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Sustainable policy development in small island development states (SIDS) in the Caribbean: evaluating sustainable economic development and diversification within the agriculture sector in Trinidad and Tobago
No full textThe Republic of Trinidad and Tobago is a twin island state within the English-speaking Caribbean, located southernmost of the Lesser Antilles, and comprises of a rich diversity of culture, ethnicities, flora and fauna, and natural resources, mainly oil and gas. It is a small but high-incomed country with a population of 1.3 million people, and has become a major financial centre in the Caribbean.Trinidad and Tobago’s economy is primarily driven by the hydrocarbon and energy sector, which contributes approximately 46% to total GDP. However as with hydrocarbon based or single sector based economies of developing countries, it is essential for sustainable economic diversification and sector development to take place in order to support the country’s economy in times of declining hydrocarbon activity.This thesis aims to examine the gaps that exist within the agriculture policy framework of the agriculture sector of Trinidad and Tobago, to outline and determine the feasibility of developing the sector thereby becoming a significant contributor to economic growth, and to propose recommendations based on the identified gaps within the agriculture policy framework, for sustainable development of the sector.The research takes an interpretivistic epistemology, following a subjective ontology, and an abductive approach towards data collection which were subsequently analysed qualitatively. Primary data were obtained using semi-structured open-ended questions from participants belonging to the three major segments of the agriculture sector where face-to-face interviews including key policy and decision makers, various stakeholders and farmers were conducted, whereas secondary data sources were obtained from statistical reports, government journals and other related reports.The data has indicated that significant gaps exist within the agriculture policy framework of Trinidad and Tobago, preventing the development of the sector, which restricts the sector as a mechanism for sustainable growth. The data also indicate that amendments to the identified gaps, as well as the themes developed and discussed during fulfilment of this research thesis, will ensure the agriculture sector of Trinidad and Tobago can serve as a catalyst to stimulate economic activity, inevitably becoming a valuable contributor to sustainable economic growth of Trinidad and Tobago’s economy.</p
Discharge against medical advice among schizophrenia patients in Germany: a multi-center cross-sectional study
No full textBackground: The objective of this study was to investigate the prevalence of discharge against medical advice (DAMA) among schizophrenia patients in Germany and to identify factors associated with the risk of DAMA.Methods: This multicenter cross-sectional study was based on data from the IQVIA hospital database, which contains records from 36 hospitals across Germany. This study included all hospitalizations for patients with a primary or secondary diagnosis of schizophrenia between January 2019 and December 2023. Multivariable logistic regression analyses adjusted for age, sex, primary or secondary schizophrenia diagnosis, as well as codiagnoses, were conducted to assess the associations between demographic and clinical variables and DAMA. Results: A total of 7663 hospitalization cases (mean age: 49.5 years, 40.6% female) were included in the study. The DAMA rate was 31.1% in patients with schizophrenia as the primary diagnoses and 6.0% in patients with schizophrenia as a secondary diagnosis. Younger age (i.e., adjusted odds ratio (aOR): 7.44; 95% CI: 4.35–12.73 in the age group 18–30; aOR: 6.63; 95% CI: 3.89–11.29 in the age group 31–40; aOR: 5.59; 95% CI: 3.28–9.54 in the age group 41–50), schizophrenia as the primary diagnosis (aOR: 3.61; 95% CI: 3.05–4.26), alcohol-related disorders (aOR: 1.68; 95% CI: 1.38–2.04), and cannabis-related disorders (aOR: 1.43; 95% CI: 1.18–1.72) were significantly associated with an increased risk of DAMA. Conclusions: This study highlights the high prevalence of DAMA among hospitalized schizophrenia patients and identifies the important factors (i.e., younger age, alcohol-related disorders, and cannabis-related disorders) associated with DAMA risk. Additional studies are recommended for further exploration into the reasons for DAMA.</p
Analysis of HIV-1-Based Lentiviral Vector Particle Composition by PacBio Long-Read Nucleic Acid Sequencing
No full textLentivirus (LV) vectors offer permanent delivery of therapeutic genes to the host through an RNA intermediate genome. They are one of the most commonly used vectors for clinical gene therapy of inherited disorders such as immune deficiencies and cancer immunotherapy. One of the most difficult challenges facing their widespread application to patients is the large-scale production of highly pure vector stocks. To improve vector production and downstream purification, there has been a recent investment in the United Kingdom to establish good manufacturing process (GMP)-licensed centers for manufacture and quality control. Other requirements for these vectors include their target cell specificity and tropism, how to regulate gene expression of the therapeutic payload and their potential side effects. Comprehensive detail on the full nucleic acid content of LV is unknown, even though they have entered clinical trials. With potential adverse effects in mind, it is important to identify these contents to assess their safety and purity. In this study, we used highly sensitive PacBio long-distance, next-generation sequencing of reverse-transcribed vector component RNA to investigate the nucleic acid composition of recombinant HIV-1 particles generated by human 293T packaging cells. In this article, we describe our findings of nucleic acids other than the recombinant vector genome that exist, which could potentially be delivered during gene transfer, and suggest that removal of these unwanted components be considered before clinical LV application.</p
Exploring critical care nurses' experience of redeployment to general medical-surgical wards for covering staff shortages: a qualitative research study
No full textBackground: The impact of redeployment on staff was not widely recognized before the COVID-19 pandemic. The redeployment of critical care nurses is frequently employed in health care organizations as a last-minute staffing management approach without proper infrastructure. Studies exploring the feelings and experiences of redeployed critical care nurses in this manner are sparse.Aim: The aim of this study was to develop an understanding of the experiences of critical care nurses during their redeployment to cover shifts in the general wards.Study Design: This study adopted a qualitative research design to explore critical care nurses' experiences of redeployment. Ten critical care nurses attending a postgraduate critical care course in one university were recruited between January and April 2019. Data were collected using a focus group which was thematically analysed.Results: Three themes were identified: ‘challenges in transitioning to ward settings’, ‘concerns regarding patient safety and satisfaction’ and ‘insufficient infrastructure and support’. Participants expressed concerns about patient and staff safety during redeployment, describing feelings of anxiety and undervaluation.Conclusions: The study illuminates the intricate challenges experienced by redeployed critical care nurses, highlighting the crucial need for comprehensive support, targeted training and strategic planning to safeguard patients’ care and nurses’ well-being during periods of staff shortages in health care settings. These findings emphasize the importance of proactive measures in fostering a resilient and adaptable health care workforce. This is a small study involving only one focus group of 10 critical care nurses, which may limit the transferability of the findings. As a result, the findings may not fully reflect the experiences of critical care nurses from other sites.Relevance to Clinical Practice: The study reveals that critical care nurses experience challenges and stress when redeployed to general wards because of insufficient support and infrastructure. It emphasizes the need for comprehensive strategies, such as job rotation, tailored training and collaborative efforts to address redeployment challenges. Research could focus on developing and testing different models of job rotation between critical care and general wards, evaluating their impact on nurse satisfaction, confidence, competence and overall experience. The findings highlight the importance of organizational support, leadership and local guidelines for effective teamwork. Conducting longitudinal studies to track the experiences of redeployed critical care nurses over an extended period would be beneficial. This approach would provide insights into the long-term effects of redeployment on job satisfaction, burnout and retention.</p
(Mis)education in authoritarian regimes: the case of Eritrea
No full textThere is a debate on the role of education as a tool to challenge or enforce authoritarian attitudes. Many posit that education, particularly higher education, reduces authoritarianism; whereas vast research indicates that education can be used as an authoritarian tool for regime survival. This suggests that there are other intervening factors, such as the curriculum used, the teaching methodology implemented, and the educational administration employed, to securitise the academic space and impose authoritarian attitudes. Informed by the notion of hegemony and the banking concept of education, this article explores the nexus between education and authoritarianism, determining the role of education as an authoritarian tool for regime survival. We use the case of Eritrea, a country that has been under authoritarian government for more than two decades. The article is based on a literature review because it is risky to conduct an objective empirical study on the “politics of education” in Eritrea, given the country’s political sensitivity. The findings suggest that the Eritrean government politicises the curriculum and militarises secondary and higher education levels to create false consciousness and maintain power. The article contributes to advancing knowledge regarding the nexus of authoritarianism and education, helping people understand the state of the politics of education.</p
Self-reported physical exercise and perceived exertion in out-of-hospital cardiac arrest survivors
No full textNo description supplied</p
SEMQ: efficient non-uniform quantization with sensitivity-based error minimization for large language models
No full textLarge Language Models (LLMs) represent a pivotal breakthrough in computational intelligence, showcasing exceptional capabilities in information aggregation and reasoning. However, their remarkable performance comes at the cost of ultra-high-scale parameters, leading to significant resource demands during deployment. Therefore, various model compression techniques have been developed, such as pruning, distillation, and quantization. Among these, quantization has gained prominence due to its ability to directly reduce the precision of model weights and activations, resulting in substantial memory savings and accelerated inference. Despite its advantages, existing quantization approaches face substantial challenges in ultra-low precisions (e.g., 2-bit), often resulting in severe performance degradation. To tackle this challenge, we propose a novel non-uniform quantization with minimal disturbance for LLM, which contains two innovations: (i) a Sensitivity-based Error Minimization Non-Uniform Quantization (SEMQ) algorithm, which finds the quantization scheme to minimize the quantization error through continuous iteration; and (ii) a Z-score-based method for outlier detection and isolation under the normal distribution assumption, reducing the complexity of the quantization process. The extensive experiments on the LLaMA family demonstrates that the proposed SEMQ enables the ultra-low precision quantization up to 2-bit, and 10 GPU memory reduction for origin LLMs while maintaining the model accuracy. Our code is publicly available at https://github.com/ldm2060/semq</p
A qualitative study to examine hidden care burden for older adults with overweight and obesity in England
No full textObjectives: The study aimed to explore the phenomena related to formal and informal social care needs among overweight and obese older adults living in England. Background Despite the rising prevalence of obesity among older adults, its impact on social care needs remains underexplored. Existing research highlights significant unmet social care needs among older adults, yet the specific challenges faced by those who are overweight or obese have received limited attention. This study addresses this gap by exploring and understanding the social care experiences and needs of older adults in England who are overweight or obese. Methods Participants were recruited from a local National Health Service (NHS) health centre in London England using a purposive sampling strategy to the point of analytical saturation. A total of 45 participants were invited and of these 33 participants were eligible to take part. All participants in this study are either of British origin or immigrants to the UK from various nationalities. A semi-structured interview was conducted, and a qualitative structural narrative analysis was undertaken. Results The study found that older adults, who are overweight or obese, were more likely to have physical health problems and problems with mobility. They were more likely to have informal voluntary care and support rather than formal social care support. They also had a weaker social support network, were more isolated and frustrated, lacked housing adaptations, felt unsafe, felt they were a burden to their families and felt discriminated against by the wider community. Care and support needs if not met, then these are likely to generate or widen health inequalities over time. Conclusions This study provides a unique perspective on unmet care needs among overweight and obese older adults in England. It highlights the compounded challenges faced by this population, emphasising the importance of holistic social care approaches that address both health and psychosocial needs. Findings suggest that minimal yet targeted interventions, such as accessible support networks and public health policies promoting social engagement, could significantly improve wellbeing and reduce long-term health inequalities.</p
Association between social engagement frequency and the risk of depression in South Korea, the US and the UK: multinational evidence from longitudinal studies of aging
No full textBackground: While greater social engagement is often associated with a reduced risk of depression, longitudinal studies that account for diverse social structures and cultural contexts among middle-aged or older are limited.Methods: This study utilized cohort data from the Korean Longitudinal Study of Ageing (n=11,174; 2006-2020) in South Korea (KR), the Health and Retirement Study (n=42,405; 2004-2019) in the US, and the English Longitudinal Study of Ageing (n=28,624; 2002-2019) in the UK, including a total of 29,378 individuals from the population aged ≥45 years. Social engagement frequency was categorized into infrequent, intermediate, and frequent, with changes classified as unchanged, increased, or decreased. The primary outcome was the onset of depression, assessed using the CES-D Scale. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using a Cox proportional hazards regression model.Results: In the KR cohort, increased social engagement significantly reduced depression risk only in the infrequent group (KR: HR, 0.20 [95% CI, 0.14-0.28]). However, decreased social engagement elevated depression risk in both the intermediate group (KR: 6.92 [3.73-12.83]; US: 1.44 [1.16-1.79]) and the frequent group (KR: 1.50 [1.30-1.74]; US: 1.24 [1.13-1.38]). Conversely, in the UK cohort, increased social engagement raised depression risk in the infrequent group (UK: 1.35 [1.01-1.79]) and intermediate group (UK: 1.63 [1.17-2.27]), while decreased engagement lowered depression risk only in the frequent group (UK: 0.80 [0.71-0.90]).Discussion: We observed notable national variations in the association between social engagement and depression risk, influenced by cultural and political differences.</p
‘Animals we’ve never seen before’: Historical wildlife management and Indigenous relations with beavers in the mainland Inuvialuit Settlement Region, Canada
No full textFor many Inuvialuit in north-west Canada, beavers are a pest. The anomalous status of the animal has been shaped by its role in the fur trade and by federal wildlife management. These processes drove a major shift in Inuvialuit relations with beavers over the course of the twentieth century.</p
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