Parker University

BACKGROUND:Cervical artery dissection (CAD) is a rare cause of stroke. This is an update of an earlier systematic review, which focuses on the risk of CAD in the general population. The objective was to identify the risk factors for CAD. METHODS:A comprehensive search was conducted in MEDLINE, EMBASE and Web of Science on 20 September 2024. Observational studies (cohort, case-control studies and case-crossover studies) that studied patients with CAD and a control group were included. Risk of bias was assessed with the ROBINS-E tool, and certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The results were stratified by healthy controls (primary analyses) and other control groups, notably ischaemic non-CAD stroke (secondary analyses). FINDINGS:In total, 128 study reports were identified, of which 54 used one or more healthy control groups. Of these reports, 49 (91%) used a case-control design. The risk of bias was generally high (93%). For the following categories, effects were identified: (1) genetic factors or factors with a familial predisposition: migraine, methylenetetrahydrofolate reductase (MTHFR), TT homozygosity, matrix metalloproteinases (MMP) concentration, and connective tissue disorders; (2) external factors: recent infection, winter or autumn-winter season and oral contraceptive use; (3) minor trauma; (4) cardiovascular factors: hypertension, hypercholesterolaemia, relative vasodilatation of internal carotid, coronary artery disease and other cardiac diseases. For other risk factors (5), there were no significant pooled estimates. The certainty of the evidence was moderate for migraine and MTHFR TT, low for minor trauma and very low certainty for all others. INTERPRETATION:This is the first review that comprehensively examined the risk of CAD in the general population. Genetic factors, cardiovascular risk factors, recent infection and minor trauma are risk factors for CAD. Caution is needed in interpretation as the evidence is overall low to very low certainty, except for migraine and MTHFR TT homozygosity.

BackgroundDigital fitness applications offer unprecedented access to structured training programs, yet the behavioral factors that predict sustained engagement in real-world settings remain incompletely understood.MethodsThis observational study analyzed data from 389,481 adult digital fitness app users (mean age: 34.7 ± 9.9) of various experience levels followed for twelve months from their first recorded workout. Long-term adherence was defined as completing at least one workout per week, allowing up to six missed weeks. Adherence trajectories were examined, along with associations between early training behaviors (training frequency, workout duration, exercise composition, equipment diversity), demographic factors, and time to dropout. Effect modifications by sex, workout duration, and training experience were also investigated.ResultsAdherence declined steadily over time, with 10.1% of beginner users remaining adherent at 12 months (i.e., 52 weeks). The median dropout time was 19 weeks. Higher sustained participation was observed in older vs. younger (51+: 13.3%; 18–40: 8.4%), male vs. female (M: 11.4%; F: 7.9%), and more experienced users (intermediate: 18.3%; advanced: 25.8%). Training consistency during the first 28 days was the strongest predictor of adherence and exhibited a protective association that attenuated over time. Greater diversity in equipment use and higher emphasis on resistance exercise were also associated with lower dropout risk. Longer workout duration was associated with improved adherence among users who trained more frequently, particularly early in follow-up.ConclusionsEarly consistency and structured training behaviors were strongly associated with long-term app-recorded exercise adherence among beginners, with relatively modest differences based on age and sex. These findings suggest that frequent training sessions and engagement with resistance-based exercise during the initial stages of exercise adoption may be relevant behavioral correlates of sustained engagement.

ABSTRACT Objective The purpose of this study was to evaluate the alignment between chiropractic educational outcomes, the National Board of Chiropractic Examiners (NBCE) prelicensure exams, and the Council on Chiropractic Education (CCE) meta-competencies. Methods A qualitative thematic analysis was performed between January 2024 and December 2024. A detailed coding framework was used to systematically assess coherence among the content of NBCE prelicensure exams, the competencies from 4 sample chiropractic educational outcomes, and the CCE meta-competency framework. Data were analyzed to identify the presence and depth of key professional domains. Results The thematic analysis revealed a substantial degree of alignment between the NBCE exams and the CCE meta-competencies. The essential domains included assessment and diagnosis, patient case management, disease prevention, communication and documentation, professional ethics, jurisprudence, spinal adjustment and manipulation, interprofessional collaboration, clinical reasoning, and practical skills. Conclusion This study provides valuable insight into the degree of alignment among chiropractic educational outcomes, NBCE exams, and the CCE meta-competency framework. The analyses offer a detailed evaluation of the extent to which NBCE exam content reflects the knowledge, skills, and professional behaviors outlined in the CCE competencies. Collectively, the findings contribute to a deeper understanding of how exam standards support the preparation of competent, entry-level chiropractic practitioners.

ABSTRACT Context: Sport-related concussion is common among student-athletes, and those who sustain multiple concussions may experience effects that extend well beyond physiological recovery. However, little is known about how student-athletes themselves interpret and make meaning of these repeated injury experiences. Objectives: To describe the lived experiences and perceptions of student-athletes with a history of two or more sport related concussions Design: Qualitative phenomenological study Setting: Midwestern Division I university Patients or Other Participants: Thirteen current and former student-athletes (2 males, 11 females; ages 18-24 years) were included if they had suffered two or more concussions during their athletic career and could speak and could understand the English language. Data Collection and Analysis: Semi-structured interviews were conducted after initial demographics were obtained. Interviews were audio-recorded, transcribed verbatim, and analyzed using an indicative thematic analysis approach. Significant statements (direct quotes) were extracted from transcripts, duplicate statements were removed, and formulated meanings were assigned to each significant statement. Formulated meanings were clustered into overarching themes. Themes were shared with participants for feedback as a means of establishing credibility and trustworthiness (member checking). Results: Participants reported an average of 3 diagnosed concussions (range 2-6). Six themes were discovered: 1) persistent post-concussion symptoms, 2) academic supports and impact, 3) limited medical coverage and self-diagnosis, 4) loss of athletic identity, 5) social relationship impact, and 6) differential perception of concussion versus other injuries. Conclusions: Student-athletes with a history of multiple concussions describe persistent symptoms and disruptions to academic, social, and athletic identity that extended well beyond clinical recovery. These lived experiences highlight the need for individualized, patient-centered concussion care, consistent medical coverage, and continued education for parents, coached, educators, teammates, and medical partners.