bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unpacking the Antecedents of Boredom and Its Impact on University Learners’ Engagement in Languages Other Than English: A Qualitative Study in the Distance Online Learning Context
Authors: Zhao Xian , Wang Danping 
Published: December 2024

ABSTRACTAlthough psychological factors such as emotion and engagement have gained increasing attention for their role in language learning success, a substantial gap remains in understanding the sources of boredom and its impact on learners’ engagement, whether behavioural, affective or cognitive, in languages other than English (LOTE). This study employs questionnaires and semi‐structured interviews to examine the cause‐and‐effect relationships between antecedents, boredom and engagement in a distance online learning context among university Chinese as a second language (CSL) teachers and learners (N = 17) from China. The findings suggest that (1) boredom is primarily a student‐oriented construct influenced by physical fatigue and academic regression. Teacher‐related factors, such as a slow and predictable teaching pace, dull classroom design, lack of questioning, explanations and untimely feedback, also contribute to boredom, along with learning tasks (e.g., repetitive, mechanical and over‐challenging tasks), and internet‐related issues. Boredom is notably more present in listening courses rather than in integrated Chinese courses. (2) Boredom primarily affected learners’ behavioural engagement (e.g., distraction, sleepiness, mind‐wandering, and task abandonment) and subsequently impaired their cognitive (e.g., concentration, comprehension) and emotional (e.g., anxiety, anger) layers. This study elucidated the intricate interconnections between layers within engagement and beyond, and the interrelationships among a list of factors across conative (engagement, effort and motivation), affective (boredom, anxiety and anger) and cognitive (concentration, comprehension and reasoning) dimensions in a domain‐specific and skill‐specific manner. In closing, pedagogical implications for both educators and learners are discussed to reduce boredom and enhance learners’ classroom engagement, ultimately improving learning outcomes and the overall language learning experience.
Unraveling of product information with discrete prices
Authors: Woo Hee Yeul 
Published: December 2024

AbstractIn a market with discrete prices, the seller provides verifiable information to buyers with privately known tastes, possibly horizontally differentiated. We present a necessary and sufficient condition, called the unraveling criteria, to achieve effective unraveling at every prudent rationalizable outcome, which extends pairwise monotonicity in a more general framework. The unraveling criteria are satisfied if we can rank seller types from the ones with the highest to the ones with the lowest sales at every price, reminiscent of vertical differentiation. We observe that cautiousness, embodied in prudent rationalizability, plays a specific role in achieving effective unraveling.
The Role of Cultural Safety Within a Human Rights‐Based Approach to Improve Indigenous Peoples’ Health: A Scoping Review
Authors: Palu Mele Lua , Wenham Kathryn , Shagar Pravina 
Published: December 2024

ABSTRACTAimTo examine the role of cultural safety within a human rights‐based approach to improving the health of Indigenous Peoples.DesignGuided by Askey and O'Malley's scoping review framework, the literature was examined on cultural safety and prioritised Indigenous voices to inform culturally safe practices. Relevant literature from 2009 to 2021 was included.Data SourcesDatabases included CINAHL, PubMed, Informit and the Australian Indigenous HealthInfoNet.Review MethodsSearch terms included ‘Indigenous Peoples’, ‘cultural safety’ and ‘human rights’ within the context of health in Australia, Aotearoa and Canada.ResultsThe database searches yielded 147 abstracts. After screening, 39 studies were included in the review, describing four overarching themes on the connection between cultural safety and the right to health.ConclusionsDespite cultural safety being linked to key elements of the right to health, such as availability, accessibility, and culturally acceptable resources and services, there is still paucity in research on cultural safety within a human rights framework. Evidence supports cultural safety to decolonise practices, embrace Indigenous knowledge and challenge racism. Linking cultural safety to key elements of the right to health compels nations that have ratified the International Covenant on Economic, Social and Cultural Rights to embed cultural safety to fulfil their legal obligation to address health equity according to International Human Rights Law. This study is the first to add a human rights lens on cultural safety.ImpactThe findings underscore the need for clear and explicit linkage between cultural safety and the right to health. This will prompt greater accountability for healthcare institutions and providers and governments to create a more culturally safe healthcare system and to recognise that cultural safety is not optional but an inherent part of the right to health.No Patient or Public ContributionCultural safety, decolonisation, health equity, human rights, Indigenous, nursing, racism.
Machine Learning‐Driven Identification of Distinct Persistent Atrial Fibrillation Phenotypes: A Cluster Analysis of DECAAF II
Authors: Noujaim Charbel , Feng Han , Bidaoui Ghassan , Huang Chao , Younes Hadi , Assaf Ala , Mekhael Mario , Chouman Nour , Lim Chanho , Donnellan Eoin , Shamaileh Ghaith , El Hajjar Abdel Hadi , Nelson Daniel , Dhore Aneesh , Li Dan , Marrouche Nassir , Kreidieh Omar 
Published: December 2024

ABSTRACTIntroductionCatheter ablation of persistent atrial fibrillation yields sub‐optimal success rates partly due to the considerable heterogeneity within the patient population. Identifying distinct patient phenotypes based on post‐ablation prognosis could improve patient selection for additional therapies and optimize treatment strategies.MethodsWe studied all patients who underwent catheter ablation of persistent atrial fibrillation in the DECAAF II trial. Out of 44 participating centers, 25% were randomly chosen as a validation set. A Gradient Boosting Method determined essential features for arrhythmia recurrence prediction and the number of clusters was determined according to the average silhouette width. K‐medoids cluster analysis identified subgroups based on these features, and Kaplan–Meier curves were further compared among different clusters.ResultsAmong 815 patients, 570 served as a training set and 245 as a validation set. Using the training set, the GBM model achieved an AUC of 0.874. K‐medoids cluster analysis used LA volume, BMI, baseline fibrosis, and age, resulting in two clusters. Cluster 1 patients were older, had higher baseline fibrosis, higher BMI, and greater LA volume compared to Cluster 2. Atrial arrhythmia recurrence rates were significantly higher in Cluster 1 (51.7% vs. 35.0%, p = 0.0002), and survival analysis showed a significant difference in primary recurrence outcomes (HR = 1.71, p < 0.0001). The validation set confirmed these findings.ConclusionUtilizing machine learning, we identified a high‐risk cluster for procedural failure in catheter ablation of persistent atrial fibrillation within the DECAAF II trial population. The primary differentiating factors of this high‐risk cluster include older age, high left atrial fibrosis, elevated BMI, and increased left atrial volume.
An Investigation of the Barriers to Care of Adult Patients With a Tracheostomy in Intensive Care Units and General Wards: Secondary Analysis of Qualitative Interview Data
Authors: Akroute A. , Fredriksen S. T. D. , Hovland A. , Brinchmann B. S. 
Published: December 2024

ABSTRACTAims and ObjectivesTo investigate the barriers experienced by intensive care nurses and registered nurses and to provide optimal nursing for adult patients with a temporary tracheostomy in intensive care and general wards.BackgroundTracheostomy is widely used in intensive care units, around 20% of intensive care unit patients undergo tracheostomy insertions and expect high quality of care. Caring for patients with a tracheostomy is complex and challenging task. An investigation of barriers to care for adult patients with a temporary tracheostomy in a hospital setting is essential to ensure that these patients receive the highest quality of care and to identify areas for improvement.DesignThis paper applied secondary analysis to data from two qualitative studies, including narrative interviews and maximum variation sampling.MethodsSecondary analysis of primary qualitative datasets is appropriate when the analysis extends rather than exceeds the primary. The analysis was based on interview data collected from six intensive care nurses and six registered nurses from two university teaching hospitals in Norway. The interviews were audio‐recorded and transcribed. The data was analysed using the qualitative analysis suggested by Graneheim and Lundman. This study adhered to the consolidated criteria for reporting in a qualitative research (COREQ) checklist.ResultsFour main themes were identified as barriers to care for adult patients with a temporary tracheostomy in the hospital: encountering ambivalence, inadequate staffing levels, lack of patient continuity of care and lack of systematic follow‐up.ConclusionsUnderstanding barriers to care is crucial for hospitals and healthcare organisations to develop targeted interventions and educational programs to address these barriers and improve the care provided to adult patients with tracheostomies in hospital settings.
Intermediary Leverage Shocks and Funding Conditions
Authors: FONTAINE JEAN‐SÉBASTIEN , GARCIA RENÉ , GUNGOR SERMIN 
Published: December 2024

ABSTRACTThe aggregate leverage of broker‐dealers responds to demand and supply disturbances that have opposite effects on financial markets. Specifically, leverage supply shocks that relax broker‐dealers' funding constraints increase leverage, liquidity, and returns and carry a positive price of risk, while leverage demand shocks also increase leverage but reduce liquidity and returns and carry a negative price of risk. Disentangling demand‐ and supply‐like shocks resolves existing puzzles around the price of leverage risk and yields consistent evidence across many markets of a central role for intermediation frictions and dealers' aggregate leverage in asset pricing.
C‐reactive protein diagnostic value for bacterial infections in the paediatric emergency department setting
Authors: Adam Iben Hamad , Kestenbom Inbal , Shmueli Moshe , Hassan Lior , Lendner Idan , Ben‐Shimol Shalom 
Published: December 2024

AimC‐reactive protein (CRP) is commonly used to assess the probability of bacterial infection and the need for empiric antibiotic treatment. We assessed the relationship between CRP levels and bacterial infection in the paediatric emergency room (PER) setting.MethodsA retrospective cohort study. Relative risks (RRs) were calculated for the relation between CRP levels and various demographic, clinical and diagnosis parameters. Additionally, the sensitivity and specificity of different CRP levels (2, 5, 7 and 10 mg/dL) for bacterial infection diagnosis was calculated.ResultsOverall, 13 092 cases were recorded. Fever, leucocytosis, hospitalisation and bacterial infection diagnosis were associated with elevated CRP levels, while lower CRP levels were associated with young age. Gender, ethnicity, hypoxemia and neutrophilia were not associated with CRP levels. The sensitivity of CRP ≥2 mg/dl for bacterial disease was 65%–70%, declining to <50% in CRP ≥5 mg/dL. The specificity of CRP ≥2 mg/dL for bacterial disease was ~60%, increasing to >80% in CRP ≥5 mg/dL.ConclusionsCRP levels of ≥5 mg/dl high specificity for bacterial disease, allow for its use as an indicator to start empiric antibiotic treatment, while the low sensitivity of various CRP levels probably excludes the possibility of withholding empiric antibiotic treatment, based only on CRP level.
How socioeconomic and structural barriers influence dental care among transgender people
Authors: Clermont Donald , Nieto Valerie , Alpert Elizabeth , Yao Elvin , Cothron Annaliese 
Published: December 2024

AbstractBackgroundWhile recent US policies restrict access to healthcare and resulting health disparities among the transgender community, little is known about oral health access and utilization among this population. This study assessed self‐reported access to dental care among transgender adults living in the United States.MethodThe study sample included 1,284,526 observations representing a weighted population of 290,000,163 from Behavioral Risk Factor and Surveillance Survey (BRFSS) datasets. Transgender identity was dichotomized and tested for association with having a dental visit in the past year. Pearson chi‐square statistics were computed for associations and multivariate logistic regression assessed the odds of seeing a dentist in the last year.ResultsNearly all socioeconomic and healthcare access covariates were associated with transgender identity. A significantly smaller proportion of transgender respondents reported established employment graduating high school, income over $50,000, non‐Hispanic White racial and ethnic identities, and a past‐year medical checkup (all p < 0.01). In all three models and across all analyses, transgender respondents had significantly lower odds of having seen a dentist in the past year, compared to cisgender people.ConclusionsTo date, no research, aside from the present study, has assessed connections between transgender identity and oral healthcare access. The results of this analysis are consistent with other healthcare disparities that transgender people experience in that a smaller proportion of transgender respondents saw a dentist in the last year compared to cisgender respondents. Implications for establishing a foundation in future research to explore oral health access, utilization, and policy recommendations are discussed.
Drift in small populations predicts mate availability and the breakdown of self‐incompatibility in a clonal polyploid
Authors: Cisternas‐Fuentes Anita , Forehand Cameron , Morris Kate , Busch Jeremiah W. , Koski Matthew H. 
Published: December 2024

Summary
Mate limitation in small populations can reduce reproductive fitness, hinder population growth, and increase extinction risk. Mate limitation is exacerbated in self‐incompatible (SI) taxa, where shared S‐alleles further restrict mating. Theory suggests genetic drift as a predictor of mate limitation and the breakdown of SI systems. We tested this prediction by evaluating mate availability and S‐allele number in populations of a tetraploid herb with gametophytic SI (GSI) spanning a range of effective population sizes.
We performed controlled crosses in 13 populations of Argentina anserina to quantify mate availability and S‐allele diversity, which were compared with simulations of tetraploid populations with GSI. We further evaluated mechanisms at the pollen–pistil interface contributing to outcross failure and leakiness in self‐recognition.
Mate availability declined in small populations, and closely fit tetraploid GSI population genetic models where maternal plants receive pollen with diverse S‐alleles generated through tetrasomic inheritance. The failure to arrest self‐pollen in the style was common in some populations. Specifically, leaky SI was more common in small populations with low mate availability, where it explained higher seed production in natural populations.
The restriction of leaky self‐recognition to the smallest populations is consistent with mate limitation as a pressure driving the breakdown of self‐incompatibility.
Unique bibenzyl cannabinoids in the liverwort Radula marginata: parallels with Cannabis chemistry
Authors: Andre Christelle M. , Sansom Catherine E. , Plunkett Blue J. , Hamiaux Cyril , Massey Lenhy , Chan Andrew , Caddie Manu , Espley Richard V. , Perry Nigel B. 
Published: December 2024

Summary
The potential of cannabinoids to address public health challenges has stimulated exploration into alternative sources and production technologies. Radula marginata, an endemic Aotearoa/New Zealand liverwort, produces the bibenzyl cannabinoid perrottetinene (PET), analogous to Cannabis psychoactive tetrahydrocannabinol (THC). Structural differences between PET and THC could alter therapeutic interactions and mitigate adverse side effects.
To understand the cannabinoid production potential of R. marginata, we analyzed 75 collections from three locations across several seasons, collaborating with kaitiaki Māori (indigenous guardians). Metabolic plasticity of the phytocannabinoids and plant growth was assessed under controlled growth conditions, and in in vitro culture.
Perrottetinene diol (trans‐PTD), analogous to cannabidiol (trans‐CBD), and its acid precursor (PTDA), were identified and fully characterized from nature for the first time. Bibenzyl‐4‐geranyl (BB4G), analogous to cannabigerol (CBG), and its corresponding acid (BB4GA), were also isolated. Radula marginata showed chemotypes dominated by PET, PTD, or BB4G, in striking analogy to the main Cannabis chemotypes. These site‐selective chemotypes persisted after growth under artificial lighting and in in vitro progeny, suggesting genetic control.
These results expand phytocannabinoid knowledge through the discovery of PTD analogous to CBD. They add a new dimension to liverwort cannabinoids and suggest convergent evolution of biosynthesis in two distant plant lineages.
A systematic review of evidence that environmental contaminant exposure impedes weight loss and glycemic control during calorie‐restricted diets in humans
Authors: Bennett Kimberley Ann , Sutherland Calum , Savage Anne Louise 
Published: December 2024

SummaryCalorie‐restricted diets cause weight loss and can drive type 2 diabetes remission. However, many patients struggle to achieve clinically relevant weight loss, and the reasons are not well understood. Chemical exposure is associated with obesity and type 2 diabetes development, and some evidence from preclinical experiments suggests it can limit the clinical benefits of calorie restriction. We systematically reviewed the evidence for the effects of environmental chemical exposure on mass loss and glycemic control during diet‐induced weight management in humans (PROSPERO: CRD42022339993). Of 222 unique citations, only six papers directly examined this question. Only one targeted people with type 2 diabetes. One linked phthalates and parabens, but not bisphenols, with slower fat loss. Two showed per‐ and polyfluoroalkyl substances were not associated with mass loss, but with faster subsequent mass regain. One linked impaired adiposity improvements with air pollutants. Two papers reported weight loss‐induced elevation in plasma organochlorines associated with altered glycemic control. The risk of bias largely arose from the potential for deviation from the intended diet, and statistics and reporting. The role of chemical exposure in impeding the effectiveness of weight management programs needs to be better understood to provide suitable support to people living with obesity and type 2 diabetes.
Impact of Procedural Aspects on Early Complications After Permanent Cardiac Implantable Device Implantations
Authors: Popiolek‐Kalisz Joanna , Chrominski Tomasz , Szczasny Marcin , Błaszczak Piotr 
Published: December 2024

ABSTRACTBackgroundCardiac implantable devices (CIED) such as pacemakers, implantable cardioverter‐defibrillators, or cardiac resynchronization devices are implanted in selected patients with bradyarrhythmia and advanced heart failure. The invasive character of these procedures poses a risk of early complications such as pneumothorax, bleeding, infections, or dislocations.AimsThere are no available data that analyzed the impact of the organization of procedures on the early complications risk after permanent pacing procedures. The aim of this study was to investigate if organizational aspects can impact early complications risk in CIED implantations.MethodsThis retrospective study analyzed the medical records of 1673 patients who underwent CIED implantation at the Department of Cardiology of Cardinal Wyszynski Hospital in the years 2016–2020 (before the conduction system pacing era).ResultsThe regression analysis revealed the predictive value of the number of leads on complication risk overall (β = 0.65, p < 0.001). Even though the significant differences in complications count were also observed for the consecutive days of the week (p = 0.002) and procedure order within the same day (p = 0.01), the regression analysis did not confirm their predictive value on complications’ risk. However, the subgroup analysis regarding the device type revealed the significant predictive value of procedure order on complications in the single‐chamber pacemaker subgroup (β = 1.10, p = 0.01). Moreover, the subgroup analysis confirmed the predictive value of the number of leads on pneumothorax (β = 0.89, p = 0.04) and dislocation (β = 0.67, p = 0.01), age of the patient, and the assist with the less experienced operator on hemopericardium (β = 0.11, p = 0.02, and β = 2.34, p = 0.04, respectively).ConclusionThe study showed that the number of leads is the main factor of early complications after CIED implantations. In the simplest devices such as single‐chamber pacemakers, the order of the procedure within the same day can also play a role in early complications risk.
Diagnostic Blind Spot: Physicians Overlook Atrial Fibrillation in Pacemaker‐Dependent Patients
Authors: Avidan Yuval , Khoury Razi , Aker Amir 
Published: December 2024

ABSTRACTBackgroundPacemaker recipients demonstrate a higher prevalence of atrial fibrillation (AF), yet the regular ventricular activation in pacemaker‐dependent patients with AF presents a substantial diagnostic challenge.MethodsA total of 310 medical practitioners completed a brief, validated survey consisting of three electrocardiograms displaying AF with ventricular pacing. Participants were instructed to identify the underlying rhythm.ResultsCardiologists outperformed all other groups with 69% correct responses, followed by emergency physicians (33%) and internists (24%). The poorest performance was observed among primary care physicians (14%) and medical interns (12%) (p < 0.0001). The comparison between groups revealed a statistically significant difference between cardiologists and non‐cardiologists (p < 0.001).ConclusionThe detection of AF in patients with ventricular‐paced rhythm remains a significant diagnostic challenge, with notable gaps even among cardiologists. It is imperative to educate physicians that AF in this context may not present with the typical irregular rhythm. Routine interrogation of cardiac devices in cases where the rhythm is unclear can facilitate a timely and accurate diagnosis of this concealed arrhythmia.