{
    "document_id": 13781,
    "page": 4,
    "width_pt": 720,
    "height_pt": 540,
    "rotation": 0,
    "pipeline_version": "paddleocr-vl-1.6+paul-48",
    "engine": "paddleocr_vl",
    "source_run_id": 13892,
    "item_count": 34,
    "counts_by_type": {
        "figure": 1,
        "footer": 1,
        "footnote": 2,
        "heading": 7,
        "table": 1,
        "table_cell": 1,
        "text": 21
    },
    "build_ms": 2,
    "items": [
        {
            "id": "p4.1",
            "order": 1,
            "type": "heading",
            "bbox": {
                "l": 4.08,
                "t": 524.16,
                "r": 675.84,
                "b": 426.48
            },
            "text": "Reminder: Health →\nA Result of Many Factors + Exposures\nExample Cardiovascular Disease",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p4.2",
            "order": 2,
            "type": "figure",
            "bbox": {
                "l": 7.68,
                "t": 378.24,
                "r": 713.28,
                "b": 64.8
            },
            "text": "",
            "attrs": {
                "block_label": "image"
            },
            "children": [
                {
                    "id": "p4.2.1",
                    "order": 3,
                    "type": "heading",
                    "bbox": {
                        "l": 591.6,
                        "t": 370.32,
                        "r": 706.08,
                        "b": 345.36
                    },
                    "text": "Increased cardiovascular\nrisk and morbidity",
                    "attrs": {
                        "block_label": "paragraph_title"
                    },
                    "level": 3
                },
                {
                    "id": "p4.2.2",
                    "order": 4,
                    "type": "heading",
                    "bbox": {
                        "l": 14.64,
                        "t": 370.08,
                        "r": 92.88,
                        "b": 346.56
                    },
                    "text": "Major exposome\nrisk factors",
                    "attrs": {
                        "block_label": "paragraph_title"
                    },
                    "level": 3
                },
                {
                    "id": "p4.2.3",
                    "order": 5,
                    "type": "text",
                    "bbox": {
                        "l": 134.4,
                        "t": 370.08,
                        "r": 202.8,
                        "b": 345.36
                    },
                    "text": "Genetic predisposition"
                },
                {
                    "id": "p4.2.4",
                    "order": 6,
                    "type": "text",
                    "bbox": {
                        "l": 223.44,
                        "t": 369.84,
                        "r": 292.32,
                        "b": 335.28
                    },
                    "text": "Pre-existing cardiovascular disease"
                },
                {
                    "id": "p4.2.5",
                    "order": 7,
                    "type": "text",
                    "bbox": {
                        "l": 329.28,
                        "t": 335.76,
                        "r": 421.68,
                        "b": 311.76
                    },
                    "text": "Central biochemical pathways"
                },
                {
                    "id": "p4.2.6",
                    "order": 8,
                    "type": "text",
                    "bbox": {
                        "l": 15.12,
                        "t": 322.08,
                        "r": 55.44,
                        "b": 308.64
                    },
                    "text": "Smoking"
                },
                {
                    "id": "p4.2.7",
                    "order": 9,
                    "type": "text",
                    "bbox": {
                        "l": 332.16,
                        "t": 311.76,
                        "r": 409.68,
                        "b": 290.88
                    },
                    "text": "- Circadian clock dysregulation\n- Stress hormone responses\n- Inflammation\n- Oxidative stress"
                },
                {
                    "id": "p4.2.8",
                    "order": 10,
                    "type": "heading",
                    "bbox": {
                        "l": 134.16,
                        "t": 284.16,
                        "r": 269.28,
                        "b": 270.96
                    },
                    "text": "Specific external environment",
                    "attrs": {
                        "block_label": "paragraph_title"
                    },
                    "level": 3
                },
                {
                    "id": "p4.2.9",
                    "order": 11,
                    "type": "text",
                    "bbox": {
                        "l": 332.16,
                        "t": 270.24,
                        "r": 402.48,
                        "b": 260.16
                    },
                    "text": "- Inflammation"
                },
                {
                    "id": "p4.2.10",
                    "order": 12,
                    "type": "text",
                    "bbox": {
                        "l": 19.92,
                        "t": 270,
                        "r": 96,
                        "b": 247.68
                    },
                    "text": "Mental health and societal factors"
                },
                {
                    "id": "p4.2.11",
                    "order": 13,
                    "type": "text",
                    "bbox": {
                        "l": 137.52,
                        "t": 269.04,
                        "r": 168.24,
                        "b": 258.96
                    },
                    "text": "Diet"
                },
                {
                    "id": "p4.2.12",
                    "order": 14,
                    "type": "text",
                    "bbox": {
                        "l": 332.16,
                        "t": 259.92,
                        "r": 411.84,
                        "b": 249.12
                    },
                    "text": "• Oxidative stress"
                },
                {
                    "id": "p4.2.13",
                    "order": 15,
                    "type": "text",
                    "bbox": {
                        "l": 137.76,
                        "t": 258.24,
                        "r": 231.6,
                        "b": 248.16
                    },
                    "text": "- Consumer products\n- Physical activity\n- Tobacco\n- Water"
                },
                {
                    "id": "p4.2.14",
                    "order": 16,
                    "type": "text",
                    "bbox": {
                        "l": 27.12,
                        "t": 237.6,
                        "r": 187.2,
                        "b": 227.04
                    },
                    "text": "Psychosocial stress • Tobacco"
                },
                {
                    "id": "p4.2.15",
                    "order": 17,
                    "type": "text",
                    "bbox": {
                        "l": 27.84,
                        "t": 227.04,
                        "r": 81.84,
                        "b": 217.44
                    },
                    "text": "Lonliness"
                },
                {
                    "id": "p4.2.16",
                    "order": 18,
                    "type": "text",
                    "bbox": {
                        "l": 138,
                        "t": 227.04,
                        "r": 176.64,
                        "b": 216.72
                    },
                    "text": "Water"
                },
                {
                    "id": "p4.2.17",
                    "order": 19,
                    "type": "heading",
                    "bbox": {
                        "l": 331.2,
                        "t": 224.4,
                        "r": 426,
                        "b": 212.4
                    },
                    "text": "Internal environment",
                    "attrs": {
                        "block_label": "paragraph_title"
                    },
                    "level": 3
                },
                {
                    "id": "p4.2.18",
                    "order": 20,
                    "type": "heading",
                    "bbox": {
                        "l": 468.72,
                        "t": 220.56,
                        "r": 554.16,
                        "b": 196.08
                    },
                    "text": "Health effects and risk assessments",
                    "attrs": {
                        "block_label": "paragraph_title"
                    },
                    "level": 3
                },
                {
                    "id": "p4.2.19",
                    "order": 21,
                    "type": "text",
                    "bbox": {
                        "l": 27.84,
                        "t": 216.72,
                        "r": 103.92,
                        "b": 206.64
                    },
                    "text": "• Social isolation"
                },
                {
                    "id": "p4.2.20",
                    "order": 22,
                    "type": "text",
                    "bbox": {
                        "l": 657.12,
                        "t": 212.64,
                        "r": 705.6,
                        "b": 189.12
                    },
                    "text": "Myocardial infarction"
                },
                {
                    "id": "p4.2.21",
                    "order": 23,
                    "type": "text",
                    "bbox": {
                        "l": 331.92,
                        "t": 210.96,
                        "r": 413.04,
                        "b": 179.52
                    },
                    "text": "• Transcriptomics\n• Proteomics\n• Metabolomics\n• Proteomics\n• Metabolomics"
                },
                {
                    "id": "p4.2.22",
                    "order": 24,
                    "type": "heading",
                    "bbox": {
                        "l": 134.4,
                        "t": 178.56,
                        "r": 267.36,
                        "b": 166.56
                    },
                    "text": "General external environment",
                    "attrs": {
                        "block_label": "paragraph_title"
                    },
                    "level": 3
                },
                {
                    "id": "p4.2.23",
                    "order": 25,
                    "type": "text",
                    "bbox": {
                        "l": 134.64,
                        "t": 173.52,
                        "r": 225.36,
                        "b": 85.68
                    },
                    "text": "General external env\n- Climate\n- Traffic\n- Urban environment\n- Green spaces\n- Social capital\nNoise"
                },
                {
                    "id": "p4.2.24",
                    "order": 26,
                    "type": "text",
                    "bbox": {
                        "l": 14.16,
                        "t": 155.76,
                        "r": 98.4,
                        "b": 131.76
                    },
                    "text": "Chemical pollution\n• Air"
                },
                {
                    "id": "p4.2.25",
                    "order": 27,
                    "type": "text",
                    "bbox": {
                        "l": 673.44,
                        "t": 138.24,
                        "r": 702.24,
                        "b": 127.2
                    },
                    "text": "Stroke"
                },
                {
                    "id": "p4.2.26",
                    "order": 28,
                    "type": "text",
                    "bbox": {
                        "l": 22.56,
                        "t": 133.44,
                        "r": 61.44,
                        "b": 123.6
                    },
                    "text": "- Water\n- Soil"
                },
                {
                    "id": "p4.2.27",
                    "order": 29,
                    "type": "text",
                    "bbox": {
                        "l": 329.52,
                        "t": 80.4,
                        "r": 430.8,
                        "b": 68.16
                    },
                    "text": "Life course dimension"
                }
            ]
        },
        {
            "id": "p4.3",
            "order": 30,
            "type": "table",
            "bbox": {
                "l": 27.12,
                "t": 247.92,
                "r": 216.72,
                "b": 237.36
            },
            "text": "",
            "attrs": {
                "n_rows": 1,
                "n_cols": 1,
                "integrity": {
                    "skipped": "no_text_layer"
                }
            },
            "children": [
                {
                    "id": "p4.3.1",
                    "order": 31,
                    "type": "table_cell",
                    "bbox": {
                        "l": 27.12,
                        "t": 247.92,
                        "r": 216.72,
                        "b": 237.36
                    },
                    "text": "",
                    "attrs": {
                        "row": 0,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1
                    }
                }
            ]
        },
        {
            "id": "p4.4",
            "order": 32,
            "type": "footnote",
            "bbox": {
                "l": 616.08,
                "t": 281.04,
                "r": 647.76,
                "b": 269.04
            },
            "text": "Plaque",
            "attrs": {
                "block_label": "vision_footnote"
            }
        },
        {
            "id": "p4.5",
            "order": 33,
            "type": "footnote",
            "bbox": {
                "l": 658.08,
                "t": 277.44,
                "r": 702.48,
                "b": 266.88
            },
            "text": "Thrombus",
            "attrs": {
                "block_label": "vision_footnote"
            }
        },
        {
            "id": "p4.6",
            "order": 34,
            "type": "footer",
            "bbox": {
                "l": 500.4,
                "t": 30.96,
                "r": 654.48,
                "b": 11.04
            },
            "text": "(Daiber, et al., 2025)",
            "attrs": {
                "block_label": "footer"
            }
        }
    ],
    "excluded_furniture": {
        "first": [],
        "last": []
    }
}