437 research outputs found
Selection of medication in hospitalised elderly patients with Angina Pectoris
Objective: To evaluate medication changes in hospitalised elderly patients diagnosed with angina pectoris and to compare the selection of medication with evidence-based treatment guidelines. Design: Review of medical notes and patient interview. Setting: St. Luke's Hospital, Malta; January - May 2001. Subjects: 226 patients, aged 60 years or over, with a history of chronic stable angina and a discharge diagnosis of angina. Main outcome measures: Prevalence of use of antiplatelet agents, lipid lowering agents, beta-blockers, calcium channel blockers, nitrates, potassium channel openers and cellular anti-ischaemic agents; presence of co-morbidities, concurrent medication and adverse effects. Results: Prior to discharge, 77% of patients were receiving antiplatelet agents and 27% were receiving lipid lowering agents. The most frequent anti-ischaemic agents used were nitrates (97%) and second-generation dihydropyridine calcium channel blockers (59%). Beta-blockers were used in 31% of patients and non-dihydropyridine calcium channel blockers were used in 4% of patients. Potassium channel openers (nicorandil) and cellular anti-ischaemic agents (trimetazidine) were used in 5% and 19% of patients respectively. Of patients discharged on a single anti-ischaemic agent, 96% were prescribed nitrates, while 64% of those on two agents were prescribed nitrates and dihydropyridine calcium channel blockers. Beta-blockers, nicorandil and trimetazidine were generally used in conjunction with at least two other antiischaemic agents. The major medication changes involved the addition, or increase in dose, of amlodipine and isosorbide dinitrate. The major determinants affecting choice of medication were age and co-morbidities. Conclusion: Medication selection for chronic stable angina was not in accordance with treatment guidelines.peer-reviewe
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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
Business process management in health care : current challenges and future prospects
The emphasis of performance management in health care is shifting from output or outcome-based to a system-based approach. In particular, clinicians and managers are re-focusing their attention on processes so as to achieve better health system performance, as a reaction to the financial crisis. Health care management is increasingly applying systems thinking and business process management (BPM) as philosophies, which have proved to make a difference in organizational performance and competitiveness to the industry at large. This commentary provides answers to five questions that emerged through a reflective exercise and use of secondary data sources and informal interviews. These questions are intended to contribute toward better understanding of the meaning and application of BPM by scholars and practitioners in health care management. The questions are as follows: What is BPM and is it relevant to health care? Has BPM been extensively applied to health care? Why focus on quality in health care delivery? What are the current challenges of health care and can BPM help? What role BPM will play in future to facilitate effective health care management?peer-reviewe
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Greenhouse gas emissions from non-recyclable residual household waste within domestic wheeled bins
The evolution of greenhouse gases (GHGs) from waste treatment processes (e.g. landfill & composting) are well documented (Chen and Lin, 2008), frequently quantified (Lou and Nair, 2009) and currently represented within climate change models (Ciais et al., 2013). Conversely, the understanding of GHG emissions from household waste (pre-collection) is largely unknown and confined to composting studies (e.g. Andersen et al., 2010), or calculating the calorific value/elemental content (Komilis et al., 2012) and biological methane potential (Alibardi and Cossu, 2015) of municipal solid waste. Generating a better understanding of GHG fluxes from non-recycled residual household waste before collection may help to further refine climate models and inform policy makers regarding the best collection strategy to mitigate GHG emissions
Cross reactivity of an alloantigen present on normal cells with the tumour-specific transplantation-type antigen of the acute myeloid leukaemia (SAL) of rats.
Resistance can be induced in the syngeneic host (August rats) to a myelogeneous leukaemia of spontaneous origin, called SAL, by immunization with allogeneic cells derived form both normal and malignant tissues obtained from the Hooded rat strain. Serological experiments support the conclusion that the antigen involved-referred to as "Ho-SAL"-has the properties of a tumour specific transplantation-type antigen for SAL cells but is a widely expressed alloantigen found in both normal and malignant cells derived from Hooded rats. Antisera to it can be raised in Wistar rats
Post-surgery length of stay using multi-criteria decision-making tool
Purpose Length of stay (LOS) in hospital after surgery varies for each patient depending on surgeon’s decision that considers criticality of the surgery, patient’s conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients’ LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions. Design/methodology/approach The study adopts an action research involving multiple stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts’ opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS—medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions—the objective data of which are obtained from the patients’ files. Findings The proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks. Research limitations/implications The proposed method needs to be tested for other interventions across various healthcare settings. Practical implications Multi-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data. Originality/value Traditionally, the duration of post-surgery LOS is mainly based on the surgeons’ clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors’ knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method
Hymn to the heroes of Malta
Ä abra ta’ poeĹĽiji u proĹĽa li tinkludi: Alla fil-ħolqien ta’ Ä użè Agius Bonello – Is-sena u l-bniedem ta’ Ä użè Ellul-Mercer – Li tiĹĽra’ taħsad ta’ Vic. Apap – Huwa ta’ Gino Muscat-Azzopardi – Ĺ»ewġ friefet ta’ Vincent Caruana – IÄ‹-Ä‹agħka ta’ Ä użè Borg – Warda midbiela ta’ C. Gauci – It-tfajla tas-sulfarini ta’ Albert M. Cassola – L-aħħar traduzzjoni ta’ May Butcher qabel ma mietet – Hymn to the heroes of Malta.N/
Gelsolin superfamily proteins: key regulators of cellular functions
Abstract.: Cytoskeletal rearrangement occurs in a variety of cellular processes and involves a wide spectrum of proteins. Among these, the gelsolin superfamily proteins control actin organization by severing filaments, capping filament ends and nucleating actin assembly [1]. Gelsolin is the founding member of this family, which now contains at least another six members: villin, adseverin, capG, advillin, supervillin and flightless I. In addition to their respective role in actin filament remodeling, these proteins have some specific and apparently non-overlapping particular roles in several cellular processes, including cell motility, control of apoptosis and regulation of phagocytosis (summarized in table 1). Evidence suggests that proteins belonging to the gelsolin superfamily may be involved in other processes, including gene expression regulation. This review will focus on some of the known functions of the gelsolin superfamily proteins, thus providing a basis for reflection on other possible and as yet incompletely understood roles for these protein
Geomorphology of the north-eastern coast of Gozo (Malta, Mediterranean Sea)
The paper presents a geomorphological map of the north-eastern coast of the Island of Gozo (Malta) integrating inland and offshore areas at the scale 1:15,000. The map derives from the integration of different methods, such as aerial photo interpretation, field surveys and analysis of seafloor bathymetry. The landforms identified on land were shaped by coastal, fluvial, karst and gravity-induced processes, and some of them prolong on the seafloor. Most of the submerged landforms appear to have been modelled in subaerial conditions during sea-level lowstands, having been sealed by the rising sea in post-glacial times. Two sketches accompany the Main Map showing the type and distribution of coastal geomorphotypes and the land cover of the area
Assessment of human influenza pandemic scenarios in Europe
The response to the emergence of the 2009 influenza A(H1N1) pandemic was the result of a decade of pandemic planning, largely centred on the threat of an avian influenza A(H5N1) pandemic. Based on a literature review, this study aims to define a set of new pandemic scenarios that could be used in case of a future influenza pandemic. A total of 338 documents were identified using a searching strategy based on seven combinations of keywords. Eighty-three of these documents provided useful information on the 13 virus-related and health-system-related parameters initially considered for describing scenarios. Among these, four parameters were finally selected (clinical attack rate, case fatality rate, hospital admission rate, and intensive care admission rate) and four different levels of severity for each of them were set. The definition of six most likely scenarios results from the combination of four different levels of severity of the four final parameters (256 possible scenarios). Although it has some limitations, this approach allows for more flexible scenarios and hence it is far from the classic scenarios structure used for pandemic plans until 2009
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