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Abstract Despite voluntary medical male circumcision (VMMC) being a cost-effective intervention for preventing HIV transmission, its scale-up has faced challenges. Several interventions to address these challenges in priority countries, including Uganda, have not yielded the desired results. This cross-sectional qualitative study aimed to explore the factors that affect the demand for VMMC and identify possible solutions. Semi-structured phone interviews were conducted with 29 males aged at least 18 and not more than 65 drawn randomly from a database representative of the general population maintained by an independent research organisation. Reflexive thematic analysis was conducted, and data analysis was done using NVivo version 12. The results were presented in narrative format with supporting quotes. The study received ethical and regulatory clearance to be conducted in Uganda. The average age of the respondents was 28 years. Almost all respondents had some education, and most lived in rural areas. Two themes were generated, namely, 1) deficits and opportunities for VMMC, which are issues that currently hinder the uptake of VMMC but, if addressed, would lead to better demand, and 2) pivots and shifts for VMMC, which are changes that need to be made to improve the uptake of VMMC. We found that several challenges, including myths, misconceptions, health system gaps, and uncertainties about the postoperative period, hindered the uptake of VMMC. Pivots and shifts for improving the uptake of VMMC include intensifying VMMC campaigns, addressing inequities, and addressing access barriers. We concluded that several challenges, including myths and misconceptions, health system-related gaps, and uncertainties in the post-circumcision period, persist and negatively impact the scale-up of VMMC in Uganda. VMMC beneficiaries have plausible proposals for addressing challenges. The Uganda Ministry of Health should address the myths, misconceptions, health system-related gaps, and uncertainties about the postoperative period and should involve VMMC beneficiaries in reviewing interventions to address gaps.

The targeted resorption of socio-economic deficits at the local (municipal) level requires the use of a cartography of development in the multidimensional sense of the term, combined with that of the causes structural factors of its possible delay. This article provides for this purpose a municipal cartography of the development of M’sila province, and its sources assimilated to education, standard of living, economic activity, housing and social services. To ensure a certain objectivity in our research, we have chosen an automatic technique following the essential steps (choice of variables, normalization, weighting and aggregation) in the hierarchical classification of municipalities. This mapping of multidimensional local development clearly shows the development deficits at the municipal level, due to the delays accumulated for years, despite the generalization of basic education and attempt the local authorities to improve the economic and social conditions of the population. The results obtained show that on the whole, the urban municipalities have a local development index higher than 0.7 and rank in the first places, this index goes from a minimum (0.310) observed in the rural municipalities Tamsa, Zerzour, Sidi M’hammed and the ones located south of the province where the climate is dry and hot, the maximum index (0.860) recorded in two urban municipalities at namely M’sila and Bousaada, The high variability of development deficits shows that any development strategy would benefit from being rethought in order to provide more effective to the different situations experienced by rural municipalities in particular. [ABSTRACT FROM AUTHOR]

This article explores the inadequate recognition and integration of the strengths of Indigenous1 people in direct practice, policy development, and research. To address this concern, I present an Indigenous strengths-based theoretical framework designed to recognise and illuminate the diverse strengths inherent in Indigenous people and communities. The ongoing structure of colonisation often presents challenges for practitioners, policymakers, researchers, and others collaborating with Indigenous people to adopt a strengths-based approach. Unfortunately, well-intentioned collaborators, especially non-Indigenous allies, often succumb to deficit-based thinking and simplistic binary comparative analysis. This article draws inspiration from Dennis Saleebey's (2023) six-step, strengths-based approach, integrating it with a micro, meso, and macro framework and Indigenous Standpoint Theory. The result is an Indigenous strengths-based theoretical framework that embraces a strengths-based approach within the context of Indigenous cultures and world views. This framework fosters the identification and development of Indigenous strengths in a respectful and culturally safe manner.IMPLICATIONSA strengths-based approach must supersede the deficit discourse that continues to be a defining feature of how social workers, allied health professionals, researchers, and policymakers interact with Indigenous Australians.This article draws inspiration from Saleebey’s (2023. The strengths perspective in social work practice: Extensions and cautions. In Social work (pp. 230–235). Routledge) six-step approach to a strengths perspective, combined with a systems theory framework and an Indigenous standpoint, and can assist in (re)defining Indigenous strength-based practice.A strengths-based approach must supersede the deficit discourse that continues to be a defining feature of how social workers, allied health professionals, researchers, and policymakers interact with Indigenous Australians.This article draws inspiration from Saleebey’s (2023. The strengths perspective in social work practice: Extensions and cautions. In Social work (pp. 230–235). Routledge) six-step approach to a strengths perspective, combined with a systems theory framework and an Indigenous standpoint, and can assist in (re)defining Indigenous strength-based practice. [ABSTRACT FROM AUTHOR]

This article attempts to estimate trends in the levels of public and private investment, and national government surpluses and deficits from accumulated capital income, taxation, and rents estimated by different economic historians for England and the UK by utilizing the concept of Paul Baran and Paul Sweezy's economic surplus. The data support historical accounts that income per capita growth begins to increase around the 1600s in Britain, perhaps due to the level of capital, tax, and land income achieving an adequate threshold amount. According to some historians, this would also be about the time of capitalism's ascent as the dominant economic system in Britain. Even then, dramatic increases in investment and economic growth do not appear until the late eighteenth century when investment and deficits reach even higher levels. The new estimates developed in this article are offered as additional macroeconomic data supplements to works created by other authors and researchers and submitted as a demonstration of the concept of economic surplus and the power of threshold levels of private and public investment. Most of all they also give some support to Baran and Sweezy's notion of a society's economic surplus coming from labor exploitation and being used to further investment and government expenditures. [ABSTRACT FROM AUTHOR]

Critically ill children are at risk of micronutrient deficiencies, which might lead to poor clinical outcomes. However, the interpretation of micronutrient concentrations in plasma is complicated due to age-dependent and critical illness-dependent changes. Certain red blood cell (RBC) concentrations might reflect the overall body status more reliably than plasma levels in the presence of systemic inflammatory response. This study longitudinally examined micronutrient concentrations in both plasma and RBC in critically ill children. This secondary analysis of the PEPaNIC RCT investigated the impact of early versus late initiation of parenteral macronutrient supplementation in critically ill children. All children received micronutrients when EN was insufficient (<80 % energy requirements). Blood samples were obtained on days 1, 3, 5 and 7 of Paediatric Intensive Care Unit (PICU) admission. Inductively coupled plasma mass spectrometry was used to measure zinc, selenium, and copper in plasma and selenium, copper, and magnesium in RBCs. Plasma magnesium was measured with colorimetric detection. Micronutrient concentrations were compared with age-specific reference values in healthy children and expressed using Z-scores. Changes in micronutrient concentrations over time were examined using the Friedman and post hoc Wilcoxon signed-rank tests. For 67 critically ill children, median (Q1; Q3) age 9.5 (5.5; 13.2) years, PIM3 score −2.3 (−3.1; −0.8), samples were available at various time points during their PICU stay. For 22 patients, longitudinal samples were available. On day 1, the median plasma Z-score for zinc was −5.2 (−5.2; −2.9), copper −1.6 (−2.9; −0.2), selenium −2.6 (−3.8; −1.0), magnesium −0.2 (−1.6; 1.3), and median RBC Z-score for copper was 0.5 (−0.1; 1.3), selenium −0.3 (−1.1; 0.7), magnesium 0.2 (−0.4; 1.3). In the longitudinal analysis, plasma zinc was significantly higher on day 5 (Z-score −3.2 (−4.6; −1.4)) than on day 1 (Z-score −5.2 (−5.2; −3.0), p = 0.032), and plasma magnesium was significantly higher on day 3 (Z-score 1.1 (−0.7; 4.0)) than on day 1 (Z-score −0.3 (−1.6; 0.5), p = 0.018). Plasma copper and selenium remained stable, and the RBC concentrations of all micronutrients remained stable during the first five days. Most patients had low plasma zinc, copper and selenium concentrations in the first week of their PICU stay, whereas they had normal to high RBC concentrations. More research is needed to examine the relationships between micronutrients and clinical outcome. [ABSTRACT FROM AUTHOR]

The article is dedicated to the issues of improving the professional competencies of educational professionals through the organization of methodological support within the framework of creating a unified system of professional development and implementing the “Modern School” federal project. The authors disclose the specifics of methodological support for educators aimed at identifying professional deficits, employing individual educational route technologies, and developing competence enhancement programs. The authors present a model of organizing methodological support for educational professionals, including a component for future educators, thereby proving the importance of organizing methodological interaction with practicing educators to shape a new type of university graduate capable of continuous professional growth. The authors are convinced that involving educators and students, i.e. future educators, in scientific and methodological events, including joint planning, contributes to the development of analytical skills and methodological culture, enhances professional mastery, fosters the establishment of conscious professional positions, and improves communication formats. Special attention is given by the authors to the application of normative and legal foundations for the organization of a multi-level methodological support system involving various methodological structures, professional communities, and subject associations. The article is addressed to the faculty and staff of the supplementary professional education system, research workers, doctoral students, teachers, and students of educational institutions, as well as those interested in educational issues in the field of improving the professional competence of educational professionals.

Political action and electoral behavior often stem from a conviction that an issue is important. Yet despite a growing literature on partisan bias, it remains unclear whether partisan attachment also affects the perceived importance of various issues. We propose a theory of partisan-motivated issue attention (PMIA), wherein citizens satisfy partisan instincts by shifting the perceived importance of an issue. We apply our theory to an issue involving a fundamental tool of the federal government—the power to deficit-spend—and test the hypothesis that partisans' concern about government overspending significantly changes depending on which party presides over deficit-spending. Leveraging pre-registered experimental and observational studies, we find strong support for this hypothesis among both Republicans and Democrats. Lastly, using text analytical methods, we also find evidence of PMIA in televised partisan media. Our study thus demonstrates that putative concern about deficit-spending contains a sizable partisan component and, more broadly, uncovers an additional means by which partisan bias guides citizens' attitude formation on policy-relevant issues in the United States. [ABSTRACT FROM AUTHOR]

RESUMO O orçamento federal dos Estados Unidos apresentou apenas 8 superávits em todo o período pós-Segunda Guerra Mundial, o último dos quais em 1969. Várias teorias foram desenvolvidas na tentativa de explicar a persistência dos déficits federais. Devido às visões keynesianas/estagnacionistas predominantes entre os teóricos de esquerda, enfatizou-se a análise do lado das despesas das finanças do governo e seu papel de apoiar a demanda agregada. Pouca ou nenhuma atenção foi dada ao lado da receita, particularmente ao impacto da diminuição da lucratividade das empresas nas receitas fiscais do governo. Este artigo estima os prejuízos fiscais resultantes da queda acentuada da lucratividade nos últimos 45 anos. Conclui apontando algumas consequências econômicas mais amplas de grandes déficits, como a dívida externa dos Estados Unidos, a maior do mundo, e as atuais tendências regressivas do sistema tributário americano.

Objectives: Impairments in neuropsychological functioning (mainly memory, learning, attention, and executive functioning) among persons with long-term opioid use disorder (OUD) have been widely reported, with few studies suggesting that these are not permanent and can improve with abstinence. Thus, present study aimed to evaluate the neuropsychological functioning in persons with OUD and examine the effects of abstinence on the same over a period 8 weeks. Methods: A total of 50 patients with diagnosis of OUD as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria underwent serial longitudinal neuropsychological assessments for executive functioning, attention and concentration, and verbal and nonverbal memory at baseline, 2 weeks, and 8 weeks of abstinence. Results: The mean performance scores representative of attention, concentration, verbal memory, and nonverbal memory showed significant improvement in the initial 2 weeks, and executive functioning showed significant improvement by 8 weeks of abstinence (all P’s < 0.01). A significant negative correlation was found between the duration of opioid use and performance on verbal memory tests (0.014), the frequency of intake per day and performance on nonverbal memory and executive functioning tests, and the severity of opioid dependence and performance on nonverbal memory test (0.019). Conclusions: Neuropsychological functioning in certain domains was associated with the duration of opioid use, the frequency of daily opioid intake, and the severity of opioid dependence among persons with OUD at baseline. It showed significant improvement in domains of attention, concentration, verbal and nonverbal memory, and executive functions over a period of 8 weeks of abstinence. [ABSTRACT FROM AUTHOR]

Previous research suggests a broad range of deficits in major depressive disorder. Our goal was to update the current assumptions and investigate the extent of cognitive impairment in depression in the acute and remitted state. A systematic review of the existing literature between 2009 and 2019 assessing the risk of bias within the included studies was performed. Of the 42 articles reviewed, an unclear risk of bias was shown overall. The risk of bias mainly concerned the sample selection, inadequate remedial measures, as well as the lack of blinding the assessors. In the acute phase, we found strong support for impairment in processing speed, learning, and memory. Follow-up studies and direct comparisons revealed less pronounced deficits in remission, however, deficits were still present in attention, learning and memory, and working memory. A positive correlation between the number of episodes and cognitive deficits as well as depression severity and cognitive deficits was reported. The results also demonstrate a resemblance between the cognitive profiles in bipolar disorder and depression. Comparisons of depression with schizophrenia led to unclear results, at times suggesting an overlap in cognitive performance. The main findings support the global deficit hypothesis and align with results from prior meta-analyses and reviews. Recommendations for future research are also presented. [ABSTRACT FROM AUTHOR]

Of the seven working modules of the mentalizing behavioral therapy MVT, the last two modules – module six and seven – are development modules. Previously, access to emotional experience was established with the Emotion Tracking module. Module six, »Affect regulation and self-efficacy«, deals with the development from the affect level to the thinking level, after the physical level has been promoted beforehand. Development is conceived as a dynamic process in relation to specific relationship contexts and situational contexts. A detailed development diagnosis is followed by the treatment of impulse blockades and avoidance behavior. Impulsive action is automated through targeted exercises. This includes correcting the deficits of the affect stage and creating an incentive for the achievements of the next thought stage. In principle, strengths are first built up and deficits reduced, only then does the step to the next higher level follow. This is done with the help of specific diagnostic and working methods. The necessary ability to control is promoted through targeted practice of understanding cause and effect until a theory of the mental or a theory of mind (ToM) is established. Experience-oriented and pictorial-scenic experiences are used for this with the help of physical sensations in order to allow new behavior, to be able to allow vital feelings again and to be able to defend one’s own needs. From here, the step to the seventh module »Change of perspective and empathy« can be made. [ABSTRACT FROM AUTHOR]

Assessing accountability in collaborative governance to identify potential deficits is one of the least discussed issues in the literature. In this study, which aims to bring to light the state of collaborative accountability in the Quebec public service (PS), a content analysis of the reports of the Auditor General of Quebec to the National Assembly from 1988 to 2022 was carried out, using the model of Lee and Ospina (2022, p. 70). Three major results were obtained. The first highlights a governance culture of the Quebec PS characterized by a low use of rewards and sanctions with an accountability process that is much lacking in termsof performance evaluation and communication and sharing of information. The second shows that the Quebec PS, under the effect of the Public Administration Act adopted in 2000, presented more lack of communication and information sharing both internally and with Parliament, but was more performance oriented. The third result from this analysis indicates that the lack of reporting to Parliament is much more related to the failure of the feedback system. These results were discussed and the limitations of the study, noted. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = −0.163, p< 0.001), executive scores (B = −0.151, p = 0.004), and processing speed (B = −0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = −0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = −0.149, p = 0.025) and attention scores (B = −0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = −0.135, p < 0.001), processing speed (B = −0.072, p = 0.009), and working memory (B = −0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities. [ABSTRACT FROM AUTHOR]

Political opposition to fiscal adjustments has varied significantly across countries. Our analysis links this variation to differences in the congruence of voter attitudes towards fiscal trade-offs across political blocs in different countries. These differences in attitudes, in turn, coincide with the implications of the distinct macroeconomic growth strategies that these countries pursue. Based on original survey data, we show that in Germany, supporters of different parties not only share similar views on the appropriate size of fiscal adjustment, but also on how to distribute these cuts across various spending items. In Spain, there is fundamental disagreement on the amount of austerity, but voters largely agree on the composition of fiscal adjustments. In the UK, there is disagreement between voters of diverging political blocs on both accounts. Variation in public attitudes, therefore, gives rise to very diverse political dynamics surrounding fiscal adjustments in different countries. [ABSTRACT FROM AUTHOR]

Central Europe, including Germany, has faced exceptional multi-year terrestrial water storage (TWS) deficits since 2018, negatively impacting various sectors such as forestry, energy production, and drinking water supply. Currently, the understanding of the recovery dynamics behind such extreme events is limited, which hampers accurate water management decisions. We used a simulation of the mesoscale hydrological model (mHM) over the last 257 years (1766–2022) to provide the first long-term perspective on the dynamics of the TWS deficit recovery in Germany. The results show that severe TWS deficits surpassing a peak deficit of −42 mm (−15 km ^3 ) exhibit large variability in recovery times (3–31 months). The 2018–2021 TWS deficit period was unprecedented in terms of recovery time (31 months), mean intensity and the associated negative 30-year TWS trend. In recent decades, we identified increased evapotranspiration ( E ) fluxes that have impacted TWS dynamics in Germany. Increased E flux anomalies contributed to prolonged TWS recovery, given that the TWS deficit did not quickly recover through above-average precipitation ( P ). An extreme TWS deficit similar to that in 2018 was recovered by above-average P within three months in the winter of 1947–1948. Our research contributes to an improved understanding of the dynamics and drivers of TWS deficit recovery.

Summary: Background: Online technology could potentially revolutionise how patients are cognitively assessed and monitored. However, it remains unclear whether assessments conducted remotely can match established pen-and-paper neuropsychological tests in terms of sensitivity and specificity. Methods: This observational study aimed to optimise an online cognitive assessment for use in traumatic brain injury (TBI) clinics. The tertiary referral clinic in which this tool has been clinically implemented typically sees patients a minimum of 6 months post-injury in the chronic phase. Between March and August 2019, we conducted a cross-group, cross-device and factor analyses at the St. Mary’s Hospital TBI clinic and major trauma wards at Imperial College NHS trust and St. George’s Hospital in London (UK), to identify a battery of tasks that assess aspects of cognition affected by TBI. Between September 2019 and February 2020, we evaluated the online battery against standard face-to-face neuropsychological tests at the Imperial College London research centre. Canonical Correlation Analysis (CCA) determined the shared variance between the online battery and standard neuropsychological tests. Finally, between October 2020 and December 2021, the tests were integrated into a framework that automatically generates a results report where patients’ performance is compared to a large normative dataset. We piloted this as a practical tool to be used under supervised and unsupervised conditions at the St. Mary’s Hospital TBI clinic in London (UK). Findings: The online assessment discriminated processing-speed, visual-attention, working-memory, and executive-function deficits in TBI. CCA identified two significant modes indicating shared variance with standard neuropsychological tests (r = 0.86, p

Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies. [ABSTRACT FROM AUTHOR]

Glioblastoma and the surgery to remove it pose high risks to the cognitive function of patients. Little reliable data exist about these risks, especially postoperatively before radiotherapy. We hypothesized that cognitive deficit risks detected before surgery will be exacerbated by surgery in patients with glioblastoma undergoing maximal treatment regimens. We used longitudinal electronic cognitive testing perioperatively to perform a prospective, longitudinal, observational study of 49 participants with glioblastoma undergoing surgery. Before surgery (A1), the participant risk of deficit in 5/6 cognitive domains was increased compared to normative data. Of these, the risks to Attention (OR = 31.19), Memory (OR = 97.38), and Perception (OR = 213.75) were markedly increased. These risks significantly increased in the early period after surgery (A2) when patients were discharged home or seen in the clinic to discuss histology results. For participants tested at 4–6 weeks after surgery (A3) before starting radiotherapy, there was evidence of risk reduction towards A1. The observed risks of cognitive deficit were independent of patient-specific, tumour-specific, and surgery-specific co-variates. These results reveal a timeframe of natural recovery in the first 4–6 weeks after surgery based on personalized deficit profiles for each participant. Future research in this period could investigate personalized rehabilitation tools to aid the recovery process found. [ABSTRACT FROM AUTHOR]

Abstract Background The Institut Pasteur de Lille, in the north of France, has implemented a large, multidisciplinary health check, which aims to identify frailty in middle-aged caregivers. We aimed to construct an adapted frailty index of cumulative deficit (FI-CD) and study the associated factors, in particular socioeconomic factors. Methods The cross-sectional study included caregivers aged 45 to 65. A 34-item FI-CD including deficits adapted to a middle-aged population (related to cognition and autonomy, dietetics, physical activity, comorbidities, functional signs, lab values and paraclinical examinations) was constructed in accordance with standard procedures. It was calculated as a ratio of deficits present out of the total number of possible deficits, giving a continuous score between 0 and 1. Scores > 0.25 and > 0.4 were classified as frailty and severe frailty, respectively. Univariate and multivariate associations were studied using linear regressions. Results One hundred and seventeen caregivers were included; among them, 111 were analyzed due to missing values. The mean FI-CD was 0.22 ± 0.08. Forty (36%) individuals were classified as frailty and three (2.7%) as severe frailty. In multivariate analysis, FI-CD was significantly associated with age (beta [95% confidence interval] = 0.005 [0.002; 0.009] per 1-year increase, p = 0.005) and social deprivation (beta = 0.054 [0.007; 0.102], p = 0.025). A significant interaction was observed between and age and social deprivation (p = 0.036). The adjusted relationship between FI-CD and age was beta = 0.010 [0.002; 0.019], p = 0.017 in precarious caregivers, and beta = 0.003 [− 0.001; 0.007], p = 0.19 in non-precarious caregivers. Conclusions The study suggested that the 34-item FI-CD could have clinical utility in the management of middle-aged caregivers. Social deprivation appeared as an important factor associated with frailty, highlighting the importance of early care and social support for precarious caregivers.

L’évaluation de l’imputabilité dans la gouvernance collaborative pour déceler d’éventuels déficits est l’une des questions les moins abordées dans la littérature. Dans la présente étude visant à mettre au jour l’état de l’imputabilité collaborative dans la fonction publique (FP) québécoise, une analyse de contenu des rapports du Vérificateur général du Québec (VGQ) à l’Assemblée nationale pour les années 1988 à 2022 a été effectuée à l’aide du modèle de Lee et Ospina (2022, p. 70). Trois résultats majeurs en sont ressortis. Le premier met en évidence une culture de gouvernance de la FP québécoise caractérisée par un faible recours aux récompenses et sanctions, et par un processus d’imputabilité très déficient en matière d’évaluation des performances et de communication et partage d’information. Le deuxième résultat révèle que, sous l’effet de la Loi sur l’administration publique (LAP) adoptée en 2000, la FP québécoise a présenté davantage de lacunes en matière de communication et de partage d’information aussi bien à l’interne qu’à l’endroit du Parlement, mais s’est montrée plus soucieuse de la performance. Le troisième résultat de notre analyse montre que la principale cause du manque de comptes rendus au Parlement réside dans la défaillance du système de rétroaction. Ces résultats ont été discutés en détail et les limites de l’étude, relevées.

Idiopathic intracranial hypertension includes ventriculoperitoneal shunt (VPS) insertion, with a reported complication of shunt revision in 25% of the cases 1 year after insertion. We report a case of a 28-year-old female with pituitary adenoma who developed sensory loss after VPS placement that could be explained by disruption in thalamic pathways. A lesson learned from this case is that although VPS is a simple procedure, complications can occur. Modalities can be used to detect the complications, and further revisions might be needed. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has triggered a massive increase in global debt levels and exacerbated the trade-offs between the benefits and costs of accumulating government debt. This paper examines these trade-offs by putting the recent debt boom into a historical context. It reports three major findings. First, during the 2020 global recession, both global government and private debt levels rose to record highs, and at their fastest single-year pace, in five decades. Second, the debt-financed, massive fiscal support programs implemented during the pandemic supported activity and illustrated the benefits of accumulating debt. However, as the recovery gains traction, the balance of benefits and costs of debt accumulation could increasingly tilt toward costs. Third, more than two-thirds of emerging market and developing economies are currently in government debt booms. On average, the current booms have already lasted three years longer, and are accompanied by a considerably larger fiscal deterioration, than earlier booms. About half of the earlier debt booms were associated with financial crises in emerging market and developing economies. [ABSTRACT FROM AUTHOR]

Background: Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its effect on outcomes and age, and (3) health care costs. Methods: Retrospective data were obtained from the New Brunswick Heart Centre registry for all cardiac surgery patients between 2012 and 2017. A 20-point FS was created using available binary risk variables. The primary outcomes of interest most relevant to vulnerable patients were prolonged hospitalization, failure to be discharged home, and hospitalization bed cost. Composite outcome of prolonged hospitalization (>8 days) and/or non-home discharge were analyzed using multivariate analysis. Results: A total of 3463 patients (mean age, 66 ± 10 years) were included in the final analysis. Tercile-based FSs were: low (0-4; n = 856), medium (5-7; n = 1709), high (≥8; n = 898). In unadjusted data, frail patients were older with more comorbidities. High FS patients had greater risks of prolonged hospitalization (median 7 vs 5 days; P 0.7% to ≤1.2% [medium], and >1.2% to 4.8% [high]; P

Our study aimed to assess the level of reading comprehension, one of the cornerstones of education of the Hungarian minority in Slovakia, and to answer the research question of what kind of deficits need to be addressed in the development of reading comprehension. The research was conducted with the participation of students from primary schools with Hungarian as the language of instruction in Slovakia. In our study, we shed light on the problems found in cognitive reasoning, accurate interpretation of information and complex reading comprehension. The extent to which the development of new cognitive schemata caused problems for the studied groups was also investigated. In several cases, the responses were not based on textual information, but only on the respondents’ existing schemas. The results also show that it was a problem for the learners to answer both the multiple-choice questions and the open-ended and explanatory questions.

La docencia universitaria pone al profesorado frente a las limitaciones del alumnado para leer con fluidez y comprender textos escritos. Para conocer de manera objetiva los niveles lectores del alumnado universitario, se desarrolló, durante el curso académico 2018-2019, un estudio en el que participaron 264 estudiantes, matriculados en los cursos de 2º y 3º de los grados de Educación Primaria y Educación Infantil en la Facultad de Educación de la Universidad de Extremadura, a quienes se aplicó la prueba TECLE. Los resultados trazan un perfil poco afortunado del alumnado y establecen diferencias con logros mejores en Educación Infantil y en el grupo de edad de los 19 a los 20 años en los estudiantes que participaron. Esto revela que muchos estudiantes no comprenden lo que están leyendo ni lo que han leído, a pesar de tener un largo recorrido como lectores y escritores en sus estudios previos. Por ello, es necesario replantearse los cometidos de la institución universitaria en este campo.

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Whether to increase taxes or cut spending is an important question with profound policy implications, especially as countries attempt to deal with the consequences of the COVID-19 pandemic. This study, therefore, investigated the relationship between revenues and spending in the Southern African Development Community (SADC), where concerns about rising debt and deficits were raised prior to the pandemic. A panel bootstrap Granger-causality technique was used to analyze annual frequency data covering the 1980–2018 period. To our best knowledge, this was the first study in Africa to simultaneously account for cross-country differences and cross-section dependence. The findings of the study have in-depth implications for fiscal policy and adjustments towards budgetary equilibria. The study found no evidence of causality between revenues and spending in eleven SADC member states, suggesting that to balance their respective budgets, governments in these countries can alter either spending or revenues, or both. However, in Botswana, we found evidence of the tax-spend hypothesis, implying that governments should consider altering revenues to eliminate budget imbalances. Finally, evidence of the spend-tax hypothesis was found in Mauritius and Mozambique, suggesting that past and current expenditures drive revenues in these countries. Accordingly, cutting spending would be an ideal policy recourse to deal with budgetary disequilibrium. [ABSTRACT FROM AUTHOR]

Long presented as a universal policy-recipe for social prosperity and economic growth, the promise of innovation seems to be increasingly in question, giving way to a new vision of progress in which society is advanced as a central enabler of technoeconomic development. Frameworks such as "Responsible" or "Mission-oriented" Innovation, for example, have become commonplace parlance and practice in the governance of the innovation–society nexus. In this paper, we study the dynamics by which this "social fix" to technoscience has gained legitimacy in institutions of global governance by investigating recent projects at two international organizations, the Organization for Economic Cooperation and Development and the European Commission, to mainstream "Responsible Innovation" frameworks and instruments across countries. Our analysis shows how the turn to societal participation in both organizations relies on a new deficit logic—a democratic deficit of innovation —that frames a lack of societal engagement in innovation governance as a major barrier to the uptake and dissemination of new technologies. These deficit politics enable global governance institutions to present "Responsible Innovation" frameworks as the solution and to claim authority over the coproduction of particular forms of democracy and innovation as intertwined pillars of a market-liberal international order. [ABSTRACT FROM AUTHOR]

Background: The Institut Pasteur de Lille, in the north of France, has implemented a large, multidisciplinary health check, which aims to identify frailty in middle-aged caregivers. We aimed to construct an adapted frailty index of cumulative deficit (FI-CD) and study the associated factors, in particular socioeconomic factors.Methods: The cross-sectional study included caregivers aged 45 to 65. A 34-item FI-CD including deficits adapted to a middle-aged population (related to cognition and autonomy, dietetics, physical activity, comorbidities, functional signs, lab values and paraclinical examinations) was constructed in accordance with standard procedures. It was calculated as a ratio of deficits present out of the total number of possible deficits, giving a continuous score between 0 and 1. Scores > 0.25 and >  0.4 were classified as frailty and severe frailty, respectively. Univariate and multivariate associations were studied using linear regressions.Results: One hundred and seventeen caregivers were included; among them, 111 were analyzed due to missing values. The mean FI-CD was 0.22 ± 0.08. Forty (36%) individuals were classified as frailty and three (2.7%) as severe frailty. In multivariate analysis, FI-CD was significantly associated with age (beta [95% confidence interval] = 0.005 [0.002; 0.009] per 1-year increase, p = 0.005) and social deprivation (beta = 0.054 [0.007; 0.102], p = 0.025). A significant interaction was observed between and age and social deprivation (p = 0.036). The adjusted relationship between FI-CD and age was beta = 0.010 [0.002; 0.019], p = 0.017 in precarious caregivers, and beta = 0.003 [- 0.001; 0.007], p = 0.19 in non-precarious caregivers.Conclusions: The study suggested that the 34-item FI-CD could have clinical utility in the management of middle-aged caregivers. Social deprivation appeared as an important factor associated with frailty, highlighting the importance of early care and social support for precarious caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment is the core feature of schizophrenia (SCZ). The affected individuals exhibit wide-ranging deficits involving multiple domains of cognitive functioning. These deficits are associated with poor functional outcome and residual disability in patients. Substantial literature exists on cognition in SCZ; however, few studies have been carried out on this subject in India and in particular in Rajasthan. Objective: The objective was to evaluate cognitive functions in SCZ patients and to compare these with healthy controls. Materials and Methods: This cross-sectional study was conducted at the psychiatry department of a tertiary care institution on fifty schizophrenic patients and matched healthy controls who fulfilled the inclusion criteria. Diagnosis was made by DSM-V criteria, and symptom severity was determined by the Positive and Negative Symptom Scale. After seeking sociodemographic details, all participants were administered Postgraduate Institute Battery of Brain Dysfunction to assess their cognitive functioning. Data collected were subjected to suitable statistical analysis (mean, standard deviation and Chi-square test). Results: Majority of the schizophrenic patients (56%) were under 35 years of age, were males (70%), were from urban background (66%) and were married (70%). Schizophrenic patients performed poorly on all domains of cognitive functioning, including memory, performance and verbal intelligence and perceptuo-motor skills. Conclusion: The present study reiterated the previous findings of wide-spread, multidomain cognitive impairment in schizophrenic patients. The resultant cognitive profile has important implications for the aetiology and treatment of this major psychiatric disorder.

Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.

Background: There is growing concern about possible cognitive consequences of COVID-19, with reports of ‘Long COVID’ symptoms persisting into the chronic phase and case studies revealing neurological problems in severely affected patients. However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of disease severity. Methods: We sought to confirm whether there was an association between cross-sectional cognitive performance data from 81,337 participants who between January and December 2020 undertook a clinically validated web-optimized assessment as part of the Great British Intelligence Test, and questionnaire items capturing self-report of suspected and confirmed COVID-19 infection and respiratory symptoms. Findings: People who had recovered from COVID-19, including those no longer reporting symptoms, exhibited significant cognitive deficits versus controls when controlling for age, gender, education level, income, racial-ethnic group, pre-existing medical disorders, tiredness, depression and anxiety. The deficits were of substantial effect size for people who had been hospitalised (N = 192), but also for non-hospitalised cases who had biological confirmation of COVID-19 infection (N = 326). Analysing markers of premorbid intelligence did not support these differences being present prior to infection. Finer grained analysis of performance across sub-tests supported the hypothesis that COVID-19 has a multi-domain impact on human cognition. Interpretation: Interpretation. These results accord with reports of ‘Long Covid’ cognitive symptoms that persist into the early-chronic phase. They should act as a clarion call for further research with longitudinal and neuroimaging cohorts to plot recovery trajectories and identify the biological basis of cognitive deficits in SARS-COV-2 survivors. Funding: Funding. AH is supported by the UK Dementia Research Institute Care Research and Technology Centre and Biomedical Research Centre at Imperial College London. WT is supported by the EPSRC Centre for Doctoral Training in Neurotechnology. SRC is funded by a Wellcome Trust Clinical Fellowship 110,049/Z/15/Z. JMB is supported by Medical Research Council (MR/N013700/1). MAM, SCRW and PJH are, in part, supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London

Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the "time matters"-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible. [ABSTRACT FROM AUTHOR]

An increasing interest in a healthy lifestyle raises questions about optimal body weight. Evidently, it should be clearly discriminated between the standardised "normal" body weight and individually optimal weight. To this end, the basic principle of personalised medicine "one size does not fit all" has to be applied. Contextually, "normal" but e.g. borderline body mass index might be optimal for one person but apparently suboptimal for another one strongly depending on the individual genetic predisposition, geographic origin, cultural and nutritional habits and relevant lifestyle parameters—all included into comprehensive individual patient profile. Even if only slightly deviant, both overweight and underweight are acknowledged risk factors for a shifted metabolism which, if being not optimised, may strongly contribute to the development and progression of severe pathologies. Development of innovative screening programmes is essential to promote population health by application of health risks assessment, individualised patient profiling and multi-parametric analysis, further used for cost-effective targeted prevention and treatments tailored to the person. The following healthcare areas are considered to be potentially strongly benefiting from the above proposed measures: suboptimal health conditions, sports medicine, stress overload and associated complications, planned pregnancies, periodontal health and dentistry, sleep medicine, eye health and disorders, inflammatory disorders, healing and pain management, metabolic disorders, cardiovascular disease, cancers, psychiatric and neurologic disorders, stroke of known and unknown aetiology, improved individual and population outcomes under pandemic conditions such as COVID-19. In a long-term way, a significantly improved healthcare economy is one of benefits of the proposed paradigm shift from reactive to Predictive, Preventive and Personalised Medicine (PPPM/3PM). A tight collaboration between all stakeholders including scientific community, healthcare givers, patient organisations, policy-makers and educators is essential for the smooth implementation of 3PM concepts in daily practice. [ABSTRACT FROM AUTHOR]

The idea that public borrowing places an intolerable burden on posterity is as old as the institution of public debt itself. But the debate over deficit-spending assumed an entirely new scope and import with the rise of the fiscal state in the early twentieth century, as governments assumed greater responsibilities with regard to public welfare and found themselves subject to a new kind of conflict concerning the uses and distribution of public income. In this context, the intergenerational argument against social welfare spending became an important tool in the fight against class redistribution. With a focus on American debates, this article provides a historical sociology of the idea that deficits constitute a burden on future generations, identifying the key historical turning points when this idea acquired new political resonance. In particular, the article investigates how we learned to blame baby boomers for the alleged ills of government deficit-spending and how this now ubiquitous motif of public discourse was reintroduced by the Virginia school public choice theorist James M. Buchanan and later refined by the chief proponent of generational accounting, Laurence Kotlikoff. [ABSTRACT FROM AUTHOR]