy. Results: Fresh OCAs can restore osteochondral defects. PTO corrects malalignment and unloads the affected medial compartment, decreasing the risk of revision graft failure or total knee arthroplasty. Discussion: Clinical and biomechanical studies that compared isolated and concomitant procedures demonstrated that OCA with PTOs had significantly greater survival rates. Significant malalignment increases the risk of graft failure. It remains unclear whether concomitant osteotomy with osteoarticular allografts leads to increased complication risk; inherent risks remain associated with individual procedures. In adolescents, simultaneous corrective osteotomy along with fresh OCA may delay arthroplasty and associated ambulatory restrictions. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Late cytomegalovirus disease after hematopoietic cell transplantation: significance of novel transplantation techniques
Authors: Sadowska-Klasa Alicja , Özkök Sezen , Xie Hu , Leisenring Wendy , Zamora Danniel , Seo Sachiko , Sheldon Jordan , Lee Stephanie J. , Jerome Keith R. , Green Margaret L. , Boeckh Michael 
Published: March 2024

Abstract
Preemptive therapy (PET) and letermovir prophylaxis are effective in preventing cytomegalovirus (CMV) disease within the first 100 days after allogeneic hematopoietic cell transplantation (HCT) but are associated with late-onset CMV disease. We retrospectively examined the clinical manifestations, risk factors, prevention algorithm, and outcome of late CMV disease in CMV seropositive day 100 survivors transplanted between 2001-2017 (PET cohort) and 2018-2021 (letermovir cohort). There were 203 episodes of late CMV disease among 2469 day 100 survivors, and the estimated cumulative incidence of first late CMV disease was 7.2% (95% confidence interval [CI], 6.2-8.3) with no difference between the PET (7.4%; 95% CI, 6.4-8.6) and the letermovir group (5.4%; 95% CI, 3.2-8.3). Thirty-seven patients (1.5%) had a second episode of CMV disease. In multivariable Cox regression models, posttransplant cyclophosphamide was associated with an increased risk of gastrointestinal CMV disease. CMV viremia or disease detected before day 100, corticosteroid treatment after day 100 at dose ≥1 mg/kg, acute and chronic graft-versus-host disease, lymphopenia, HLA-mismatched related donor status, were also associated with late CMV disease. HLA-mismatched donor status and late use of corticosteroids (≥1 mg/kg) were risk factors for late CMV disease recurrence. Late CMV disease occurred most frequently in a setting of prolonged low-level untreated viremia and was independently associated with death by 2 years after HCT. In summary, late CMV disease continues to occur in the present era. Improved prevention strategies for late CMV disease are needed.
Comparative transcriptome and coexpression network analysis reveals key pathways and hub candidate genes associated with sunflower (Helianthus annuus L.) drought tolerance
Authors: Shi Huimin , Hou Jianhua , Li Dandan , Hu Haibo , Wang Yanxia , Wu Yang , Yi Liuxi 
Published: March 2024

Abstract
Background
Drought severely limits sunflower production especially at the seedling stage. To investigate the response mechanism of sunflowers to drought stress, we utilized two genotypes of sunflower materials with different drought resistances as test materials. The physiological responses were investigated under well-watered (0 h) and drought-stressed conditions (24 h, 48 h, and 72 h).

Results
ANOVA revealed the greatest differences in physiological indices between 72 h of drought stress and 0 h of drought stress. Transcriptome analysis was performed after 72 h of drought stress. At 0 h, there were 7482 and 5627 differentially expressed genes (DEGs) in the leaves of K55 and K58, respectively, and 2150 and 2527 DEGs in the roots of K55 and K58, respectively. A total of 870 transcription factors (TFs) were identified among theDEGs, among which the high-abundance TF families included AP2/ERF, MYB, bHLH,and WRKY. Five modules were screened using weighted gene coexpressionnetwork analysis (WGCNA), three and two of which were positively and negatively, respectively, related to physiological traits. KEGG analysis revealedthat under drought stress, “photosynthesis”, “carotenoid biosynthesis”, “starch and sucrose metabolism”, “ribosome”, “carotenoid biosynthesis”, “starch and sucrose metabolism”, “protein phosphorylation” and “phytohormone signaling” are six important metabolic pathways involved in the response of sunflower to drought stress. Cytoscape software was used to visualize the three key modules, and the hub genes were screened. Finally, a total of 99 important candidate genes that may be associated with the drought response in sunflower plants were obtained, and the homology of these genes was compared with that in Arabidopsis thaliana.

Conclusions
Taken together, our findings could lead to a better understanding of drought tolerance in sunflowers and facilitate the selection of drought-tolerant sunflower varieties.
A national perspective on cardiovascular diseases in Saudi Arabia
Authors: Alqahtani Bader A. , Alenazi Aqeel M. 
Published: March 2024

Abstract
Background
Cardiovascular diseases (CVDs) are common chronic conditions that lead to morbidity and mortality worldwide. However, there are no recent national or regional reports about CVDs in Saudi Arabia. Therefore, this study aimed to estimate the national and regional prevalence rates of CVDs among the Saudi population.

Methods
This study used data from an ongoing household health survey conducted by the General Authority for Statistics in 2017. The survey sample comprised 24,012 homes that were determined to be a representative sample of the population and dispersed throughout the 13 administrative areas. A self-reported diagnosis of CVD was collected by asking subjects if they had been diagnosed by a physician.

Results
The prevalence of CVDs among the Saudi population aged 15 years and older was 1.6% (n = 236,815). The prevalence is higher in males at 1.9% compared to females at 1.4%. Age is a significant factor, with a gradual increase in CVD prevalence until the age of 50, followed by a sharp rise. The prevalence among the age group (≥ 65 years) was the highest, recording 11% (n = 93,971), followed by the age group (60–64 years) which reached 6.5% (n = 31156.71), and the lowest prevalence was found in the age group (< 40 years) as 1.2% (n = 108,226). When considering regional differences, Makkah has the highest prevalence at 1.9% (n = 85,814), followed by Riyadh at 1.7% (n = 79,191). Conversely, Najran has the lowest prevalence at 0.76% (n = 332), with the Northern Border Region having the second lowest rate at 1,46% ( n = 4218) These findings underscore the importance of considering both demographic and regional factors in addressing and managing cardiovascular health in Saudi Arabia.

Conclusion
This study provides the most recent estimates of the national and regional prevalence rates of CVDs in Saudi Arabia. The findings suggest that CVDs are more common among older adults, males, and residents of the Makkah region. This information can be used to inform public health policies and interventions to reduce the burden of CVDs in Saudi Arabia.
Randomized controlled trial of a positive emotion regulation intervention to reduce stress in family caregivers of individuals with Alzheimer’s disease: protocol and design for the LEAF 2.0 study
Authors: Leong Caroline A. , Summers Amanda , Grote Veronika , Jackson Kathryn , Dowling Glenna , Snowberg Kari , Cotten Paul , Cheung Elaine , Yang DerShung , Addington Elizabeth L. , Moskowitz Judith T. 
Published: March 2024

Abstract
Background
Caring for a loved one with Alzheimer’s disease can be stressful, resulting in poorer emotional and physical health among family caregivers. Although supportive resources for caregivers are available, distance, caregiver health, and the daily demands of caregiving are barriers to access. Based on research demonstrating the importance of positive emotions in coping with stress, our previous trial showed that dementia caregivers who participated in facilitated, web-based delivery of a positive emotion regulation intervention called LEAF (Life Enhancing Activities for Family caregivers) experienced increased positive emotion and decreased depression and anxiety. Building on this evidence, the LEAF 2.0 study aims to test whether web-based, self-guided delivery can confer similar benefits for caregivers of individuals with Alzheimer’s disease.

Methods
This paper presents the design and methods for LEAF 2.0, a 3-arm web-based randomized controlled trial (N = 500) in which family caregivers of patients with Alzheimer’s disease (AD) are randomized to (1) the LEAF intervention facilitated remotely via the web (N = 200), (2) the LEAF intervention self-guided online (N = 200), or (3) an emotion reporting control (N = 100), which then crosses over to the intervention after approximately 6 months, half to the facilitated arm and half to the self-guided arm. We aim to (1) compare the effect of the facilitated and self-guided LEAF positive emotion interventions to an emotion reporting control condition on AD caregiver well-being (positive emotion, depression, anxiety, and perceived stress) and secondary outcomes (caregiving burden, caregiving self-efficacy, positive aspects of caregiving, quality of care, and AD patient quality of life); (2) assess whether effects are mediated by improvements in positive emotion or other aspects of caregiver well-being; and (3) test whether caregiver age or gender or the care recipient’s dementia severity moderates the effects of the intervention.

Discussion
If demonstrated to be effective, LEAF can be widely disseminated and ultimately have a significant impact on the stress experienced by AD caregivers and the well-being of people living with Alzheimer’s disease.

Trial Registration
ClinicalTrials.gov NCT03610698.
The effect of social pension on health-related quality of life of the rural older people: a panel study from China
Authors: Liu Siyuan , He Hong , Gao Hanzhi 
Published: March 2024

Abstract
Background
Social pensions, social assistance systems for older people in rural areas, have been put into place in many nations and have positively impacted health. The long-term health consequences of social pension programs in China are uncertain. The aim of this study is to evaluate the long-term health consequences of the new rural social pension (NRSP) for the rural older people in China.

Methods
Based on the 2011 and 2018 China Health and Retirement Longitudinal Study, we compared the scores on eight Health-Related Quality of Life (HRQoL) subscales of the rural older people before and after participation in the NRSP. The propensity score matching and difference-in-difference methods were used in data analysis. We also conducted a heterogeneity analysis for subgroups with different characteristics and pension enrolment times.

Results
The NRSP significantly enhanced scores on physical functioning, role-physical, and self-rated mental health of old rural participants by 1.90 (p < 0.01), 2.05 (p < 0.01), and 2.93 (p < 0.05), respectively. After excluding newly enrolled individuals, the beneficial health effects of the NRSP remained significant. There were no significant changes due to NRSP in the other five scores on the HRQoL subscale of the rural older people. The NRSP had more health benefits for older people in underdeveloped areas without formal schooling.

Conclusions
The NRSP reduced health disparities and had long-term benefits on the physical and mental health of the rural older people. We suggest continuously expanding the NRSP throughout rural China and further improving the social support system to enhance the overall quality of life of the rural older people. Comparable social pension programs aimed at underprivileged groups could also be conducted in other low- or middle-income nations.
Tools to measure barriers to medication management capacity in older adults: a scoping review
Authors: Baby Bincy , McKinnon Annette , Patterson Kirk , Patel Hawa , Sharma Rishabh , Carter Caitlin , Griffin Ryan , Burns Catherine , Chang Feng , Guilcher Sara JT , Lee Linda , Fadaleh Sara Abu , Patel Tejal 
Published: March 2024

Abstract
Background
Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications.

Purpose
1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers.

Methods
The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus.

Results and discussion
In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA).

Conclusion
This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.