bluuebunny/crossref_metadata_2025 huggingface dataset:
Convergence administrative au sein du système des Nations unies ? Évolution des modèles de réforme administrative dans quatre institutions des Nations unies
Authors: Grohs Stephan , Rasch Daniel
Published: December 2021

Dans cet article, nous nous interrogeons sur les modalités et les motifs selon lesquels des institutions des Nations unies réforment leur structure et leurs processus administratifs au cours du temps. Nous cherchons à savoir s’il est possible d’observer une convergence vers un modèle administratif cohérent au sein du système des Nations unies. Comme dans la plupart des États-nations, les débats sur des réformes telles que le New Public Management (NPM) ou le Post-New Public Management se sont invités dans les administrations publiques internationales. Dans ce contexte, la question de la convergence administrative dans les systèmes administratifs nationaux se pose également dans les administrations publiques internationales des Nations unies. D’un côté, les difficultés similaires, les “tendances” de réforme communes et la croissance des échanges au sein du système des Nations rendent une convergence probable. Mais d’un autre côté, la diversité des tâches, des styles administratifs et des dépendances au chemin emprunté pourrait favoriser des divergences dans les trajectoires de réforme. Nous étudions cette question de la convergence en mesurant la fréquence, l’orientation et les motifs des réformes, à l’aide d’un échantillon de quatre administrations publiques internationales parmi les institutions spécialisées des Nations unies (l’Organisation des Nations unies pour l’alimentation et l’agriculture, l’Organisation internationale du travail, le Fonds monétaire international et la Banque mondiale). Nous constatons que la convergence varie selon le domaine de la réforme (les ressources humaines ou les questions organisationnelles sont plus harmonisées que d’autres) et le temps (certaines administrations publiques internationales réforment plus rapidement ou plus précocement que d’autres). Remarques à l’intention des praticiens Dans cet article, nous identifions différents moteurs de réforme, ainsi que plusieurs conditions favorables et défavorables aux réformes dans l’administration publique internationale, qui servent à comprendre et à prévoir la gestion des changements. Nous mettons en évidence les questions que les décideurs doivent prendre en considération lors de la mise en œuvre des mesures de réforme, telles que le contexte institutionnel, les styles administratifs et les constellations d’acteurs concernés. Nous montrons notamment les éléments suivants : la création d’organes de coordination conduit à des pratiques administratives plus homogènes ; les chefs de secrétariat jouent un rôle décisif dans l’élaboration des réformes administratives et ont un intérêt spécifique à favoriser la coordination et le contrôle dans les organisations publiques ; et l’autonomie permet aux organisations de mener des politiques de réforme adaptées à leurs difficultés propres.
Les conséquences inattendues de la mise en œuvre des réformes de la comptabilité du secteur public dans les économies émergentes : observations en Égypte, au Népal et au Sri Lanka
Authors: Adhikari Pawan , Kuruppu Chamara , Ouda Hassan , Grossi Giuseppe , Ambalangodage Dayananda
Published: December 2021

La présente étude examine la mise en œuvre des réformes de la comptabilité du secteur public en Égypte, au Népal et au Sri Lanka. Les données utilisées ici proviennent d’une analyse de documents et d’entretiens semi-structurés avec des administrateurs publics, des fonctionnaires comptables et des membres d’organismes comptables professionnels. Notre article met en évidence les facteurs qui ont, individuellement ou collectivement, entravé la trajectoire de diffusion des réformes comptables du secteur public en Égypte, au Népal et au Sri Lanka lors de leur phase de mise en œuvre, comme le processus de regroupement, les partis pris en faveur de l’innovation, les réseaux informels et interpersonnels, le processus d’extension des frontières, la communication organisationnelle, la disparité des pouvoirs et la domination. En conséquence, les réformes de la comptabilité du secteur public ont suscité des résistances, des conflits internes et des conséquences inattendues, comme la fabrication de résultats, dans ces trois pays, sans qu’il soit prouvé qu’elles donnent de meilleurs résultats en matière de gouvernance et d’imputabilité du secteur public. Remarques à l’intention des praticiens Les praticiens de la comptabilité du secteur public doivent prendre conscience de l’importance de tenir compte des contextes propres aux économies émergentes, comme les structures de pouvoir, les canaux de communication, les réseaux informels et les flux de communication, avant de diffuser des réformes. Lorsque ces éléments contextuels ne sont pas pris en compte, les réformes ont tendance à être retardées et à rencontrer de la résistance, comme le montrent les réformes en cours en Égypte, au Népal et au Sri Lanka. De même, au lieu de déléguer des compétences à des comptables professionnels et à des groupes d’experts, ceux-ci peuvent servir de passeurs de frontières pour faciliter la communication avec les fonctionnaires comptables à propos des complexités techniques des réformes de la comptabilité du secteur public. Cette façon de faire peut contribuer à mettre en place un réseau de communication efficace et à renforcer les réseaux interpersonnels et informels, et permettre ainsi aux réformes d’emprunter la trajectoire de diffusion sans être entravées lors de la phase de mise en œuvre.
L’analogie du visible aux invisibilia Dei
Authors: Durand Emmanuel
Published: December 2021

Pour resituer l’analogie théologique dans sa constellation propre, cette étude explore les divers arguments dans lesquels Thomas d’Aquin recourt à Rm  1, 19-20a et/ou à Sg  13, 5. Le passage du visible aux invisibilia Dei est un moment (rationnel) qui a un ressort noétique interne, un fondement externe dans l’expressivité du créé, des vertus et des limites au sein d’une économie de la manifestation de Dieu par le sensible. La connaissance de Dieu par les sages des nations est orientée vers une pédagogie salvifique de la foi, avec ses secours propres : la Loi, l’Incarnation et l’Évangile. L’exégèse et les usages de Rm  1, 19-20 demeurent toujours soumis à la thèse de Rm  1, 16 au sujet de «  la puissance de la grâce évangélique ». La connaissance naturelle de Dieu, altérée par une faute envers Dieu, ne diminue en rien la nécessité de la grâce pour être sauvé.
Comment l’aide alimentaire est utile à la politique alimentaire
Authors: Bonzi Bénédicte
Published: December 2021

L’observation fine des lieux de distributions alimentaires révèle une inadéquation entre la chose donnée, la chose demandée et la chose reçue. Malgré leur don de temps, les bénévoles chargés de distribuer l’aide alimentaire se sentent débordés par toujours plus de personnes à nourrir. À leur tour les bénéficiaires ne parviennent pas à sortir d’un dispositif qui ne les satisfait pas. Cet article montre comment le capitalisme s’approprie le système du don. S’attachant à l’ensemble du système alimentaire, il aborde comment les énoncés visant la protection de l’environnement sont mis à mal dans une perspective utilitariste des aliments. Il aboutit sur la prise de conscience récente, au sein de collectifs citoyens, d’une synergie nécessaire entre les problématiques agricoles, environnementales et sociales que croise l’aide alimentaire.
Longitudinal Association of Health Literacy with Parental Oral Health Behavior
Authors: Brega Angela G. , Johnson Rachel L. , Schmiege Sarah J. , Jiang Luohua , Wilson Anne R. , Albino Judith
Published: December 2021

Background:

Prior studies suggest that parents with limited health literacy (HL) may be less likely to engage in oral health practices known to protect children's oral health. Earlier work has relied on cross-sectional data, however, so it is unclear whether HL influences parental behavior or is merely correlated with it.

Objective:

We sought to clarify the impact of HL on subsequent adherence to parental oral health practices.

Methods:

This secondary analysis used survey data from a randomized controlled trial designed to reduce dental decay in American Indian children (
N
= 579). We used path analysis to test a theoretical framework developed to clarify the mechanisms through which HL might influence parental oral health behavior. The framework proposed that HL (1) has a direct effect on parental oral health knowledge, beliefs (i.e., self-efficacy, perceived susceptibility, perceived severity, perceived barriers, perceived benefits), and behavior; (2) has an indirect effect on beliefs through knowledge; and (3) has an indirect effect on behavior through knowledge and beliefs. To test expectations regarding the temporal precedence of the constructs, we examined the association of HL at baseline with knowledge at the 12-month time point, beliefs at 24 months, and behavior at 36 months.

Key Results:

HL had significant direct effects on knowledge and specific beliefs (i.e., self-efficacy, perceived susceptibility, perceived barriers), but not on behavior. HL had significant indirect effects on beliefs—except perceived susceptibility—through knowledge. HL had significant indirect effects on behavior, through knowledge and beliefs. Both HL and knowledge had significant total effects on subsequent parental oral health behavior.

Conclusions:

HL influenced behavior measured 3 years later through its impact on parental oral health knowledge and beliefs. Our results highlight the importance of addressing HL in development of oral health promotion efforts aimed at protecting the teeth of young Native children.

[
HLRP: Health Literacy Research and Practice
. 2021;5(4):e333–e341.]

Plain Language Summary:

It is unclear whether HL influences how parents care for their children's teeth. We analyzed data from a project to reduce dental decay in children. We found that HL impacted parents' oral health knowledge, beliefs, and behavior at later points in time. This suggests that HL may influence development of knowledge and beliefs that support positive behavior.
Predictive analytics for 30-day hospital readmissions
Authors: Xiong Lu , Sun Tingting , Green Randall
Published: December 2021

The 30-day hospital readmission rate is the percentage of patients who are readmitted within 30 days after the last hospital discharge. Hospitals with high readmission rates would have to pay penalties to the Centers for Medicare & Medicaid Services (CMS). Predicting the readmissions can help the hospital better allocate its resources to reduce the readmission rate. In this research, we use a data set from a hospital in North Carolina during the years from 2011 to 2016, including 71724 hospital admissions. We aim to provide a predictive model that can be helpful for related entities including hospitals, health insurance actuaries, and Medicare to reduce the cost and improve the clinical outcome of the healthcare system. We used R to process data and applied clustering, generalized linear model (GLM) and LASSO regressions to predict the 30-day readmissions. It turns out that the patient's age is the most important factor impacting hospital readmission. This research can help hospitals and CMS reduce costly readmissions.
Construcción de caminos y reformismo ilustrado: fundamentos económicos y políticos en el caso chileno en el siglo XVIII
Authors: Sanhueza Benavente María Carolina
Published: December 2021

Este artículo plantea que los caminos construidos en Chile en la segunda mitad del siglo XVIII respondieron a una política vial que fue impulsada por los Borbones. Si bien estos proyectos surgieron desde instancias locales, lograron materializarse cuando coincidieron con los objetivos reformistas e imperiales de la Monarquía hispana. Entre ellos, acentuar el control territorial sobre sus dominios en un contexto de cambios geopolíticos, así como maximizar sus recursos económicos bajo los postulados de las ideas ilustradas.
Modelos de feminidad de los años cuarenta: Ingenuas y pitucas en el intercambio cinematográfico Argentina-España
Authors: Diez Puertas Emeterio
Published: December 2021

En la década de 1940, en un periodo de aislamiento internacional, Argentina y España coincidieron en intercambiarse un número importante de comedias sentimentales. En ellas podía observarse dos modelos de feminidad: la ingenua y la pituca. Ambos estereotipos eran adaptaciones hispanas de modelos narrativos hollywoodienses. El intercambio se hacía en virtud de la política autárquica española que era, a la vez, un control de la balanza de pagos y, en principio, una garantía del contenido de las películas, pues lo importado y lo exportado provenía de países afines por cultura, tradición o ideología.
Prioritizing Parents
Authors: Gorin Moti
Published: December 2021

Should parents or other primary caregivers of dependent children receive some priority when health care resources are scarce? This paper argues they should. The COVID-19 pandemic has given new urgency to discussions about resource allocation and yet there has been little to no discussion of the important role parents play in protecting and promoting the health of their dependent children. Historically, priority for parents was justified on questionable grounds of social value and this may have led bioethicists and policy makers to overlook more plausible justifications for prioritizing parents. After discussing and criticizing several such justifications for their violation of principles of pluralism and neutrality, a new justification is offered and defended from objections. The reason we should grant some priority to primary caregivers of dependent children is that research shows that doing so would protect and promote the health and lives of children.
Reciprocity and Resources
Authors: Fenton Elizabeth
Published: December 2021

Reciprocity has been deployed as the moral concept underpinning an obligation to ensure that health care workers (HCW) who work during a pandemic have access to essential goods, such as personal protective equipment (PPE), and as a principle for giving priority to HCW for scarce resources, such as intensive care beds or ventilators. In this paper I examine the concept of reciprocity, arguing that it is best understood as a form of fairness, or “fair return for services rendered.” This interpretation works well in explaining our obligation to provide HCW with PPE and other risk-mitigation resources, but I give reasons to suggest that it does not support an obligation to prioritize HCW for scarce medical interventions.
Crianças Afastadas do Convívio Familiar: os sentidos do acolhimento institucional
Authors: De Sousa João Paulo , Aparecida Serralha Conceição
Published: December 2021

Estudo qualitativo, descritivo e de corte transversal, cujo objetivo foi compreender o sentido que a criança acolhida em instituição atribui à sua situação de acolhimento. Participaram cinco crianças acolhidas em uma Casa Lar, com idades entre três e 11 anos. Os dados foram coletados por meio de entrevista lúdica, entrevista semiestruturada e observação participante, analisados pela Análise de Conteúdo Temática e da Enunciação, sendo os resultados discutidos na perspectiva winnicottiana. Os participantes sentiam-se bem na instituição, mostraram desconhecer os motivos para o acolhimento e lhe davam o sentido de distanciamento de seus cuidadores primários, de determinação de seus futuros, de suas relações, do tempo de acolhimento, em nome de uma proteção necessária, mas nem sempre efetiva e afetiva. Conclui-se que há necessidade de uma comunicação mais eficaz entre instituição e acolhido, em que sejam considerados os graus de desenvolvimento de cada criança, que lhes favoreça a compreensão e a elaboração dos sentidos.
Escuta Clínica a Adolescentes que se Cortam: um olhar para o corpo e o vínculo materno na perspectiva da psicanálise
Authors: Amorim Viana de Castro Yara , Dias Couto Vilma Valéria
Published: December 2021

Este estudo teve o objetivo de investigar a automutilação que ocorre na adolescência, buscando compreender os significados particulares dessa conduta e identificar fatores psíquicos relacionados. É uma pesquisa orientada pela psicanálise e que adotou o método do estudo de caso, com base na experiência clínica com duas adolescentes que se cortam. Os resultados demonstraram a relevância do corpo na adolescência e que os cortes são entendidos como via de comunicação e expressão de sofrimento psíquico. A busca de identidade própria e dificuldade de separação da figura materna, também, tiveram relevância na compreensão da conduta de automutilação. A investigação clínica sustentada pelo processo de pesquisa ofereceu caminhos para a reflexão e propiciou acolher as particularidades de cada adolescente.
Níveis de Depressão, Ansiedade e Estresse em Familiares Cuidadores de Crianças Com e Sem Diagnóstico de TEA Durante a Pandemia de COVID-19
Authors: Marino da Silva Thamires , Ferreira Couto Leila Maria , Nunes Baptista Makilim
Published: December 2021

O Transtorno do Espectro Autista (TEA) é um transtorno do neurodesenvolvimento. Familiares cuidadores de crianças diagnosticadas com TEA podem ter níveis elevados de depressão, ansiedade e estresse, comparados aos familiares de crianças sem TEA, com possibilidade de intensificação diante da pandemia de COVID-19. O objetivo foi comparar os níveis de depressão, ansiedade e estresse de familiares cuidadores de crianças com e sem diagnóstico de TEA, durante o isolamento social, e analisar os impactos da pandemia a partir de variáveis sociodemográficas aos cuidadores de modo geral. Participaram 77 familiares cuidadores de crianças com idades entre cinco e oito anos (M = 6,06, DP = 1,27). Destes, 42 pertenciam ao grupo de cuidadores de crianças com diagnóstico, com idades entre 20 e 56 anos (M = 36,9; DP = 8,36), e 35 ao outro grupo, com idades entre 19 e 47 anos (M = 34,8 DP = 8,47). Os resultados indicaram diferença entre o grupo de cuidadores de crianças com diagnóstico (M = 19; DP = 11,12) e o de familiares de crianças não diagnosticadas (M= 12,8; DP = 10,7) em relação à depressão. Variáveis sociodemográficas estiveram relacionadas às dificuldades enfrentadas pelos familiares e são discutidas juntamente a limitações e estudos futuros.
Clinical Features, Diagnosis, Management, and Outcomes of Idiopathic Pulmonary Fibrosis in Korea: Analysis of the Korea IPF Cohort (KICO) Registry
Authors: Jegal Yangjin , Park Jong Sun , Kim Song Yee , Yoo Hongseok , Jeong Sung Hwan , Song Jin Woo , Lee Jae Ha , Lee Hong Lyeol , Choi Sun Mi , Kim Young Whan , Kim Yong Hyun , Choi Hye Sook , Lee Jongmin , Uh Soo-Taek , Kim Tae-Hyung , Kim Sang-Heon , Lee Won-Yeon , Kim Yee Hyung , Lee Hyun-kyung , Lee Eun Joo , Heo Eun Young , Yang Sei Hoon , Kang Hyung Koo , Chung Man Pyo ,   on behalf of Korea ILD Study Group
Published: December 2021

Background: The Korea Interstitial Lung Disease Study Group has made a new nationwide idiopathic pulmonary fibrosis (IPF) registry because the routine clinical practice has changed due to new guidelines and newly developed antifibrotic agents in the recent decade. The aim of this study was to describe recent clinical characteristics of Korean IPF patients.Methods: Both newly diagnosed and following IPF patients diagnosed after the previous registry in 2008 were enrolled. Survival analysis was only conducted for patients diagnosed with IPF after 2016 because antifibrotic agents started to be covered by medical insurance of Korea in October 2015.Results: A total of 2,139 patients were analyzed. Their mean age at diagnosis was 67.4±9.3 years. Of these patients, 76.1% were males, 71.0% were ever-smokers, 14.4% were asymptomatic at the time of diagnosis, and 56.9% were at gender-agephysiology stage I. Occupational toxic material exposure was reported in 534 patients. The mean forced vital capacity was 74.6% and the diffusing capacity for carbon monoxide was 63.6%. Treatment with pirfenidone was increased over time: 62.4% of IPF patients were treated with pirfenidone initially. And 79.2% of patients were treated with antifiboritics for more than three months during the course of the disease since 2016. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality.Conclusion: In the recent Korean IPF registry, the percentage of IPF patients treated with antifibrotics was increased compared to that in the previous IPF registry. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality.
Association between neutrophil to lymphocyte ratio and mortality among community acquired pneumonia patients: a meta-analysis
Authors: Alzoubi Osama , Khanfar Asim
Published: December 2021

The neutrophil to lymphocyte ratio (NLR)is an emerging biomarker used in the prognosis of many conditions. We aimed to conduct a meta-analysis to assess the prognostic accuracy of the NLR in determining mortality in patients with Community acquired pneumonia (CAP). The Pubmed, EBSCO, and Scopus databases were searched to find all relevant articles. 10 articles with 5220 patients were included. The pooled area under the curve (AUC) of NLR admission levels to predict 30-Day mortality of CAP patients was 0.706; 95% CI (0.631 to 0.781), while the pooled AUC of NLR levels taken at 3-5 days was 0.882; 95% CI (0.818 to 0.945). Meta analysis also showed a significant difference in the NLR between the Survivors and 30-Day non-survivors. This difference was greater when NLR levels were taken at 3-5 days; Standardized mean difference (SMD) = 1.646; 95% CI (0.451 to 2.840) compared to NLR levels at admission SMD = 1.139; 95% CI (0.514 to 1.764). These results show that the NLR has potential to be incorporated in the routine assessment and stratification of CAP patients, especially in the early-stage evolution (3-5 days), keeping in mind the availability and cost effectiveness of this test.
Clinical, Biochemical, Radiological, and Genetic Profile of Patients with Homocysteine Remethylation Pathway Defect and Spastic Paraplegia
Authors: Padmanabha Hansashree , Mahale Rohan , Christopher Rita , Arunachal Gautham , Bhat Maya , Mondal Mahammad Samim , Anjanappa Ram Murthy , Mundlamuri Ravindranadh Chowdhary , Yadav Ravi , Vengalil Seena , Mailankody Pooja , Mathuranath Pavagada S. , Chandra Sadanandavalli R. , Nalini Atchayaram
Published: December 2021

Objectives:

The objective of this study is to describe the clinical, biochemical, radiological, and genetic profile of patients presenting with progressive spastic paraparesis due to homocysteine remethylation pathway defect.

Methods:

This was a retrospective study conducted by reviewing the medical records of patients with serum homocysteine levels >50 μmol/L between January 2015 and January 2019 at our hospital. We included patients presenting with progressive spastic paraparesis, having serum homocysteine >50 μmol/L with low or normal blood methionine suggesting disorders of homocysteine remethylation. Demographic details, clinical manifestations, biochemical abnormalities, neuroimaging findings, and genetic profile were analyzed.

Results:

A total of seven patients (M: F = 5:2) fulfilled the study eligibility criteria. The mean age at onset of the disease was 13.4 ± 2.4 years (range: 9–17 years). Spastic paraparesis was the presenting manifestation in 4/7 (57.1%) patients. Other manifestations included cognitive decline, poor scholastic performance, behavioral disturbances, seizures, and spastic bladder. Severe hyperhomocysteinemia (>100 μmol/L) was noted in 6/7 (85.7%) patients with median levels of serum homocysteine being 185.7 μmol/L (range: 85.78–338.5 μmol/L). Neuroimaging showed parieto-occipital predominant leukoencephalopathy in 5/7 (71.4%) and diffuse cerebral atrophy in 1/7 (14.2%). Genetic analysis in three patients revealed pathogenic missense variants c.459C >G (p.Ile153Met), c.973C >T (p.Arg325Cys), and c.1031G >T (p.Arg344Met) in MTHFR gene. All the patients received vitamin B12 (injection and oral), folic acid, and pyridoxine and two patients received betaine. At the last follow-up of a median duration of 12 months, there was a good clinical and biochemical response with reduction in the median value of serum homocysteine by 77.5 μmol/L.

Conclusion:

Evaluation of serum homocysteine and blood methionine in adolescents presenting with progressive spastic paraparesis gives clue to a treatable homocysteine remethylation disorders.
Non-AIDS Comorbidities among People with HIV at a Moroccan Referral Hospital
Authors: Titou Hicham , Boui Mohammed , Hjira Naoufal
Published: December 2021

Background:

Among people living with HIV receiving antiretroviral therapy, the prevalence of non-AIDS-related comorbidities is increasing. In Morocco, there are limited dataregarding the profile of non-AIDS comorbidities in this population. The prevalence of non-AIDS comorbidities and the factors associated with metabolic complications among HIV-infected patients are described.

Materials and Methods:

A cross-sectional study was conducted in 2018 and included 269 HIV-infected patients. A medical officer reviewed records for non-AIDS comorbidities. Univariate and multivariate logistic regression analyses were used to assess the association between metabolic complications and interesting potential variables.

Results:

A total of 269 individuals were inducted into the study. The mean age was 48.9 ± 10.7 years and 75.5% were men. The median current CD4+ T-cell count was 613 cells ml−1 (IQR: 390–784 cells ml− 1). More than a third of the patients (34.8%) had at least two non-AIDS comorbidities. The most prevalent comorbidities were hyperlipidemia in 56 (20.8%) patients. In multivariate analysis, older age (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.02–1.07) and obesity (OR = 4.25, 95% CI = 1.54–8.74) were associated with the presence of metabolic complications.

Conclusions:

The prevalence of comorbidities is high, particularly in older people. Care models for HIV-positive patients should include clinical monitoring and effective management of these comorbidities and metabolic complications to complete long-term survival.
Interleukin-9 and soluble tumor necrosis factor-like weak inducer of apoptosis in serum and suction blister fluid of nonsegmental vitiligo patients
Authors: Eid Amira Abulfotooh , Issa Yasmine Amr , Mohamed Amira Naser , Badran Fairouz Khalil
Published: December 2021

Background:

Autoimmunity is a key player in nonsegmental vitiligo (NSV). Interleukin-9 (IL-9) and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) are pleiotropic cytokines that are involved in many chronic autoimmune diseases.

Objectives:

To measure IL-9 and TWEAK in serum and suction blister fluid of NSV patients and study their relation to vitiligo.

Methods:

Thirty NSV patients and thirty controls were recruited. Following detailed history and clinical examination, the vitiligo area scoring index (VASI) and the vitiligo disease activity score (VIDA) of the patients were calculated. IL-9 and TWEAK were measured in serum of patients and controls and in suction blister fluid of patients.

Results:

Serum levels of IL-9 and TWEAK were significantly higher in patients than in controls (P < 0.001). Meanwhile, in patients, IL-9 and TWEAK were significantly higher in serum than in blister fluid (P < 0.001). A significant positive correlation of serum IL-9 (P < 0.001) and serum TWEAK (P < 0.001) with VASI was detected. A significant positive correlation between serum IL-9 and TWEAK in patients was also detected (P < 0.001). Blister fluid levels of both cytokines showed no significant correlation with any of the studied parameters.

Conclusion:

The elevated serum IL-9 and TWEAK in NSV possibly contributes to disease development and influences disease severity. Exploring their potential as possible therapeutic targets is, therefore, recommended.
Obesity and Sexual Dysfunction among Women
Authors: Shaji Princey , Singh Maharaj , Sahu Bharti
Published: December 2021

For many obese and overweight women, sexual functioning is a critical, but often ignored, aspect of their quality of life. Obesity is becoming a global problem. The aim of this article was to provide an introductory insight into the relationship between obesity and sexual dysfunction in women from the recent literature. The link between obesity and sexual functioning is poorly understood, and therapeutic choices are even less well understood. Weight did, however, affect the some aspects of sexual function in studies of special populations such as women with gestational diabetes, polycystic ovarian syndrome, pelvic organ prolapse or urinary incontinence. Surgical weight loss, but not non-surgical weight loss is linked to the resolution of some aspects of sexual dysfunction in women. When it comes to sexual dysfunction, women's weight plays a pivotal role. Non-weight loss surgery has been linked to improved sexual function in women. To fully understand the link between weight and sexual function, more research is needed.
COVID-19 and its Impact on the Management of Patients with Acute Coronary Syndrome during the First COVID Wave – A Questionnaire-Based Survey among Interventional Cardiologists from Southern India
Authors: Muralidharan Thoddi Ramamurthy , Kumar Balakrishnan Vinod , Krishnamurthy Preetam , Senguttuvan Nagendra Boopathy , Balasubramaniyan Jayanthy Venkata , Sadhanandham Shanmugasundaram , Rathinasamy Jebaraj , Sankaran Ramesh , Panchanatham Manokar , Murthy Jayanthy Sathynarayana , Sadagopan Thanikachalam
Published: December 2021

Background:

The COVID-19 pandemic has transformed the medical society in many ways. With significant drain on the resources and altered healthcare priorities, there is a greater need for redeployment of the resources from noncommunicable diseases to COVID-19-related healthcare services. To understand the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Tamil Nadu, a survey was administered across cardiologists in Tamil Nadu.

Methods:

A survey was done using an electronic questionnaire administered regarding the change of patterns of acute coronary syndromes during the COVID through Google Forms with responses collected in excel format.

Results:

Among 256 cardiologists contacted, 101 responded to the survey. Among cardiologists who responded, all were interventional cardiologists– with most of them performing primary percutaneous coronary intervention (PCI) (95%) regularly during pre-COVID times. Most of them have noticed a significant reduction in the number of patients with ACS seeking health care (94%) and another 61% of respondents felt that there was a reduction in the number of patients with acute coronary syndrome. There was a significant delay in ST-segment elevation myocardial infarction presentation to the hospital (88%) and significant reduction in the number of primary PCI (47%). Only 19% of respondents did primary PCI for COVID-positive patients.

Conclusions:

COVID pandemic has emerged as a big challenge to the global health care system. Optimal acute coronary care could not be delivered in a timely manner due to multiple social, patient, and physician-related factors. The emerging techniques in rapid diagnosis of COVID-19 and protective measures of COVID infection are expected to improve the situation.

Trial Registration:

Clinical Trials Registry – India (CTRI), CTRI/2020/09/027517, Registered September 1, 2020 http://CTRI.nic.In/Clinicaltrials/pmaindet2. php? trialid = 47025 and EncHid = and user Name =.
A Clinical Relevance of Fossa Ovalis and Patent Foramen Ovale
Authors: Honnegowda Thittamaranahalli Muguregowda , Alghamdi Mansour A
Published: December 2021

Background:

The anatomical characterization of foramen ovale (FO) along with annulus or limbus varies in size and shape from the heart to heart. Patent FO (PFO) has been implicated in the etiology of a number of diseases, PFO is not an uncommon condition; their prevalence rate is 15%–35% in the population. Hence, morphological study of FO serves importance to know the exact location of the fossa ovalis (FOv) and prevalence of PFO in the Indian population by the autopsy method.

Materials and Methods:

This study was conducted in 106 apparently normal hearts available in the Department of Anatomy and Forensic Medicine and Toxicology. After opening the right atrium, the shape of FOv was observed, and dimensions were measured with the digital Vernier caliper and thickness of anterior and posterior limbus was noted. Probe patency was confirmed.

Results:

Area of the FOv (160.20 ± 104.9 mm2), thickness anterior limbus (7.24 ± 1.83 mm), and thickness of posterior limbus (6.38 ± 2.46 mm). The shape of FOv was oval (83%) in majority; in 86.7%, the rim of the limbus was raised and 13.3% it was flat; in 20.75%, a recess was found deep to the margin of the limbus and 10.37% showed probe patency. A significant positive correlation was observed between cardiac weight and area of FOv.

Conclusion:

By autopsy method, we found the prevalence of PFO is 4.71%, which is lower than Western population, our study also provides the accurate measurements related with several morphometric variation such as shape of FOv and limbus FOv.
Histomorphological Spectrum of Incidentally Detected Fallopian Tube Lesions in Patients Operated for Various Clinical Conditions and Detection of Precursor Lesion by Applying Sectioning and Extensively Examining the Fimbriated End Sampling Protocol
Authors: Singh Neha , Dhal Ipsita , Mohanpuria Aneesha , Saxena Swati
Published: December 2021

Background:

Fallopian tube specimens are studied either in conjunction with ovaries, uterus, and cervix or alone. However, there is less knowledge about the spectrum of histopathological changes in these specimens due to paucity of data.

Aim:

This study aims to describe the spectrum of histopathological changes with frequency observed in the resected fallopian tube specimens, especially to detect the malignant precursor lesions and malignancy rate.

Materials and Methods:

Four hundred and ninety-four patients of resected fallopian tubes either separately or along with other female genital tract organs were retrospectively reviewed for histopathological findings. Hematoxylin- and eosin-stained histopathology slides were retrieved and re-examined. The distal fimbriated end was longitudinally sectioned for examination of fimbrial epithelium. The “sectioning and extensively examining the fimbriated end” (SEE-FIM) sampling protocol was used.

Results:

Out of 494 resected specimens, 247 patients (50%) had some kind of fallopian tube pathology. Fibrosis was the most common lesion observed in 59 cases followed by hematosalpinx (33 cases). Primary neoplasm was seen in 3 (0.6%) of specimens and all were of serous adenocarcinoma histology. Whereas, secondary malignancies were seen in 2 cases (0.4%), with primary being ovary. Four cases of serous tubal intraepithelial carcinoma (STIC) (0.8%) were detected using SEE-FIM protocol.

Conclusion:

A thorough histopathological examination including SEE-FIM protocols should be followed for detection of various fallopian tube lesions, which will eventually help in appropriate patient workup and treatment. Early detection of precursor lesions such as STIC and prompt treatment intervention may help in the prevention of ovarian malignancies.
Transformative Learning in Graduate Medical Education: A Scoping Review
Authors: Vipler Benjamin , Knehans Amy , Rausa Daniel , Haidet Paul , McCall-Hosenfeld Jennifer
Published: December 2021

Background

Transformative learning (TL) is an educational theory focused on deep fundamental shifts in an individual's worldview. Such shifts are well known to occur within graduate medical education (GME). However, TL in GME has yet to be formally explored.

Objective

We performed a scoping review of the literature on TL within GME to identify areas where trainees currently experience or have potential to experience TL, and to explore areas where fostering TL has been used as a pedagogical tool.

Methods

In January 2020, we searched 7 databases to identify literature on TL in GME. Additional articles were identified by hand-searching the Journal of Graduate Medical Education.

Results

A total of 956 articles were identified through database search with 3 unique articles found via hand-searching. Abstracts and manuscripts were screened by 2 authors and disagreements arbitrated by a third, yielding 28 articles for our analysis. The main components of TL (disorienting dilemma, reflection, discourse, action) took various forms. TL was closely linked with professionalism training and professional identity formation. Training programs in primary care fields were most frequently referenced. Often, trainees were experiencing TL without recognition of the theory by their educators. Gaps in the graduate medical education literature exist pertaining to TL in venues such as diversity, equity, and inclusion.

Conclusions

Our scoping review uncovered the following themes: TL and professionalism, TL and primary care, and TL by other names. TL is likely occurring but going unrecognized in some settings.
The Relationship Between Applicant Gender and Internal Medicine Residency Interview Scores
Authors: Stern Robert M. , Montgomery Mary W. , Osman Nora Y. , Katz Joel T. , Yialamas Maria A.
Published: December 2021

Background

Gender inequity is widespread in academic medicine, including in the promotion, academic recognition, and compensation of female faculty.

Objective

To assess whether these inequities extend to the GME intern selection process, this study examines differences in the interview scores assigned to male and female applicants at one large internal medicine residency program.

Methods

Subjects include 1399 applicants who completed 3099 interviews for internship positions for the Brigham and Women's Hospital internal medicine residency in Electronic Residency Application Service (ERAS) cycles 2015–2016, 2017–2018, 2018–2019, and 2019–2020. Unadjusted and multivariable linear regressions were used to assess the simultaneous effect of applicant gender, interviewer gender, and applicant academic characteristics on pre-interview, post-interview, and change in interview scores.

Results

Our analysis included 3027 interviews (97.7%) of 1359 applicants (97.1%). There were no statistically significant differences in the interview scores assigned to female versus male applicants. This was true across pre-interview scores (difference = 0.03, P = .61), post-interview scores (difference = 0.00, P = .98), and change in interview scores (difference = 0.01, P = .24) as well as when adjusting for the baseline academic characteristics of both male and female applicants. This was also true when analyzing individual application years, individual residency tracks, and accounting for the gender of the faculty interviewers.

Conclusions

The findings do not support the presence of gender inequity in the interview scores assigned to male and female applicants included in this study.
UME-to-GME PandEMonium in COVID-19: Large-Scale Implementation of a Virtual ACGME Milestone-Based Curriculum for Senior Medical Students Matched Into Emergency Medicine
Authors: McLean Mary E. , Cotarelo Adrian A. , Huls Thomas A. , Husain Abbas , Hillman Emily A. , Cygan Lukasz D. , Archer Linette O. , Beck-Esmay Jennifer , Burke Shannon M. , Carrick Angela I. , Chen Angela S. , Hyde Robert J. , Karalius Vytas P. , Lee Eric , Park Joel C. , Pugliese Angela M. , Wilbanks Morgan D. , Young Amanda , Kulkarni Miriam L.
Published: December 2021

Background

The COVID-19 pandemic displaced newly matched emergency medicine “pre-interns” from in-person educational experiences at the end of medical school. This called for novel remote teaching modalities.

Objective

This study assesses effectiveness of a multisite Accreditation Council for Graduate Medical Education (ACGME) sub-competency-based curricular implementation on Slack during the first wave of the COVID-19 pandemic in the United States.

Methods

Emergency medicine residency programs were recruited via national organization listservs. Programs designated instructors to manage communications and teaching for the senior medical students who had matched to their programs (pre-interns) in spring/summer 2020. Pre- and post-surveys of trainees and instructors assessed perceived preparedness for residency, perceived effectiveness of common virtual educational modalities, and concern for the pandemic's effects on medical education utilizing a Likert scale of 1 (very unconcerned) to 5 (very concerned). Data were analyzed using descriptive statistics and the t test.

Results

Of 276 possible residency programs, 28 enrolled. Of 324 possible pre-interns, 297 (91.7%) completed pre-surveys in April/May and 249 (76.9%) completed post-surveys in June/July. The median weeks since performing a physical examination was 8 (IQR 7–12), since attending in-person didactics was 10 (IQR 8–15) and of rotation displacement was 4 (IQR 2–6). Perceived preparedness increased both overall and for 14 of 21 ACGME Milestone topics taught. Instructors reported higher mean concern (4.32, 95% CI 4.23–4.41) than pre-interns (2.88, 95% CI 2.74–3.02) regarding the pandemic's negative effects on medical education.

Conclusions

Pre-interns reported improvements in residency preparedness after participating in this ACGME sub-competency-based curriculum on Slack.
Indiscipline as Method: From Telescopes to Ventilators in Times of Covid
Authors: Turner Irina , Lamoureaux Siri , Merron James
Published: December 2021

There is no unproblematic way to study things as “African”, yet an epistemologically situated approach based on concrete technological projects situated in Africa and their social and political implications offers an important account of the intersection of the Fourth Industrial Revolution and African Studies. We explore this perspective through the notion of “indiscipline” using the Square Kilometre Array radio telescope project (SKA) based in South Africa as a case study through which to observe “indiscipline” as a methodological approach to technoscience at work. Indiscipline helps frame the socio-technical (by)products of astrophysics and engineering, and we present the production of ventilators for COVID-19 patients as an example of how the design of mega-science projects can become entangled with the dynamic concerns of society. Our conclusion elaborates on the politics of large technological systems, opening up a conversation on the intersection of science and society in the context of the Fourth Industrial Revolution in African settings, using the template of experiences with the SKA and the National Ventilator Project in South Africa.
Leadership Styles of Social Studies Teachers and Academic Achievement of Junior Secondary School Students in Social Studies in Calabar Metropolis, Cross River State Nigeria
Authors: Odey Edward Ogar , Odey Esther Edward
Published: December 2021

This study was carried out to determine leadership styles of Social Studies teachers and academic achievement of junior secondary school students in Social Studies in Calabar Metropolis, Cross River State-Nigeria. Ex-post facto research design was adopted. The simple random sampling technique was used in selecting the six public secondary schools used for the study. A sample of two hundred junior secondary school three students (JSS 3) was drawn from the population and used for the study. Three research questions and hypotheses were formulated to guide the study. Data were collected using two researcher made instruments tagged “Social Studies Teachers Leadership Styles Questionnaire (STLSQ) and Social Studies Achievement Test (SOSAT) The Data Collected was analysed using the Analysis of Variance (ANOVA) and the Fisher Least Square Difference (SLD) was used in the multiple comparism. The findings of the study revealed significant differences in the academic achievement of students based on  their teachers’ leadership styles. Students taught by teachers with autocratic and laissez-faire leadership styles had a lower LSD  value compared to students taught by teachers with democratic leadership styles. Students taught by teachers with democratic styles  performed academically higher than those taught by teachers with either autocratic or laissez-faire leadership styles. Based on this, it was recommended amongst other things that Social Studies teachers imbibe more of democratic rather than autocratic or laissez faire leadership styles in their classroom and that educational administrator should organize workshop and seminars for teachers on proper classroom management.
Egalitarianism to gender inequality: Cross-cultural exploration of gender relations, in economic systems
Authors: Ugwu Ugochukwu T.
Published: December 2021

Gender inequality has generated a lot of debates among scholars across disciplines. Much of these studies have not explored a robust scholarship on the historical development of gender inequality by comparing different human societies and their subsistence strategies. This review study is designed to fill this gap, thereby contributing to corpus of literature on gender inequality in economic relations. As a historical research, the study uses secondary materials. These materials are mainly ethnographies of the societies under comparison. The study compares the roles of each of the gender categories in subsistence activities, in economic systems, to trace the sources of gender inequality in economic relations. Data available suggest egalitarian gender and economic relations. However, as societies evolved, there became a gradual decline in egalitarianism, leading to marked inequality. The inequality is relative to the complexity of social structure peculiar to the societies under review.
Legal Reforms as a Tool for Sustainable Development in Former Mining Communities: A Case Study of Kabwe Lead-Zinc Mine, Zambia
Authors: Chibbabbuka Ruth Hachitapika , Masinja Jewette , Franco Isabel B.
Published: December 2021

No Abstract
Brassica juncea polysaccharides induce apoptosis of colorectal cancer cells via mitochondrial- and caspasedependent apoptosis pathways
Authors: Peng Li , Yu Lin , Yong-Le Chen
Published: December 2021

Purpose: To determine the effect of polysaccharides from Gleditsia on apoptosis of colorectal cancer cells, and the mechanism involved.Methods: Polysaccharides were extracted from Lycium barbarum, and their concentration was more than 85 %. Then, DLD-1 cells were cultured in medium with the polysaccharides at concentrations of 75 and 150 μg/mL. Cell proliferation was determined with MTT (3-(4,5)-dimethylthiahiazo (-z-y1)-3,5- diphenytetrazoliumromide) assay and colony formation assay, while apoptosis was determined with flow cytometry. Changes in MMP were measured flow cytometrically. The protein levels of PARP, Bcl-2, Bax, and caspases 3 and 9 were determined with Western blot assay.Results: Cell viability decreased time-dependently. Compared with control without polysaccharide exposure, cell viability, colony forming cells, % apoptosis, red: green fluorescence ratio, and bcl-2 expression were significantly and concentration-dependently decreased, while the expression levels of PARP, Bax, caspase-3 and caspase-8 were significantly increased (p < 0.05).Conclusion: These results indicate that the polysaccharides suppressed apoptosis of colorectal cancer cells by inhibiting the mitochondrial and caspase-dependent apoptosis pathways. Gleditsia polysaccharide may be used as an adjuvant therapy for colorectal cancer.