The attitudes, knowledge and practices of Maltese family doctors in disease prevention and health promotion

Introduction: Family doctors are in a unique position to advocate health promotion and disease prevention, though it is known that this is not always given its due importance due to various reasons. Aim: To assess the knowledge, attitudes and practices of Maltese family doctors in health promotion and disease prevention. The results of the study were compared with a similar study in 2000. Methodology: A validated questionnaire was sent in 2011 to all Maltese general practitioners (GPs) and GP trainees. The results were analysed statistically. A focus group was conducted to discuss the results and develop a set of recommendations. Results: An improvement was seen in health promotion practice since 2000. Family doctors look after their own health better. However, they have difficulties regarding which prevention guidelines they should follow. Time constraints remain the biggest obstacle to promoting health. GPs who are involved in post- graduate teaching activities find it easier to promote health (p<0.05), while doctors working in both private and public settings find it most difficult (p<0.05). GPs who smoke find it harder to advise on smoking cessation (p<0.05), while doctors who are obese find it more difficult to recommend exercise (p<0.05). Conclusions and recommendations: Health promotion practice by family doctors is on the increase, yet there is clearly room for enhancement of their service. Web-based training, lectures and seminars would help family doctors to enhance their knowledge. Flyers, posters and video-clips in waiting areas could increase patient awareness on healthy lifestyles.peer-reviewe

Tree-mediated methane emissions from tropical and temperate peatlands

Methane production and transport processes in peatlands are fairly well understood, but growing evidence for emission of methane through trees has highlighted the need to revisit methane transport processes. In wetland trees, morphological adaptations such as development of hypertrophied lenticels, aerenchyma and adventitious roots in response to soil anoxia mediates gas transport, transporting both oxygen from the atmosphere to oxygen-deprived roots and soil-produced methane from the root-zone to the atmosphere. Although, tree-mediated methane emissions from temperate tree species have been confirmed, methane emissions from tropical tree species and processes that control tree-mediated methane emissions remain unclear. This study explains the role of trees in transporting soil-produced methane to the atmosphere and uncovers the principal mechanisms of tree-mediated methane emissions. Methane emissions from eight tropical tree species and two temperate tree species were studied in situ. The mechanisms and controls on tree-mediated methane emissions were investigated using three year old common alder (Alnus glutinosa; 50 trees) grown under two artificially controlled water-table positions. Methane fluxes from whole mesocosms, the soil surface and tree stems were measured using static closed chambers. Both temperate and tropical tree species released significant quantities of methane, with tropical trees dominating ecosystem level methane fluxes. In temperate peatlands, both the methane gas transport mechanism and quantity of methane emitted from stems is tree-species dependent. In Alnus glutinosa, no correlations were observed between stomatal behaviour and tree-mediated methane emissions, however, stem methane emissions were positively correlated with both stem lenticel density and dissolved soil methane concentration. In Alnus glutinosa, no emissions were observed from leaf surfaces. The results demonstrate that exclusion of tree-mediated methane emissions from flux measurement campaigns in forested peatlands will lead to an underestimation of ecosystem-wide methane emissions

An echocardiographic comparison of sutureless and conventional aortic valve replacement : a matched case-control study

Background: Patients at a high operative risk for conventional aortic valve replacement (AVR) may be offered sutureless valve implantation. Sutureless valves resemble conventional valves but incorporate an anchoring mechanism without using annular sutures. Methods Pre-operative and six month post-operative echocardiography data from our first year, single centre experience of sutureless valves was compared to conventional aortic valve replacements in patients matched for operative risk. Left ventricular ejection fraction, mean and peak AV gradients and inter-ventricular septal thickness, effective orifice area (EOA) and indexed effective orifice area (iEOA) were measured. Results The drops in mean and peak pre- to post-operative gradients were greater in the sutureless group, p=0.039 and p=0.001 respectively. Post-operative EOA was 1.69 cm2 and 1.26 cm2 (p=0.001) in the sutureless and conventional groups. Similarly iEOA was 0.93 cm2 and 0.74 cm2 (p=0.001) in the sutureless and conventional groups. There was also a reduction in patient prosthesis mismatch (PPM) in the sutureless group as compared to the conventional group (Chi square test p=0.026). Post-operative inter-ventricular septal thickness was 1.13 cm2 in the sutureless group and 1.35 cm2 in the conventional group (p=0.011). Conclusions Use of sutureless valves with a stent framework resulted in larger EOA and iEOA and a diminution in PPM; and lead to a statistically significant faster regression in inter-ventricular septal thickness that is a measure of left ventricular mass. The rate and extent of regression in left ventricular hypertrophy after AVR is important since it determines long-term survival including mortality, heart failure and decreased admission rates.peer-reviewe

Finding consensus without computation

A canonical problem for swarms of agents is to collectively choose one of multiple options in their environment. We present a novel control strategy for solving this problem-the first to be free of arithmetic computation. The agents do not communicate with each other nor do they store run-time information. They have a line-of-sight sensor that extracts one ternary digit of information from the environment. At every time step, they directly map this information onto constant-value motor commands. We evaluate the control strategy with both simulated and physical e-puck robots. By default, the robots are expected to choose, and move to, one of two options of equal value. The simulation studies show that the strategy is robust against sensory noise, scalable to large swarm sizes, and generalizes to the problems of choosing between more than two options or between unequal options. The experiments-50 trials conducted with a group of 20 e-puck robots-show that the group achieves consensus in 96% of the trials. Given the extremely low hardware requirements of the strategy, it opens up new possibilities for the design of swarms of robots that are small in size (≪10 -3 m) and large in numbers (≫10 3 )

Occlusion-based cooperative transport with a swarm of miniature mobile robots

This paper proposes a strategy for transporting a large object to a goal using a large number of mobile robots that are significantly smaller than the object. The robots only push the object at positions where the direct line of sight to the goal is occluded by the object. This strategy is fully decentralized and requires neither explicit communication nor specific manipulation mechanisms. We prove that it can transport any convex object in a planar environment. We implement this strategy on the e-puck robotic platform and present systematic experiments with a group of 20 e-pucks transporting three objects of different shapes. The objects were successfully transported to the goal in 43 out of 45 trials. When using a mobile goal, teleoperated by a human, the object could be navigated through an environment with obstacles. We also tested the strategy in a 3-D environment using physics-based computer simulation. Due to its simplicity, the transport strategy is particularly suited for implementation on microscale robotic systems

Pathophysiological mechanism of post-lobectomy air leaks

Background: Air leak post-lobectomy continues to remain a significant clinical problem, with upper lobectomy associated with higher air leak rates. This paper investigated the pathophysiological role of pleural stress in the development of post-lobectomy air leak.Methods: Preoperative characteristics and postoperative data from 367 consecutive video assisted thoracic surgery (VATS) lobectomy resections from one centre were collected prospectively between January 2014 and March 2017. Computer modelling of a lung model using finite element analysis (FEA) was used to calculate pleural stress in differing areas of the lung.Results: Air leak following upper lobectomy was significantly higher than after middle or lower lobectomy (6.3% versus 2.5%, P=0.044), resulting in a significant six-day increase in mean hospital stay, P=0.004. The computer simulation model of the lung showed that an apical bullet shape was subject to eightyfold higher stress than the base of the lung model.Conclusions: After upper lobectomy, the bullet shape of the apex of the exposed lower lobe was associated with high pleural stress, and a reduction in mechanical support by the chest wall to the visceral pleura due to initial post-op lack of chest wall confluence. It is suggested that such higher stress in the lower lobe apex explains the higher parenchymal air leak post-upper lobectomy. The pleural stress model also accounts for the higher incidence of right-sided prolonged air leak post-resection.peer-reviewe

Nullity of a graph with a cut-edge

The nullity of a graph is known to be an analytical tool to predict reactivity and conductivity of molecular π-systems. In this paper we consider the change in nullity when graphs with a cut-edge, and others derived from them, undergo geometrical operations. In particular, we consider the deletion of edges and vertices, the contraction of edges and the insertion of an edge at a coalescence vertex. We also derive three inequalities on the nullity of graphs along the same lines as the consequences of the Interlacing Theorem. These results shed light, in the tight-binding source and sink potential model, on the behaviour of molecular graphs which allow or bar conductivity in the cases when the connections are either distinct or ipso.peer-reviewe

Self-organized aggregation without computation

This paper presents a solution to the problem of self-organized aggregation of embodied robots that requires no arithmetic computation. The robots have no memory and are equipped with one binary sensor, which informs them whether or not there is another robot in their line of sight. It is proven that the sensor needs to have a sufficiently long range; otherwise aggregation cannot be guaranteed, irrespective of the controller used. The optimal controller is found by performing a grid search over the space of all possible controllers. With this controller, robots rotate on the spot when they perceive another robot, and move backwards along a circular trajectory otherwise. This controller is proven to always aggregate two simultaneously moving robots in finite time, an upper bound for which is provided. Simulations show that the controller also aggregates at least 1000 robots into a single cluster consistently. Moreover, in 30 experiments with 40 physical e-puck robots, 98.6% of the robots aggregated into one cluster. The results obtained have profound implications for the implementation of multi-robot systems at scales where conventional approaches to sensing and information processing are no longer applicable

Degradation Risk Assessment: Understanding the Impacts of Climate Change on Geoheritage

Several factors and processes, both natural and anthropogenic, can threaten the integrity of any geosite, leading to their degradation. For this reason, geoheritage degradation risks should be considered a fundamental step in any geoconservation strategy, all the more when the aim is to tackle the effects of climate change. The present work proposes a quantitative methodology for the degradation risk assessment of geosites by considering the extrinsic factors that can damage the geoheritage. The methodology has been tested on the Maltese Islands, where considerable previous research has been undertaken in order to highlight the international significance of the Maltese landscapes. Three criteria to assess the degradation risk are proposed: natural vulnerability, anthropogenic vulnerability and public use. For each criterion, several parameters have been identified in order to propose a detailed numerical evaluation. The results show that the degradation risk of geosites is mainly related to negligence and lack of knowledge of its inherent geological heritage, and which leads to public misuse and mismanagement of the geosites. The results give an overview of the condition of the geosites and provide information for the design and management of suitable protection measures, especially in the light of future threats related to climate change

Coalescing Fiedler and core vertices

The nullity of a graph G is the multiplicity of zero as an eigenvalue in the spectrum of its adjacency matrix. From the interlacing theorem, derived from Cauchy’s inequalities for matrices, a vertex of a graph can be a core vertex if, on deleting the vertex, the nullity decreases, or a Fiedler vertex, otherwise. We adopt a graph theoretical approach to determine conditions required for the identification of a pair of prescribed types of root vertices of two graphs to form a cut-vertex of unique type in the coalescence. Moreover, the nullity of subgraphs obtained by perturbations of the coalescence G is determined relative to the nullity of G. This has direct applications in spectral graph theory as well as in the construction of certain ipso-connected nano-molecular insulators.peer-reviewe