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Bioregenerative Life Support Systems (BLSS) are a key facet of plans for long term habitats on other celestial bodies. With the Artemis program headed to the moon and SpaceX pushing towards Mars the roadmap is about 10–20 years. Therefore it is vital to consider how BLSS will work with the traditional physicochemical Environmental Control and Life Support Systems (ECLSS). Biological systems are complicated. Their inputs and outputs cannot be turned on and off the way physicochemical systems can. Therefore the accurate monitoring and prediction of these systems is fundamental to integrating the BLSS into the life support system as a whole. This paper will summarize the history of BLSS research, the system requirements for integrating a BLSS into the ECLSS, and the research needed to meet these requirements. As the world looks towards the future of humans living on other celestial bodies, there is a lot of work to do to support keeping them safe and healthy. Bioregenerative Life Support Systems have potential to provide massive support, if they are effectively integrated with the physicochemical systems. • Explores the systems requirements of physicochemical and bioregenerative systems. • Provides updated equivalent system mass estimates using LED lighting technologies. • Calculates return on investment time for bioregenerative food production. • Suggests future research directions for bioregenerative life support systems (BLSS). [ABSTRACT FROM AUTHOR]

Individualized case management services that identify and provide support for treatment, housing, and employment may improve opportunities for success for those housed in community residential facilities (CRFs) upon release, particularly when evaluated against the goals of reducing the length of stay in the CRF and reducing the rate of return to prison among a targeted parole population with severe mental health needs and moderate-to-high criminogenic risk. Following an experimental design with random assignment design, this study evaluated 349 participants who were eligible for specialized case management services while housed and released from a CRF between January 2018 and June 2019. Findings reveal that participants who received specialized service referrals significantly decreased their length of stay in the CRF compared to the control group. Successful program completion was further related to a reduced length of stay and a significant reduction in the likelihood of returning to prison. [ABSTRACT FROM AUTHOR]

Resilient systems can absorb and recover from disturbances and adapt to changed conditions to maintain system functionality. Uncertainty about the meaning of resilience and the attributes it requires has limited the application of resilience thinking in biosecurity. However, considering increasing pressures from trade, travel and climate change, enhancing the resilience of biosecurity systems is likely to be critical to reduce the impacts of pests and diseases on economies, societies and environments. Here we provide a pathway for resilience thinking into risk management. Based on a literature review we discuss its benefits, develop an operational definition of resilience for biosecurity systems and identify the fundamental attributes that support resilience. We show that resilient biosecurity systems can anticipate disturbances, cope with low‐probability high‐impact events and adapt to new and changing circumstances. The status of biosecurity system resilience can be measured using evaluative rubrics, which give decision‐makers an overall performance rating and insight into system weaknesses. General measures, objective functions and simulation approaches are potential avenues for quantifying biosecurity system resilience in practice. Policy implications: Adopting resilience thinking into biosecurity risk management has the potential to reduce the damages caused by invading pests and diseases. If resilience thinking is used alongside traditional risk analysis, then regulators can more effectively address and prepare for the systemic consequences of high‐impact incursions and outbreaks of pests and diseases, which are unpredictable, low‐probability events. However, the design of resilience‐enhancing measures should be guided by economic principles and consider the rate of return of these measures over time. [ABSTRACT FROM AUTHOR]

Purpose: Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL‐R) for athletes when ACL graft rupture is a career‐threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL‐R using bone‐patellar tendon‐bone (BPTB) or hamstring (HT) autograft in high‐level athletes with a minimum postoperative follow‐up of 24 months. Methods: This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL‐R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow‐ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow‐ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury. Results: Ninety‐nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL‐R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty‐three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300–5.160; p = 0.007) was associated with a higher potential for RTP after ACL‐R. The incidence of ACL graft rupture after ACL‐R decreased with BPTB (OR, 0.861; 95% CI, 0.770–0.962; p = 0.009). Conclusions: The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL‐R using HT autograft. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

The Energy Return On Investment (EROI) is a recognised indicator for assessing the relevance of an energy project in terms of net energy delivered to society. For woody biomass divergences remain on the right methodology to assess the EROI leading to large variations in the published estimates. This article presents an in‐depth discussion about the EROI of woody biomass in three different forms: woodchips, pellets and liquid fuels. The conceptualisation of EROI is further developed to reach a consistent definition for biomass post‐processed fuels. It considers, on top of the external energy investments, the grey energy associated with the energy used to enrich the fuel. With the proposed methodology, all woodchips have an EROI of the same order of magnitude, between 20 and 37, depending on forestry types, operations and machineries. For secondary residues, the first estimate is 170 if, as co‐products, no energy investment is allocated to the forestry operations and transport. On the basis of a mass allocation for forestry operations and transport, the EROI for secondary residues becomes of the same order of magnitude as that for wood chips. Woodchips can be further post‐processed into pellets or liquid fuels. Pellets have an EROI of 4–7 if the heat is externally supplied and 8–23 if internally supplied (self‐consumption of part of the raw material). Liquid fuels derived from primary wood and residues through gasification and Fischer‐Tropsch synthesis have an EROI between 4 and 16. Fuel enhancement with hydrogen (Power & Biomass to Liquids) impacts negatively the EROI due to the low EROI of hydrogen produced from renewable electricity. However, these fuels offer other advantages such as improved carbon efficiency. A correct estimate of EROI for forestry biomass, as proposed in this work, is a necessary dimension in assessing the suitability of a project. [ABSTRACT FROM AUTHOR]

Context: There is little published information on how long it takes for the performance of phosphorus (P)-deficient mature cows to improve once they start receiving P supplements, or whether their long-term performance is impaired by P deficiency early in life. Aims: The performance of mature P-deficient and P-adequate Brahman cows was compared over 3 years to investigate the time it takes for the performance of P-deficient mature cows to improve once they are supplemented with P, and whether their long-term performance is compromised by P deficiency early in life. Methods: Cows that had been a part of a P-supplementation trial at Victoria River Research Station from weaning until they were 5.5 years old were used for this study. One treatment group had received continuous P supplement (P+) since weaning and the other treatment had never received any P supplement (P−). At the conclusion of the original trial, 42 cows were randomly selected from each treatment and then grazed together in the same paddock for 3 years, during which time they were given P supplement continuously. Performance attributes were measured and compared. Key results: This study found that P supplementation rapidly improved the liveweight, body condition, reproductive performance and survival rate of the P-deficient (P−) mature cows. Within a year of receiving P supplement, their performance improved to be similar to that of P+ cows. However, P deficiency early in life did have some residual stunting effects, resulting in lower mean hip height and liveweights of P− cows. Conclusions: The performance of P-deficient mature cows improved rapidly once they were given P supplements and matched that of cows that had always been supplemented. However, P deficiency early in life caused stunting, resulting in mature cows being shorter and lighter. Implications: Cattle producers in P-deficient country should see a rapid improvement in performance and return on investment once they start supplementing P-deficient cows. However, it is better to supplement cattle throughout their lives in P-deficient areas to avoid stunting. This study investigated how long it takes for the performance of phosphorus (P)-deficient mature cows to improve once they are supplemented with P, and whether their long-term performance is compromised by P deficiency early in life. The performance of P-deficient cows improved to be similar to that of P-adequate cows within a year of P supplementation commencing. However, P deficiency early in life did have some residual stunting effects, resulting in lower hip height and liveweight. [ABSTRACT FROM AUTHOR]

Background: The Veterans Health Administration (VHA) is the United States largest learning health system. The Diffusion of Excellence (DoE) program is a large-scale model of diffusion that identifies and diffuses evidence-informed practices across VHA. During the period of 2016-2021, 57 evidence-informed practices were implemented across 82 VHA facilities. This setting provides a unique opportunity to understand sustainment determinants and pathways. Our objective was to characterize the longitudinal pathways of practices as they transition from initial implementation to long-term sustainment at each facility. Methods: A longitudinal, mixed-methods evaluation of 82 VHA facilities. Eighty-two facility representatives, chosen by leadership as points-of-contact for 57 DoE practices, were eligible for post-implementation interviews and annual sustainment surveys. Primary outcomes (implementation, sustainment), and secondary outcomes (institutionalization, effectiveness, anticipated sustainment) at four time-points were collected. We performed descriptive statistics and directed content analysis using Hailemariam et al.'s factors influencing sustainment. Results: After approximately five years post-implementation (e.g., 2021 sustainment outcomes), of the 82 facilities, about one-third fully sustained their practice compared to one-third that did not fully sustain their practice because it was in a "liminal" stage (neither sustained nor discontinued) or permanently discontinued. The remaining one-third of facilities had missing 2021 sustainment outcomes. A higher percentage of facilities (70%) had inconsistent primary outcomes (changing over time) compared to facilities (30%) with consistent primary outcomes (same over time). Thirty-four percent of facilities with sustained practices reported resilience since they overcame implementation and sustainment barriers. Facilities with sustained practices reported more positive secondary outcomes compared to those that did not sustain their practice. Key factors facilitating practice sustainment included: demonstrating practice effectiveness/benefit, sufficient organizational leadership, sufficient workforce, and adaptation/alignment with local context. Key factors hindering practice sustainment included: insufficient workforce, not able to maintain practice fidelity/integrity, critical incidents related to the COVID-19 pandemic, organizational leadership did not support sustainment of practice, and no ongoing support. Conclusions: We identified diverse pathways from implementation to sustainment, and our data underscore that initial implementation outcomes may not determine long-term sustainment outcomes. This longitudinal evaluation contributes to understanding impacts of the DoE program, including return on investment, achieving learning health system goals, and insights into achieving high-quality healthcare in VHA. [ABSTRACT FROM AUTHOR]

Sweetpotato (Ipomoea batatas (L) Lam) is prioritized among crops that enhance food security and reduce malnutrition in Ghana. The production is expanding faster than other food crops owing to its superior nutrient composition. This study evaluates integrated approaches to increase on‐farm productivity, income, and utilization of sweetpotato. The first part evaluated the agronomic yield performance, financial return, and sensory quality of 10 varieties under different fertilizer treatments. The second part of activities assessed both storage root and leaf composition (i.e., total sugars, dry matter, protein, Fe, Zn, Ca, total phenolic, total monomeric anthocyanins, lutein, zeaxanthin, α‐tocopherol, β‐carotene, and total carotenoids). Third, storage stability characteristics were assessed (i.e., shelf life and the incidence of decay). Application of NPK of 40:40:70 at 300 kg ha−1 significantly (p < 0.001) increased storage root yield from 12.4 to 17.3 t ha−1, which represents a 32% increase in yield compared to farmers' standard practice. The variety SARI‐JanLow (where SARI is Savanna Agricultural Research Institute) was outstanding for root yield (23.5 t ha−1) and β‐carotene content (20.8 Mg 100 g−1). SARI‐Tiemeh was consistently ranked among the three most preferred varieties by the sensory panel across the production hubs. At locations Nyankpala and Nikongo, the most responsive varieties to fertilizer application with regard to marketable storage root yield were SARI‐Tiemeh (108%) and PGA14351‐4 (79%), respectively. The varieties SARI‐Nyumengre (1.4%), SARI‐Nyoriberi‐gu (1.4%), and PGA14351‐4 (1.6%) were the least susceptible to sweetpotato weevil attack. Considering the benefit–cost ratio and a return on investments, the four most economically viable varieties appear to be SARI‐JanLow, SARI‐Suyolo, SARI‐Tiemeh, and SARI‐Nyoriberi‐gu. Core Ideas: Fertilizer application increased storage root yield productivity by 36%–108% compared to farmers' standard practice.The benefit–cost ratio of 4.1:6 and a return on investment of 306%–501% were recorded in high‐yielding varieties.SARI‐JanLow (where SARI is Savanna Agricultural Research Institute) recorded the highest storage root yield and β‐carotene content, but SARI‐Tiemeh possesses superior sensory qualities.At the 40% decay threshold, SARI‐Nyoriberi‐gu, SARI‐Nyumengre, and SARI‐Nan showed longer shelf‐life.Leaf nutrients are compared favorably with vegetables such as Amaranthus spp. and Colocasia spp. [ABSTRACT FROM AUTHOR]

Investment decisions in personal financial management especially for students is crucial because investment is a process of learning to manage finances, starting now and in the future. Low knowledge about planning an often makes students experience fraud, because offers from investment returns are also very tempting. Based on the phenomenon, this study aims to determine the effect of financial technology, investment literacy, investment interest, and return investment tolerance on investment decisions. This research was conducted by distributing questionnaires to respondents with the criteria of students at the University of Sidoarjo city in study program, economy &; business class. The number of research respondents was 288 students and data management used SmartPLS 3.2.8 analysis techniques. The results of this study state that financial technology, investment literacy, investment interest has a positive and significant effect on investment decisions, while return investment have a insignificant effect on investment decisions of University student University of Sidoarjo city in study program economy & business. [ABSTRACT FROM AUTHOR]

The combination of a land‐based system and natural habitat can propagate donor plants from cuttings for use in seagrass restoration projects; however, the appropriate period for land‐based cultivation is unclear. Eelgrass (Zostera marina) cuttings were cultivated under different combinations of land‐based (0, 3, 6, 9, and 12 weeks) and natural habitat cultivation for 12 weeks. We measured survivorship, growth, productivity, leaf pigmentation, and carbohydrate concentration in eelgrass. Return on investment (defined as the number of ramets of Z. marina returned through input cultivation costs in the seagrass cultivation process) analysis suggested that the optimal period of land‐based cultivation for the propagation of Z. marina is 3.1–3.8 weeks. The ramet frequency of Z. marina exposed to a combination of land‐based cultivation (3 weeks) and natural habitat cultivation (9 weeks) was 1.4 times higher than that of plants cultivated in natural habitats for 12 weeks. The promotional effect of the combination of land‐based and natural habitat cultivation on Z. marina mainly depended on the increase in chlorophyll content and the accumulation and synthesis of nonstructural carbohydrates. The soluble sugar content of Z. marina leaves exposed to a combination of land‐based cultivation (3 weeks) and natural habitat cultivation (9 weeks) was 1.5 times higher than that of plants cultivated in natural habitats for 12 weeks. These results indicated that implementation of a controlled plant cultivation system and process to acquire abundant donor plants. This can help provide valuable data for the development of efficient artificial propagation technologies for Z. marina. [ABSTRACT FROM AUTHOR]

This study presents a hybrid multicriteria decision-making approach for evaluating stocks in the Saudi Stock Market. The objective is to provide investors and stakeholders with a robust evaluation methodology to inform their investment decisions. With a market value of USD 2.89 trillion dollars in September 2022, the Saudi Stock Market is of significant importance for the country's economy. However, navigating the complexities of stock market performance poses investment challenges. This study employs the best–worst method and the technique for order preference by similarity to identify an ideal solution to address these challenges. Utilizing data from the Saudi Stock Market (Tadawul), this study evaluates stock performance based on financial criteria, including return on equity, return on assets, net profit margin, and asset turnover. The findings reveal valuable insights, particularly in the banking sector, which exhibited the highest net profit margin ratios among sectors. The hybrid multicriteria decision-making-based approach enhances investment decisions. This research provides a foundation for future investigations, facilitating a deeper exploration and analysis of additional aspects of the Saudi Stock Market's performance. The developed methodology and findings have implications for investors and stakeholders, aiding their investment decisions and maximizing returns. [ABSTRACT FROM AUTHOR]

This paper is devoted to asymptotic analysis for a continuous-time risk model with the insurance surplus process and the log-price process of the investment driven by two dependent jump-diffusion processes. We take into account arbitrary dependence between the insurance claims and their corresponding investment return jumps caused by a sequence of systematic factors, whose arrival times constitute a renewal counting process. Under the framework of regular variation, we obtain a simple and unified asymptotic formula for the finite-time ruin probability as the initial wealth becomes large. It turns out that, in the weakly dependent case, the tails of the claims determine the exact decay rate of the finite-time ruin probability while the investment return jumps only contribute to the coefficient of the asymptotic formula; however, in the strongly dependent case, they both produce essential impacts on the finite-time ruin probability which is under-estimated in the weakly dependent case. [ABSTRACT FROM AUTHOR]

The present study conceptualizes and simulates a methanol production process through the direct hydrogenation of captured CO2. CuO/ZnO/ZrO2 was employed as the catalyst and Aspen HYSYS was used for the process simulation. Configurational optimization of the process flowsheet was carried out using a step-by-step hierarchical approach. Many alternate flowsheets have resulted, and their capital investment, product cost, and profitability measures were calculated. The discrimination among the competing flowsheets was carried out based on net profit and percent return on investment. The retained flowsheet was further analyzed for optimizing the recycle ratio and evaluating the effect of the price of captured CO2, green H2, natural gas (fuel), and catalyst on the economic performance of the plant. The optimum value of the recycle ratio was computed to be 4.23. Additionally, it was found that the price of H2 is the most important parameter in defining the feasibility and profitability of the process. Mathematical correlations were also developed that relate the profitability and price of the above-mentioned feed materials. [ABSTRACT FROM AUTHOR]

Antibiotics are considered one of the most important contributions to clinical medicine in the last century. Due to the use and overuse of these drugs, there have been increasing frequencies of infections with resistant pathogens. One form of resistance, heteroresistance, is particularly problematic; pathogens appear sensitive to a drug by common susceptibility tests. However, upon exposure to the antibiotic, resistance rapidly ascends, and treatment fails. To quantitatively explore the processes contributing to the emergence and ascent of resistance during treatment and the waning of resistance following cessation of treatment, we develop two distinct mathematical and computer-simulation models of heteroresistance. In our analysis of the properties of these models, we consider the factors that determine the response to antibiotic-mediated selection. In one model, heteroresistance is progressive, with each resistant state sequentially generating a higher resistance level. In the other model, heteroresistance is non-progressive, with a susceptible population directly generating populations with different resistance levels. The conditions where resistance will ascend in the progressive model are narrower than those of the non-progressive model. The rates of reversion from the resistant to the sensitive states are critically dependent on the transition rates and the fitness cost of resistance. Our results demonstrate that the standard test used to identify heteroresistance is insufficient. The predictions of our models are consistent with empirical results. Our results demand a reevaluation of the definition and criteria employed to identify heteroresistance. We recommend that the definition of heteroresistance should include a consideration of the rate of return to susceptibility. [ABSTRACT FROM AUTHOR]

School and district leaders make annual decisions about investing their budgets in a multitude of educational programs. Policy directives set expectations for investing in programs that show evidence of improving student outcomes. However, evaluating many simultaneously-implemented programs under typical school operating conditions is challenging. We investigated three methods – cost-effectiveness analysis, program value-added analysis, and academic return on investment – to assess how each one fares against three criteria: rigor of methodology, difficulty of execution, and usability of results for decision-making. We apply each method to three programs implemented in a large, U.S. school district: Reading Recovery, Restorative Practices, and school nurses. [ABSTRACT FROM AUTHOR]

A random-effects meta-analysis was conducted to investigate the effect of mycotoxins (MT) without or with the inclusion of yeast cell wall extract (YCWE, Mycosorb®, Alltech, Inc., Nicholasville, KY, USA) on laying hen performance. A total of 25 trials were collected from a literature search, and data were extracted from 8 of these that met inclusion criteria, for a total of 12 treatments and 1774 birds. Laying hens fed MT had lower (p < 0.05) body weight (BW) by −50 g, egg production by −6.3 percentage points, and egg weight by −1.95 g than control fed hens (CTRL). Inclusion of YCWE during the mycotoxin challenges (YCWE + MT) resulted in numerically greater (p = 0.441) BW by 12.5 g, while egg production and egg weight were significantly (p < 0.0001) higher by 4.2 percentage points and 1.37 g, respectively. Furthermore, economic assessment calculations indicated that YCWE may not only support hen performance but also resulted in a positive return on investment. In conclusion, mycotoxins can play a role in negatively impacting laying hen performance and profitability. Inclusion of YCWE in feed with mycotoxin challenges provided benefits to egg production and egg weight and may support profitability. As such, the inclusion of YCWE could play an important role in minimizing mycotoxin effects and in turn aid farm efficiency and profitability. [ABSTRACT FROM AUTHOR]

Product variety, in combination with today's unstable market environment, brings strong challenges to manufacturing firms. Single-product assembly systems become difficult to implement as the return on investment is difficult to obtain with decreasing lot sizes and unstable customer demands. Multi-product assembly systems are a possible solution to this problem, as they allow to compensate demand fluctuations throughout the product mix. However, variety is a strong barrier to this kind of production systems. A new method is presented in this paper to identify multi-product assembly system architectures adapted to a product family, based on the identification of components for common positioning. This method has been applied to a supplier in the automotive industry and a return of experience of this case study is provided, highlighting its potentials and barriers. [ABSTRACT FROM AUTHOR]

Cloud providers offer various purchasing options to enable users to tailor their costs according to their specific requirements, including on-demand, reserved instances, and spot instances. On-demand and spot instances satisfy short-term workloads, whereas reserved instances fulfill long-term instances. However, there are workloads that fall outside of either long-term or short-term categories. Consequently, there is a notable absence of services specifically tailored for medium-term workloads. On-demand services, while offering flexibility, often come with high costs. Spot instances, though cost-effective, carry the risk of termination. Reserved instances, while stable and less expensive, may have a remaining period that extends beyond the duration of users' tasks. This gap underscores the need for solutions that address the unique requirements and challenges associated with medium-term workloads in the cloud computing landscape. This paper introduces a new cloud broker that introduces IaaS services for medium-term workloads. On one hand, this broker strategically reserves resources from providers, and on the other hand, it interacts with users. Its interaction with users is twofold. It collects users' preferences regarding commitment term for medium-term workloads and then transforms the leased resources based on commitment term, aligning with the requirements of most users. To ensure profitability, the broker sells these services utilizing an auction algorithm. Hence, in this paper, an auction algorithm is introduced and developed, which treats cloud services as virtual assets and integrates the depreciation over time. The findings affirm the lack of services that fulfill medium workloads while ensuring the financial viabilty and profitability of the broker, given that the estimated return on investment (ROI) is acceptable. [ABSTRACT FROM AUTHOR]

Background: Public–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. Methods: We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author. Results: We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change. Conclusions: Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability. [ABSTRACT FROM AUTHOR]

Managerial ability and managerial efforts play key role in the performance of business enterprises. However, this indicator is not directly observable. The current paper focuses on estimating managerial ability in the context of the Indian and Iranian general insurance sectors. The study is based on 140 firm-year observations in India and 140 firm-year observations in Iran spread over 7 years (2012–13 to 2018–19). For measuring managerial ability, we have used a three-stage procedure that involves the estimation of insurer-wise efficiency using Data Envelopment analysis (DEA) in the first stage and then regression of the logarithm of technical efficiency on a set of explanatory variables. In the final stage, we have estimated managerial ability from regression residuals (the difference between the observed and fitted values of insurer efficiency). In order to test the validity of the relationship between return on equity and managerial ability we use the general additive model (GAM). Our results confirmed that there is a positive relationship between return on equity and managerial ability. Our findings also revealed that the mean technical and output allocative efficiencies and managerial ability of Iranian markets highly fluctuated with a high variance. In contrast, these indicators did not fluctuate much in India. [ABSTRACT FROM AUTHOR]

Pancreatic cancer has the highest growth in incidence among patients aged ≥80 years. Discharge destination after hospitalization is increasingly recognized as a marker of return to baseline functional status. Our aim was to identify the preoperative and intraoperative predictors of non-home discharge in those aged 80 or older. The ACS-NSQIP pancreas-targeted database was queried to identify patients aged ≥80 years who underwent pancreatoduodenectomy (PD) from 2014 to 2020. Home discharge (HD) versus non-HD cohorts were compared using univariate logistic regression. Multivariable logistic regression was used to identify predictors of non-HD. Non-HD was over twice as likely to occur in patients aged ≥80 years than in those aged 65–79 years (p < 0.01). Comorbidity factors significantly associated with non-HD in patients aged ≥80 years included COPD, hypertension, HF, lower preoperative albumin, but not obesity. Non-comorbidity factors included older age, female gender, ASA III–IV, preoperative dependent functional status, and transfer origin before PD. Individuals ≥80 years have possibly delayed or lower rate of return to baseline functional status following PD compared to those aged 65–79 years. Predictors of non-HD can be identified to facilitate preoperative counseling and discharge planning, thus enhancing care workflow efficiency. [Display omitted] [ABSTRACT FROM AUTHOR]

Conservation funding is currently limited; cost‐effective conservation solutions are essential. We suggest that the thousands of field stations worldwide can play key roles at the frontline of biodiversity conservation and have high intrinsic value. We assessed field stations' conservation return on investment and explored the impact of COVID‐19. We surveyed leaders of field stations across tropical regions that host primate research; 157 field stations in 56 countries responded. Respondents reported improved habitat quality and reduced hunting rates at over 80% of field stations and lower operational costs per km2 than protected areas, yet half of those surveyed have less funding now than in 2019. Spatial analyses support field station presence as reducing deforestation. These "earth observatories" provide a high return on investment; we advocate for increased support of field station programs and for governments to support their vital conservation efforts by investing accordingly. [ABSTRACT FROM AUTHOR]

In this article, we consider a renewal risk model with by-claims, where the price process of the investment portfolio follows an exponential Lévy process. We further assume that the main claim is a one-sided linear process and there exists a certain dependence structure between the innovations and by-claims. In the presence of heavy tails, we obtain a series of uniform formulas in finite and infinite intervals. In order to better describe the obtained results, we carry on the numerical simulations. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing surgery for Superior-Labrum-anterior-to-posterior (SLAP) lesions are often worried about their return to sport performance. This systematic review determined the rate of return to sport and return to sport at the previous level (RTSP) after surgery for SLAP lesion. Materials and Methods: The PRISMA guidelines were followed. Meta-analysis of data through forest plot projections was conducted. Studies were divided and analyzed according to the type of interventions (isolated slap repair or SLAP repair with rotator cuff debridement and biceps tenodesis). Results: The mean overall rate of return to sport after the procedures was 90.6% and the mean overall rate of return to sport at the previous level after the procedures was 71.7%. RTSP rates of the whole population were 71% (95% CI: 60%–80%), 66% (95% CI: 49%–79%), and 78% (95% CI: 67%–87%) for isolated SLAP repair, SLAP repair with the rotator cuff debridement and biceps tenodesis, respectively. A lack of subgroup analysis for the specific performance demand or type of lesion related to the surgical technique used might induce a high risk of bias. Discussion: Return to sports at the previous level after surgically treated superior labrum anterior to posterior lesion is possible and highly frequent, with the highest rates of RTSP in patients treated with biceps tenodesis. More studies and better-designed trials are needed to enrich the evidence on indications of SLAP surgical treatment in relation to specific sports-level demand. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe the postoperative psychological state of patients following osteochondral allograft (OCA) transplantation in the knee and to determine whether patient‐perceived kinesiophobia is associated with the rate of return to sport (RTS). Methods: A retrospective review of the electronic medical record at a single institution was conducted for all patients that underwent OCA transplantation from January 2010 to 2020. Patient‐reported outcomes including the visual analog scale (VAS), knee injury and osteoarthritis outcome score (KOOS) and the Tampa scale of kinesiophobia‐11 (TSK‐11) were collected. Patients were surveyed regarding their postoperative RTS status. Results: A total of 38 patients (52.6% female) were included in our analysis. Overall, 24 patients (63.2%) returned to sport with 12 (50%) of these patients returning at a lower level of play. When comparing patients that return to sport to those that did not, patients that return had significantly superior KOOS pain (p = 0.019) and KOOS QOL (p = 0.011). Measures of kinesiophobia (TSK‐11) were significantly higher among patients that did not return to sport (p = 0.014), while satisfaction (n.s.) and pain intensity (n.s.) were comparable between groups. Logistic regression models controlling for demographic factors, VAS pain scores and lesion size showed that for every one‐point increase in TSK‐11 kinesiophobia score, patients were 1.33 times more likely to return to sport at a lower level (p = 0.009). For every one‐point increase in TSK‐11 scores KOOS QOL decreased by 2.4 points (p < 0.001). Conclusion: Fear of reinjury decreases the likelihood that patients will return to their preoperative level of sport after OCA transplantation. Patients that do not return to sport report significantly greater fear of reinjury and inferior clinical outcomes, despite similar levels of satisfaction and pain compared to those that return. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the rate of return to sports and sport psychological readiness between patients who underwent isolated MPFLR (iMPFLR) compared to a matched cohort of patients who underwent MPFLR with anteromedializing tibial tubercle osteotomy (MPFLR/TTO). Methods: Patients who underwent primary MPFLR with or without TTO for recurrent patellar instability were retrospectively reviewed from 2012 to 2020 at a single institution. Preinjury sport and work information, Kujala, Tegner, Visual Analogue Score for pain, satisfaction and MPFL‐Return to Sport after Injury (MPFL‐RSI) score were collected. Two readers independently measured the tibial tuberosity‐trochlear groove distance, Caton–Deschamps index and Dejour classification for trochlear dysplasia. Patients in iMPFLR and MPFLR/TTO groups were matched 1:1 on age, sex, body mass index and follow‐up length. Multivariate regression analysis was performed to determine whether the MPFL‐RSI was associated with a return to sport. Results: This study included 74 patients at mean follow‐up of 52.5 months (range: 24–117). These groups returned to sport at similar rates (iMPFLR: 67.6%, MPFLR/TTO: 73.0%, not significant [ns]), though iMPFLR patients returned more quickly (8.4 vs. 12.8 months, p = 0.019). Rates of return to preinjury sport level were also similar (45.9% vs. 40.5%, ns). Patients with Dejour B/C took more time to return to sport compared to patients with mild/no trochlear pathology (13.8 vs. 7.9 months, p = 0.003). Increasing MPFL‐RSI score was significantly predictive of the overall return to sport (odds ratio [OR]: 1.08, 95% confidence interval [CI] [1.03, 1.13], p < 0.001) and return to preinjury level (OR: 1.07, 95% CI [1.04, 1.13], p < 0.001). Most patients in iMPFLR and MPFLR/TTO groups resumed work (95.7% vs. 88.5%, ns), though iMPFLR patients who returned to preinjury work levels did so more quickly (1.7 vs. 4.6 months, p = 0.005). Conclusion: Patients who underwent MPFLR with anteromedializing TTO demonstrated similar rates of return to sport and psychological readiness compared to an isolated MPFLR matched comparison group, though iMPFLRs returned more quickly. Patients with more severe trochlear pathology required more time to return to sports. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability. Methods: A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure. Results: There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play. Discussion: Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes. [ABSTRACT FROM AUTHOR]

The Catholic Church embarked upon an ambitious project of property development in the nineteenth century that transformed the Irish built environment and landscape. People responded energetically to fundraising drives for churches, convents, monasteries and welfare-focused institutions. The acquisition of significant property and substantial capital by the Irish Catholic Church was a major source of its power, which continued into independent Ireland. Much of this wealth came to the Catholic Church through bequests, donations, and returns on investment, which were managed by the relevant dioceses and orders. This article focuses on the episcopacy of Archbishop William Walsh of Dublin during the 1880s and 1890s to understand the way in which the management of the archdiocese of Dublin's financial resources shaped the social, economic, and political development of Ireland's capital city. By focusing on the management of one of the most significant bequests under Walsh's supervision – the Egan Bequest – a complex story of religion, investment and infrastructure building is revealed. This activity helped produce a model of investor capitalism that shaped Dublin in ways that remain contested to this day. [ABSTRACT FROM AUTHOR]

This study aims to investigate the impact of product complexity on product lifetime. As product lifetime increases, firms have a longer time to develop new products and gain a higher return on investment. This study posits that product complexity has an effect on product lifetime and then investigates a product portfolio strategy for product complexity by using Korean mobile phone data released from 2004 to 2013. The impact of product complexity on product lifetime is investigated by pooled ordinary least squares regression. Then, we derive a product portfolio strategy that increases product complexity using panel data analysis. The results show that an increase in product complexity lengthens product lifetime and that a firm needs to design its product portfolio by concentrating its resources and capabilities on releasing products of the latest product type. The findings of this study can help a firm establish an optimal product portfolio that increases the return on investment. [ABSTRACT FROM AUTHOR]

Consider a nonstandard compound renewal risk model with stochastic return on investments, where the price process of investment portfolio is modeled as an exponential Lévy process. In the presence of heavy tails and dependence structures among modeling components, we study the uniform asymptotics of the tail probability of stochastic discounted aggregate claims and the finite-time ruin probability for all time varying in a relevant finite or infinite interval. [ABSTRACT FROM AUTHOR]

This study investigates the impact of capital structure on the performance of commercial stateowned enterprises (SOEs) in Namibia using panel data modelling techniques on data from 2011 to 2020. The research extends performance measures and leverage measures employed by previous studies, utilizing total liabilities to total assets (TLTA) and total equity to total assets (TETA) to examine the effects of debt structures on corporate finance. The study employs return on equity (ROE) and return on assets (ROA) as performance measures. The findings reveal no significant relationship between capital structure and profitability of commercial SOEs in Namibia, thus supporting the irrelevance theory. Additionally, a unidirectional causality is found between capital structure and profitability measures. The study's implications suggest that high debt levels should be reduced to optimize capital structure and that policies should be implemented to enhance SOE performance through innovation and best practices. The findings contribute to the ongoing debate on public sector reforms and provide a basis for further research in this area. [ABSTRACT FROM AUTHOR]

Surgery performed at night and on weekends is thought to be associated with increased complications. However, the impact of time of day on outcomes has not been studied within cranial neurosurgery. We aim to determine if there are differences in outcomes for cranial neurosurgery performed after hours (AH) compared with during hours (DH). We performed a single-center retrospective study of cranial neurosurgery patients who underwent emergent surgery from January 2015 through December 2019. Surgery was considered DH if the incision occurred between 8 am and 5 pm Monday through Friday. We assessed outcome measures for differences between operations performed DH or AH. Three-hundred and ninety-three patients (114 DH, 279 AH) underwent surgery. There was a lower rate of return to the operating room within 30 days for AH (8.6%) compared with DH (14.0%), P = 0.03, on multivariate analysis. There were no significant differences in length of operation, estimated blood loss, improvement in Glasgow Coma Scale, intensive care unit and total hospital length of stay, 30-day readmission, 30-day mortality, and in-hospital mortality for cases performed DH compared with AH. Further subgroup analyses were performed for patients who underwent immediate surgery for subdural hematomas, with no differences noted in outcomes on multivariate analysis. This study suggests that operating AH does not appear to negatively impact outcomes when compared with operating DH, in cases of cranial neurosurgical emergencies. Further study assessing the impact on elective neurosurgical cases is required. [ABSTRACT FROM AUTHOR]

Purpose: The concept of digitization covers a wide range of initiatives to achieve sustainable development. This paper aims to determine the impact of bank digitization strategies on financial performance in an African country. Design/methodology/approach: This study used the generalized least squares estimation method to analyze data from a sample of 12 Tunisian banks from 2010 to 2020. The reason for selecting this method was its ability to address issues of heteroscedasticity and autocorrelation. Findings: This study indicates that digital transformation has a positive effect on Tunisian banks financial performance, as measured by return on assets and return on equity. Specifically, investing in payment tools, digital channels and internet security leads to improved performance for banks. These findings suggest that banks that offer digital services perform better, as they are able to increase profitability, maintain financial stability and improve transparency. Research limitations/implications: This study is important for central bank, regulators, policymakers and investors. Overall, this study emphasizes the need for banks in Tunisia to embrace digital transformation to improve their performance and remain viable in the modern business landscape. Originality/value: This study ponders the effect of Tunisian banks' digital transformation on financial performance. Tunisia context serves as model for other African countries. Tunisian banks should prioritize investments in digital technologies to stay competitive in the market. [ABSTRACT FROM AUTHOR]

Market discipline, which concerns aspects of monitoring and the ability of market participants to play a role in influencing management behavior, is an aspect of the financial industry that has not yet clearly existed in the life insurance industry in Indonesia. This condition is the background of a study that aims to determine the possibility of market discipline in the life insurance industry in Indonesia through observation of the relationship between the acquisition of investment returns of life insurance companies with the acquisition of new business and termination of contracts or lapse policies. Testing based on sample data from 27 life insurance companies (Financial Statements published by OJK) resulted that: can accept the hypothesis of a positive correlation (unidirectional) trend between investment returns and new businesses, but cannot accept the hypothesis that there is a negative tendency (not in the same direction) between investment returns and policy lapse. The market (life insurance consumers) has not been able to express disapproval of the company's performance that is not in accordance with the wishes. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine the carbon emission data of the firms listed in the Borsa Istanbul Sustainability Index in Turkey and analyze the relationship between carbon emissions and the financial performance of these firms. In this research, annual data for 31 firms listed in the Borsa Istanbul Sustainability Index for the period 2017–2020 were used. The relationship between the financial performance indicators of the firms and their carbon emissions was analyzed using a random effects panel data model. The dependent variables identified were return on assets and return on equity as measures of financial performance, while carbon emissions were considered as the independent variable, along with control variables such as firm size, leverage ratio, firm growth, and firm value. The research findings indicate that carbon emissions have a negative impact on both return on assets and return on equity [ABSTRACT FROM AUTHOR]

Prior to the 1990s, all U.S. states used a "cost of service (COS)" regulation regime in which investor-owned utilities were allowed to recover prudently incurred costs plus a rate of return on capital expenditures, and retail customers were unable to choose their electricity supplier. From 1996--2000, multiple states passed retail electricity market "restructuring." This empirical research examines the effect of retail restructuring on electricity prices to final consumers. We find that rates increased in restructured states relative to plausible counterfactuals in the years post-restructuring. But by twelve years after retail restructuring, we no longer observe any difference. We investigate plausible mechanisms, finding evidence that retail prices became more responsive to natural gas prices due to retail restructuring, the timing of which coincided with increases in natural gas prices nationally. We also test for whether restructuring had distributional effects across customer classes and find that in the short run residential customers benefited relative to industrial customers during transition periods, but that this difference does not persist into full implementation. [ABSTRACT FROM AUTHOR]

The purpose of this research is to study the possibility of enhancing the multifunctionality of permanent degraded grasslands by overseeding, with special look on economic efficiency. The experience that is the subject of the research was organized in the Research and Development Station for Meadows, Vaslui area, on a Dichanthium ischaemum (L.) Roberty meadow. In the study area there are large areas of permanent meadows, at different stages of degradation, due to the positioning on surfaces with different degrees of inclination, eroded or subject to erosion process, due to abandonment or non-rational use, with an inappropriate load of animals and failure to apply maintenance or improvement measures. Due to these aspects, the production is small and the floral composition is dominated by species with medium and low fodder value. In order to increase the production of permanent grassland in the area, it was considered necessary to apply organic fertilizers, and their effect was compared to that of abandonment, mulching or simple use, and with overseeding measures. Biological material used (a mixture of: 70% Bromus inermis Leyss. + 30% Onobrychis viciifolia Scop. - 30 kg·ha-¹ + 25 kg·ha-1). Total expenses, net income and profitability rate (rate of return) were calculated. The lowest costs were recorded when the biomass was only harvested, no other action being performed. When overseeding and fertilization were overlapping the costs were the highest, the economic efficiency being carried close to zero, but more likely, the effect of fertilization has been greatly diminished due to poor climatic conditions. [ABSTRACT FROM AUTHOR]

This study evaluated the economic feasibility and environmental sustainability of producing nutritionally superior snacks on an industrial scale by supercritical fluid extrusion (SCFX) using milk protein concentrate (MPC81-AP) or starch (Starch-AP)-based formulations enriched with apple pomace powder. Selected nutrient contents and antioxidant attributes were also studied to highlight the nutritional qualities of the final products. For large-scale implementation using a low-temperature (85 °C) and low-shear SCFX system, capital budgeting, breakeven point, and profitability ratios were determined. During a standard 12-hour production run, a substantial margin of safety of 29.03% and a breakeven point of 0.71 years were estimated, indicating resilience against potential losses and a swift return on investment. The projected prices for MPC81-AP and Starch-AP-based products were $30.13/kg (Similar market snacks, $32-150/kg) and $26.29/kg, respectively. In summary, both formulations exhibited superior nutritional qualities, better gross profit margins and return on investment with environmentally sustainability, compared with the conventional extrudate snack foods available in the market today. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the effect of prior period adjustments (PPA) on Equity and on Return on Equity (ROE). Methodology: The Statements of Changes in Equity and the Explanatory Notes of the companies listed on the B3's New Market, from 2010 to 2019, were researched. To analyze the effects of PPA on equity and ROE, the Wilcoxon test was applied. Results: The majority of the identified PPA pertain to changes in accounting policies, notably related to the application of IFRS 9/CPC 48 and IFRS 15/CPC 47 in 2018. This means that companies chose to recognize the effects of adopting these standards retrospectively, with a cumulative effect on equity, without presenting comparative information (accounting choice). There was a statistically significant difference between the average variations in adjusted and unadjusted equity and return on equity (ROE). In other words, it is observed that changes in accounting policies and/or error corrections influence the analysis of these indicators. It is important to note that PPA should not affect the net income for the current period, suggesting that the effects resulting from changes in accounting policies and errors tend to protect present and/or future results at the expense of past results. Contributions of the Study: The main contribution of the study lies in evaluating changes in the equity that do not necessarily result from operating performance or financing strategies, but arising from changes in accounting criteria or errors, which may affect other equity components. [ABSTRACT FROM AUTHOR]

In the context of national efforts to promote country-wide distributed photovoltaics (DPVs), the installation of distributed energy storage systems (DESSs) can solve the current problems of DPV consumption, peak shaving, and valley filling, as well as operation optimization faced by medium-voltage distribution networks (DN). In this paper, firstly, a price elasticity matrix based on the peak and valley tariff mechanism is introduced to establish a master–slave game framework for DN-DESSs under the DPV multi-point access environment. Secondly, the main model optimizes the pricing strategy of peak and valley tariffs with the objective of the lowest annual operating cost of the DN, and the slave model establishes a two-layer optimization model of DESSs with the objective of the maximum investment return of the DESSs and the lowest daily operating costs and call the CPLEX solver and particle swarm optimization algorithm for solving. Finally, the IEEE33 node system is used as a prototype for simulation verification. The results show that the proposed model can not only effectively reduce the operating cost of the distribution network but also play a role in improving the energy storage revenue and DPV consumption capacity, which has a certain degree of rationality and practicality. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of using different contents and sources of Reclaimed Asphalt Pavement (RAP) on the bottom-up fatigue cracking of asphalt mixtures and the return on investment (ROI). Two RAP sources were used that primarily provided a significant difference in RAP binder Performance Grade (PG): Source A was a PG 76-22 while Source B was a PG 94-10. Bottom-up fatigue cracking was predicted using Level 1 of the AASHTOWare Pavement Mechanistic-Empirical Design (PMED) software. The ROI was then evaluated using FHWA RealCost. To increase the accuracies of the predictions, volumetric properties and blended binder properties were calculated based on the amount of RAP binder that actively blended with the virgin binder. The accuracies were also increased by determining the AASHTOWare PMED fatigue strength coefficients, $k_{\,f1}$ k f 1 , $k_{\,f2}$ k f 2 , and $k_{\,f3}$ k f 3 , using flexural bending beam fatigue tests rather than using the global defaults provided by this software. In conclusion, the ROI of the six RAP mixtures based on bottom-up fatigue cracking was found to be affected by both RAP content and RAP source, and because of the effect of RAP source, it could not be generalised that using either a higher or lower RAP content will always provide a higher ROI. [ABSTRACT FROM AUTHOR]

The article examines the creation of a Cost Economy Energy Savings Simulation Model (CEESS Model) as an economic scenario generator for energy-independent structures using the Monte Carlo method. The CEESS model is a continuous simulation model created on the ExtendSim simulation system platform. The problem is related to the constantly changing environmental parameters for the purpose of energy security for buildings as modern, energy-independent and self-sufficient systems. In terms of the implementation of the defined part of the research, a logistical approach was applied: system analysis, coordination, algorithm work, planning, efficiency. We define logistics as a system, principle, philosophy of management of flows. The numerous simulation experiments carried out show that the return on investment of the option with an initial investment of 5000 euros is in the range of 2422 to 4978 days, the return on investment of the option with an initial investment of 10000 euros is in the range of 4233 to 7902 days and the return on investment of the option with an initial investment of 15000 euros is in the range of 5691 to 10073 days. [ABSTRACT FROM AUTHOR]

This study identifies evidence of the influence of diversification and leverage on the financial performance of Brazilian and Mexican family businesses. It analyzes 102 Brazilian and 71 Mexican publicly traded family companies. Data analysis uses ordinary least squares regression in Stata. The results indicate that Brazilian family businesses have a higher return on assets when diversifying their products or services. When diversifying international markets, Brazilian companies present a lower return on assets and return on equity. For Mexican companies, international diversification derives a higher return on assets and return on equity. In addition, results show that leverage moderates the relationship between diversification and performance both for Brazilian and Mexican family businesses. The study contributes to the current literature by investigating that diversification improves business performance and that leverage is a significant element in intensifying the benefits of this strategy in the performance of family businesses. The study also emphasizes that diversification can be useful to address market difficulties and imperfections in unstable scenarios, such as when it is targeted to planned performance and considers financial conservatism in family companies. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review and meta-analysis aimed to (1) determine the proportion of patients who underwent anterior shoulder instability surgery and did not return to sports for psychological reasons and (2) estimate differences in psychological readiness scores between patients who did and did not return to sports. Methods: The EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE and Cochrane Library databases were searched for relevant studies. The data synthesis included the proportion of patients who did not return to sports for psychological reasons and the mean differences in the psychological readiness of athletes who returned and those who did not return to sports. Non-binomial data were analysed using the inverse-variance approach and expressed as the mean difference with 95% confidence intervals. Results: The search yielded 700 records, of which 13 (1093 patients) were included. Fourteen psychological factors were identified as potential causes for not returning to sports. The rates of return to sports at any level or to the preinjury level were 79.3% and 61.9%, respectively. A total of 55.9% of the patients cited psychological factors as the primary reason for not returning to sports. The pooled estimate showed that patients who returned to sports had a significantly higher Shoulder Instability-Return to Sport After Injury score (P < 0.00001) than those who did not, with a mean difference of 30.24 (95% CI 24.95–35.53; I2 = 0%; n.s.). Conclusions: Psychological factors have a substantial impact on the rate of return to sports after anterior shoulder instability surgery. Patients who returned to sports had significantly higher psychological readiness than those who did not return to sports. Based on these results, healthcare professionals should include psychological and functional measurements when assessing athletes' readiness to return to sports. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]