Structural Adjustment Research Articles (Page 1)

Background: Palliative care in Iraq remains severely underdeveloped, despite growing recognition of its critical role in alleviating the suffering of patients with terminal illnesses. Structural limitations, socio-cultural barriers, and political instability continue to undermine its accessibility and integration into the national health system. Objectives: This paper explores the evolution, current gaps, and future opportunities for palliative care in Iraq, with a focus on institutional readiness, geographic equity, and cultural dimensions. It aims to offer a comprehensive overview of the systemic challenges and to outline a strategic path forward. Methods: This is a narrative review and policy analysis based on published literature, institutional observations, and recent regional developments in palliative care infrastructure, training, and cultural attitudes. Special emphasis is placed on the interaction between family roles, healthcare delivery, and end-of-life decision-making in the Iraqi context. Results: Findings reveal a profound misalignment between the need for palliative care and its current availability. Terminal patients often receive aggressive, non-beneficial treatments in intensive care settings, while community-based services are scarce or absent. Cultural stigma, lack of trained personnel, insufficient funding, and the legacy of conflict further complicate access. Family caregivers carry a disproportionate burden, often without professional or psychosocial support. Conclusion: Integrating palliative care into Iraq’s health system requires both structural reform and cultural transformation. A national policy that prioritizes palliative education, decentralizes services, and respects local values could significantly improve end-of-life care for Iraqi patients and their families. Keywords: Palliative care, end-of-life care, health system challenges, Iraq, cultural barriers

ABSTRACT Balancing debt levels with capital needs is a key challenge in corporate financing decisions. The speed of capital structure adjustment (SOA) determines how efficiently firms return to their target leverage after deviations, thereby affecting risk control, the cost of capital, and strategic resilience. As artificial intelligence (AI) increasingly permeates corporate operations and governance, whether and how AI enhances SOA has become an important question. This study investigates the impact of AI on SOA using panel data on Chinese A-share listed firms from 2010 to 2023. We employ partial adjustment models and fixed effects estimation, supplemented by alternative AI proxies and leverage measures, system GMM, one- and two-year lag regressions, propensity score matching (PSM), and two-stage least squares (2SLS) methods to ensure robustness. The results show that AI significantly accelerates SOA, primarily by enhancing the information environment and mitigating operational risk. Heterogeneity analyses reveal that the effect is strongest at moderate board independence and among low-growth firms. These findings deepen our understanding of how emerging technologies influence corporate financing decisions and provide practical implications for managers and policymakers seeking to optimize capital structure in the era of AI.

Abstract Fiscal policy is often one of the economic Achilles heels of emerging markets. Therefore, adequately modeling it becomes crucial to understanding the effects of shocks impacting this class of economies. This paper seeks to make a new proposal on how to model an emerging market such as Brazil, with a particular emphasis on the fiscal side. To that end, we build a medium-scale open-economy DSGE model, enriched with a detailed government structure and a comprehensive array of fiscal tools. We then compare the effects of some relevant shocks to those generated by the Central Bank of Brazil’s DSGE workhorse model, SAMBA. Additionally, we analyze several fiscal structural reforms that have been suggested or implemented within the last decade. Our results show that our model does a good job of reproducing the movements of key economic variables, shedding light on the fiscal dynamics and their interactions with monetary policy and external shocks. Introducing Stone–Geary (subsistence) preferences for non-Ricardian households strengthens empirical realism without altering our main conclusions.

Abstract This study examined teachers’ ( n = 19), and peer coaches’ ( n = 10) perceptions of a job-embedded peer coaching professional development intervention designed to support teachers’ assistive technology (AT) use in inclusive preschool classrooms. Under this professional development model, school-based personnel, trained as coaches, supported teachers' AT use. The six-month professional development intervention combined online learning modules, access to AT tools, and structured peer coaching cycles. Data from participant focus groups and teachers’ written reflections were analyzed using thematic analysis. Findings revealed teachers’ and coaches’ agreement that the job-embedded coaching intervention expanded teachers' understanding and use of a range of AT and enhanced student engagement, communication, and participation. At the same time, participants noted multiple barriers to optimal implementation of the model, including time constraints, classroom management challenges, and staffing shortages. Study findings support the promise of job-embedded peer coaching for AT implementation while underscoring the critical need for structural reforms that are essential for peer coaching to reach its full potential.

Most military servicemembers (SMs) struggle to obtain sufficient sleep. Research indicates that SMs work extended hours and delay their sleep in order to create time to engage in meaningful life activities. The purpose of this study was to characterize the occurrence of, and association between, role overload and revenge bedtime procrastination (RBP) in military SMs and to what extent these variables contribute to functional performance. This study utilized a cross-sectional design to collect data from 393 SMs. Outcome measures included the Bedtime Procrastination Scale, the Work Role-Overload Scale, the Walter Reed Functional Impairment Scale (WRFIS), and the Functional Outcomes of Sleep Questionnaire (FOSQ-10). This study was approved by the San Antonio Institutional Review Board (IRB #24-19390). This study found that SMs who report higher levels of role overload also reported greater engagement in bedtime procrastination, and that both variables significantly predicted declines in functional performance as measured by the FOSQ-10 and the WRFIS. Our findings suggest that RBP in SMs occurs as a byproduct of an imbalance between occupational demands and opportunities to participate in other life roles. Addressing sleep readiness in the military will be ineffective without leadership training, structural reforms, and policies that support optimizing work-life balance. Strengths of this study include the use of validated psychometric instruments and a substantial sample of active-duty SMs across all rank categories. Limitations include the cross-sectional design, which prevents causal inference, and the reliance on self-reported data, which may be influenced by recall bias or social desirability.

The coordinated development of Production-Living-Ecological (PLE) spaces has emerged as a core challenge for regional sustainability amid rapid urbanization processes. This study examines the Guanzhong Plain Urban Agglomeration (2001–2021) using an integrated Markov-PLUS model coupled with Random Forest algorithms and 17 driving factors to construct 4 policy scenarios for future projections. The results reveal dramatic spatial restructuring: living space expanded 73.89% while production and ecological spaces contracted 7.47% and 8.94%. Evolution occurred through four distinct phases—rapid expansion, structural adjustment, quality improvement, and green transformation—each corresponding to national policy transitions with regional lags. Driving mechanism analysis identified environmental factors contributing 45–55% of variance, population density driving 24.2% of living space expansion, and elevation thresholds constraining urban growth above 1000 m. Multi-scenario simulations revealed fundamental trade-offs: urban development scenarios achieved 55.34% built-up expansion but sacrificed 15.4% ecological space, while ecological protection scenarios maintained 92% food production capacity with optimal connectivity (0.63) and maximum carbon storage (1287 Mt C). Model validation achieved exceptional accuracy (Kappa = 0.91, FoM = 0.24). This research emphasizes three strategic imperatives: (1) differentiated spatial governance (urban priority in cores, farmland protection in plains, ecological restoration in mountains); (2) temporal coordination mechanisms accounting for 3–5-year policy transmission lags; (3) adaptive management approaches addressing nonlinear evolution characteristics. This framework provides scientific foundations for balancing economic development, food security, and ecological protection in rapidly urbanizing regions.

Cellulose, as a natural material, serves as an excellent raw material for creating antimicrobial biological materials due to its unique nanostructure for cell scaffolds, customizable mechanical properties, biodegradability, and biocompatibility. The cellulose hydrogel offers exceptional structural adjustability and functional design options, thanks to the abundance of hydroxyl groups on its surface, making it suitable for various applications in tissue engineering, biomedicine carriers, wound dressings, and more. Despite its potential in stomatology, the research progress in this area remains unclear. This review focuses on the performance criteria for ideal cellulose-based hydrogels, including self-healing, adhesion, antibacterial properties, and drug delivery. It also covers preparation methods, repair mechanisms, and applications in biomimetic remineralization for hard tooth tissues, periodontitis, dental body repair, alveolar bone repair, and more. Persistent challenges—including scalable manufacturing processes, cost-effective production of functionalized variants, long-term biological safety assurances, antimicrobial resistance management, and ecological sustainability require resolution. Concurrently, establishing standardized regulatory protocols for clinical translation warrants prioritized efforts. By aligning material innovations with unresolved clinical demands in dental care, this review positions cellulose hydrogels as foundational components for personalized stomatological interventions, accelerating the transition toward precision-oriented dental therapeutics.

Purpose: The study focuses on the ways in which education equity can be employed to stimulate sustainable development between national economies that have interest to China and Thailand. It talks of how equal access to education contributes to human capital and productivity and inclusive economic growth and provides empirical evidence of the same in the light of a cross country comparative framework. Methodology/Approach: The panel data used in the quantitative econometric analysis were 2000-2023, which was gathered in the World Bank, UNESCO, and national statistical bureaus. The identification of the causal relationship between education equity and the outcomes of sustainable development was completed with the help of the fixed-effects regression models as well as the indicators, such as the Education Gini Index, Sustainable development goal (SDG) achievement scores, and GDP per capita growth. Originality/Relevance: The research is based on the discussion of sustainable development and it introduces the equity of education in the macroeconomic analysis as the gap that exists between social justice and the economic sustainability. It pays attention to the contribution of structural educational reform and inclusion in alleviating regional disparities as well as accelerating economic sustainability on a long-term basis in developing economies. Key Findings: The results show that China and Thailand are positively correlated in terms of the education equity and sustainability indices. The rapid rural education has brought about quantifiable benefits in the human capital and environmental consciousness in China and the gender parity programs in Thailand. The marginal effect however is higher in China because it has a wider scope of investment and regional policies of innovation. The results indicate that the key to the attainment of a balanced, sustainable economic development lies in the inclusion of educational structures. Theoretical/Methodological Contributions: The research has added to the literature by incorporating economic modeling and sustainable development theory to provide a model that can be replicated in other countries to analyze educational inclusiveness. It contributes to the empirical knowledge of the functioning of equity in education as a long-term source of sustainability in education, leading the policymakers to

The social work profession stands at a critical juncture where financial and regulatory mechanisms intersect with its core values of equity, justice, and empowerment. This think piece examines these intersections through the lens of Critical Race Theory (CRT), focusing on the tenets of intersectionality and interest convergence. It explores the inequities in licensure pass rates, shedding light on the compounded barriers faced by marginalized groups, where race, class, gender, and other social identities intersect to exacerbate disparities. Specifically, it analyzes how factors such as exam construction, educational preparation, and financial barriers disproportionately affect these groups, contributing to their lower pass rates. The historical context of how learning is acquired in social work is framed within an understanding of systemic oppression, emphasizing the tension between transactional operations and the profession’s commitment to transformative impact. The tenet of interest convergence highlights how changes in licensure processes may only occur when the interests of marginalized groups align with those of dominant groups, underscoring the need for structural reform that addresses systemic inequities and professional advancement opportunities. The discussion proposes strategies to mitigate these inequities, ensuring that licensure processes are accessible, just, and equitable for all social workers, particularly those from historically underrepresented communities.

Abstract Black women remain acutely underrepresented in senior leadership roles within higher education, often experiencing precarious appointments during times of institutional instability—a phenomenon known as the “glass cliff.” While existing research addresses the barriers to leadership access, limited scholarship explores what happens once Black women assume these high-risk roles. This study asks, “What are the lived experiences of Black women in high-level leadership roles in higher education, and how do they describe navigating workplace cultures shaped by the intersections of race and gender?” Using narrative inquiry, the researchers conducted semi-structured interviews with five Black women who have held high-level academic leadership positions. Participants were recruited through purposive and snowball sampling. Data were thematically analyzed using a five-step coding process, with multivocality and researcher reflexivity employed to ensure rigor. Findings revealed eight interrelated themes, including the impact of racial and gender identity on professional trajectories, limited mentorship and sponsorship, inequitable compensation, and persistent organizational cultures reflective of glass cliff conditions. Participants described feeling devalued, under-supported, and excluded from critical decision-making spaces. Despite these challenges, they demonstrated resilience and emphasized the importance of culturally affirming support systems, intentional recruitment practices, and transparent institutional cultures. This study contributes to higher education leadership literature by demonstrating how misogynoir and racialized organizational risk shape Black women’s leadership experiences post-appointment. The findings call for urgent structural reforms in recruitment, support, and retention strategies to ensure that Black women not only access leadership roles but are positioned to thrive within them.

Introduction: Medical educators are central to guiding students through the emotional challenges of moral dilemmas in end-of-life (EoL) decisions. However, the literature often overlooks how medical educators support students during these moments. This study explored strategies medical educators employed and challenges they encountered in supporting students facing moral dilemmas in EoL care. Method: This qualitative study analyzed interviews with fifteen medical educators from diverse clinical settings, focusing on how they support students during EoL decisions to withhold or withdraw life-sustaining therapy. Results: Medical educators initially offered equal support to all students but progressively adapted their strategies based on perceived student engagement. These strategies were not pre-planned or fully conscious, but emerged in real time as educators navigated the emotional and cognitive demands of EoL decisions. Medical educators increased personalized support to students perceived as “highly engaged”, while gradually reducing support for those perceived as “less engaged”. They struggled to balance their role as comprehensive supporters with time constraints, administrative duties, and a hidden curriculum prioritizing clinical skills over emotional connections and patient-centered care. Discussion: Building on our previous investigation into medical students’ experiences of moral dilemmas in EoL care, this study shifts the lens to medical educators. It reveals a critical oversight: students feeling emotionally overwhelmed may be misinterpreted as disengagement. This misalignment can hinder educators’ support strategies, potentially reducing support when most needed. The study advocates for an ‘Educational Alliance’ grounded in trust and mutual respect, and calls for structural reforms to sustain educators’ capacity to provide consistent, emotionally attuned support.

This study examines gendered experiences of pain management within clinical settings through the narratives of six college-aged interlocutors. Their testimonies reveal patterns of dismissal and minimization of women's pain reports, highlighting the intersection of gender identity, sociocultural influences, and institutional barriers to adequate healthcare in these contexts. Common themes include difficulty in articulating pain in ways that elicit effective provider responses, the psychological toll of persistent pain, and the necessity of self-advocacy. These findings underscore the urgent need for structural reforms in medical education and clinical practice to ensure equitable pain management. By analyzing these lived experiences, this study contributes to a broader discourse on gender disparities in healthcare and the rhetorical framing of women's pain in medical settings. Through a combination of content analysis of the interviews conducted and review of relevant literature, this paper sheds light on current realities surrounding women's illness experiences and provides insights for effecting meaningful change in pain care and management for women.

The rapid growth of generative AI (GAI) has transformed how artistic works are created and raised new challenges for copyright law. The traditional safe harbor regime is under strain. Due to widespread and instant outputs by GAI, the old notice-and-takedown approach no longer works. This paper reviews the main academic views on the liability of GAI platforms and the scope of safe harbor protection. It identifies three main positions: complete rejection of immunity, conditional immunity with new duties, and structural reform of liability rules. It explains the reasons and limits of each view. Based on this review, the paper proposes a duty-based exemption model: a limited immunity system that matches the platforms level of control, the predictability of risk, and the benefits received. This model aims to balance copyright protection with technological innovation.

Understory vegetation diversity is the key indicator of ecological outcomes in the close-to-nature transformation of plantations, with its composition revealing successional dynamics and ecosystem functionality. In response to China’s “Green and Beautiful Guangdong” Initiative, enhancing the ecological quality of plantations has been established as a critical objective for sustainable forest management. This study assessed the understory vegetation in four representative transformed plantations in Guangdong Province, China, using Multi-Response Permutation Procedure (MRPP), Indicator Species Analysis (ISA), Detrended Correspondence Analysis (DCA), and Redundancy Analysis (RDA). The results showed that: (1) Species richness was highest in the Eucalyptus L’Hér plantation (102 species), followed by Pinus massoniana Lamb (94), Acacia mangium Willd (92), and Litchi chinensis Soon plantations (85). (2) MRPP analysis revealed significant differences in species composition among plantation types (A = 0.149, p < 0.001). ISA identified 5, 7, 3, and 5 indicator species for each type, respectively, predominantly light-demanding pioneers such as Dicranopteris dichotoma (Thunb.) Bernh and Microstegium vagans (Nees ex Steud.) A. Camus. (3) DCA ordination showed clear compositional segregation among the understory communities of Eucalyptus, Pinus massoniana, and Acacia mangium plantations, whereas the Litchi chinensis plantation exhibited substantial overlap with others. RDA further demonstrated a significant negative correlation between mean diameter at breast height (DBH) and understory diversity (p < 0.01) across all plantations except Litchi chinensis. These findings offer a quantitative basis for tailored management strategies. We recommend structural adjustments through target-tree thinning to optimize light availability by regulating DBH, combined with interplanting native understory species. This integrated approach can enhance structural heterogeneity and promote more effective and sustainable plantation restoration.

Background: Black women in the United States experience a disproportionate burden of cardiometabolic disease (CMD) beginning in adolescence, although CMD mortality is often thought to emerge at menopause. Objectives: This study estimates and compares CMD mortality risks in Black and White women aged 25-44 years. Methods: Using National Vital Statistics System data and standard life table methods, we estimated CMD mortality risk in hypothetical cohorts of non-Hispanic Black and White women aged 25-44, with cohort sizes matched to the 2022 U.S. population. We estimated cumulative risk and quantified excess mortality, proportional mortality, and years of life lost (YLL). Results: The cumulative CMD mortality was 0.90% (1 in 111) for Black women and 0.33% (1 in 306) for White women (risk ratio: 2.73, 95% CI: 2.59–2.87). Of the 2,716 expected CMD deaths in the Black cohort, 1,726 (63.6%) were excess deaths. CMD accounted for 20.1% of deaths in Black women (rising from 7.8% at age 25 to 27.6% at age 44) versus 10.7% in White women (6.0% to 15.6%). Average YLL was 4.42 months for Black women and 1.70 months for White women. Conclusions: CMD mortality was higher in younger Black than White women and emerged well before menopause. Reducing these disparities requires earlier screening, improved healthcare access, and structural reforms.

This study aimed to evaluate the potential impact of the hospital-university restructuring implemented since 2016 on students' stress levels and their satisfaction with teaching, while considering other factors that might influence the results. A secondary goal was to identify persistent causes of dissatisfaction to guide future improvements. A cross-sectional survey was conducted among 182 clinical students (Years 4-6) at the Faculty of Dentistry between January and February 2023. Students completed an anonymous questionnaire covering socio-demographic data, perceived stress (Dental Environmental Stress scale), and satisfaction with clinical and theoretical teaching (selected items from the Student Course Experience Questionnaire). Descriptive statistics were used for data analysis. The Mann-Whitney U test was applied to compare current results with those from 2016. Stress levels significantly increased compared to 2016 (p < 0.001). Major stressors included increased clinical quotas, reduced chair time, and difficult interactions with teaching staff. These were reported consistently across all academic years. Students who repeated a year or felt overwhelmed experienced significantly higher stress (p ≤ 0.04). Satisfaction with clinical teaching dropped significantly across all levels (p < 0.001), especially regarding supervision, clinical case access, and feedback. Theoretical teaching satisfaction also declined. Overall student satisfaction was significantly correlated with stress levels and satisfaction with both theoretical and clinical teaching, with key factors including repeating a year, feeling overwhelmed, and fears about the future (all p ≤ 0.04). The findings highlight a clear deterioration in student well-being and satisfaction since 2016, emphasising the need for structural reform and enhanced teacher training in student support and stress management.

Sustainable utilization of energy depends on the establishment of an advanced energy system. As the world’s largest consumer and importer of energy, China’s progress in this field has attracted considerable attention. This study seeks to address the limitations of most existing research, which largely remains at a qualitative level, by expanding perspectives and methodologies. Utilizing think-tank research approaches and indicator system evaluation methods, it quantitatively evaluates the development level of new energy systems across thirty provincial-level administrative regions in China from 2011 to 2023. Machine learning methods were applied to empirically analyze the driving mechanisms of “new” factors through the construction of a random forest model. The results reveal that: (1) China’s new energy system exhibited an overall positive development trend, albeit at a relatively slow pace and with notable spatial disparities. The development levels of the three core objectives followed a gradient pattern, showing marked improvements after the implementation of China’s supply-side structural reform policies. (2) Innovation funding and high-level labor input served as the dominant driving forces for development, while factors such as the scale of the technology market, the proportion of the tertiary sector, and environmental regulation investment played supplementary roles, with regional variations observed.

A two-dimensional axisymmetric fluid model was implemented in COMSOL Multiphysics to study the plasma characteristic in radio frequency capacitively coupled SiH4/NH3 plasmas, generally using for deposition of silicon nitride films. The model fully resolves coupled multiphysics (electric-thermal-fluid-plasma interactions), enabling systematic analysis of plasma density uniformity modulation via dielectric structures near the radio frequency-powered upper electrode. By varying the thickness of this dielectric structure, the electric field at the electrode edge can be significantly modified, thereby modulating both the generation rate and spatial distribution of electrons and radicals. Interestingly, when substantial gas flow is introduced, while the electron density distribution remains unchanged, the radical distribution undergoes significant modification. Moreover, the thickness-dependent dielectric structure geometrically constricts the electrode edge gap, accelerating local gas flow and consequently modifying radical transport. This interdependence necessitates coupled optimization of flow patterns and structural parameters for uniformity control.

South Asian (SA) communities in Ontario, Canada experienced disproportionately higher rates of COVID-19 infection. Moreover, these communities also faced racism fueled by COVID-19-related misinformation and xenophobic sentiments that placed blame on them for virus transmission. The aim of this research was to understand, from the perspective of local SA communities, the causes behind higher incidences of COVID-19. SA adults (N = 25) participated in a focus group (N = 3) investigating experiences during the early stages of the pandemic. Data, interpreted through the lens of the Public Health Critical Race Praxis, suggest that the structural determinants of health, alongside racism and xenophobia, negatively impacted health outcomes for these communities. By not taking an active anti-racist stance, media, health and government authorities were viewed as perpetuating discriminatory narratives and practices, fueling blame and stigma towards these South Asian communities for COVID-19 transmission. Local public health policies, practices and communications were perceived to be informed by, and best serve, white Anglo-European settlers. This research provides insight into the role that health officials can play in addressing local and regional discrimination and stigma to promote equity-centered disease prevention efforts. Our findings should be integral to current and ongoing research and action related to pandemic preparedness.

What Is the Impact of Industrial Structure Adjustment on the Ecological Efficiency of Marine Carbon Sink Fishery: Evidence from Coastal Provinces in China?