bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health literacy among adolescents and young adults in the Eastern Mediterranean region: a scoping review
Authors: Sarhan Mohammed B A , Fujiya Rika , Kiriya Junko , Htay Zin Wai , Nakajima Kayono , Fuse Rie , Wakabayashi Nao , Jimba Masamine 
Published: June 2023

ObjectivesFor adolescents and young adults, most health literacy research has been conducted in Western countries, but few studies have been conducted in the Eastern Mediterranean region (EMR). This review aimed to explore the existing health literacy research in the EMR in addition to the levels of health literacy and its associated factors among adolescents and young adults.MethodsThe search, conducted using the PubMed/MEDLINE, EBSCOhost/CINAHL plus, Web of Science and J-STAGE databases, was initially performed on 16 June 2022 and later updated on 1 October 2022. Studies that targeted 10–25 years old persons, conducted in any of the EMR countries and that used the health literacy concept and/or described its levels or predictors were included in the review. Content analysis was used for data extraction and analysis. Data related to the study methods, participants, outcome variables and health literacy were extracted.ResultsThe review included 82 studies, most of which were conducted in Iran and Turkey and adopted a cross-sectional design. Half of the studies showed that more than half of adolescents and young adults had low or moderate health literacy. Nine studies applied university-based or school-based health education interventions to improve health literacy, which was also predicted by demographic and socioeconomic factors and internet usage. Little attention was paid to assessing the health literacy of vulnerable people, such as refugees and those with a disability and exposed to violence. Finally, various health literacy topics were investigated, including nutrition, non-communicable diseases, media and depression.ConclusionHealth literacy levels were low-to-moderate in adolescents and young adults in the EMR. To promote health literacy, it is recommended to use school-based health education and attempt to reach adolescents and young adults through social media platforms. More attention should be paid to refugees, people with disabilities and those exposed to violence.
Home-based cardiac rehabilitation: development, implementation and outcome evaluation in patients with coronary artery diseases in Lahore, Pakistan – a mixed-methods study protocol
Authors: Yaqoob Adnan , Barolia Rubina , Ladak Laila , Hanif Asif , Khan Aamir Hameed , Sahar Wajeeha 
Published: June 2023

IntroductionCardiac rehabilitation (CR) is an important strategy to bring cardiac patients back to a normal life after a cardiac event. The benefits of CR as part of secondary prevention are widely known among people who have undergone myocardial infarction or revascularisation. As evidenced by several systematic reviews and meta-analyses, home-based CR (HBCR) has similar or greater effects on health-related quality of life, health outcomes, physical activity, anxiety and unplanned visits to the emergency department as compared with centre-based CR. The purpose of this study is to develop a contextual HBCR intervention and evaluate its effects on quality of life, health behaviours, bio-physiological parameters and emergency hospital visits of patients with coronary artery diseases in Lahore, Pakistan.Methods and analysisThis study will employ a mixed-method exploratory sequential research design. The researchers will invite 15–20 cardiac patients and 12–15 healthcare providers for semi-structured interviews in the qualitative phase of the study. Once the intervention is developed and validated through the qualitative phase, the outcomes will be evaluated through a single-blinded randomised control trial in the quantitative phase. A total of 118 patients with acute coronary syndrome will be recruited through a screening checklist and randomly allocated into the control and intervention groups (59 patients in each group). The inductive coding approach will be used for the thematic analysis of qualitative data, whereas the quantitative data will be analysed through descriptive and inferential statistics using SPSS to see the difference within the groups, between groups and between three intervals.Ethics and disseminationThe Ethical Review Committee of Aga Khan University and Mayo Hospital Lahore under the registration number 2023-8282-24191 and No/75749MH have approved this study protocol, respectively. The results of this study will be disseminated to participating patients (in the Urdu language), healthcare professionals and the public by publishing the manuscript in an open-access peer-reviewed journal and presenting it at different conferences.Trial registration numberAustralian New Zealand Clinical Trial Registry (ACTRN12623000049673p).
Observational study of survival outcomes of people referred for ‘fast-track’ end-of-life care funding in a district general hospital: too little too late?
Authors: Morrison Jo , Choudhary Cherry , Beazley Ryan , Richards James , Davis Charlie 
Published: June 2023

BackgroundEnd-of-life care requires support for people to die where they feel safe and well-cared for. End-of-life care may require funding to support dying outside of hospital. In England, funding is procured through Continuing Healthcare Fast-Track funding, requiring assessment to determine eligibility. Anecdotal evidence suggested that Fast-Track funding applications were deferred where clinicians thought this inappropriate due to limited life-expectancy.AimTo evaluate overall survival after Fast-Track funding application.DesignProspective evaluation of Fast-Track funding application outcomes and survival.Setting/participantsAll people in 2021 who had a Fast-Track funding application from a medium-sized district general hospital in Southwest England.Results439 people were referred for Fast-Track funding with a median age of 80 years (range 31–100 years). 413/439 (94.1%) died during follow-up, with a median survival of 15 days (range 0–436 days). Median survival for people with Fast-Track funding approved or deferred was 18 days and 25 days, respectively (p=0.0013). 129 people (29.4%) died before discharge (median survival 4 days) and only 7.5% were still alive 90 days after referral for Fast-Track funding.ConclusionsFast-Track funding applications were deferred for those with very limited life-expectancy, with minimal clinical difference in survival (7 days) compared with those who had applications approved. This is likely to delay discharge to the preferred place of death and reduce quality of end-of-life care. A blanket acceptance of Fast-Track funding applications, with review for those still alive after 60 days, may improve end-of-life care and be more efficient for the healthcare system.
The Phenotypic variability of 16p11.2 distal BP2–BP3 deletion in a transgenerational family and in neurodevelopmentally ascertained samples
Authors: Woodbury-Smith Marc , D’Abate Lia , Stavropoulos Dimitri J , Howe Jennifer , Drmic Irene , Hoang Ny , Zarrei Mehdi , Trost Brett , Iaboni Alana , Anagnostou Evdokia , Scherer Stephen W 
Published: June 2023

BackgroundWe present genomic and phenotypic findings of a transgenerational family consisting of three male offspring, each with a maternally inherited distal 220 kb deletion at locus 16p11.2 (BP2–BP3). Genomic analysis of all family members was prompted by a diagnosis of autism spectrum disorder (ASD) in the eldest child, who also presented with a low body mass index.MethodsAll male offspring underwent extensive neuropsychiatric evaluation. Both parents were also assessed for social functioning and cognition. The family underwent whole-genome sequencing. Further data curation was undertaken from samples ascertained for neurodevelopmental disorders and congenital abnormalities.ResultsOn medical examination, both the second and third-born male offspring presented with obesity. The second-born male offspring met research diagnostic criteria for ASD at 8 years of age and presented with mild attention deficits. The third-born male offspring was only noted as having motor deficits and received a diagnosis of developmental coordination disorder. Other than the 16p11.2 distal deletion, no additional contributing variants of clinical significance were observed. The mother was clinically evaluated and noted as having a broader autism phenotype.ConclusionIn this family, the phenotypes observed are most likely caused by the 16p11.2 distal deletion. The lack of other overt pathogenic mutations identified by genomic sequencing reinforces the variable expressivity that should be heeded in a clinical setting. Importantly, distal 16p11.2 deletions can present with a highly variable phenotype even within a single family. Our additional data curation provides further evidence on the variable clinical presentation among those with pathogenetic 16p11.2 (BP2–BP3) mutations.
Towards compact laser-driven accelerators: exploring the potential of advanced double-layer targets
Authors: Maffini Alessandro , Mirani Francesco , Galbiati Marta , Ambrogioni Kevin , Gatti Francesco , Galli De Magistris Maria Sole , Vavassori Davide , Orecchia Davide , Dellasega David , Russo Valeria , Zavelani-Rossi Margherita , Passoni Matteo 
Published: June 2023

AbstractThe interest in compact, cost-effective, and versatile accelerators is increasing for many applications of great societal relevance, ranging from nuclear medicine to agriculture, pollution control, and cultural heritage conservation. For instance, Particle Induced X-ray Emission (PIXE) is a non-destructive material characterization technique applied to environmental analysis that requires MeV-energy ions. In this context, superintense laser-driven ion sources represent a promising alternative to conventional accelerators. In particular, the optimization of the laser-target coupling by acting on target properties results in an enhancement of ion current and energy with reduced requirements on the laser system. Among the advanced target concepts that have been explored, one appealing option is given by double-layer targets (DLTs), where a very low-density layer, which acts as an enhanced laser absorber, is grown to a thin solid foil. Here we present some of the most recent results concerning the production with deposition techniques of advanced DLTs for laser-driven particle acceleration. We assess the potential of these targets for laser-driven ion acceleration with particle-in-cell simulations, as well as their application to PIXE analysis of aerosol samples with Monte Carlo simulations. Our investigation reports that MeV protons, accelerated with a ∼20 TW compact laser and optimized DLTs, can allow performing PIXE with comparable performances to conventional sources. We conclude that compact DLT-based laser-driven accelerators can be relevant for environmental monitoring.
The Determinants of Early Investments in Urban School Systems in the United States
Authors: Schmick Ethan 
Published: June 2023

AbstractGrowth in per pupil education spending in the United States was mostly flat until 1918, after which it increased by almost 100 percent in a brief six-year period. This is the fastest documented increase in per pupil education spending in U.S. history. Using newly digitized biennial data on 386 of the largest urban school systems in the United States from 1900 to 1930, I investigate the origins of this spending increase. I first document that there was significant expansion in all spending and revenue categories with particularly large increases in capital expenditures, which were likely financed through borrowing. My results suggest that state education policies were largely ineffective in increasing school resources, as laws increasing state aid to local districts crowded out local receipts while compulsory schooling and English-only laws were not accompanied by increases in receipts or expenditures per pupil. Rather, I find that substantial increases in educational spending per pupil were linked to women's suffrage. Providing women with the right to vote can explain about 20 percent of the increase in per pupil spending.
From Puzzle to Paradigm: A Kuhnian Perspective on Javanese Islam
Authors: van den Boogert Jochem 
Published: June 2023

Abstract
Drawing on Kuhn’s understanding of scientific paradigms as exemplary ways of problem solving, this article critically assesses the current status of the study of Javanese Islam, in particular the long-standing debate on its nature. Is it a syncretist, animist religion or is it essentially Islamic? An analysis from a Kuhnian perspective indicates that both stances are actually the outcome of the same standardized theoretical approach. Consequentially, certain phenomena that are usually considered part of the Javanese religious condition now appear as anomalies of a paradigm. They will remain unsolvable, unless different theoretical approaches are developed. Locating a central assumption in the research into non-Western cultures – the universality of religion – is a step in that direction. From there, generating new descriptions and new research questions becomes a possibility.
Variability of the Deep Western Boundary Current in the Northern Philippine Sea
Authors: Xu Qinbo , Zhou Chun , Zhang Linlin , Wang Fan , Zhao Wei , Hu Dunxin 
Published: June 2023

Abstract
The deep western boundary current (DWBC) was studied based on a full-depth mooring east of Luzon Island in the Northern Philippine Sea deep basin during the period from January 2018 to May 2020. On average, the DWBC in the Philippine Sea flows southward with a velocity of approximately 1.18 cm s−1 at a depth of 3050 m. Significant intraseasonal and seasonal variations of the DWBC are identified. The intraseasonal variations have multiple spectral peaks in the range of 30–200 days, with the most obvious peak at approximately 120 days. On the seasonal time scale, the DWBC intensifies in summer/autumn and weakens in winter/spring, corresponding well with the seasonal variation of the ocean bottom pressure (OBP) from the Gravity Recovery and Climate Experiment. Both intraseasonal and seasonal variations have no significant correlation with the temporal variations in the upper and middle layers but have a certain correlation with transport through the Yap–Mariana Junction (YMJ). A set of experiments based on an inverted-reduced-gravity model and the OBP data reveal that the temporal variations originating from the YMJ could propagate counterclockwise along the boundary of the deep basin to the western boundary of the deep Philippine Sea, dominating the temporal variations of DWBC.
Coagulation after paediatric miniaturised versus conventional cardiopulmonary bypass: Retrospective cohort study
Authors: Ti Yunxing , Meng Baoying , Wang Yuanxiang , Liu Huaipu , Wang Pengcheng , Huang Junrong , Wu Wenzhi , Zheng Fengnan , Zhang Qing 
Published: June 2023

Background Cardiopulmonary bypass (CPB) causes coagulation disorders after surgery. This study aimed to compare the coagulation parameters after congenital cardiac surgery with miniaturised CPB (MCPB) versus conventional CPB (CCPB). Methods We gathered information about children who underwent cardiac surgery between 1/1/2016 and 12/31/2019. Using propensity score–matched data, we compared the coagulation parameters and postoperative outcomes of the MCPB and CCPB groups. Results A total of 496 patients (327 with MCPB, 169 withCCPB) underwent congenital cardiac surgery, and 160 matched pairs in each group were enrolled in the analysis. Compared with CCPB children, MCPB children had a lowermean prothrombin time (14.9 ± 2.0 vs 16.4 ± 4.1; p < 0.001)and international normalised ratio (1.3 ± 0.2 vs. 1.4 ± 0.3; p < 0.001), but higher thrombin time (23.4 ± 20.4 vs 18.2 ± 4.4; p = 0.002). The CCPB group had greaterperioperative changes inprothrombin time, international normalised ratio, fibrinogen, and antithrombin III activity (all p < 0.01) but lower perioperative changesin thrombin time ( p = 0.001) thanthe MCPB group. Ultra-fasttrack extubation and blood transfusionrates, postoperative blood loss, and intensive care unitlength of stay were considerably decreased in the MCPB group. There were no considerable intergroup differences in the activated partial thromboplastin time or platelet count. Conclusions Compared with CCPB, MCPB was associated with lower coagulation changes and better early outcomes, including shorter intensive care unit stay and less postoperative blood loss.
UK local government experience of COVID-19 Lockdown: Local responses to global challenges
Authors: Machin Richard 
Published: June 2023

Local authorities in the United Kingdom played an integral role in responding to the COVID-19 pandemic. During a time of unprecedented crisis, local authorities acted quickly to strengthen local governance arrangements and to deliver frontline services. The public health emergency created unparalleled challenges for local authorities. This paper reflects on the experience of Nottingham City Council, a local authority in the East Midlands of England. It draws on an in-depth interview with the then Deputy Leader of the authority and the chair of the Outbreak Control Engagement Board, and the publicly available minutes from this committee. This paper places the specific experiences of this local authority in a broader context reflecting on emergency planning, best practice, and legacy. It contributes to understanding the national impact of COVID-19 on local government. Four key themes emerge from this analysis: first central government was too slow in responding to the emerging crisis and communication with local government was poor, second the local authority quickly moved online but there has subsequently been a return to pre-pandemic working practices, third local government played a critical role in supporting vulnerable citizens despite huge budgetary pressures, and finally relationships between partners was crucial in achieving positive outcomes.
Evaluation of the New England Office Based Addiction Treatment ECHO: A Tool for Strengthening the Addiction Workforce
Authors: Heerema Matthew R. , Ventura Alicia S. , Blakemore Samantha C. , Montoya Ivan D. , Gobel Danna E. , Kiang Mathew V. , LaBelle Colleen T. , Bazzi Angela R. 
Published: June 2023

Introduction: Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program’s impact on the knowledge and attitudes of NE OBAT ECHO participants. Methods: We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control. Results: Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points. Conclusions: NE OBAT ECHO may have improved participants’ confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.
“It’s a Heavy Thing to Carry:” Internal Medicine and Pediatric Resident Experiences Caring for Dying Patients
Authors: Gibbon Lindsay M. , Buck Laura , Schmidt Lauren , Bogetz Jori F. , Trowbridge Amy 
Published: June 2023

Background Residents often feel unprepared to care for dying patients and may benefit from more training. Little is known about factors in the clinical setting that promote resident learning about end of life (EOL) care. Objectives This qualitative study aimed to characterize the experiences of residents caring for dying patients and elucidate the impact of emotional, cultural, and logistical factors on learning. Methods 6 US internal medicine and 8 pediatric residents who had cared for at least 1 dying patient completed a semi-structured one-on-one interview between 2019 and 2020. Residents described an experience caring for a dying patient including their confidence in clinical skills, emotional experience, role within the interdisciplinary team, and perspective on how to improve their education. Interviews were transcribed verbatim and investigators conducted content analysis to generate themes. Results 3 themes (with subthemes) emerged: (1) experiencing strong emotion or tension (loss of patient personhood, emerging professional identity, emotional dissonance); (2) processing the experience (innate resilience, team support); and (3) recognition of a new perspective or skill (bearing witness, meaning making, recognizing biases, emotional work of doctoring). Conclusions Our data suggests a model for the process by which residents learn affective skills critical to EOL care: residents (1) notice strong emotion, (2) reflect on the meaning of the emotion, and (3) crystallize this reflection into a new perspective or skill. Educators can use this model to develop educational methods that emphasize normalization of physician emotions and space for processing and professional identity formation.