bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tobacco use, secondhand exposure and knowledge of secondhand and third-hand smoke among medical college students in Western Nepal: a cross-sectional study
Authors: Sagar Surabhi , Bhattarai Dikshya , Ghimire Srijana , Bhattarai Apeksha , Wagle Anupa , Subedi Krishna 
Published: September 2024

ObjectivesThis study was conducted to assess the prevalence of tobacco use, secondhand smoke (SHS) exposure and knowledge about SHS and third-hand smoke (THS) exposure among students in a medical college in Western Nepal.DesignThis is a cross-sectional study.SettingData collection was done from 8 July 2023 to 8 August 2023 in a medical college in Nepal.ParticipantsThis study was conducted on undergraduate students studying in a medical college in Western Nepal using a census (whole population) sampling technique.Main outcome measuresPrevalence of tobacco use was assessed by asking a question, ‘Did you use tobacco products within the last 30 days?’. Secondhand smoke exposure and knowledge about SHS and THS exposure were assessed by using structured questionnaires. The χ2test was used to compare the group exposed and non-exposed to tobacco, SHS and THS by sociodemographic variables (sex, residence, year of study and academic stream).ResultsThe response rate was 96.43% (n=595/617). The overall prevalence of tobacco use was found to be 16.30%. A total of 88.83% of students from clinical years knew about SHS which was more than preclinical students (p <0.001). The Bachelor of Medicine and Bachelor of Surgery students have higher knowledge of SHS as compared with others (p =0.003). More than 95% of students favoured banning smoking in public places. Nearly half of the participants (45.45%) experienced SHS exposure in the last 7 days. More than half proportion of the clinical students knew about THS, which was higher than preclinical students and interns (p <0.001).ConclusionsTobacco use prevalence among the participants was found to be lower in comparison to other studies including medical students in several Asian countries. Despite more than three-fourths of students knowing the harmful effects of SHS exposure, almost one-half of them were exposed to SHS. The proportion of students who knew about THS exposure was comparably lower.
Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services
Authors: Carroll Christopher , Kundakci Burak , Muhinyi Amber , Bastounis Anastasios , Jones Katherine , Sutton Anthea , Goodacre Steve , Marincowitz Carl , Booth Andrew 
Published: September 2024

IntroductionProlonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate the evidence base for 10 urgent and emergency care high-impact initiatives identified by the National Health Service (NHS) England.MethodsA two-stage approach was employed. First, a comprehensive search for reviews (2018–2023) was conducted across PubMed, Epistemonikos and Google Scholar. Additionally, full-text searches using Google Scholar were performed for studies related to the key outcomes. In the absence of sufficient review-level evidence, relevant available primary research studies were identified through targeted MEDLINE and HMIC searches. Relevant reviews and studies were mapped to the 10 high-impact initiatives. Reviewers worked in pairs or singly to identify studies, extract, tabulate and summarise data.ResultsThe search yielded 20 771 citations, with 48 reviews meeting the inclusion criteria across 10 sections. In the absence of substantive review-level evidence for the key outcomes, primary research studies were also sought for seven of the 10 initiatives. Evidence for interventions improving ambulance response times was generally scarce. ED wait times were commonly studied using ED length of stay, with some evidence that same day emergency care, acute frailty units, care transfer hubs and some in-patient flow interventions might reduce direct and indirect measures of wait times. Proximal evidence existed for initiatives such as urgent community response, virtual hospitals/hospital at home and inpatient flow interventions (involving flow coordinators), which did not typically evaluate the NHS England outcomes of interest.ConclusionsEffective interventions were often only identifiable as components within the NHS England 10 high-impact initiative groupings. The evidence base remains limited, with substantial heterogeneity in urgent and emergency care initiatives, metrics and reporting across different studies and settings. Future research should focus on well-defined interventions while remaining sensitive to local context.
Patients’ experiences with ‘sludge’ (administrative burden) in the cancer screening process and its relationship with screening completion, experience and health system distrust
Authors: Rockwell Michelle S , Chang Brianna , Zagarese Vivian , Turner Jamie K , Southworth Ally , Wu YingXing , Yeaton Paul , Li Li , Stein Jeffrey S , Parker Sarah H , Epling John W 
Published: September 2024

Objective‘Sludge’ refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated patients’ perceptions of sludge in the colorectal cancer (CRC) screening process and some impacts of this sludge.DesignWe employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient survey. The interviews informed final survey revisions and captured contextual data about patients’ experiences with sludge. Interview transcripts were inductively and deductively analysed to identify overarching themes. The survey quantified sludge, delayed or forgone screenings, screening experience (Net Promoter Score) and health system distrust (Health System Distrust Scale). We used χ2or t-tests for univariable comparisons and logistic or linear regressions to evaluate the association between cumulative sludge score and delayed or forgone screenings, screening experience and health system distrust. Results were integrated for interpretation.SettingSoutheastern United States.ParticipantsPatients who were 45–75 years of age, at average risk for CRC and had either completed or been referred for CRC screening (colonoscopy or stool-based test) within the previous 12 months.Results22 interview participants and 255 survey participants completed the study. 38 (15%) survey participants rated their screening experience as poor (Net Promoter Score=0–7 out of 10). The mean (SD) Health System Distrust Scale score was 22.4 (6.3) out of 45 possible points (higher score=greater distrust). Perceptions of sludge in the CRC screening process varied, with long waiting times and burdensome communication being the most common sources (58% and 35% of participants, respectively). Sludge was positively associated with delayed or forgone screenings (OR=1.42, 95% CI 1.28, 1.57, p<0.001), poor screening experience (OR=1.15, 95% CI 1.04, 1.28, p=0.009) and health system distrust (β=0.47, p<0.001). Qualitative findings add descriptive detail about sludge encountered, context to impacts experienced, and illustrate the heavy emotional impact of sludge: ‘it just isn’t worth it’.ConclusionEfforts to reduce sludge in the CRC screening process may improve timely completion of CRC screening, enhance patient experience and restore trust in the health system.
Acquisition of Prehospital Stroke Severity Scale is associated with shorter door-to-puncture times in patients with prehospital notifications transported directly to a thrombectomy center
Authors: Bhatt Nirav R , Martin-Gill Christian , Al-Qudah Abdullah , Dermigny Katharine , Doheim Mohamed F , Rios Rocha Lucas , Sultany Abdullah , Kakamyradov Guvanch , Rocha Marcelo , Starr Matthew , Patterson Rebecca , Al-Bayati Alhamza R , Guyette Francis X , Nogueira Raul G 
Published: September 2024

BackgroundWe sought to identify systemic factors influencing door-to-puncture times (DTP) among patients with pre-arrival notifications presenting directly to a comprehensive stroke center (CSC) and undergoing emergent mechanical thrombectomy (MT).MethodsIn this retrospective analysis of a prospectively maintained registry of acute ischemic stroke (AIS) patients undergoing MT at two CSCs between January 2021 and October 2023, we included consecutive AIS patients presenting directly to the CSC with pre-arrival notifications via emergency medical services (EMS) and who underwent emergent MT. We excluded patients with known confounders to DTP and divided this cohort into two groups: DTP ≤75 min and >75 min. We used variables with P value <0.2 in the univariate analysis to build a binary logistic regression model to identify their association with DTP >75 min, adjusting for door-to-CT time.ResultsOf 900 patients, 605 were inter-facility transfers, 89 were excluded due to known confounders/missing prehospital notifications, leaving 206 qualifying patients. On multivariable analysis, not meeting American Heart Association (AHA) level 1 criteria (adjusted OR (aOR) 3.04, 95% CI 1.62 to 5.82, P<0.001), lack of Prehospital Stroke Severity Scale (PSSS) acquisition (aOR 2.2, 95% CI 1.19 to 4.11, P=0.01), and presentation after-hours (aOR 2.27, 95% CI 1.23 to 4.28, P=0.01) were associated with >75 min DTP times. Most patients (62.3%) had no clearly documented reasons for delay in MT, whereas 25.8% of delays were attributed to prolonged medical decision-making.ConclusionArrival outside business hours, not meeting AHA level 1 criteria, and lack of PSSS acquisition by EMS were associated with prolonged DTP. Impacting modifiable factors such as prehospital assessment of stroke severity is an optimal target for quality improvement.
Characterisation and outcomes of different subsets of low disease activity states in patients with systemic lupus erythematosus
Authors: Hao Yanjie , Hansen Dylan , Louthrenoo Worawit , Chen Yi-Hsing , Cho Jiacai , Lateef Aisha , Hamijoyo Laniyati , Luo Shue-Fen , Wu Yeong-Jian Jan , Navarra Sandra , Zamora Leonid , Li Zhanguo , Sockalingam Sargunan , Katsumata Yasuhiro , Harigai Masayoshi , Zhang Zhuoli , Chan Madelynn , Kikuchi Jun , Takeuchi Tsutomu , Bae Sang-Cheol , Goldblatt Fiona , O’Neill Sean , Ng Kristine , Basnayake B M D B , Tugnet Nicola , Tanaka Yoshiya , Lau Chak Sing , Li Ning , Golder Vera , Hoi Alberta , Kandane-Rathnayake Rangi , Morand Eric , Oon Shereen , Nikpour Mandana 
Published: September 2024

ObjectivesThe lupus low disease activity state (LLDAS) allows for certain clinical and/or serological activity of SLE, provided overall disease activity does not exceed predefined cut-offs. This study aimed to evaluate the outcomes of patients who achieved LLDAS with clinical activity, serological activity only or neither clinical nor serological activity.MethodsPatients with SLE enrolled in a prospective multinational cohort from March 2013 to December 2020 who were in LLDAS at least once were included. Visits that fulfilled both LLDAS and Definition of Remission in SLE (DORIS) criteria were excluded.Results2099 patients were included, with median follow-up of 3.5 (IQR 1.3–5.8) years. At 6150 visits, patients were in LLDAS but not DORIS criteria; of these 1280 (20.8%) had some clinical activity, 3102 (50.4%) visits had serological activity only and 1768 (28.8%) visits had neither clinical nor serological activity. Multivariable regression analysis showed that compared with non-LLDAS, all three subsets of LLDAS had a protective association with flares in the ensuing 6 months and damage accrual in the ensuing 36 months. LLDAS with no clinical or serological activity had a significantly stronger protective association with severe flares in the ensuing 6 months compared with LLDAS with clinical activity (HR 0.47, 95% CI (0.27 to 0.82), p=0.007).ConclusionsLLDAS without any clinical activity accounted for almost 80% of LLDAS visits. This study confirms that all subsets of LLDAS are associated with reduced flare and damage accrual. However, LLDAS without any clinical or serological activity has the strongest protective association with severe flares.
Acute cardiovascular responses to the 100-mi Western States Endurance Run
Authors: Babcock Matthew C. , El-Kurd Omar B. , Bagley James R. , Linder Braxton A. , Stute Nina L. , Jeong Soolim , Vondrasek Joseph D. , Watso Joseph C. , Robinson Austin T. , Grosicki Gregory J. 
Published: September 2024

Ultramarathon participation is growing in popularity and exposes runners to unique stressors including extreme temperatures, high altitude, and exceedingly long exercise duration. However, the acute effects of ultramarathon participation on the cardiovascular system are not well understood. To determine the acute effects of trail ultramarathon participation on central artery stiffness and hemodynamics, 41 participants (9 F, 32 M) participating in the 2023 Western States Endurance Run underwent measures of carotid-femoral pulse wave velocity (cf-PWV) and pulse wave analysis pre- and <1 h post-race. Subendocardial viability ratio (SEVR) was calculated from central blood pressure (BP) waveforms. Serum was analyzed for creatine kinase (CK) activity as a measure of muscle damage. Normally distributed data are presented as means ± standard deviation (SD), and nonnormally distributed data are presented as median (interquartile range). Runners were middle-aged and generally lean [age = 44 ± 9 yr, body mass index (BMI) = 22.7 ± 1.8 kg·m−2]. There was no difference in cf-PWV from pre- to post-race (pre = 6.4 ± 1.0, post = 6.2 ± 0.85 m/s, P = 0.104), a finding that persisted after adjusting for mean arterial pressure ( P = 0.563). Systolic and diastolic BPs were lower post-race (pre = 129/77 ± 9/7, post = 122/74 ± 10/8 mmHg, P < 0.001). Augmentation index (AIx; pre = 17.3 ± 12.2, post = 6.0 ± 13.7%, P < 0.001), AIx normalized to a heart rate of 75 beats/min ( P = 0.043), reflection magnitude (pre = 55.5(49.0–60.8), post = 45.5(41.8–48.8)%, P < 0.001), and SEVR (pre = 173.0(158.0–190.0), post = 127.5(116.5–145.8)%, P < 0.001) were reduced post-race. CK increased markedly from pre- to post-race (pre = 111(85–162), post = 11,973(5,049–17,954) U/L, P < 0.001). Completing a 161-km trail ultramarathon does not affect central arterial stiffness and acutely reduces BP despite eliciting profound muscle damage. However, the reduced post-race SEVR suggests a short-term mismatch between myocardial work and coronary artery perfusion. NEW AND NOTEWORTHY Ultramarathon participation is growing dramatically. However, the acute cardiovascular effects of completing a 161-km trail ultramarathon remain unknown. We examined the acute effects of completing the 2023 Western States Endurance Run on arterial stiffness and central hemodynamics in a relatively large sample of males and females. We observed dramatic postexercise hypotension, reductions in reflected wave amplitude and reduced subendocardial viability ratio post-race. These findings suggest that ultramarathon participation has few negative effects on cardiovascular health.
eRST: A Signaled Graph Theory of Discourse Relations and Organization
Authors: Zeldes Amir , Aoyama Tatsuya , Liu Yang Janet , Peng Siyao , Das Debopam , Gessler Luke 
Published: September 2024

Abstract
In this article we present Enhanced Rhetorical Structure Theory (eRST), a new theoretical framework for computational discourse analysis, based on an expansion of Rhetorical Structure Theory (RST). The framework encompasses discourse relation graphs with tree-breaking, non-projective and concurrent relations, as well as implicit and explicit signals which give explainable rationales to our analyses. We survey shortcomings of RST and other existing frameworks, such as Segmented Discourse Representation Theory, the Penn Discourse Treebank, and Discourse Dependencies, and address these using constructs in the proposed theory. We provide annotation, search, and visualization tools for data, and present and evaluate a freely available corpus of English annotated according to our framework, encompassing 12 spoken and written genres with over 200K tokens. Finally, we discuss automatic parsing, evaluation metrics, and applications for data in our framework.
Unity and Hostility
Authors: Davila E.J. 
Published: September 2024

Abstract
This article utilizes narrative-critical analysis to examine the ten appearances of the adverb ὁμοθυμαδόν (“with one accord/purpose/impulse”) in the book of Acts. By situating each use of the adverb within the structure and plot of Acts, this article contends that Luke uses the adverb to characterize two distinct collective bodies—the church and its adversaries—and to exhort his audience toward unified perseverance amidst rising hostility.
“Agricultural to Non-agricultural” Ways and Chinese Labor Market Differentiation: Endowment Difference or Identity Discrimination?
Authors: Ren Yuzhuo , Zheng Linhao , Dai Wei , Cheng Mengyao 
Published: September 2024

Abstract
Different methods of transforming rural migrants’ household registration can affect their integration into citizenship. This study assesses the impact of different rural-to- urban hukou conversion methods on labor market wages and job entry, utilizing empirical analysis with China General Social Survey (CGSS) data. Rural migrants transitioning to urban hukou are categorized as active or passive “agricultural to non-agricultural” groups. Wage disparities between these groups are analyzed using the Oaxaca-Blinder decomposition method, revealing that 50% of the wage gap remains unexplained by individual characteristics. Additionally, this paper explores factors contributing to wage and job entry differences using OLS regression analysis. Empirical findings indicate that discrimination significantly contributes to the wage and job entry gap between passive and active groups, with primary mechanisms including statistical bias, information acquisition differences, and identity challenges. These results underscore the inevitable transition of the agricultural population to urban areas in emerging nations’ development trajectory. However, challenges may arise during this transformation, particularly in China, where passive “agricultural to non-agricultural” individuals face discrimination. Addressing the rights and interests of this group is crucial for ensuring smooth urbanization in China and offers insights to improve urbanization efforts in developing nations.
A Cross-Lagged Panel Analysis of Social Participation in the Relationship Between Functional Limitations and Cognitive Functioning: Evidence From CHARLS
Authors: Tsang Alex Pak Lik , Lee Chi Ko , Chan Stephen Cheong Yu 
Published: September 2024

Functional limitations refer to the dependency to perform activities of daily living. Increasing evidence has demonstrated a bidirectional association between functional limitations and cognitive functioning, although the exact mechanism remains unclear. This study investigated whether social participation bidirectionally mediates the association between functional limitations and cognitive decline. We analyzed a sample of 16,385 middle-aged and older adults (aged over 50 years) using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS; Waves 1–4). We utilized a cross-lagged panel model to examine the bidirectional mediation of social participation between functional limitations and cognitive functioning over a span of eight years. The results indicated that social participation bidirectionally and partially mediated the relationship between the onset of functional limitations and cognitive decline, indicating that social participation may play an important role in mitigating the disablement process.
Inhaled Medications for Maintenance Therapy in Pediatric Noncystic Fibrosis Bronchiectasis
Authors: Harvath Gray Emily M. , Pettit Rebecca S. , Engdahl Samantha 
Published: September 2024

Objective: This review focuses on evaluating literature for the use of inhaled mucolytics (hypertonic saline, mannitol, and dornase alfa), inhaled antibiotics (tobramycin, aztreonam, colistin, and amikacin), and inhaled corticosteroids in pediatric noncystic fibrosis bronchiectasis. Data Sources: A literature search via PubMed was conducted using the search terms “non-cystic fibrosis bronchiectasis,” “primary ciliary dyskinesia,” and “bronchiectasis” in combination with each inhaled agent of interest. Study Selection and Data Extraction: Studies were included if they were specific to patients with a clinical diagnosis of noncystic fibrosis bronchiectasis published from 1998 to July 2024. Data Synthesis: Several inhaled medications can be considered as maintenance therapies for pediatric patients with noncystic fibrosis bronchiectasis. Hypertonic saline could be considered for its potential airway clearance benefits and low risk of causing harm. Inhaled antipseudomonal antibiotics should be considered in patients who are colonized with Pseudomonas aeruginosa. Inhaled corticosteroid therapy should be reserved for patients with concomitant asthma. Dornase alfa has shown worse outcomes in adults with noncystic fibrosis bronchiectasis and should be used with caution. Risks and benefits should be carefully considered when evaluating these therapies for use in noncystic fibrosis bronchiectasis, and patient-specific treatment regimens should be developed. Relevance to Patient Care and Clinical Practice: Chronic management of pediatric noncystic fibrosis bronchiectasis remains challenging due to paucity of applicable literature. Risks and benefits of different agents are discussed in this article with recommendations for application to clinical practice based on studies performed in both adult and pediatric patients with noncystic fibrosis bronchiectasis. Conclusion: Several inhaled medications could be considered as maintenance therapies for pediatric patients with noncystic fibrosis bronchiectasis, with more robust evidence to support use of inhaled antipseudomonal antibiotics and hypertonic saline compared with other available agents. Further investigation is needed to identify a clear place in therapy for inhaled therapies in pediatric noncystic fibrosis bronchiectasis.