bluuebunny/crossref_metadata_2025_split huggingface dataset:
Une crise à combustion lente : les relations exécutives et la normalisation de la méfiance dans le fiasco du « cash for ash » en Irlande du Nord
Authors: Rice Charis , Connaughton Bernadette , Ratcliffe Jenny , Somerville Ian 
Published: July 2024

Cet article explore les relations entre les ministres, les conseillers spéciaux et les fonctionnaires à travers le prisme d’une crise gouvernementale très médiatisée en Irlande du Nord. Bien que les relations politico-administratives soient un pilier de la recherche sur l’administration publique, la manière dont ces relations se présentent et fonctionnent au sein de la « famille Westminster » de la gouvernance est encore mal comprise lorsqu’elle opère dans des institutions décentralisées ou des sociétés post-conflit, tout comme leur rôle en cas de crise. Nous utilisons les piliers institutionnels de Scott comme cadre analytique et menons une analyse documentaire des déclarations des témoins de l’enquête publique pour explorer la crise du programme d’incitation au chauffage renouvelable qui a conduit à l’effondrement du Parlement d’Irlande du Nord. Grâce à une nouvelle application de la théorie existante, nous démontrons que la mise en œuvre du modèle de partage du pouvoir décentralisé et consociatif a engendré de nouvelles normes de gouvernance, qui ont donné la priorité et légitimé les agendas et les actions des acteurs politiques (ministres et conseillers spéciaux), par rapport aux fonctionnaires. Plus précisément, en comprenant comment les normes relationnelles – en particulier la méfiance – alimentent l’échec des politiques publiques et la crise institutionnelle, nos résultats contribuent à ce domaine de recherche et à celui, plus large, de l’administration publique. Les crises institutionnelles des gouvernements ont un impact négatif sur la prestation des services publics et sur la santé de la démocratie en général. La compréhension de ces crises est un premier pas important vers leur amélioration. Remarques à l’intention des praticiens La formation structurelle, systémique et comportementale quotidienne de la méfiance a un impact négatif sur la capacité des professionnels du gouvernement à reconnaître, communiquer et répondre aux risques ; cela peut créer des problèmes politiques qui peuvent s’aggraver, sans contrôle, jusqu’à ce qu’ils deviennent des crises à part entière. Afin d’atténuer de manière proactive les crises dans d’autres contextes de politique publique, les responsables et les équipes devraient intégrer des processus de sensibilisation, de réflexion et de gestion dans les évaluations des performances individuelles et opérationnelles afin d’améliorer les normes relationnelles et d’empêcher la normalisation de la méfiance.
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Authors: Gilson Laurent 
Published: July 2024

L’asile psychiatrique est incontestablement un lieu d’enfermement. Mais il fût aussi un lieu de rencontre : celle du cinéma et de la psychiatrie. Tout au long de sa courte histoire, la machine cinématographique s’est attelée à mettre en images l’intérieur (et l’intériorité) de cette institution, dont le caractère mystérieux a eu tôt fait d’offrir un terrain de jeu fécond pour l’imaginaire des réalisateurs, ainsi que pour leurs velléités critiques. Cet ouvrage se propose d’explorer la complexité de cette rencontre à partir de différents films. De Caligari à Shutter Island, de Titicut Follies à 12 jours, l’image de l’institution se transforme en même temps que l’histoire de la psychiatrie va de crises en bifurcations. Tantôt dépeint sous les traits d’une institution totalitaire où les malades ne sont peut-être pas ceux que l’on croit, tantôt conçu comme lieu où la vérité du récit est elle-même inquiétée par le trouble qui s’y déploie, le cinéma n’aura cessé de porter, voire de fabriquer la mémoire de l’asile, de la faire déborder par son propre contenu, travaillant par-là la profondeur de nos imaginaires, dialoguant de près avec notre étrangeté, et critiquant du même coup les traitements réservés à celles et ceux que notre Histoire a exclus de l’espace de la raison. Qu’on les juge authentiques ou fantasmées, il se pourrait bien qu’à la surface des images de l’asile scintillent les bribes de notre expérience de la folie qui, une fois installée entre les murs de l’institution, a pris des allures de cauchemar ; un mauvais rêve dont les figures spectrales se dérobent à notre regard, mais continuent de hanter notre contemporanéité par le biais du grand écran et de son pouvoir.
Factors associated with delays in seeking treatment for leptospirosis: a prospective study in Monaragala District, Sri Lanka
Authors: Kumari Prabha , Vidanapathirana Janaki , Amarasekara Jagath , Karunanayaka Lilani 
Published: July 2024

Introduction: Leptospirosis is a life-threatening zoonotic infection and delayed seeking treatment has been associated with complications and poor prognosis. The aim of this study was to analyze socio-demographic factors associated with delays in seeking treatment of patients with leptospirosis in Monaragala District.Methods: A hospital-based descriptive cross-sectional study was conducted to analyze the factors associated with delays in seeking treatment of patients with leptospirosis using 450 clinically diagnosed leptospirosis patients admitted to base and above hospitals in Monaragala district, using a pretested interviewer administered questionnaire among laboratory confirmed leptospirosis.Results: The incidence of leptospirosis in Monaragala district during the study period from the present study was 59.8 per 100,000 population. Significant socio-demographic factors associate with delays in seeking treatment by laboratory confirmed patients in bi variable analysis was marital status (OR=1.85; CI=1.02-3.33), monthly income (OR=2.63; CI=1.02-7.14), time taken to reach a health care facility (OR=4.95; CI=1.48-16.62) and cost of travel (OR=2.73; CI=1.10-6.75), while age (OR=1.25; CI=0.68-2.28), sex (OR=1.44; CI=0.69-2.98), education (OR=1.5; CI=0.88-2.77), nationality (OR=1.64; CI=0.39-6.66), occupation (OR=1.01; CI=0.56-1.81), distance from home to a health care facility (OR=1.44; CI=0.79-2.59) and mode of travel (OR=1.78; CI=0.92-3.57) was not significant. After adjusting for the effect of confounders, only the source of infection of leptospirosis showed a significant association (AOR=3.65; 95% CI=1.48-8.98) with delay in seeking treatment. Conclusions and Recommendations: Awareness of the source of the leptospirosis infection should be more emphasized and raising awareness is needed all year to prevent medical complications and deaths.
Prevalence of being &lsquo;high-risk&rsquo; of hospitalization due to exacerbation among asthma patients aged &ge; 20 years in a district of Sri Lanka.
Authors: Punyadasa Dhanusha , Kumarapeli Vindya , Senaratne Wijith 
Published: July 2024

Introduction: Hospitalizations due to exacerbated asthma remai ns high in Sri Lanka leaving a huge burden on the healthcare system. Identification of the burden of ‘high risk asthma patients’ for hospitalization due to exacerbation is a cost-effective strategy for prioritizing management options. Objectives: To estimate the prevalence of ‘high-risk asthma patients ’ and selected risk predictors for hospitalization due to exacerbation among asthma patients aged ≥20 years in the district of Gampaha, Sri Lanka Methods: A community-based descriptive cross-sectional study was conducted among 1200 asthma patients aged ≥20 years, selected using a multistage sampling technique. The risk for hospi talization was assessed using a newly developed and validated risk prediction model. High-risk asthma patients were defi ned according to the cut-off value of the summary risk score of the model. Results: The prevalence of ‘high-risk asthma patients’ for hospitali zation due to exacerbation was 16.4% (95% CI: 14.2, 18.6). The prevalence of selected risk predictors: age ≥ 60 years 24.2% (95% CI: 21.9, 26.7), poor educational attainment 67.3% (95% CI: 64.5, 70.0), having diabetes mellitus 18.8% (95% CI: 16.5, 21.0), family history of asthma 41.3% (95% CI: 38.5, 44.2), ever smoked 12.2% (95% CI: 10.2, 14.1), ever int ubated or given intensive care 2.8% (95% CI: 1.8, 3.7), previous hospitalizations due to exacerbations 6.6% (95% CI: 5.1, 8.0) , having uncontrolled asthma 63.6% (95% CI: 60.8, 66.7), having symptomatic GORD 18% (95% CI: 15.7, 20.2) and ha ving body mass index (BMI) ≥ 25 kg/m2 36.3% (95% CI: 33.5, 39.0). Conclusions & Recommendations: A significant proportion of asthm a patients being at risk of hospitalization indicates the need to adopt cost-effective asthma management strategies to ac hieve better control of the disease. Prompt primary healthcare interventions are required to address modifiable risk predi ctors among asthma patients.
Novel mutations in LRRC23 cause asthenozoospermia in a nonconsanguineous family
Authors: Tang Song-Xi , Liu Si-Yu , Xiao Hong , Zhang Xin , Xiao Zhuang , Zhou Shan , Ding Yi-Lang , Yang Peng , Chen Qiang , Huang Hai-Lin , Chen Xi , Lin Xi , Zhou Hui-Liang , Liu Ming-Xi 
Published: July 2024

Abstract
The cause of asthenozoospermia (AZS) is not well understood because of its complexity and heterogeneity. Although some gene mutations have been identified as contributing factors, they are only responsible for a small number of cases. Radial spokes (RSs) are critical for adenosine triphosphate-driven flagellar beating and axoneme stability, which is essential for flagellum motility. In this study, we found novel compound heterozygous mutations in leucine-rich repeat-containing protein 23 (LRRC23; c.1018C>T: p.Q340X and c.881_897 Del: p.R295Gfs*32) in a proband from a nonconsanguineous family with AZS and male infertility. Diff-Quik staining and scanning electron microscopy revealed no abnormal sperm morphology. Western blotting and immunofluorescence staining showed that these mutations suppressed LRRC23 expression in sperm flagella. Additionally, transmission electron microscopy showed the absence of RS3 in sperm flagella, which disrupts stability of the radial spoke complex and impairs motility. Following in vitro fertilization and embryo transfer, the proband’s spouse achieved successful pregnancy and delivered a healthy baby. In conclusion, our study indicates that two novel mutations in LRRC23 are associated with AZS, but successful fertility outcomes can be achieved by in vitro fertilization-embryo transfer techniques.
Toothpick Perforation of the Stomach Causing Gastro-hepatic Recess Abscess Treated by Laparoscopy: A Case Report and Review of the Literature
Authors: Alkhulaifi Sumaya A. , Saffaf Mohannad K. , Aldarwish Abdullah S. , Alhawassi Sami 
Published: July 2024

Abstract
Intraabdominal abscess due to gastric perforation by a foreign body is rare and may be fatal. In such cases, diagnosis is usually difficult due to non-specific symptoms and failure to remember the ingestion event by the patient as well as low clinical suspicion by the physician. This article demonstrates a rare case of gastro-hepatic recess abscess secondary to a toothpick perforating the lesser curvature of the stomach, diagnosed by a computed tomography scan. Laparoscopy was performed to drain the abscess and extract the foreign body without complications; the patient made a complete uncomplicated recovery. Our case highlighted the clinical challenges in the diagnosis and treatment of such rare cases.
Adaptation of a New Maternal Vaccination to the National Antenatal Care Program among Obstetricians and the Impact on the Patient’s Acceptance after the COVID-19 Pandemic
Authors: Alhudhud Majed , Marzoug Amani , Al Johani Hanan , Zainalabedin Noora , Aldulhum Anfal 
Published: July 2024

Abstract
The idea of maternal immunization has attracted significant interest in recent years; however, its adaptation has been slower than expected. The coronavirus disease 2019 (COVID-19) pandemic has shed light on the importance of the role of healthcare providers and the weight they place on society to encourage and introduce the concept of maternal immunization to a higher level.

Aim of the Study:
To examine the impact of the COVID-19 pandemic on physicians’ attitudes towards the immunization protocol of the adaptation of a newly introduced maternal immunization vaccine for tetanus, diphtheria and acellular pertussis (TDAP) to pregnant women between 27 and 36 weeks of gestation in the Kingdom of Saudi Arabia.

Method:
This was a retrospective observational study conducted between February 2021 and December 2021. Initially, the rate of antenatal utilization of the TDAP vaccine was assessed for 3 months by our booked patients. Another assessment of vaccine uptake was conducted after another 3 months, where more education and encouragement to healthcare providers was provided at the same hospital.

Results:
The initial adaptation of the TDAP vaccination by both healthcare providers and patients was below expectation [100 out of 716 patients (approximately 14%)]. After further education and involvement of the doctors in the national maternal vaccination program, the second round of assessment of 1928 patients showed that 749 patients received the vaccine with an uptake rate of 38.85%. These findings suggest the pivotal role of doctors during the COVID-19 pandemic in enhancing the adaptation of the new maternal vaccination. When more doctors were convinced of the importance of maternal immunization and offered it to their patients, there was a significant improvement in the utilization of the vaccine.
Adherent Right Atrial Cardiac Lipoma with Obstructive Symptoms: An Unusual Case Report
Authors: Pawar Ranjit , Konsam Rima , Garg Anurag , Dolas Ashish , Maheshwari Ankit , Bajaj Jayant 
Published: July 2024

Abstract
Benign cardiac tumors are rare, and cardiac lipomas constitute a small proportion. Since the majority of these lipomas vary in morphology, size, clinical presentation, and diagnosis, it is difficult to diagnose them until they become symptomatic. Management of large adherent cardiac lipomas presenting with obstructive symptoms can be challenging. It can be arduous to excise them completely, as they may involve vital structures and may sometimes need debulking only, leading to the possibility of recurring tumors. We report a case of a 60-year-old male with complaints of chest pain and dyspnea on exertion, diagnosed with a large right atrial mass, extensive involvement of the right atrial wall, and impingement on the tricuspid valve and was managed by surgical resection with a positive clinical result. This case highlights that obstructive or symptomatic cardiac lipomas can be effectively resected with favorable outcomes.
Sleep, Sleep Disorders, and Mental Health: A Narrative Review
Authors: Howarth Nathan E. , Miller Michelle A. 
Published: July 2024

AbstractEvidence suggests that sleep is a vital component of physical and health well-being. However, while sleep problems are present in individuals with mental health problems such as depression, it has not been clear whether these conditions are independent or whether they might be causally related. Indeed, if sleep or sleep disorders predispose or modify onset and outcomes of mental health issues, treatment of these factors could be explored as new mental health prevention or treatment options. The aim of this review was to examine in detail the bidirectional relationship between sleep, sleep disorders, and mental and physical health and well-being. It has considered the evidence that sleep architecture disruption, occurring through both quantity, quality, and timing of sleep as well as through the presence of sleep disorders may both influence mental health and well-being as well as be disrupted by both physical and mental health conditions. Also, the review has explored the effects of sleep disruption on mental health and performance through fatigue, mood, and vigilance. The review has considered the bidirectionality between sleep, sleep disorders, and mental health to examine how these may lead to or exacerbate mental health disorders such as affective, anxiety, autism, depressive and schizophrenia disorders but also considers how these conditions can affect sleep. The review highlights that poor sleep or the presence of a sleep disorder can increase the risks from mental health conditions such as suicidality. Furthermore, mental health conditions such as anxiety and worry can cause racing or repetitive thoughts that can keep an individual awake, leading to shortened sleep. It is important that sleep and sleep disorders are considered potential modifiable factors that could improve mental health outcomes. The important interconnect between both physical and mental health and sleep, in patient evaluations, also needs to be considered as these may affect treatment pathways and patient outcomes. Further, more robust and perspective research is required to establish the triad relationship of physical, mental health, and sleep.
Evaluation of a short-structured learner-centric training program on rational drug prescribing for medical interns: A quasi-experimental study
Authors: Nishanthi Anandabaskar , Mahendran Rajalakshmi , Ganapathy Kalaiselvan , Shanthi Manickam 
Published: July 2024

ABSTRACT

Introduction:
Rational drug prescribing skills of interns remain bleak despite clinical pharmacology training during their second year, warranting the need for further training. This study was designed to evaluate the effectiveness of a short-structured learner-centric training program using the World Health Organization (WHO) guide to good prescribing in improving interns’ knowledge of rational drug use and their rational drug prescribing skills.

Methods:
This quasi-experimental study was implemented at a tertiary care teaching hospital in South India. We conducted a short-structured learner-centric training program on rational drug prescribing for interns in September 2022, using the WHO guide to good prescribing. The medical interns who consented to participate were included in the study. A pre-test was administered at the start of the training, followed by a post-test and feedback questions at the end of the program. Statistical tests used for quantitative data were the Wilcoxon signed-ranks test and McNemar’s Chi-square test. Qualitative data were analyzed using manual content analysis.

Results:
Of the 77 interns who attended the training program, 73 provided consent and completed both the pre-test and the post-test. Their mean age was 22 years, with a slight preponderance of female participants (53.4%). Overall, there was a statistically significant increase in the median (interquartile range) total scores from 52 (44.6 – 60) to 84 (70 – 88) after the training (P = 0.001), out of a maximum score of 93. Also, a significantly greater number of them wrote legible prescriptions (grade 4/excellent – 44 in pre-test vs 52 in post-test; P = 0.001) after the training.

Conclusion:
The short-structured learner-centric training program based on the WHO guide to good prescribing significantly improved the knowledge of rational drug use and rational drug prescribing skills among medical interns.
Assessment of the services provided at the family medicine staff clinics in King Saud Medical City, Riyadh
Authors: ELNasieh Abdulrahman M. , Almesned Mohammed , Alomran Yousef A. , Alhadlaq Razan K. , Alhazmi Akram N. , Alhuwaidi Faisal , Hazazi Yahya O. , Alawami Hawra M. , Derani Maria A. , Ahmed Amani A. 
Published: July 2024

ABSTRACT

Background:
Patient satisfaction is the subjective evaluation of a patient’s cognitive and emotional responses. This reflects their expectations regarding the ideal healthcare to be provided. This study aims to assess the satisfaction level of the attendees to the family medicine staff clinics at King Saud Medical City, Riyadh.

Materials and Methods:
A descriptive cross-sectional study recruited 378 participants. An adapted and piloted questionnaire was used to gather the data. The questionnaire enquires about the communication skills of the receptionist, the triage nurse, and the assigned physician. It included questions regarding the structure of the clinics.

Results:
Females represent the majority of about 255 (67.5%). About 2/3 of the respondents were within the age group of 18-34 years, 245 (64.8%). A high level of satisfaction was reported by the participants regarding the professionalism, kindness, interest of the staff member, and waiting time. Gender, marital status, and age group have no significant effect on the satisfaction level; the P value was uniformly more than 0.05.

Conclusion:
The result of this study identified high satisfaction responses regarding the communication skills of the receptionist, triage nurse, and physicians. The overall evaluation of the experience during staff clinic visits was satisfactory. Periodic evaluation of these attributes and other indicators that promote patient-centered care should be undertaken to improve the overall quality of care.
Adverse pregnancy outcomes with respect to treatment modalities in women with gestational diabetes mellitus at a rural tertiary care teaching hospital
Authors: Bailore Vidyasri , Basany Kalpana , Banda Maheshwari 
Published: July 2024

ABSTRACT

Objectives:
To estimate the prevalence of gestational diabetes mellitus (GDM) and compare adverse pregnancy outcomes with respect to treatment modalities in a peri-urban teaching hospital in Telangana.

Methods:
A prospective study was conducted on GDM cases delivered from January 2019 to March 2020. GDM was diagnosed using a two-step procedure of screening using IADPSG criteria. Women diagnosed with GDM were divided into four groups – diet group, metformin group, metformin plus insulin group and insulin group based on the treatment modalities. Adverse pregnancy outcomes of the women managed with different treatment modalities were recorded.

Results:
Good glycaemic control (FBS, P = 0.04, 2 hrs PLBS, P = 0.01) was achieved in diet and metformin groups. Incidence of Gestational hypertension (P = 0.01) and preeclampsia (P = 0.01) were found to be higher in the insulin group when compared to the metformin and insulin group, metformin group and diet group. No difference was noted with respect to polyhydramnios, preterm birth, premature rupture of membranes, induction labour and caesarean delivery rates between the treatment groups. Apgar score at 5 min of <7 (P = 0.02), neonatal intensive care unit admissions for >24 hrs (P = 0.03) and neonatal hypoglycaemia (P = 0.01) were found to be higher in insulin-required groups. Rates of shoulder dystocia, stillbirth, early neonatal death within 1 week and respiratory distress did not vary significantly between the treatment groups.

Conclusion:
Universal screening of women for GDM and multidisciplinary management of women once diagnosed tend to lessen maternal and fetal complications. Metformin can be an effective, cheaper and non-invasive alternative to insulin in the management of GDM.