Transformational Leadership and Fiscal Sustainability in the Eastern Caribbean Currency Union

Fiscal sustainability is an existing problem for countries in the Eastern Caribbean Currency Union (ECCU), particularly during a time of crisis. The concept of fiscal sustainability is a function of the policy posture of the government, which is largely influenced by leadership. Theoretically, the characteristics associated with transformational leadership align with what is required to design and implement fiscal policies that promote fiscal sustainability. Grounded in the transformational leadership theory and Kingdon’s multiple streams framework, this quantitative correlational study involved examining the relationship between transformational leadership and fiscal sustainability in the ECCU. Data were collected from 85 participants working within the fiscal policy space in the region to assess qualities of leaders while published macro-economic data were obtained from the Eastern Caribbean Central Bank and International Monetary Fund to calculate fiscal sustainability. Results of the multiple regression analysis indicated that transformational leadership did not significantly predict fiscal sustainability, with F (4, 80) =.764 and p \u3e 05. The results do not diminish the role of transformational leadership in terms of enhancing organizational performance. However, a key positive social change implication is the need to strengthen or build resilience infrastructures to withstand the lingering effects of an exogenous shock

Gadolinium Doped Layered Double Hydroxides for Simultaneous Drug Delivery and Magnetic Resonance Imaging

In this study, gadolinium (Gd) doped MgAl layered double hydroxides (LDHs) were synthesized via a ‘bottom-up’ method and fully characterized by X-ray diffraction, infrared spectroscopy and relaxivity measurements. Two cytotoxic agents were then intercalated via ion-exchange. X-ray diffraction patterns exhibit expanded interlayer spacings as a result of successful drug intercalation. Infrared spectra also showed characteristic peaks of the incorporated methotrexate (MTX) or 5-fluorouracil (5-FU). The LDHs were found to be highly stable under physiological conditions, while in acidic conditions a small proportion of Gd was freed into the immersion medium. Dissolution tests revealed that both 5FU and MTX were rapidly released from the LDH carrier. The longitudinal relaxivity of Gd-LDHs remains largely stable during drug release over 24 h, and was higher in acidic environments. Overall, the drug-loaded Gd-LDH systems prepared in this study could serve as pH-sensitive theranostic platforms for MRI-guided anti-cancer therapy

Layered rare-earth hydroxides as multi-modal medical imaging probes: particle size optimisation and compositional exploration

Recently, layered rare-earth hydroxides (LRHs) have received growing attention in the field of theranostics. We have previously reported the hydrothermal synthesis of layered terbium hydroxide (LTbH), which exhibited high biocompatibility, reversible uptake of a range of model drugs, and release-sensitive phosphorescence. Despite these favourable properties, LTbH particles produced by the reported method suffered from poor size-uniformity (670 ± 564 nm), and are thus not suitable for therapeutic applications. To ameliorate this issue, we first derive an optimised hydrothermal synthesis method to generate LTbH particles with a high degree of homogeneity and reproducibility, within a size range appropriate for in vivo applications (152 ± 59 nm, n = 6). Subsequently, we apply this optimised method to synthesise a selected range of LRH materials (R = Pr, Nd, Gd, Dy, Er, Yb), four of which produced particles with an average size under 200 nm (Pr, Nd, Gd, and Dy) without the need for further optimisation. Finally, we incorporate Gd and Tb into LRHs in varying molar ratios (1 : 3, 1 : 1, and 3 : 1) and assess the combined magnetic relaxivity and phosphorescence properties of the resultant LRH materials. The lead formulation, LGd1.41Tb0.59H, was demonstrated to significantly shorten the T2 relaxation time of water (r2 = 52.06 mM−1 s−1), in addition to exhibiting a strong phosphorescence signal (over twice that of the other LRH formulations, including previously reported LTbH), therefore holding great promise as a potential multi-modal medical imaging probe

Magnetically driven preparation of 1-D nano-necklaces capable of MRI relaxation enhancement

We report a novel magnetically-facilitated approach to produce 1-D ‘nano-necklace’ arrays composed of 0-D magnetic nanoparticles, which are assembled and coated with an oxide layer to produce semiflexible core@shell type structures. These ‘nano-necklaces’ demonstrate good MRI relaxation properties despite their coating and permanent alignment, with low field enhancement due to structural and magnetocrystalline anisotropy

The Inconvenient Truth About Mobile Phone Distraction: Understanding the Means, Motive, and Opportunity for Driver Resistance to Legal and Safety Messages

The research evidence around distraction caused to drivers by mobile phone use is clear. Phone using drivers are four times more likely to be involved in a collision, are far less likely to notice and react to hazards, take much longer to react to any hazards they do notice and can look at hazards yet fail to see them. These findings relate equally to handsfree and handheld use. It is also clear that drivers are often resistant to these research findings and that self-reported mobile phone use by drivers is increasing. This paper combines a review of what is currently known about the dangers of mobile phone use by drivers with what research tells us about the ways drivers think about themselves, the law, and their risk of both crashing and being prosecuted. We blend these insights to explain why research evidence may be resisted both by drivers and policy makers, highlighting the inconvenient truth that is the distraction caused by mobile phone use

Taking the right course: the possibilities and challenges of offering alternatives to prosecution for drivers detected using mobile phones while driving

There is a considerable body of literature that outlines the dangers of mobile phone use by drivers. However, there is very little research that explores the role and effectiveness of attempts to tackle this specific road user problem. Generally, normative motives are more likely to generate compliance with traffic law, and are more likely to be developed through approaches which focus on engagement and education. There would seem to be little potential for them to be developed through the use of penalty points and fines, which rely on more instrumental logic. Nonetheless, the decision was made in the UK in recent years to cease offering ‘courses’ (inputs to detected phone-using drivers offered as an alternative to prosecution) for mobile phone offences. This decision was made despite a lack of evidence one way or another about their effectiveness in tackling both handheld mobile phone use and handsfree mobile phone distraction – a form of distraction not explicitly covered in law. This research project aimed to explore driver education as an alternative to prosecution for mobile phone use while driving offences, focusing on perceptions and experiences of one particular educational intervention. This paper draws on 46 semi-structured interviews with those involved in delivering a specific intervention aimed at reducing handheld mobile phone use by drivers that was previously offered as an alternative to prosecution in the UK; the police officers identifying offenders for referral to such courses, those delivering the intervention, drivers attending the course as an alternative to prosecution and members of the public attending the course as general education. Four key themes, with underpinning subthemes, emerged; 1) Police officer discretion and entry into the criminal justice system 2) Police-public interactions, 3) Course experiences, and 4) Post-course considerations. Firstly, police officer discretion is an important determinant of criminal justice system outcome, based on subjective rather than legal decisions about whether or not to report drivers for an offence. Secondly, police officers negotiate encounters with road users using the avoidance of prosecution as a way of diffusing difficult conversations, sometimes by offering a course as a preferable alternative to prosecution, sometimes by encouraging handsfree phone use. Thirdly, course attendance provides an opportunity to develop both normative alignment through increased understanding of police work, and to appreciate a range of instrumental consequences associated with mobile phone use. Both self-reportedly impacted upon mobile phone use while driving. Finally, post-course considerations emphasised a focus on who should be offered courses as an alternative to prosecution, focusing upon desires for both punitive and rehabilitative responses to mobile phone using drivers

The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study

Background: Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province. Objective: This study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality. Methods: Cremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario\u27s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality. Results: Between 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data. Conclusions: The percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies

Protocol for the economic evaluation of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression

INTRODUCTION: Cardiac rehabilitation (CR) is offered to reduce the risk of further cardiac events and to improve patients' health and quality of life following a cardiac event. Psychological care is a common component of CR as symptoms of depression and/or anxiety are more prevalent in this population, however evidence for the cost-effectiveness of current interventions is limited. Metacognitive therapy (MCT), is a recent treatment development that is effective in treating anxiety and depression in mental health settings and is being evaluated in CR patients. This protocol describes the planned approach to the economic evaluation of MCT for CR patients. METHODS AND ANALYSIS: The economic evaluation work will consist of a within-trial analysis and an economic model. The PATHWAY Group MCT study has been prospectively designed to collect comprehensive self-reported resource use and health outcome data, including the EQ-5D, within a randomised controlled trial study design (UK Clinical Trials Gateway). A within-trial economic evaluation and economic model will compare the cost-effectiveness of MCT plus usual care (UC) to UC, from a health and social care perspective in the UK. The within-trial analysis will use intention-to-treat and estimate total costs and quality-adjusted life-years (QALYs) for the trial follow-up. Single imputation will be used to impute missing baseline variables. Multiple imputation will be used to impute values missing at follow-up. Items of resource use will be multiplied by published national healthcare costs. Regression analysis will be used to estimate net costs and net QALYs and these estimates will be bootstrapped to generate 10 000 net pairs of costs and QALYs to inform the probability of cost-effectiveness. A decision analytical economic model will be developed to synthesise trial data with the published literature over a longer time frame. Sensitivity analysis will explore uncertainty. Guidance of the methods for economic models will be followed and dissemination will adhere to reporting guidelines. ETHICS AND DISSEMINATION: The economic evaluation includes a within-trial analysis. The trial which included the collection of this data was reviewed and approved by Ethics. Ethics approval was obtained by the Preston Research Ethics Committee (project ID 156862). The modelling analysis is not applicable for Ethics as it will use data from the trial (secondary analysis) and the published literature. Results of the main trial and economic evaluation will be published in the peer-reviewed National Institute for Health Research (NIHR) journals library (Programme Grants for Applied Research), submitted to a peer-reviewed journal and presented at appropriate conferences. TRIAL REGISTRATION NUMBER: ISRCTN74643496; Pre-results