Turks and Caicos National Museum

WHO’s Global HEARTS is the largest worldwide effort to improve hypertension control through standardised care. HEARTS in the Americas is its regional adaptation. To address the rising burden of cardiovascular, kidney and metabolic conditions, the initiative launched HEARTS 2.0, aiming to promote integrated care, reduce fragmentation and improve quality, access and health outcomes. In phase I, an expert-led consensus identified 45 evidence-based interventions for inclusion in an expanded Clinical Pathway. This report presents findings from phase II on the readiness of 26 Latin American and Caribbean countries to implement these interventions. We used a cross-sectional design and a structured, self-administered questionnaire completed by national implementation teams. It systematically assessed the availability, feasibility, time required and key barriers for each proposed intervention. While many interventions, especially for risk assessment and non-pharmacological treatments, are considered feasible in many countries, their current availability is limited due to ongoing shortages of diagnostics, medicines and infrastructure. Over the next 3 years, 18 countries are projected to implement >30 of the 45 interventions, four countries aim to implement 20–30 and four expect to implement fewer than 20. While primary health systems in most HEARTS-implementing countries do not yet appear ready to deliver integrated cardiovascular, kidney and metabolic care, the scale-up of HEARTS 2.0 presents a strong opportunity to advance this integration. As health systems worldwide face the challenge of increasing multimorbidity in their patients and fragmented care delivery systems, this assessment offers a practical tool for planning and action.

This paper focuses on the quality assurance culture in a college in a multicultural setting. Its purpose is to explore the role of higher education leaders in creating a culture of quality assurance practices in a multicultural environment. The external stakeholders’ perceived value of the institution has been declining over the past ten years, and it is unknown if the lack of a common culture of quality assurance practices within the institution contributes to its decline. The overarching research question is, how do educational leaders create a culture of quality assurance practice and standards in a multicultural environment to improve the perceived value of the institution? The qualitative approach to this research engaged a single case study design. Data was collected using semi-structured interviews, observation, and document review. The data were analysed using manual coding that extracted themes such as the need for a curriculum committee and the creation of policy documents. The conceptual framework outlined the concepts and theories that contributed to the analysis and discussion of the findings. The literature reviewed addressed the use of Hofstede’s six-dimension framework in determining the current culture in the institution and the ISO-9001 quality management system’s application in the multicultural setting. The findings of the research were that the college lacked a common culture of quality assurance. Participants believed that adapting a quality control model would improve the perceived value of the institution and that the leader played a critical role in creating a culture of quality assurance practices.

Understanding and awareness of the United Nations Sustainable Development Goals are critical in ensuring students are geared towards protecting the future for themselves and others. This qualitative case study research design aims to increase the level of awareness and engagement among our students to create sustainable leaders and foster more sustainable organizations, households, and communities at the micro and macro levels. A design thinking workshop was used to raise students’ level of awareness and engagement. An open-ended survey was used to gather data on students’ views of how the business community and higher educational institutions can play their part in the nation’s sustainability issues. The design thinking workshop resulted in the development of a sustainable development project proposal on renewable energy. Results of the survey revealed that students were not fully aware of the United Nations Sustainable Development Goals. The study recommends that higher educational institutions need to play a more critical role in educating students about the SDGs and need to infuse sustainability within the curriculum.

Abstract For future climate projections to be useful they must be actionable at the local level. In this study, we develop daily temperature and precipitation climate scenarios suitable for use in projections of drought, energy use, water use, and crop production. We investigate the magnitude of future changes to air temperature and precipitation in the Midwest United States in response to three future climate change scenarios. Results are used to assess changes to incidence of precipitation extremes and human comfort (using heat index) associated with the anticipated climate changes in the region. We use self‐organizing maps and random forest based techniques to generate daily realizations of temperature and precipitation for 279 weather stations in a region centred on Illinois. We determine that the random forest model performs best for maximum and minimum temperatures, while the self‐organizing map performs best for precipitation. Using nine models from the Coupled Model Inter‐Comparison Project Phase 5, downscaled daily temperature and precipitation values are generated for low, moderate, and high greenhouse gas emissions scenarios for historical and future periods. Based on recent trends, we focus our results on the high emissions scenario, and show an average increase of 4.3°C in maximum daily air temperature across the region for the 2071–2100 period. Precipitation decreases by up to 15% in the southern half of the study region, with a similar percentage increase in the northern half of the region. The regional environmental changes result in an increase of 5.8° in average summer heat index, and increase of 48% in the number of days likely to produce extreme heat, and a decrease in the average value of the standardized precipitation and evapotranspiration index of 1.9 (indicating increased drought) across the region by 2100.

The medical records of 983 patients diagnosed with the human immunodeficiency virus (HIV) were reviewed, 501 of whom were female and 482 were male. The mean age was 42.1 years, the mean number of years since diagnosis of HIV was 7.4, and the average duration of highly active antiretroviral therapy (HAART) was 51.7 months. The mean CD4 count at diagnosis was 268.5

The HIV/AIDS pandemic has had significant impact on the health, livelihood and population of its human host. According to the website of the Centers for Disease Control and Prevention (1), there were 2.1 million new cases of HIV in 2013. In the same year, about 35 million people were living with HIV around the world and about 1.5 million of the persons living with