The applied knowledge test : theory and practice

The Applied Knowledge Test (AKT) forms part of the summative assessment for the Membership of the Malta College of Family Doctors (MMCFD). Candidates who are successful in the summative assessment and who have successfully finished the Specialist Training Programme in Family Medicine are awarded the MMCFD and the MRCGP[Int] on the basis of a tripartite agreement in place between the Government of Malta, the Malta College of Family Doctors and the Royal College of General Practitioners. This article looks at the local setup of the AKT. It explains the whole process from item writing, to piloting, blueprinting and standard setting. The article also attempts to explore the theory behind the AKT that underpins it as a reliable, valid, educational, cost-effective and acceptable mode of assessment within Miller’s pyramid of clinical competence.peer-reviewe

An analysis of the effect of educational environment on burnout : a cross-sectional observational study of trainee doctors at the Malta Foundation Programme

BACKGROUND: A suboptimal educational environment has been associated with effects on both patient care and trainee wellbeing. Burnout is associated with negative effects at both the personal and the institutional level. The role of the educational environment in the development of burnout has been studied in many countries. This is the first such study in a Maltese population.METHODS: The aim of this study was to analyse the effect of the educational environment on the prevalence of burnout among doctors within the Malta Foundation Programme. A cross-sectional observational methodology using Google Forms was adopted. The questionnaire was distributed to all Foundation and Extended Foundation doctors. The Postgraduate Hospital Educational Environment Measure (PHEEM) was used to assess the educational environment as perceived by the Foundation doctors. The Copenhagen Burnout Inventory (CBI) was used to analyse burnout among Foundation doctors. SPSS v25.0 was used for statistical analysis using a threshold for statistical significance of p < 0.05 and 95% confidence interval.RESULTS: Both PHEEM and CBI showed good reliability scores. The educational environment was deemed as more positive than negative with ample room for improvement. High burnout rates were recorded. There was a highly significant negative correlation between autonomy, teaching and social support, and personal, work-related and client-related burnout. The results show that there is a significant association between the learning environment and burnout.CONCLUSION: The high level of burnout identified is a cause for concern and calls for action aimed at improving the wellbeing of these young doctors. An improved educational environment can improve the quality and safety of patient care, as well as improve the mental and physical health of the trainees.peer-reviewe

Mental healthcare services support: the social role of medical educator involved in the destigmatization process to generate inclusion.

Introduction: The stigmatization of mental healthcare services and users is a barrier to the achievement of mental wellness present on a global level. 800000 suicides are estimated each year, 25 suicide attempts for every suicide (ratio of 25:1), and in 2017 estimated a prevalence &gt; 10% of people suffering from mental disorder or substance abuse (global data). The stigmatization is a multifactorial phenomenon and process that involves different factors, which overall cause health, social and economic damage. Slowing down and reducing access to mental health and well-being pathways due to their influence in the community, also affect social relationships and self-determination. Purpose: to identify and describe the process, causes, and factors of stigmatization. Propose destigmatization activities led by the medical educator. Methodology: The manuscript develops a proposal focused on the destigmatization process of mental health/wellbeing services and users, through the guidance of the medical educator as a figure of connection between different professions (interdisciplinary and multidisciplinary), and between different stakeholders. Conclusion: each identifies factor described, can be involved in the destigmatization process to generate inclusion, through different social interventions led by the role of the medical educator, with the aim of supporting access to patient support processes and quality of life in communities, generating inclusion through destigmatizatio

Dynamic Ferromagnetic Hysteresis Modelling Using a Preisach-Recurrent Neural Network Model

In this work, a Preisach-recurrent neural network model is proposed to predict the dynamic hysteresis in ARMCO pure iron, an important soft magnetic material in particle accelerator magnets. A recurrent neural network coupled with Preisach play operators is proposed, along with a novel validation method for the identification of the model's parameters. The proposed model is found to predict the magnetic flux density of ARMCO pure iron with a Normalised Root Mean Square Error (NRMSE) better than 0.7%, when trained with just six different hysteresis loops. The model is evaluated using ramp-rates not used in the training procedure, which shows the ability of the model to predict data which has not been measured. The results demonstrate that the Preisach model based on a recurrent neural network can accurately describe ferromagnetic dynamic hysteresis when trained with a limited amount of data, showing the model's potential in the field of materials science

A narrative review of anaemia in the elderly in a primary care setting

BACKGROUND: Anaemia in the elderly is a common finding. Its causes are multiple and its management will depend on the underlying cause.OBJECTIVE: The aim of this article is to review the latest literature on anaemia in the elderly with a specific focus on the primary care setting.METHOD: A search for review articles using the MeSH words “Elderly” OR “Older People” OR “Older Persons” or “Age 65+” AND “anaemia” OR “anemia” AND “primary care” was carried out on Medline EBSCO for articles in English published between 2012 and 2022. The PRISMA guideline was followed in the selection of articles to ensure research rigour. The initial search yielded 931 articles which were finally reduced to 17 articles.RESULTS: The topics discussed in the selected articles were varied. The vast majority gave a broad overview of anaemia. Others focused on specific aspects of anaemia like treatment, iron deficiency anaemia, autoimmune hemolytic anaemia, chronic kidney disease, the role of nutrition and the inflammatory pathways leading to anaemia.DISCUSSION: The authors focused on themes that came out of the selected papers, namely: symptoms and significance, causes, approach to investigations and therapeutic options.CONCLUSION: Anaemia is a common finding in the elderly population and it should not be considered as a normal aging process. Proper investigation can frequently elucidate the cause and provide adequate treatment.peer-reviewe

Communication between primary health care and the emergency department during transfer of care of patients in Malta

BACKGROUND: Communication is important within the healthcare system. Communication failure can have negative effects on patients as it can result in adverse events.OBJECTIVE: To investigate the communication between the emergency department and primary health care in Malta using qualitative methods.METHOD: The data for this study was collected via semistructured interviews conducted in 2021- 2022. The interviews were carried out online for convenience and safety measures due to COVID-19. The data collected was qualitative in nature. Twelve participants were involved in the study: four from the emergency department, four from private general practice and four from public general practice. The data collected was transcribed. The transcripts were confirmed with the participants, and analysed using the thematic analysis method to elicit common themes.RESULTS: The themes elicited were introduction to roles and similarities between them; frequency of communication; reasons for communication; the current methods of communication and opinions; recommendations; nurturing relationships and respect; and the physician’s perception of the patient’s experience.CONCLUSION: Participants shared different ideas on how to improve communication and inter-personal relationships. The consensus was that, over the years, there has been an improvement in communication. However, there was still room for improvement. Several participants were in favour of improving direct contact, mainly by calling.peer-reviewe

Resistance Analysis for a Trimaran

Importance has been given to resistance analysis for various types of vessels; however explicit guidelines applied to multihull vessels have not been clearly defined. The purpose of this investigation is to highlight the importance of the vessel's layout in terms of three axes positioning, the transverse (separation), the longitudinal (stagger) and the vertical (draught) with respect to resistance analysis. A vessel has the potential to experience less resistance, at a particular range of speeds, for a vast selection of hull positioning. Many potential layouts create opportunities of various design for both the commercial and leisure market

Performance comparison of nuclear magnetic resonance and FerriMagnetic resonance field markers for the control of low-energy synchrotrons

A field marker is a magnetic field sensor used in synchrotrons, which provides a digital trigger when the magnetic field reaches a pre-set threshold. This paper describes the results of an in-situ measurement performed on the Extra Low ENergy Antiproton (ELENA) decelerator's main bending dipoles at the European Organization for Nuclear Research (CERN). It compares the dynamic behavior of Nuclear Magnetic Resonance (NMR) markers and FerriMagnetic Resonance (FMR) markers in different magnetic fields for the operation of these sensors in low-energy synchrotrons.peer-reviewe

Error characterization and calibration of real-time magnetic field measurement systems

In synchrotrons at the European Organization for Nuclear Research (CERN), magnetic measurement systems known as B-trains measure the magnetic field in the main bending magnets in real-time, and transmit this signal for the control of the synchrotron’s RF accelerating cavities, magnet power converter and beam monitoring systems. This work presents an assessment of the capabilities and performance of the new FIRESTORM (Field In REal-time STreaming from Online Reference Magnets) system as part of the first phase of commissioning. A short summary of the architecture of the measurement system is provided first, followed by the definition of an error model which can be used to characterize random and systematic errors separately. We present a procedure for the metrological calibration and qualification of the B-trains, including an experimental evaluation of the different error sources for the four new systems being commissioned in the Proton Synchrotron Booster (PSB), Low Energy Ion Ring (LEIR), Proton Synchrotron (PS) and the Extra Low ENergy Antiproton (ELENA) ring. In particular, we discuss a method to calibrate systematic gain and offset errors based on the RF cavity frequency offset needed to center the beam on its theoretical orbit

Optical Probing of Ultrafast Laser-Induced Solid-to-Overdense-Plasma Transitions

Understanding the target dynamics during its interaction with a relativistic ultrashort laser pulse is a challenging fundamental multi-physics problem involving at least atomic and solid-state physics, plasma physics, and laser physics. Already, the properties of the so-called pre-plasma formed as the laser pulse's rising edge ionizes the target are complicated to access in experiments and modeling, and many aspects of this laser-induced transition from solid to overdense plasma over picosecond time scales are still open questions. At the same time, applications like laser-driven ion acceleration require precise knowledge and control of the pre-plasma because the efficiency of the acceleration process itself crucially depends on the target properties at the arrival of the relativistic intensity peak of the pulse. By capturing the dynamics of the initial stage of the interaction, we report on a detailed visualization of the pre-plasma formation and evolution. Nanometer-thin diamond-like carbon foils are shown to transition from solid to plasma during the laser rising edge with intensities < 10^16 W/cm^2. Single-shot near-infrared probe transmission measurements evidence sub-picosecond dynamics of an expanding plasma with densities above 10^23 cm^-3 (about 100 times the critical plasma density). The complementarity of a solid-state interaction model and a kinetic plasma description provides deep insight into the interplay of ionization, collisions, and expansion