Current Deficit Research Articles

Contextualization Matters: Beyond Abstract, Normative and Universal Approaches

The negative ecological, health and social impacts of intensive agricultural production and deforestation, coupled with rapid urban and suburban development motivated some architects, land-use planners, landscape and urban designers last century to consider how the morphology and size of human settlements impact on natural and human ecosystems at local, regional and global levels. Some initiatives 50 years ago, including the seminal contributions of Constantinos A. Doxiadis, John Habraken, Victor Papanek (among others), preceded current concerns about complex people-society-environment-biosphere interrelations in a rapidly urbanizing world. Notably, the United Nations 2030 Agenda for Sustainable Development and the New Urban Agenda recognize these dilemmas, but these initiatives have not borne anticipated outcomes since 2015. This article explains that the proposed responses to these societal challenges by these international initiatives have devalued fundamental elements of ekistics that combined and synthesized five forces - economic, social, political, technical and cultural factors in a holistic and systemic model. In addition, abstract, dogmatic, normative, and universal approaches commonly used in architecture and urban planning during the last century have remained dominant. The author requests a fundamental rethinking of key drivers of rapid urbanization that need to be understood and corrected according to the diversity and plurality of contextual conditions in which human settlements are constructed. These can be identified and accommodated in Living Labs which are creative real-world settings that explicitly reconnect knowledge and praxis about human habitats, thus overcoming the current deficit in implementing the SDGs, and in particular SDG 11.

Testing the triple deficits in the emerging economies of Europe

In the literature, increases in the ratio of current deficit to gross domestic product (GDP) are considered a crisis indicator, and budget and savings deficits are deemed to be significant causes of the current deficit. This situation, called the triple deficit hypothesis in the literature, is analyzed with the panel dynamic ordinary least square (panel DOLS) and fully modified ordinary least squares (FMOLS) using 2000-2019 data for Bulgaria, Czechia, Estonia, Latvia, Lithuania, Hungary, Malta, Romania, and Slovenia, which are generally referred to as the emerging economies of Europe. The results showed a long-term relationship between the variables. Accordingly, budget and private savings deficits increase the current deficit in the long term. The causality analysis found a reciprocal causal relationship between the variables, such that while budget and private savings deficits cause an increase in the current deficit, increases in the current deficit also increase the budget and private savings deficits. Thus, the triple deficit hypothesis is valid in these countries.

Towards practicality: Navigating challenges in designing predictive-reactive scheduling

Today’s agile production systems face an ever-increasing complexity due to individualized mass production, a volatile customer demand and dynamic events which disrupt the baseline schedule. Robustness and optimality of the schedule affect the efficiency of the production systems, which in turn negatively affects resource consumption and waste generation. To achieve near-optimal performance, while adhering to due dates and robustly handling disturbances, predictive-reactive scheduling is often proposed. In the current state-of-the-art research on predictive-reactive scheduling there still exist some open issues. One issue to address is a current deficit in generalization, that is, when handling new, previously unseen data. Arguably the main culprit is the reactive (re)scheduling component. Designing such highly complex systems imposes many difficulties. We identify existing problems which ultimately limit the applicability of predictive-reactive scheduling and investigate and evaluate a design approach for predictive-reactive scheduling. We propose predictive-reactive scheduling, which uses match-up scheduling and promising decentralized multi-agent reinforcement learning, which allows for fast and flexible real-time decision-making. The aim of this study is to provide insights and improve the applicability of research on predictive-reactive scheduling.

"Not doing it justice": Perspectives of Recent Family Medicine Graduates on Mental Health and Addictions Training in Residency.

Family physicians report feeling inadequately prepared to meet the evolving mental health care needs of the population. Little scholarship exists evaluating the effectiveness of curricula designed to teach mental health and addiction (MH&A) care to family medicine (FM) residents. As such, the purpose of this study was to explore the experiences of recent FM residency graduates in providing mental health care, and their perceptions of mental health training gaps during their residencies. A qualitative descriptive study design was conducted by 8 recent graduates of the University of Toronto's FM residency program, who participated in semi-structured video interviews. A thematic analysis approach was used to collect and analyze the data. Through thematic analysis, 3 overarching themes were developed: (1) barriers in providing mental health and addiction care, (2) curriculum renewal, and (3) the role of FPs and professional identity. Consistent with the literature, the majority of recent FM graduates expressed discomfort when managing patients with mental health and addiction concerns. Additionally, participants perceived residency program time constraints, rotational site differences, and limited exposure to marginalized populations all impacted learning and mastery of skills. The findings of this study underscore current gaps within the FM residency curriculum and highlight the need to address current curricular deficits.

Carbohydrate beliefs and practices of ultra-endurance runners in Ireland for gastrointestinal symptom management.

This study aimed to investigate the carbohydrate beliefs and practices of ultra-endurance runners in Ireland to gain an understanding of their gastrointestinal symptom (GIS) management strategies. An adapted version of a previously developed and validated questionnaire was distributed online to ultra-endurance runners, recognized as those who completed a single bout of exercise lasting 4 or more hours. The questionnaire asked about carbohydrate awareness and sourcing, and dietary practices, particularly in relation to GIS management. A total of n = 68 individuals completed the adapted questionnaire. Of these, n = 1 was excluded due to their reporting of an ulcerative colitis diagnosis. The remaining participants included 46 men and 21 women. Personal previous experience was the main source directing participants' nutrition practices (n = 30), while only 3 participants quoted sourcing information from qualified professionals. Forty-two participants experienced GIS, usually equally around training and competition times. Many participants had not previously implemented any specific dietary or non-dietary strategies to alleviate exercise-induced GIS. Supplementing with nitrates (n = 9) and probiotics (n = 4) were the most common dietary practices to alleviate GIS, while other practices (n = 14) and portion control (n = 13) were the most reported non-dietary practices. Similar to previous studies, these findings suggest that GISs are prevalent in the ultra-endurance running community, occurring regardless of whether during training or an event. Similarly, this research highlights the vast range of GISs experienced by this population. However, the absence of both dietary and non-dietary-related practices used for GIS management alludes to a current deficit in the availability of nutrition information specific to this problem. Further research is required to understand the mechanisms behind ultra-endurance-associated GISs and its various management strategies as well as best practices for communicating these to the target audience to reduce individuals' risks of developing long-term, chronic health complications.

Transfer of musculoskeletal care from paediatric to adult services for patients with cerebral palsy and chronic neuromuscular conditions: Identifying the unmet need

IntroductionChildren with cerebral palsy (CP) are treated by well-co-ordinated multi-disciplinary neuromuscular teams. With a comprehensive multidisciplinary team, co-ordinating the transfer to adult care is a challenge. Orthopaedic care becomes fragmented as patients transfer from paediatric orthopaedic surgeons with training in multi-joint neuromuscular conditions (NMCs), to adult orthopaedic surgeons where this expertise rarely exists. Orthopaedic and spinal problems are a major unmet health need in this population. There is a lack of research in the literature regarding availability and access to orthopaedic services post transferring, which this study aimed to address. MethodsThis was a cross-sectional study conducted at an NHS referral centre for specialist paediatric services to evaluate the existing transfer program. A 10-item questionnaire was developed by senior clinicians for patients with CP or NMCs and their families to answer. It focused on three domains: Availability of a transfer of care plan, access to healthcare services and satisfaction with the services. ResultsThere were 39 responses from patients, or their families received between December 2021 to April 2022. Patients were aged between 17 and 28 years at the time of answering. Availability of a transfer of care plan was poor, at only 20.5 % (8/39). Sixty-nine percent (27/39) stated there was not an orthopaedic surgeon overseeing their bone and joint health and a further 33.3 % (13/39) reported lack of supervision from a physiotherapist. Fifty-six percent (22/39) of respondents reported a decline in musculoskeletal health. Those that did receive ongoing orthopaedic care reported high rates of satisfaction. ConclusionOur study has shown that the transfer of care for patients with CP and NMCs continues to remain poor, contrary to national guidelines, with lack of access to adequate musculoskeletal healthcare services after transfer to adulthood. The unmet needs of patients with CP or NMCs with orthopaedic and spinal pathologies are higher than previously reported. This area has been critically understudied, but this manuscript has highlighted an urgent need to improve and reform transfer practises, to fulfil the current deficit.

The contribution of metal allergy to the failure of metal alloy implants, with special reference to titanium: Current knowledge and controversies.

After almost three-quarters of a century during which contact dermatologists have often struggled to comprehend the relationship between metal allergy and failure of metal-alloy containing implant, it is possible to say that a relationship does exist, particularly for cobalt and chromium, but also for nickel. There is still debate as to whether allergy develops as a consequent of failure but thenceforth contributes to it, or whether sensitisation starts first and induces failure secondarily-opinion probably favours the first. Metal-on-polypropylene articulations were associated with few metal allergic problems but now are less favoured by orthopaedists due to plastic wear products causing osteolysis and pseudotumour formation through local inflammation. New metal alloys are regularly being introduced such that interested dermatologists need to stay on top of the situation. The jury is still out as to whether the recent favouring of titanium-containing alloys will confirm them to be more inert allergenically. Case reports do show some clinical reactions to titanium-containing implants and patch test series have inferred sometimes quite a high background rate of allergy, but interpretation must be tempered by the awareness that titanium salts on patch testing have a tendency to cause irritant reactions. Blood monitoring of metal ion values is now recommended in certain situations after joint replacement and increasing levels may be an indication that allergy with joint failure can develop, in which case patch testing is indicated, and suggested series are available. Predictive patch testing, whilst generally not recommended in the past, has been introduced into some protocols often by non-dermatologists, such that it is now needed for temporo-mandibular joint and Nuss bar insertion, and it can be anticipated that this may become more commonplace in the future. One of the major current deficits for patch testers is standardised guidance on which preparation or preparations to use for suspected titanium allergy. One suggestion is 0.5% titanium sulphate in petrolatum, though experience in at least one centre suggests the use of a battery of titanium salts might be desirable.

Effect of Public Debt on the twin deficits using a Threshold time series model: Case Study of Jordan 1980-2020

This study examines the Effect of Public Debt on the twin deficits using the threshold time series model of the Jordanian economy from 1980-2020. The independent variables were relied upon: private saving, production gap, economic growth, trade openness, and budget deficit. In addition to public debt as a threshold variable. The results indicated that the optimal number of model systems is six systems only, which means that there are only five thresholds. The results also showed that three threshold values are significant, but there are two values of the threshold which are not significant, but there are two values of the threshold which are not significant. The results support the Keynesian view of the strong and positive relationship between the current account balance deficit, saving, budget deficit, and trade openness in Jordan during the period 1980-2020. Work must be done to reduce the budget deficit or to enhance saving and investment, or both in Jordan, which may help reduce the current account deficit. However, it requires radical reforms in the trade and financial sectors to achieve efficient markets. To increase external competitiveness, it is necessary to put in place incentive policies for production to increase exports to take advantage of trade liberalization policies in the field of specialization in production.

Preparation of Glutamine-Enriched Fermented Feed from Corn Gluten Meal and Its Functionality Evaluation.

China faces a persistent deficiency in feed protein resources. Enhancing the utilization efficiency of indigenous feed protein resources emerges as a viable strategy to alleviate the current deficit in protein feed supply. Corn gluten meal (CGM), characterized by a high proportion of crude protein and glutamine, is predominantly employed in animal feed. Nonetheless, the water-insolubility of CGM protein hampers its protein bioavailability when utilized as feed material. The aim of this study was to augment protein bioavailability, liberate glutamine peptides from CGM, and produce glutamine-enriched CGM fermented feed. We executed a co-fermentation protocol using Bacillus subtilis A5, Lactobacillus 02002, and acid protease to generate the CGM fermented feed. Subsequent in vivo experiments with broilers were conducted to assess the efficacy of the fermented product. The findings revealed that the soluble protein, glutamine, small peptides, and lactic acid contents in the fermented feed increased by 69.1%, 700%, 47.6%, and 125.9%, respectively. Incorporating 15% and 30% CGM fermented feed into the diet markedly enhanced the growth performance and intestinal health of broilers, positively modulated the cecal microbiota structure, and augmented the population of beneficial bacteria, specifically Lactobacillus. These results furnish both experimental and theoretical foundations for deploying CGM fermented feed as an alternative protein feed resource.

Global universal basic skills: Current deficits and implications for world development

How far is the world away from ensuring that every child obtains the basic skills needed to be competitive in a modern economy? And what would accomplishing this mean for world development? We provide new approaches for estimating the lack of basic skills that allow mapping achievement across countries of the world onto a common (PISA) scale. We then estimate the share of children not achieving basic skills for 159 countries that cover 98% of world population and 99% of world GDP. We find that at least two-thirds of the world's youth do not reach basic skill levels, ranging from 24% in North America to 89% in South Asia and 94% in Sub-Saharan Africa. Our economic analysis suggests that the present value of lost world economic output due to missing the goal of global universal basic skills amounts to over $700 trillion over the remaining century, or 12% of discounted GDP.

Affective Goals in Teaching Philosophy in Higher Secondary Education: Reality, Criticism, Perspectives

The study has the character of a critical reflection of the assumed combination of cognitive and affective goals of teaching philosophy in the environment of higher secondary education. Official state documents work with this connection as unproblematic, but the author tries to problematize this link between cognitive and affective and focuses on the current deficits in achieving affective goals in the teaching of philosophy. The article finds its inspiration for a different approach to achieving them in the pragmatism of Richard Rorty and Richard Shusterman.

The global distribution of oral and maxillofacial surgeons: a mixed-methods study

Despite its role in treating the most dominant non-communicable diseases worldwide, the global workforce of oral and maxillofacial (OM) surgeons is not well-characterized. To address the current deficit in understanding of the global OM surgeon workforce and to elevate oral and maxillofacial surgery (OMS) in the global health discourse, we join other surgical specialties in evaluating global surgical capacity with a descriptive analysis of the distribution of OM surgeons worldwide. A mixed-methods study was implemented using a combination of literature review, in-country contacts, internet searches, and survey data. The survey was distributed globally from January to June 2022. Data regarding OM surgeon workforce estimates were obtained for 104 of 195 United Nations-recognized countries (53.3%). Among countries with available estimates, the median global workforce density was 0.518 OM surgeons per 100,000 population. Twenty-eight countries (26.9%) were reported to have two or fewer OM surgeons. The median OM surgeon workforce density for low-income countries was 0.015 surgeons per 100,000 population, compared to 1.087 surgeons per 100,000 population in high-income countries. low and middle-income countries countries have the least workforce density as well as the least data coverage. More work is needed to better understand the capacity of the global OM surgeon workforce and access to OMS care.

Radiotherapy Resources in Latin America and the Caribbean: An International Atomic Energy Agency Analysis of Current and Projected Needs

The inequitable access to radiotherapy (RT) is recognized to be a complex undertaking that will require sustained work identifying gaps and mobilizing efforts to fill in those gaps. Data can support policy-makers as they embark on programs to reduce premature mortality from cancer in their countries and regions. The purpose of this analysis is to identify the current gaps and needs in Latin America and the Caribbean (LAC). We created a database of 41 countries in LAC using open-source data, including data on population size (UN Department of Economic and Social Affairs data), gross national income per capita (GNIPC) (World Bank Data), current and projected cancer incidence and mortality (Globocan 2020). The International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers (DIRAC) was used to identify the number and operational status of megavoltage (MV) teletherapy machines (Cobalt-60 and Linear Accelerators LINACs) and brachytherapy facilities (HDR and LDR). To calculate current and projected gaps in external beam RT (EBRT) facilities, we matched DIRAC data with Globocan cancer incidence data for 2020 and projections for 2025 and 2030 while applying a 64% optimal EBRT utilization rate (taking into account re-treatment). For brachytherapy, analysis took into account both HDR and LDR capacity and was primarily focused on needs based on current and projected incidence of cervical cancer cases in LAC. EBRT was available in 32 (76%) of 41 countries. There were 742 RT centers in 32 countries with a total of 1131 MV units. Average coverage in 2022 based on an optimal utilization rate of 64% was 64%. LINACs accounted for 87% of the total MV units and Cobalt-60 capacity decreased to 13% of total teletherapy capacity compared to capacity in 2018. Most countries clustered in the same range of GNIPC to teletherapy units per 1000 cases, however outliers were most notable in the Caribbean. The median GNIPC was $6340 and the median MV units per 1000 cancer cases were 1.4. The current deficit in MV units is estimated at 672 megavoltage units and projected to be 2455 units by 2030 representing more than double the current capacity. 28 out of 41 countries (68%) had brachytherapy including 279 installed services, both HDR and LDR. At a 75% optimal utilization rate of brachytherapy in locally advanced cervical cancer, the current brachytherapy capacity in LAC could treat 108,420 patients with cervical cancer/year, which meets the current needs in the region albeit with significant inequity in distribution of resources. There is 15% improvement in the current EBRT capacity in LAC compared to 2018. However, there is still shortage of at least 672 extra units needed. By 2030, the need for MV units will be double the current capacity. The current brachytherapy capacity meets needs albeit with inequitable distribution across the region primarily in the Caribbean.

Gamification of Physical Therapy Exercises Using Commercial Entertainment Content: A Safety and Feasibility Study.

Independent physiotherapy at home is a crucial element of rehabilitative care for a wide range of conditions as it constitutes a large portion of the overall therapy dose. However, up to 80% of individuals who are prescribed at-home physiotherapy do not consistently adhere to their treatment schedule, resulting in poor treatment outcomes. This is likely due to a lack of motivation and progress tracking in the current standard of care. We have developed a novel software prototype that allows users to control commercial entertainment content, such as video games or interactive music videos, with their movements during physiotherapy. By connecting therapy to proven entertainment content, we aim to improve on the current motivational deficits. This study investigated the safety and feasibility of this concept in a controlled environment over four physical therapy sessions with seven patients suffering from musculoskeletal and neurological conditions. As a secondary outcome, patients were asked about their enjoyment, perceived competence and effort using the Intrinsic Motivation Inventory (IMI) questionnaire. All participants were able to interact with the presented entertainment content and completed the study with no adverse events. Despite the diversity in pathology, age and training scenarios, the entertainment content maintained the patients' enjoyment with a high average rate of 6/7 on the IMI scale. Interacting with commercial entertainment content by doing physical therapy exercises was feasible, safe, and well-received over the six-week study period.

Critical gaps in understanding treatment outcomes in adolescents and young adults with lymphoma: A review of current data.

Adolescents and young adults (AYA) with lymphoma experience treatment-related effects in the short and long term that impact their quality of life and survivorship experience. The effort to improve outcomes for AYA lymphoma survivors requires understanding the available literature, identifying current knowledge deficits, designing better clinical trials incorporating the patient perspective, using novel tools to bridge data gaps and building survivorship guidelines that translate research to clinical practice. This review article summarizes the current state of lymphoma treatment-related outcomes in AYAs and provides future direction.

Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research.

Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.

Reclaiming public service ethics through algorithms: Implications for teaching and development

The use of algorithms and automation of public services is not new, but in recent years there has been a step change in processing power and a decrease in the price of these technologies, which means we are seeing more widespread use. These advances are reframing our perception of what matters in ways that impact the ethical dimensions of day-to-day life. In turn, these changes challenge long-standing assumptions about public service ethics and how it is taught. In this multidisciplinary authored paper, we argue that public service leaders must be attentive to ethical questions that converge around adopting “data-driven” techniques, including algorithmic decision-making. Algorithmic and technology focused ethics question assumptions about the current deficits within public service ethics pedagogy in public service programs and university programs and the future direction of the discipline. To do so raises longstanding but neglected questions about the public services’ role in the state and recovering what Rohr refers to as the ‘ethics of the office.’ This, we argue, will have implications for teaching public service ethics.

Community aged care in Australia: the need for innovative programmes to boost workforce capacity

Across Western nations, ‘ageing in place’ policies rely on having a sufficient and skilled aged care workforce. In Australia, due to the impact of successive policy reforms, this workforce including the sector that provides community-based services has declined in number and skills. At the same time the need to upskill and sustain this workforce has intensified as the frailty and health needs of consumers have increased. This paper reports on an integrative literature review undertaken during 2021 to describe workforce needs and peer reviewed reports of programs instituted in aged care settings that aimed to address these needs. The review sought to examine programs implemented in both long-term and community care settings and to draw from these elements that may be utilised in future program design across the sector. It focussed primarily on workforce deficits in the community aged care sector and on the capacity of rurally-based services to meet and respond to growing consumer demand. The findings emphasise current workforce deficits while they also reveal a paucity of peer-reviewed reports of implemented programs across the sector as a whole. Nevertheless, the few programs examined in this review provide examples of the capacity and willingness of workers and providers to trial measures that aim to increase the recruitment, retention, skill and job-satisfaction of direct care workers. We propose that the key elements of the programs identified in this paper provide the foundation for the development of strategically designed programs that address particular workforce needs such as those shaped by rural contexts.

The PNG Midwifery Leadership Buddy Program: An evaluation

ProblemPapua New Guinea (PNG) has a high rate of preventable maternal and neonatal deaths. BackgroundDeveloping midwifery leadership is vital to addressing the current deficits in health outcomes for women and their babies. The PNG Midwifery Leadership Buddy Program responds to this need through leadership training and partnering of midwives across PNG and Australia. Participants in the program undertake a workshop in Port Moresby and commit to a 12-month peer support relationship with a midwife ‘buddy’. AimTo evaluate participants’ experiences of the Buddy Program and the impact of the program on leadership skills. MethodsAll 23 midwives who had completed the program were invited to participate in the evaluation. The study used a concurrent mixed methods approach. Qualitative data were collected via interviews and then thematically analysed. Quantitative data were collected via a survey and analysed with descriptive statistics, then findings were triangulated. FindingsParticipants reported increased confidence for leadership, action and advocacy. Numerous quality improvement projects were implemented in health services in PNG. Challenges to the success of the program included technological limitations, cultural differences and the COVID-19 pandemic. DiscussionParticipants reported the PNG Midwifery Leadership Buddy Program was successful in increasing their leadership skills and collaborative opportunities, as well as strengthening midwifery more broadly. While there were barriers, most participants valued the experience and believed it benefited them professionally and personally ConclusionThe Buddy Program provides a practical model for building midwifery leadership capacity that may be transferrable to other contexts.

The Relationship between Bank Loans and the Current Deficit: Asymmetric Causesity Analysis for Turkey

Ülke ekonomileri birçok makroekonomik sorunla karşı karşıya kalmaktadırlar. Sorunların çözüldüğü düşünüldüğü noktalarda, başka sorunlar ortaya çıkmaktadır. Türkiye ekonomisi, enflasyon, cari açık, işsizlik, döviz kuru, ödemeler dengesi, tasarrufların yetersizliği, aşırı yükselen kredi hacmi gibi makroekonomik sorunlarla yıllardır mücadele etmektedir. Bu sorunların her biri ayrı ayrı ciddi düzeyde irdelenmesi muhakkak gereklidir. Ancak cari açık, uzun süredir çözülememiş, kronik hale gelmiş bir sorundur. Cari açığın en önemli belirleyicilerinden bir tanesi ise bankacılık kesimi tarafından kullandırılan kredileridir. Bu çalışma, Türkiye’de banka kredileri ile cari açık arasındaki ilişkiyi test etmeyi amaçlamaktadır. Çalışmada kullanılan seriler, Genişletilmiş Dickey Fuller (ADF), Philips Perron (PP) birim kök testlerinin yanı sıra yapısal kırılmaları da dikkate alan Zivot-Andrews birim kök testiyle serilerin durağanlık dereceleri araştırılmıştır. Seriler arasında bir nedensellik ilişkisi olup olmadığı, nedensellik varsa yönlerinin tespit edilmesi için karşılıklı olarak Toda-Yamamoto yöntemiyle analiz edilmiştir. Toda-Yamamoto nedensellik testi sonuçlarına göre, %5 anlamlılık seviyesinde kredi hacmi ve cari açık değişkenleri arasında karşılıklı olarak nedensellik ilişkisi tespit edilmiştir.