Medical education and the 21st century

Medical education at both the undergraduate and postgraduate levels has been undergoing continuous changes in the last 40 years. The author why future Maltese doctors should continue with their medical education and have the opportunity to specialize in their fields locally. The duty of the medical profession and the State is to ensure that such a programme is not only instituted but also supported and be actively monitored and audited.peer-reviewe

The major changes in medical practice in the 20th century

One could truly say that there were more advances in medicine in the last 60 years than there had been in the previous 500 years. Indeed the medical breakthroughs of the last 50 years have probably saved more lives than those of any epoch since medicine began. In this article the author examine the major changes in medical practice in the 20th century.peer-reviewe

Community-Acquired Pneumonia : what is new in aetiology and treatment

Community-Acquired Pneumonia (CAP) remains a considerable problem in terms of morbidity, mortality and use of hospital resources despite the remarkable advances in antibiotic therapy. This study describes the changes in the pattern of pneumonias, as manifested by new diseases, new modes of transmission and new manifestations of old diseases.peer-reviewe

Study made of ductility limitations of aluminum-silicon alloys

Study of the relation between microstructure and mechanical properties of aluminum-silicon alloys determines the cause of the variations in properties resulting from differences in solidification rate. It was found that variations in strength are a consequence of variations in ductility and that ductility is inversely proportional to dendrite cell size

The great simulator

Cardiac myxoma often simulates multisystem disease and initially defies diagnosis. In this paper, we present three cases of cardiac myxoma in adults. Their clinical features and differential diagnosis will be reviewed, with special emphasis on their insidiousness and suspicion necessary for correct and prompt diagnosis. The role of echocardiography in diagnosis and treatment will be discussed, and finally, the surgical management and prognosis is briefly outlined.peer-reviewe

Modeling of the heat transfer in bypass transitional boundary-layer flows

A low Reynolds number k-epsilon turbulence model and conditioned momentum, energy and turbulence equations were used to predict bypass transition heat transfer on a flat plate in a high-disturbance environment with zero pressure gradient. The use of conditioned equations was demonstrated to be an improvement over the use of the global-time-averaged equations for the calculation of velocity profiles and turbulence intensity profiles in the transition region of a boundary layer. The approach of conditioned equations is extended to include heat transfer and a modeling of transition events is used to predict transition onset and the extent of transition on a flat plate. The events, which describe the boundary layer at the leading edge, result in boundary-layer regions consisting of: (1) the laminar, (2) pseudolaminar, (3) transitional, and (4) turbulent boundary layers. The modeled transition events were incorporated into the TEXSTAN 2-D boundary-layer code which is used to numerically predict the heat transfer. The numerical predictions in general compared well with the experimental data and revealed areas where additional experimental information is needed

The Opacity of the Intergalactic Medium Measured Along Quasar Sightlines at z∼6z\sim 6

We publicly release a new sample of $34$ medium resolution quasar spectra at $5.77\leq z_{\rm em}\leq6.54$ observed with the Echellette Spectrograph and Imager (ESI) on the Keck telescope. This quasar sample represents an ideal laboratory to study the intergalactic medium (IGM) during the end stages of the epoch of reionization, and constrain the timing and morphology of the phase transition. For a subset of $23$ of our highest signal-to-noise ratio spectra (S/N$>7$, per $10\,{\rm km\,s^{-1}}$ pixel), we present a new measurement of the Lyman-$\alpha$ (Ly$\alpha$) forest opacity spanning the redshift range $4.8\lesssim z\lesssim6.3$. We carefully eliminate spectral regions that could be causing biases in our measurements due to additional transmitted flux in the proximity zone of the quasars, or extra absorption caused by strong intervening absorption systems along the line of sight. We compare the observed evolution of the IGM opacity with redshift to predictions from a hydrodynamical simulation with uniform ultraviolet background (UVB) radiation, as well as two semi-numerical patchy reionization models, one with a fluctuating UVB and another with a fluctuating temperature field. Our measurements show a steep rise in opacity at $z\gtrsim5.0$ and an increased scatter and thus support the picture of a spatially inhomogeneous reionization process, consistent with previous work. However, we measure significantly higher optical depths at $5.3\lesssim z\lesssim5.7$ than previous studies, which reduces the contrast between the highest opacity Gunn-Peterson troughs and the average opacity trend of the IGM, which may relieve some of the previously noted tension between these measurements and reionization models.Comment: accepted for publication at Ap

Antibiotic prescribing on two medical wards at St Luke’s Hospital : what scope for improvement?

Antibiotics are frequently prescribed drugs and form a significant part of the hospital budget. The literature suggests that prescribing is not without problems and may need constant review. We have no data relating to our hospital. This study aims to explore some aspects of antibiotic use in our setting. Records of all patients prescribed antibiotics on two medical wards over a 4 month period were analysed for indication, choice of antibiotic, outcome and cost. There were 126 patients: 54% males; 75.4%, >60 years old; 62% were admitted because of infection. Of the whole group, 8.7% received antibiotics with no evidence of infection and no indication for prophylaxis. There were 118 infections, 64% respiratory, 13.5% urinary and the rest of miscellaneous sites; 14% of infections were nosocomial. Microbiological studies were available in only 29% of infections. For 6 patients, the antibiotics prescribed were relatively contraindicated because of impaired hepatic and renal function. There was one adverse drug reaction. The total drug cost was Lm2181.79; i.v. treatment accounted for 93% of this cost and ceftazidime for 60%. There is room for improvement in the selection of antibiotics and their route of administration. The hospital microbiologists and the Antibiotic Policy should be consulted more often. Laboratory diagnosis of infection and biochemical patient monitoring are inadequate. Restricting i.v. treatment could reduce cost very substantially.peer-reviewe