An overview of irrigation system performance on the island of Malta

The island of Malta has a typical Mediterranean climate with an annual precipitation of circa 500mm spreading over the October to March period. The semi arid environment has always provoked the indigenous population to develop and adopt techniques that would maximise water harvesting and distribution efficiency. Within the nine year span (1991-2000), the agricultural land in Malta decreased by an estimated 1,164 hectares, reaching a total land base of 10,738 hectares. Despite this loss, the National Statistics Office registered an increase of 420 hectares in irrigated land. This could be interpreted as 1) water availability has increased or 2) efficiency in water distribution has increased. Furthermore, protected cropping through the use of greenhouses and cloches equipped with drip irrigation systems are now increasing in use and popularity. The use of treated sewage water was a key factor in stimulating agricultural development in the south region. Irrigation efficiency may be measured using a variety of indicators, such as: area under irrigation, amount of produce marketed, volume of water storage, and deterioration of ground water resources. A review of irrigation under a Maltese context is presented.peer-reviewe

The international competitiveness of Malta as a tourist destination.

Many small islands depend on sustainable tourism to attain long term economic prosperity and well-being for their citizens. As they become more dependent on tourism for their growth, they are more concerned with improving their competitiveness to adapt to a highly charged competitive environment and to the dynamic market conditions. The quintessential problem is how to achieve, maintain, and enhance competitiveness. There is limited research on tourism destination competitiveness (TDC), and much less on small island destinations. This study concentrates on TDC with a special focus on Malta as a small Mediterranean island in an attempt to develop a comprehensive TDC framework that is useful to small island destinations, and advances models and measures to assess competitiveness based on importance-performance analysis techniques (IPA). To achieve its research objectives, this study adopts a methodological position reflecting pragmatist assumptions and uses a sequential, exploratory, Mixed Methods design strategy. In the qualitative first phase of the design, thirty-five in-depth interviews are conducted with key experts in tourism. It emerges from the participants description that sixty tourism-specific and business-related determinants provide a broad framework for assessing TDC. In the second phase, survey research is applied in order to develop quantitative measures to reveal the relative importance of the competitiveness factors, to assess the performance of the destination on these factors, and to identify priority areas that require immediate attention for improvement. Statistical measures and procedures are modified, introduced, and tested to establish a valid model for measuring TDC. Results show that the diagonal approach and the adjusted weighted partial ranking method for measuring importance and performance are the best combination that satisfies validity criteria. When applying these techniques to assess Maltas competitiveness relative to a competing set of Mediterranean destinations, twelve tourism attributes and fourteen business-related factors are identified as priority areas for improvement, with the competitiveness deficiency gaps in business factors being notably higher than those in tourism-specific areas. This study has several implications for the development of TDC theory, methods, and application to small islands. It provides tourism researchers, policymakers, and practitioners with a theoretically robust framework that can assist them in the formulation of policies, the management of the destination, and the implementation of strategies to optimise resource allocation in order to enhance a destinations competitive position. Given that there are few studies that focus on the development and measurement of TDC models for small islands, this study makes a valid contribution to knowledge. The methodological approaches adopted in this inquiry have substantive application in IPA studies both within and beyond tourism studies. The studys outcomes are also transferable to small island destinations operating in similar environments

Pyogenic granuloma as a surrogate indicator of deep seated foreign bodies: a case report

Although pyogenic granulomas are often clinically associated with foreign bodies or recurrent traumatic injury, this association is not well documented. We report a case of a recurrent, intractable pyogenic granuloma due to a missed foreign body. An extensive search retrieved no previous literature reporting this association. This lack of evidence bases may hinder the hand surgeon from extending the wound incision and thorough exploration. Recurrent pyogenic granulomas should lead the hand surgeon to entertain the possibility of a missed foreign body

Bioresponsive dextrin-colistin conjugates as antimicrobial agents for the treatment of Gram-negative infection

Abstract Multidrug-resistant Gram-negative infection is an important cause of mortality and morbidity. Management of these infections is often dependent upon “treatment of last resort” "small molecule" antibiotics which suffer from significant toxicity and an indiscriminate volume of distribution. The aim of this study was to develop a prototype polymer-antibiotic conjugate that may be customised by polymer modification and binding chemistry to afford selective, controlled release at an infected site. These studies employed the biodegradable, naturally-occurring polymer, dextrin, and a polymyxin antibiotic, colistin, as the first model combination. Physicochemical characterisation of a library of succinoylated dextrins and dextrin-colistin conjugates demonstrated that conjugation of dextrin to colistin was feasible and reproducible, resulting in masking of colistin's amino groups through incorporation in peptide bonds. Exposure to physiological �-amylase activity resulted in controlled degradation of the dextrin component, leading to sustained colistin release. Following exposure of the conjugates to physiological concentrations of �-amylase, minimally-modified, low molecular weight dextrin, conjugated to colistin, demonstrated significantly earlier, maximal release of colistin and subsequent reinstatement of antimicrobial activity. At maximum unmasking, the lead conjugate reported equivalent antimicrobial activity to the current clinical formulation of colistin (Colimycin®)against a range of MDR organisms including: A. baumannii, K. pneumoniae and E. coli. A static two-compartment dialysis bag model was developed under infinite sink conditions, which demonstrated that the conjugates were able to suppress bacterial growth over a significantly greater duration than colistin sulfate. Ex vivo studies of infected human wound fluid samples confirmed that colistin could be readily liberated from conjugate in infected sites. Significantly higher amylase activity in these wound fluid samples supported the notion of locally-triggered, enzymatically-mediated unmasking. An in vivo intravenous, pharmacokinetic model in rats demonstrated the increased half-life associated with conjugation and succinoylation. Moreover,the dextrin-colistin conjugates were better tolerated than colistin sulfate at higher concentrations. These studies have demonstrated the feasibility of developing this new class of “nanoantibiotics” and highlighted their potential usefulness as bioresponsive nanomedicines for the treatment of MDR Gram-negative infection

Fluid resuscitation in adults with severe burns at risk of secondary abdominal compartment syndrome—An evidence based systematic review

Background: Secondary abdominal compartment syndrome (sACS) in adults with severe burns is commonly unsuspected, can be rapidly fatal and seriously compromises the reliability of urine output as an indicator of perfusion and resuscitation status. Current literature lacks an exhaustive, evidence-based review critically appraising all retrieved literature on which clinical decisions may be based. Methods: The evidence on three inter-related concepts was evaluated: fluid-volume management and its contribution to sACS; the role of urinary bladder pressure monitoring; and awareness of the burns community to sACS. Literature published over the last ten years across the major databases was retrieved, and the search strategy was fully reported to reduce the retrieval bias ubiquitous in previous literature. Each article was individually appraised and classified into a framework of evidence, enabling the formulation of specific, graded recommendations. Results: Current best evidence supports recommendations to reduce fluid-volume administered through use of colloids or hypertonic saline especially if the projected resuscitation volume surpasses a ‘volume ceiling’. Continuous intra-vesical monitoring is recommended: to guide fluid resuscitation for early diagnosis of sACS; and as a guide to reliability of urine output as indicator of organ perfusion. A priming volume of 75 cm3 or less is recommended. Conclusion: Fluid resuscitation volume is causative to sACS, especially once a predetermined maxima is reached. Continuous intra-vesical pressure monitoring is a cheap, reliable, userfriendly monitoringmethod recommended in high-risk patients. Poor awareness among the burns community requires urgent dissemination of evidence based information

Family education seminar for hypospadias surgery, a powerful preoperative tool -7yr outcomes

The effectiveness of educational pre-operative interventions is welldocumented. Parents of children with hypospadias have been shown to retain little of the information provided in the standard hospital outpatient setting.1 Pre-operative educational interventions have not been documented in hypospadias2 . We present experience of our multidisciplinary hypospadias family seminars over 7 years (20122018) in a regional centre. The contribution to parents satisfaction, of various domains demonstrated through formal quantitative-qualitative analysis.peer-reviewe

Value of clinical, ultrasonographic and MRI signs as diagnostic differentiators of non-benign lipomatous tumours

Suspicion of malignant change within a lipoma is a common and increasing workload within the UK Sarcoma multidisciplinary team (MDT) network, and a source of considerable patient anxiety. Currently, there is no lipoma-specific data, with regard to which clinical or radiographic features predict non-benign histology, or calculate an odds-ratio specific to a lipomatous lesion being non-benign. We performed a 9-year, double-blind, unmatched cohort study, comparing post-operative histology outcomes (benign versus non-benign) versus 15 signs across three domains: Clinical (size of tumour, depth, growth noticed by patient, previous lipoma, patient felt pain), Ultrasonographic (size, depth, vascularity, heterogenous features, septae) and MRI (size, depth, vascularity, heterogenous features, septae, complete fat signal suppression). Receiver operating characteristic (ROC) analysis, odds ratios and binary logistic regression analysis was performed double-blind. When each sign is considered independently, (ROC analysis, followed by binary logistic regression) only Ultrasound depth is a significant predictor (p = 0.044) of a histologically non-benign lipoma. Ultrasonographically determined vascularity and septation were not statistically significant predictors. None of the clinical signs were statistically significant (p > 0.05). Of the MRI signs none was statistically significant (p > 0.05). However, heterogeneous MRI features fared better than MRI depth. Ultrasound signs (Pseudo R-Square = 0.105) are more predictive of the post-operation histology outcome than Clinical signs (Pseudo R-Square = 0.082) or MRI tests (Pseudo R-Square = 0.052) Ultrasound and Clinical tests combined (Pseudo R-Square = 0.147) are more predictive of the post-operation histology outcome than MRI tests (Pseudo R-Square = 0.052). This work challenges the traditional perception of “red-flag” signs when applied to lipomatous tumours. We provide accurate data upon which an informed choice can be made, and provides a robust bases for expedited risk/benefit. The importance of an experienced and cohesive MDT network is emphasised.peer-reviewe