bluuebunny/crossref_metadata_2025_split 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.
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.
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.
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.
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

ABSTRACT

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

ABSTRACT

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.