A training needs analysis of health care providers within Malta’s Primary Health Department : a boon or a bane?

In 2009, the Practice Development Unit and the Specialist Training Programme in Family Medicine within Malta’s Primary Health Department carried out a training needs analysis of health care providers working in government primary health centres and clinics so as to investigate their educational requirements. Method: After a questionnaire was developed as a tool, a pilot study was conducted in a particular health centre to test its validity. The amended version of the questionnaire was then mailed individually to all health providers working at that time in the various health centres and peripheral clinics. Out of the 498 questionnaires sent, 215 were completed and returned, with a resulting response rate of 43%. One main finding was that, irrespective of one’s discipline, the programme topic and the lecturer were the important decisive factors of whether one attended a training course or not. On the other hand, specific obstacles to training emerged that are directly related to one’s profession: these included shortage of staff, lack of time and other commitments. From the information revealed by the training needs analysis, the department revamped its training strategy to consist of three-monthly Saturday seminars dealing with topics relevant to primary health care, with such activities being oversubscribed and well-received. In this manner a thriving continuing professional development programme was designed and delivered for health care professionals within Malta’s Primary Health Departmentpeer-reviewe

Trotter-Kato product formulae in Dixmier ideal

It is shown that for a certain class of the Kato functions the Trotter-Kato product formulae converge in Dixmier ideal C 1,$\infty$ in topology, which is defined by the $\times$ 1,$\infty$-norm. Moreover, the rate of convergence in this topology inherits the error-bound estimate for the corresponding operator-norm convergence. 1 since [24], [14]. Note that a subtle point of this program is the question about the rate of convergence in the corresponding topology. Since the limit of the Trotter-Kato product formula is a strongly continuous semigroup, for the von Neumann-Schatten ideals this topology is the trace-norm $\times$ 1 on the trace-class ideal C 1 (H). In this case the limit is a Gibbs semigroup [25]. For self-adjoint Gibbs semigroups the rate of convergence was estimated for the first time in [7] and [9]. The authors considered the case of the Gibbs-Schr{\"o}dinger semigroups. They scrutinised in these papers a dependence of the rate of convergence for the (exponential) Trotter formula on the smoothness of the potential in the Schr{\"o}dinger generator. The first abstract result in this direction was due to [19]. In this paper a general scheme of lifting the operator-norm rate convergence for the Trotter-Kato product formulae was proposed and advocated for estimation the rate of the trace-nor

Mapping the Early Cortical Folding Process in the Preterm Newborn Brain

In the developing human brain, the cortical sulci formation is a complex process starting from 14 weeks of gestation onward. The potential influence of underlying mechanisms (genetic, epigenetic, mechanical or environmental) is still poorly understood, because reliable quantification in vivo of the early folding is lacking. In this study, we investigate the sulcal emergence noninvasively in 35 preterm newborns, by applying dedicated postprocessing tools to magnetic resonance images acquired shortly after birth over a developmental period critical for the human cortex maturation (26-36 weeks of age). Through the original three-dimensional reconstruction of the interface between developing cortex and white matter and correlation with volumetric measurements, we document early sulcation in vivo, and quantify changes with age, gender, and the presence of small white matter lesions. We observe a trend towards lower cortical surface, smaller cortex, and white matter volumes, but equivalent sulcation in females compared with males. By precisely mapping the sulci, we highlight interindividual variability in time appearance and interhemispherical asymmetries, with a larger right superior temporal sulcus than the left. Thus, such an approach, included in a longitudinal follow-up, may provide early indicators on the structural basis of cortical functional specialization and abnormalities induced by genetic and environmental factor

The Socio-economic Impact of Social Computing: Proceedings of a Validation and Policy Options Workshop

This report presents the major outcomes of a validation and policy options workshop on social computing, held at IPTS in Seville, on 26-27 February 2008. It points to a number of relevant issues (including methodological and conceptual ones) that need to be taken into account in a study of the socio-economic impacts of social computing. It argues that there is little room for direct policy interventions in social computing but that framework conditions and impacts at sector-level (e.g. education, government) need to be considered. The report also discusses the future of social computing and the opportunities it offers Europe.JRC.J.4-Information Societ

Primary cortical folding in the human newborn: an early marker of later functional development

In the human brain, the morphology of cortical gyri and sulci is complex and variable among individuals, and it may reflect pathological functioning with specific abnormalities observed in certain developmental and neuropsychiatric disorders. Since cortical folding occurs early during brain development, these structural abnormalities might be present long before the appearance of functional symptoms. So far, the precise mechanisms responsible for such alteration in the convolution pattern during intra-uterine or post-natal development are still poorly understood. Here we compared anatomical and functional brain development in vivo among 45 premature newborns who experienced different intra-uterine environments: 22 normal singletons, 12 twins and 11 newborns with intrauterine growth restriction (IUGR). Using magnetic resonance imaging (MRI) and dedicated post-processing tools, we investigated early disturbances in cortical formation at birth, over the developmental period critical for the emergence of convolutions (26-36 weeks of gestational age), and defined early ‘endophenotypes' of sulcal development. We demonstrated that twins have a delayed but harmonious maturation, with reduced surface and sulcation index compared to singletons, whereas the gyrification of IUGR newborns is discordant to the normal developmental trajectory, with a more pronounced reduction of surface in relation to the sulcation index compared to normal newborns. Furthermore, we showed that these structural measurements of the brain at birth are predictors of infants' outcome at term equivalent age, for MRI-based cerebral volumes and neurobehavioural development evaluated with the assessment of preterm infant's behaviour (APIB

The SIGMA rat brain templates and atlases for multimodal MRI data analysis and visualization

Preclinical imaging studies offer a unique access to the rat brain, allowing investigations that go beyond what is possible in human studies. Unfortunately, these techniques still suffer from a lack of dedicated and standardized neuroimaging tools, namely brain templates and descriptive atlases. Here, we present two rat brain MRI templates and their associated gray matter, white matter and cerebrospinal fluid probability maps, generated from ex vivo [Formula: see text]-weighted images (90 µm isotropic resolution) and in vivo T2-weighted images (150 µm isotropic resolution). In association with these templates, we also provide both anatomical and functional 3D brain atlases, respectively derived from the merging of the Waxholm and Tohoku atlases, and analysis of resting-state functional MRI data. Finally, we propose a complete set of preclinical MRI reference resources, compatible with common neuroimaging software, for the investigation of rat brain structures and functions.This work is part of the SIGMA project with the reference FCT-ANR/NEU-OSD/0258/2012, co-financed by the French public funding agency ANR (Agence Nationale pour laRecherche, APP Blanc International II 2012), the Portuguese FCT (Fundação para aCiência e Tecnologia) and the Portuguese North Regional Operational Program (ON.2—O Novo Norte) under the National Strategic Reference Framework (QREN), through theEuropean Regional Development Fund (FEDER) as well as the Projecto Estratégico co-funded by FCT (PEst-C/SAU/LA0026-/2013) and the European Regional DevelopmentFund COMPETE (FCOMP-01-0124-FEDER-037298). D.A.B. and A.N. were funded bygrants from FCT-ANR/NEU-OSD/0258/2012. R.M. was supported by the FCT fellow-ship grant with the reference PDE/BDE/113604/2015 from the PhDiHES program. A.C.was supported by a grant from the foundation NRJ. P.M. was funded by FundaçãoCalouste Gulbenkian (Portugal;‘Better mental health during ageing based on temporalprediction of individual brain ageing trajectories TEMPO’) with Grant Number P-139977. France Life Imaging is acknowledged for its support in funding the NeuroSpinplatform of preclinical MRI scanners. The authors also acknowledge and thank EdwardGanz, MD, for proof reading our work

Evidence in cortical folding patterns for prenatal predispositions to hallucinations in schizophrenia.

All perception is a construction of the brain from sensory input. Our first perceptions begin during gestation, making fetal brain development fundamental to how we experience a diverse world. Hallucinations are percepts without origin in physical reality that occur in health and disease. Despite longstanding research on the brain structures supporting hallucinations and on perinatal contributions to the pathophysiology of schizophrenia, what links these two distinct lines of research remains unclear. Sulcal patterns derived from structural magnetic resonance (MR) images can provide a proxy in adulthood for early brain development. We studied two independent datasets of patients with schizophrenia who underwent clinical assessment and 3T MR imaging from the United Kingdom and Shanghai, China (n = 181 combined) and 63 healthy controls from Shanghai. Participants were stratified into those with (n = 79 UK; n = 22 Shanghai) and without (n = 43 UK; n = 37 Shanghai) hallucinations from the PANSS P3 scores for hallucinatory behaviour. We quantified the length, depth, and asymmetry indices of the paracingulate and superior temporal sulci (PCS, STS), which have previously been associated with hallucinations in schizophrenia, and constructed cortical folding covariance matrices organized by large-scale functional networks. In both ethnic groups, we demonstrated a significantly shorter left PCS in patients with hallucinations compared to those without, and to healthy controls. Reduced PCS length and STS depth corresponded to focal deviations in their geometry and to significantly increased covariance within and between areas of the salience and auditory networks. The discovery of neurodevelopmental alterations contributing to hallucinations establishes testable models for these enigmatic, sometimes highly distressing, perceptions and provides mechanistic insight into the pathological consequences of prenatal origins

Climatic change and the Mediterranean

The temperature and precipitation scenarios for the Malta region developed by the Climate Research Unit of the University of East Anglia suggest that annual temperature will increase by 0.8 to 0.9°C per degree Celsius of global change and that there will be little if any change in the annual rainfall amounts around Malta. A statistical analysis of past meteorological data for Malta indicates an existing trend towards increasing extremes of temperature; namely an increase in the maximum and a decrease in the minimum temperatures. The mean annual temperature is also apparently increasing. These data also suggest a trend towards lower total annual rainfall; an increase in the atmospheric pressure; an increase in the number of days with thunderstorms; and decreases in cloud cover and the number of hours of bright sunshine. These trends suggest that a process of desertification is already occurring in Malta, and that there is an increase in the suspended particle concentration including pollutants, in the atmosphere over the island. The hydrological cycle will be significantly affected by global warming. In Malta, natural sources of freshwater account for about 37% of all potable water in the public supply and for 84% of all irrigation water. Global warming will affect the freshwater supply through changes to relative sea level, and through changes in rainfall and evapotranspiration. A eustatic rise in sea level of around 65 ± 35 cm by the year 2100 would adversely affect the existing extraction rates from Malta's principal aquifer and make it more vulnerable to sea water intrusion. In contrast, the direct climatic effect will be less pronounced, since only a small change in local precipitation is predicted to accompany global warming. Climate is a fundamental factor influencing the nature of the soils of Malta. Since an increase in temperature with little change in the total rainfall is anticipated, evapotranspiration will increase, leading to an increase in aridity, and to soil degradation mainly due to salinization and alkalinization. The anticipated increase in temperature; a shift in precipitation patterns; a decrease in soil water availability; and a rise in sea level, will have negative impacts on agriculture, natural vegetation and associated fauna, favouring an increase in xerophilic, thermophilic and halophilic species. Such species are likely to be introduced ones, thriving at the expense of native species. It is predicted that the character of the vegetation will change from that typical of Mediterranean coastal lowlands, to associations more typical of deserts. This shift in vegetation pattern would be enhanced by soil erosion and increased soil salinity. Remedial action at a local level could include measures to prevent soil erosion by gradually changing to crops and trees that stabilize soils and which tolerate the new climatic conditions. A change in temperature could possibly lead to an increase in agricultural pests, whilst sea level rise may cause inundation of low-lying agricultural land such as that at Pwales and of groves such as those at Salina Bay. The impacts on fisheries may be less dramatic but changes in migration patterns of important fish such as lampuki might happen; and the potentially adverse effects which competitive thermophilic seaweeds may have on the important Posidonia meadows may be of concern in the future. The effects on aquaculture are difficult to assess but may include an increase in pathogens. The control of pollutants and protection of the Posidonia meadows are recommended, together with development of more sustainable use of fisheries resources. The present coastal, near-shore and freshwater ecosystems are threatened by a number of anthropogenic, non-climatic changes. Any additional impacts on these ecosystems resulting from climatic changes will have to be assessed in the light of such nonclimatic effects, if the overall projections of future changes are to be accurate. Increased eutrophic conditions and increased water stratification are likely to occur under conditions of global change in certain localities already influenced by other non-climatic human activities. Non-linear biological responses to climatic changes are discussed and may prove to be quite significant but difficult to predict with the present state of knowledge. Coastal sandy beaches, sand dunes and saline marsh habitats are considered to be sensitive to predicted climate change impacts, through increased erosion, enhanced shoreline recession and increased environmental fluctuations. The extent of impacts on such habitats, under less severe climatic change scenarios, will depend largely on present and future land-use management practices. Given the coastal topography, present drainage patterns and negligible tectonic movements in Malta, the predicted rise in sea level will have coast and especially those in the main drainage basins will become more susceptible to periodic rainfall-induced flooding and anticipatory action will be needed to address the consequential economic and social disruption. Impacts on coastal settlements are expected as a result of tidal and storm surges rather than from permanent inundation. A rise in sea level may cause sewage systems to flood, and new systems may have to be developed to reduce public health risks from such a hazard, including the increased risk of epidemics of enteric disorders such as typhoid fever. Salt water intrusion into aquifers will reduce the quantity and quality of potable water resources. Temperature rise and an increased frequency of extreme high temperatures, especially when combined with high humidity, will put some population groups such as the elderly and infants at risk from heat stress. Diseases presently confined to the tropics may spread to higher latitudes, and tropical and sub-tropical vector borne diseases may become more widespread, partly because vector survival will increase and partly because the parasites may be able to complete their life cycle more easily. Malaria may reappear in Europe, whilst Leishmaniasis, which has been under control in the recent past, already seems to be on the increase, possibly as a result of recent increases in temperature and humidity. Increased exposure to the sun when combined with possible ozone layer depletion may result in a further rise in the incidence of both melanomas and non-melanotic skin cancers. Exposure to increased ultraviolet (UV) radiation is expected to cause damage to the cornea and lens and an increased incidence of cataracts. The effect of UVB radiation on the human immune system is far less well understood, but it is a well accepted fact however, that UV, possibly acting through DNA damage, is an important precipitating factor of the auto-immune condition, systemic lupus erythematosus. The tourist industry has, for many years, been one of the Islands' most important economic activities, employing 5.8% of the total working population. If the climate conditions of the Maltese Islands change, the tourist industry could suffer, causing disruption to the Maltese economy and hardship to the population. Sea level rise will certainly have an impact on this site-dependent and coastal industry, which would be adversely affected by the loss of sandy beaches and the reduction in potable water supply. The tourist industry, is by its very nature, fragile and susceptible to political, economic and social changes. Climate change will add another element of uncertainty to this sector. Transport in Malta depends entirely on roads, whilst a ferry service connects the islands of Malta, Gozo and Comino and is also used around the Grand Harbour area. Road traffic would suffer in the event of flooding of the main traffic arteries as a result of severe rain storms, which will probably increase along with the anticipated increase in autumn precipitation. Changes in climate are expected to have an effect on the patterns of energy demand to heat and cool buildings. Electricity generation, which accounts for almost two thirds of primary energy consumption, has grown on average by about 8.5% per year in recent years. The predicted average temperature increases would, theoretically, reduce the need to provide heating, thereby saving energy. Given the low thermal performance of Maltese buildings, an increase in ambient temperature may merely result in a more thermally comfortable interior, rather than a saving of energy. · In the commercial and industrial sectors, the interhal heat generated by the use of machinery is high and an increase in ambient temperature, may result in a need for cooling through increased ventilation and possibly an extension of the air conditioning season. The introduction of thermal insulation to the building envelope, would reduce both the heating demand in winter as well as the cooling demand in summer. The displacement of fossil fuels by renewable energy sources particularly biomass and hydro power would reduce carbon dioxide emissions. In Malta there is good potential for development of solar energy, although land availability is a major obstacle. There is less possibility of harnessing wind energy on a large scale although wind energy is already widely used for water pumping in agriculture.peer-reviewe