The development of public mental health in Malta

Public health practitioners in Malta have been drivers of public mental health reform throughout the last twenty-five years. However, early political and financial support for the implementation of policy and strategy dwindled over the years. Whilst services continued to expand, these were not matched with the adequate injection of human and financial resources. Twenty years later, the mental health service is still experiencing problems of underfinancing as reflected by the dire state of the psychiatric hospital infrastructure, poor leadership, management and accountability structures, and a largely insufficient albeit dedicated workforce. In 2012, the enactment of the new Mental Health Act and the establishment of a Commissioner for Mental Health recharged a national focus on mental health. Mental health is now a subject for the local media, the public is more receptive, NGOs and professionals are more vocal, the significance of mental health in schools, homes, and the workplace is taking root, and the subject has gained increasing political will, culminating with the launch of a Mental Health Strategy document for consultation in December 2018. This is our window of opportunity to ensure that policies and strategies are now translated into resources and action that reap sustained improvement in population mental health and well-being for this and future generations.peer-reviewe

Quantifying human-robot interaction by developing a measure for safe collaboration

This research investigated whether human motion prediction by an assistive robot can always lead to a safe and efficient human-robot interaction. Using human motion, prediction can encourage interaction in close physical proximity and can help build trust in collaborative human-robot interactions. However, when the interaction gets more complicated due to external disturbances and the complex nature of the humans, it may lead to physical harm or interaction failures. Despite the literature raising safety issues in physically assistive robots, research regarding potential disturbances and adverse outcomes is limited. Therefore, this research considers the impact of external disturbances and their effect on the collaboration. To address this gap, the present study investigates the consequences of external disturbances on the collaborative state of humans, particularly in the context of assistive tasks in natural living environments like care homes. A comprehensive examination of the impact of disturbances on human motion is conducted through surveys, human-robot interaction experiments, human motion recordings, and observational studies involving professionals in care homes. Two case studies are conducted to analyze different interaction scenarios and complexities, resulting in the collection of two time-series datasets capturing human movement.The first case study focuses on human reaching movement in a shared workspace, utilizing movement primitives to predict and distinguish minor variations in the final reaching position. The second case study examines human movement during an assistive dressing task, introducing cognitive overloading and distractions to evaluate the effects of disturbances in a more complex interaction environment. Quantitative and Qualitative techniques are employed to identify differences in movement patterns during these irregularities, revealing that collaboration is hindered in the presence of disturbances.The findings from the observations carried out in care homes contribute to further analysis of complex interaction and their requirements to provide safe physical assistance. The natural occurrence of successful, safe and efficient collaborative interactions witnessed in care homes, regardless of the vulnerability level of older adults, is examined and questioned. This leads to the belief that a measure of collaboration between humans and robots through input modalities is necessary for ensuring safety. This measure acts as an implicit constraint for the robot, particularly when there is variation between human and robot movement, especially during changes in the collaborative state of humans. It enables a more realistic evaluation of human motion prediction by directly assessing the safety of continuing collaborative movements.The aforementioned case studies served as a foundation for further analysis of human movement as input modalities. To ensure physical safety, knowledge similar to that obtained from the second case study can be utilized as priors, represented in the form of latent spaces, to provide information about the human's collaborative state. This approach allows for a more accurate assessment of the safety of continuing collaborative movements. The core contribution of the thesis lies in leveraging the input modality of human movement as an affordance that ensures physical safety in assistive robots, incorporating knowledge about collaboration while considering the influence of environmental factors, human factors, and the human state

Mdina: Should it be inscribted as a World Heritage Site?

The author strongly believes in the cultural and heritage product which Malta can offer to the tourism industry. Authorities have tried to use this product to reposition Malta from a Sun, Sand and Sea destination to a heritage destination, reducing the seasonality of the tourism sector. However, not everything comes easy, culture and heritage have been neglected for years and these two major assets need substantial planning, development and conservation to achieve badly needed positive results in the tourism industry. Through these improvements, Malta will have a new image and therefore, attract more sophisticated, high spending tourists. Malta is the second richest country per square kilometre in cultural sites, after Rome (Zahra Winston J. Conference, 2004). If this is the reality, why not develop and exploit this major resource to Malta's advantage? The assets are there, we just need to exploit them. The Maltese Islands already carry three World Heritage Site (WHS) inscriptions, and if we get the forth one this could be a greater marketing tool. This study targets one particular site, Mdina a fortified city built high above terraced fields and Malta's former capital city (UNESCO, 1998a). The author gathers information through the use of in-depth interviews, among Malta's responsible entities as to why this particular site is not yet Malta's forth WHS, as it contributes to Malta's glorious history, culture, heritage and traditions (UNESCO, 1998a), and its beauty and value is something to highlight and stress among other cultures. The author gathered information directly from the tourists visiting the city, through a series of questions. Since Malta wants to offer the tourists a unique experience, then the focus must be on the tourists themselves so that there is an understanding of what they really want and appreciate when visiting the Islands. Once Malta is recommended to friends and other members of the family, can we say that all the efforts by the authorities and other entities are successful

An assistive robot to support dressing-strategies for planning and error handling

© 2016 IEEE. Assistive robots are emerging to address a social need due to changing demographic trends such as an ageing population. The main emphasis is to offer independence to those in need and to fill a potential labour gap in response to the increasing demand for caregiving. This paper presents work undertaken as part of a dressing task using a compliant robotic arm on a mannequin. Several strategies are explored on how to undertake this task with minimal complexity and a mix of sensors. A Vicon tracking system is used to determine the arm position of the mannequin for trajectory planning by means of waypoints. Methods of failure detection were explored through torque feedback and sensor tag data. A fixed vocabulary of recognised speech commands was implemented allowing the user to successfully correct detected dressing errors. This work indicates that low cost sensors and simple HRI strategies, without complex learning algorithms, could be used successfully in a robot assisted dressing task

Multidisciplinary Psychosomatic Assessment for UX Design Evaluation

“In the mirror of the Wonder of Luca Giordano” was a multi-sensorial experience created in the gallery frescoed by Luca Giordano in Palazzo Medici Riccardi, in Florence; the project involved different disciplines and researchers. The entire experience was subjected to an impact analysis, combining principally psycho-physiological, qualitative psychological and neuro-physiological aspects. In most of the visitors who participated in the study the experience evoked a sense of pleasure, enjoyment, relaxation, lightness, space-time suspension, involvement and immersiveness. In many of the visitors, the devices detected changes in heartbeat with a stastically significant decrease in blood pressure and heart rate, demontrating that the impact of artwork in a multi-sensorial experience and in an augmented perception environment is a psycho-somatic impact. Our experience suggests that projects such as "In the mirror of the Wonder of Luca Giordano" could be a very useful tool for cultivating emotional intelligence and could be developed in museums alongside the more classical paths of fruition

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mdina: Should it be inscribted as a World Heritage Site?

The author strongly believes in the cultural and heritage product which Malta can offer to the tourism industry. Authorities have tried to use this product to reposition Malta from a Sun, Sand and Sea destination to a heritage destination, reducing the seasonality of the tourism sector. However, not everything comes easy, culture and heritage have been neglected for years and these two major assets need substantial planning, development and conservation to achieve badly needed positive results in the tourism industry. Through these improvements, Malta will have a new image and therefore, attract more sophisticated, high spending tourists. Malta is the second richest country per square kilometre in cultural sites, after Rome (Zahra Winston J. Conference, 2004). If this is the reality, why not develop and exploit this major resource to Malta's advantage? The assets are there, we just need to exploit them. The Maltese Islands already carry three World Heritage Site (WHS) inscriptions, and if we get the forth one this could be a greater marketing tool. This study targets one particular site, Mdina a fortified city built high above terraced fields and Malta's former capital city (UNESCO, 1998a). The author gathers information through the use of in-depth interviews, among Malta's responsible entities as to why this particular site is not yet Malta's forth WHS, as it contributes to Malta's glorious history, culture, heritage and traditions (UNESCO, 1998a), and its beauty and value is something to highlight and stress among other cultures. The author gathered information directly from the tourists visiting the city, through a series of questions. Since Malta wants to offer the tourists a unique experience, then the focus must be on the tourists themselves so that there is an understanding of what they really want and appreciate when visiting the Islands. Once Malta is recommended to friends and other members of the family, can we say that all the efforts by the authorities and other entities are successful

Boosting vision through combined perceptual learning and non-invasive transcranial random noise stimulation

Introduction Perceptual learning has been shown to produce an improvement of visual functions such as an increase of visual acuity and contrast sensitivity both in participants with cortical visual defects such as amblyopia as well as refractive defects such as myopia or presbyopia. Additionally, transcranial random noise stimulation (tRNS), a type of alternating current stimulation, has proven to be efficacious in accelerating neural plasticity and boosting visual perceptual learning in healthy participants. This work investigates whether a short visual behavioural training regime using a contrast detection task, combined with online hf-tRNS, is more effective than the training plus sham stimulation, or stimulation alone, in improving visual functions (VA and CS) in participants with visual defects, specifically: mild myopia and amblyopia. Method A battery of tests measuring visual functions was administered prior to (pre-test) and following the training (post-test). Eight consecutive training sessions on a contrast detection task (combined or not with tRNS) were undertaken by the participants. A third group of participants in the myopia group underwent solely brain stimulation, in the absence of any visual training. Results The experimental groups (tRNS + PL) reached a larger improvement, with respect to the control groups, in both VA (mean improvement of 0.18 LogMAR) and CS at intermediate spatial frequencies. Conclusions These results suggest that neuromodulatory techniques can boost perceptual learning and its generalization to non-trained visual functions, strongly reducing the duration of behavioural trainings needed to improve sight in people both with non-corrected refractive defects as well as with cortical visual defects such as amblyopia

Boosting vision through combined perceptual learning and non-invasive transcranial random noise stimulation

Introduction Perceptual learning has been shown to produce an improvement of visual functions such as an increase of visual acuity and contrast sensitivity both in participants with cortical visual defects such as amblyopia as well as refractive defects such as myopia or presbyopia. Additionally, transcranial random noise stimulation (tRNS), a type of alternating current stimulation, has proven to be efficacious in accelerating neural plasticity and boosting visual perceptual learning in healthy participants. This work investigates whether a short visual behavioural training regime using a contrast detection task, combined with online hf-tRNS, is more effective than the training plus sham stimulation, or stimulation alone, in improving visual functions (VA and CS) in participants with visual defects, specifically: mild myopia and amblyopia. Method A battery of tests measuring visual functions was administered prior to (pre-test) and following the training (post-test). Eight consecutive training sessions on a contrast detection task (combined or not with tRNS) were undertaken by the participants. A third group of participants in the myopia group underwent solely brain stimulation, in the absence of any visual training. Results The experimental groups (tRNS + PL) reached a larger improvement, with respect to the control groups, in both VA (mean improvement of 0.18 LogMAR) and CS at intermediate spatial frequencies. Conclusions These results suggest that neuromodulatory techniques can boost perceptual learning and its generalization to non-trained visual functions, strongly reducing the duration of behavioural trainings needed to improve sight in people both with non-corrected refractive defects as well as with cortical visual defects such as amblyopia