Security on board energy carrying vessels: an analysis of international and regional regulatory measures.

Master of Laws. University of KwaZulu-Natal, Pietermaritzburg, 2018.Although the overall number of piracy incidents has decreased over the past few years, almost half the incidents that are reported, involve energy carrying vessels. Given the important role that energy plays in society and the fact that approximately 90% of the world’s energy is transported by sea, an adequate framework is essential to ensure energy security. To determine whether the current framework is sufficient, a survey of all the relevant international, regional and domestic instruments is conducted. What becomes evident is that there are no provisions that relate specifically to energy carrying vessels. Energy carrying vessels are used to carry valuable cargo, they are large and slow moving, they travel specific routes and are manned with few crew. For those reasons, energy carrying vessels require additional protections to bridge their vulnerabilities. The need is emphasized by the vast negative effects an attack on an energy carrying vessel can have, which threatens the environment, the economy and the safety and security of crew. A key instrument focusing on maritime energy security is the Luanda Declaration on Maritime and Energy Security (Luanda Declaration). The Luanda Declaration is an African initiative with a regional application. The declaration, however, is merely a guideline and is not binding. The continued high number of incidents affecting energy carrying vessels shows that states have not taken sufficient positive steps in accordance with the Luanda Declaration and that the current framework is insufficient to ensure maritime energy security

Medication Adherence in Renal Transplant Recipients: A Latent Variable Model of Psychosocial and Neurocognitive Predictors

Objective Estimates indicate that 20–70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group. Methods Participants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data. ResultsEveryday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms. Conclusions We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients

Impact of Once- Versus Twice-Daily Tacrolimus Dosing on Medication Adherence in Stable Renal Transplant Recipients: A Canadian Single-Center Randomized Controlled Trial

Background: Prevalence of immunosuppressant nonadherence in renal transplant recipients is high despite negative clinical outcomes associated with nonadherence. Simplification of dosing has been demonstrated to improve adherence in renal transplant recipients as measured through electronic monitoring and self-report. Objective: The purpose of this study was to replicate and extend previous findings by measuring adherence with multiple methods in a Canadian sample. Design: The study design was a randomized controlled medication dosing trial in adult renal transplant patients. The trial length was 4 months. Setting: This study was conducted within the Solid Organ Transplant (SOT) Clinic at Vancouver General Hospital (VGH; Vancouver, Canada). Patients: A total of 46 adult renal recipients (at least 1 year post-transplant) were recruited through the SOT clinic. With 8 withdrawals, 38 individuals completed all phases of the study. Measurements: Medication adherence was measured for a period of 4 months using multiple methods, including electronic monitoring (MEMS [Medication Event Monitoring System]), pharmacy refill data (medication possession ratio [MPR]), and by self-report using the Adherence subscale of the Transplant Effects Questionnaire (TEQ). Methods: Participants were randomized to twice-daily (n = 19) or once-daily tacrolimus dosing (n = 19) and followed over a 4-month period via monthly clinic study visits. Comparisons between the treatment groups were performed using the Mann-Whitney U and chi-square tests, for continuous and categorical variables, respectively. Results: As outlined in Table 3, the once-daily dosing group showed significantly better MEMS Dose Adherence (P = .001), whereas MEMS Timing Adherence showed a tendency toward better adherence for this group, but was not significant (P = .052). MEMS Days Adherent (P = .418), MPR% (P = .123), and self-reported adherence (P = .284) did not differ between the once- and twice-daily dosing groups when measured as continuous variables. The MPR% was significantly better for the once-daily dosing group when measured dichotomously but not continuously (P = .044). Notably, most of those exposed to once-daily dosing (63.2%) preferred this to the twice-daily regimen. Limitations: Limitations included small sample size and short follow-up period, precluding the examination of clinical outcome differences. Conclusions: Results for dose adherence replicate the finding that dose simplification increases adherence to immunosuppressants as measured through electronic monitoring. Such an advantage for the once-daily dosing group was not seen across the 2 other electronic monitoring measurement variables (days and timing adherence). This study extends previous research by examining adherence in once versus twice-daily dosing via prescription refill data in a Canadian sample. Given the gravity of potential health outcomes associated with nonadherence, although results indicate inconsistencies in significance testing across measurement methods, the medium to large effect sizes seen in the data favoring better adherence with once-daily dosing provide an indication of the potential clinical significance of these findings. Trial registration: This study was registered with ClinicalTrials.gov (NCT01334333) on April 11, 2011

Effects of cumulative COVID-19 cases on mental health: Evidence from multi-country survey.

Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019 (COVID-19) pandemic. The pandemic affected, and in many cases threatened, the health and lives of millions of people across the globe and within the first year, global prevalence of anxiety and depression increased by 25% with the greatest influx in places highly affected by COVID-19. To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic. A repeated, cross-sectional online international survey of adults, 16 years and above, was carried out in 10 countries (United Kingdom, India, Canada, Bangladesh, Ukraine, Hong Kong, Pakistan, Egypt, Bahrain, Saudi Arabia). The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions. Five standardised measures were included to explore levels of depression [patient health questionnaire (PHQ-9)], anxiety [generalized anxiety disorder (GAD) assessment], impact of trauma [the impact of events scale-revised (IES-R)], loneliness (a brief loneliness scale), and social support (The Multi-dimensional Scale of Perceived Social support). There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2. The largest number of participants recruited from the United Kingdom (112985 overall). The majority of participants reported receiving no support from mental health services throughout the pandemic. This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9, GAD-7, and IES-R scores. These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification (to control lockdown effects) confirming these results. The study findings imply that participants' mental health worsened with high cumulative COVID-19 cases. Whist we are still living through the impact of COVID-19, this paper focuses on its impact on mental health, discusses the possible consequences and future implications. This study revealed that daily cumulative COVID-19 cases have a significant impact on depression, anxiety, and trauma. Increasing cumulative cases influenced and impacted education, employment, socialization and finances, to name but a few. Building a database of global evidence will allow for future planning of pandemics, particularly the impact on mental health of populations considering the cultural differences. [Abstract copyright: ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.

Mediating medication adherence in renal transplant recipients: the roles of depressive symptoms and cognition

Cognitive abilities and depressive symptoms have been previously linked to medication adherence following renal transplantation. To further elucidate these relationships, we assessed two potential mediational models: 1) depressive symptoms mediate the relationship between cognition and adherence; and 2) cognition mediates the relationship between depressive symptoms and adherence. Renal transplant recipients (N=101) completed a cognitive battery, the CES-D, and the Transplant Effects Questionnaire (TxEQ). Using a product-of-coefficients method, we compared the proposed models. Weaker cognitive performance was correlated with reduced adherence. Additionally, depressive symptoms (CES-D total score) and the CES-D Somatic Symptoms subscale, each partially mediated the relationship between cognition (PCA derived composite score) and TxEQ adherence scores. None of the other CES-D subscales were significant mediators. Conversely, cognition did not mediate the relationship between depressive symptoms and adherence. The CES-D Somatic Symptoms sub-scale (five questions) may have important utility as a predictor of medication adherence in renal transplant patients

Predictors of Medication Adherence in Renal Transplant Recipients: Self-Efficacy, Depressive Symptomatology, and Neurocognitive Abilities.

Background: Estimates indicate 20-70% of renal transplant recipients (RTR) are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence decreases in relation to everyday problem solving (EPS), and associations between depressive symptoms, self-efficacy (SE), and adherence are reported in RTR. Nonetheless, to date, these individual associations have not been examined concurrently and comprehensively. To increase our understanding of adherence in RTR, we computed an omnibus model examining relationships among neurocognitive abilities, depressive symptoms, SE, and medication adherence. Methods: RTR (N= 211) underwent transplant at least 6-months prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressed and positive affect, somatic, and interpersonal symptoms of depression were measured via self-report, as were general and medication adherence related SE. Structural equation modeling was used to assess the fit of the model to available data. Results: For our final model, the fit indices examined indicated a good fit between the model and the data (CFI =.97; SRMR =.072; RMSEA =.031). EPS and SE had direct positive effects on adherence. Depressive symptoms were negatively associated with SE. Traditionally-measured neurocognitive abilities were positively associated with SE, and negatively associated with depressive symptoms. Conclusions: This study presents a comprehensive investigation of relationships between neurocognitive and psychosocial factors and adherence in RTR. Findings confirm the importance of EPS and SE in predicting adherence within a causal model, and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in RTR

The role of attention and relatedness in emotionally enhanced memory

Examining the positive and negative pictures separately revealed that emotionally enhanced memory (EEM) for positive pictures was mediated by attention, with no significant influence of emotional arousal, whereas the reverse was true of negative pictures. Consistent with this finding, in Experiment 2 EEM for negative pictures was found even when task emphasis was manipulated so that equivalent attention was allocated to negative and neutral pictures. The results show that attention and semantic relatedness contribute to EEM, with the extent varying with emotional valence. Negative emotion can influence memory independently of these 2 factors

Interindividual and intraindividual variability in amnestic mild cognitive impairment (aMCI) measured with an online cognitive assessment

Investigating interindividual variability (diversity) and intraindividual variability across tasks (dispersion) in amnestic mild cognitive impairment (aMCI) using online tests of memory and attention (the Cogniciti Brain Health Assessment, BHA). The study uses an existing dataset (Paterson et al., in review)