Biodiversity conservation and utilisation in the Maltese Islands

The Maltese archipelago which occupies an area of c.316km2 consists of the inhabited islands of Malta, Gozo and Comino and several other uninhabited islets and rocks. In spite of their restricted area, the limited number of habitats, and the intense human pressure, the Maltese Islands support a very diverse terrestrial and freshwater biota, with some 2000 species of plants and fungi known, more than 4000 species of insects, several hundred species of other invertebrates, and more than 200 terrestrial or freshwater vertebrates; of these c.80 taxa are considered as endemic. The most characteristic terrestrial ecosystems are those represented by the Mediterranean scrubland, of which the maquis, garigue and steppe are the main types present - evergreen woodlands are all but extinct and only four relict patches occur. Minor terrestrial ecosystems include rupestral, freshwater and coastal communities including sand dunes, saline marshlands and rocky coasts. Marine communities include those characteristic of both hard and mobile substrata. Human impact is significant, and human influence is a key feature of the islands' ecology. In fact, the population density is the highest in Europe and built-up areas have increased from 5 to 16% in the past 30 years. Some 38% is agricultural land and 46% of the area is undeveloped, but even so, no wilderness areas remain in the Maltese Islands. The management practices of the islands include mainly those concerned with agriculture, animal husbandry and herding, and the use of fire, which all proved to be detrimental to the local biota, mainly through habitat destruction, the removal of competing species and the introduction of alien ones, particularly goats, rabbits and sheep. All these human activities have put great stress on the Maltese biodiversity, with a consequent impoverishment of the flora and fauna. Flora and fauna which are directly or indirectly exploited in the Maltese Islands are reviewed. Work on biodiversity carried out by national institutions, government departments, agencies and non-governmental organisations is also outlined. Legislation safeguarding biodiversity is relatively new to Malta. Prior to the Environment Protection Act [EPA] (1991), and the Development Planning Act [DPA] (1992), legislation mainly protected species due to their associated economic importance. Both the EPA and DPA have permitted the creation of protected areas. The EPA also protects some of the flora and fauna, including some 10% of the endemics. The DPA, on the other hand incorporates the Structure Plan for the Maltese Islands which is a strategic plan meant to harmonise development with conservation. On the international level, Malta is party to the Washington Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) which is implemented locally by means of regulations controlling trade in species of flora and fauna (1992). Malta is also party to the Ramsar Convention, the Berne Convention, the Barcelona Convention, the Convention on Biological Diversity, and the Law of the Sea Convention.peer-reviewe

Comparing Categorical and Probabilistic Fingerprint Evidence

Fingerprint examiners traditionally express conclusions in categorical terms, opining that impressions do or do not originate from the same source. Recently, probabilistic conclusions have been proposed, with examiners estimating the probability of a match between recovered and known prints. This study presented a nationally representative sample of jury‐eligible adults with a hypothetical robbery case in which an examiner opined on the likelihood that a defendant\u27s fingerprints matched latent fingerprints in categorical or probabilistic terms. We studied model language developed by the U.S. Defense Forensic Science Center to summarize results of statistical analysis of the similarity between prints. Participant ratings of the likelihood the defendant left prints at the crime scene and committed the crime were similar when exposed to categorical and strong probabilistic match evidence. Participants reduced these likelihoods when exposed to the weaker probabilistic evidence, but did not otherwise discriminate among the prints assigned different match probabilities

Polypharmacy and potentially inappropriate medication use in geriatric oncology.

Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in geriatrics, and particularly in geriatric oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods

Measuring a Safety Culture: Critical Pathway or Academic Activity?

he Institute of Medicine (IOM) identified six core needs in a health care system, the first of which was safety. 1 Furthermore, several IOM committees and others have identified the creation of a “culture of safety ” as the key institutional requirement to achieve safe medical care. 1–3 In this issue of the journal, Modak et al. 4 present an instrument that may help measure the extent to which a patient safety culture exists in an ambulatory setting. While these authors and others have done considerable work on defining and measuring a culture of safety in the hospital setting, 5,6 few have tackled the difficult task of measuring a safety culture in the ambulatory arena within the US health care system. Even in the hospital setting, where there has been more effort, the development of a culture of safety within all US hospitals has been spotty and, for some safety advocates, too slow. 7 There are many potential reasons for the poor progress in developing a culture of safety: confusion about the difference between safety and quality, concerns that increasing safety will further erode profits, or perhaps simply a lack of attention by institutional leaders. Whatever the reasons for the slow pace of transformation across the nation’s 5,000-plus hospitals, it is likely that this transformation will be even more difficult to achieve in the much larger and more diverse ambulatory setting. Thus, it is important to define and measure an ambulatory culture of safety. It is also difficult, perhaps impossible, to change beliefs, attitudes, knowledge, or actions (all components of a “culture”) without some form of feedback. Therefore, a necessary step in creating a culture of safety is to develop tools to measure the components of that culture. For those individuals and institutions that wish to truly improve the safety of the care they deliver, the creation and testing of tools such as the Safety Attitudes Questionnaire-Ambulatory (SAQ-A) version is critical. Beliefs, attitudes, and knowledge do not always lend themselves to clear-cut end points. Thus, we can expect to see more than one safety culture measuremen

Determinants of Mortality and Loss to Follow-Up among Adults Enrolled in HIV Care Services in Rwanda

Antiretroviral therapy (ART) improves morbidity and mortality in patients with HIV, however high rates of loss to follow-up (LTF) and mortality have been documented in HIV care and treatment programs. We analyzed routinely-collected data on HIV-infected patients ≥15 years enrolled at 41 healthcare facilities in Rwanda from 2005 to 2010. LTF was defined as not attending clinic in the last 12 months for pre-ART patients and 6 months for ART patients. For the pre-ART period, sub-distribution hazards models were constructed to estimate LTF and death to account for competing risks. Kaplan-Meier (KM) and Cox proportional hazards models were used for patients on ART. Low rates of LTF and death were founds among pre-ART and ART patients in Rwanda but greater efforts are needed to retain patients in care prior to ART initiation, particularly among those who are healthy at enrollment

Development of a context model to prioritize drug safety alerts in CPOE systems

Background: Computerized physician order entry systems (CPOE) can reduce the number of medication errors and adverse drug events (ADEs) in healthcare institutions. Unfortunately, they tend to produce a large number of partly irrelevant alerts, in turn leading to alert overload and causing alert fatigue. The objective of this work is to identify factors that can be used to prioritize and present alerts depending on the 'context' of a clinical situation. Methods: We used a combination of literature searches and expert interviews to identify and validate the possible context factors. The internal validation of the context factors was performed by calculating the inter-rater agreement of two researcher's classification of 33 relevant articles. Results: We developed a context model containing 20 factors. We grouped these context factors into three categories: characteristics of the patient or case (e. g. clinical status of the patient); characteristics of the organizational unit or user (e. g. professional experience of the user); and alert characteristics (e. g. severity of the effect). The internal validation resulted in nearly perfect agreement (Cohen's Kappa value of 0.97). Conclusion: To our knowledge, this is the first structured attempt to develop a comprehensive context model for prioritizing drug safety alerts in CPOE systems. The outcome of this work can be used to develop future tailored drug safety alerting in CPOE systems

Targeting brains, producing responsibilities:The use of neuroscience within British social policy

AbstractConcepts and findings ‘translated’ from neuroscientific research are finding their way into UK health and social policy discourse. Critical scholars have begun to analyse how policies tend to ‘misuse’ the neurosciences and, further, how these discourses produce unwarranted and individualizing effects, rooted in middle-class values and inducing guilt and anxiety. In this article, we extend such work while simultaneously departing from the normative assumptions implied in the concept of ‘misuse’. Through a documentary analysis of UK policy reports focused on the early years, adolescence and older adults, we examine how these employ neuroscientific concepts and consequently (re)define responsibility. In the documents analysed, responsibility was produced in three different but intersecting ways: through a focus on optimisation, self-governance, and vulnerability. Our work thereby adds to social scientific examinations of neuroscience in society that show how neurobiological terms and concepts can be used to construct and support a particular imaginary of citizenship and the role of the state. Neuroscience may be leveraged by policy makers in ways that (potentially) reduce the target of their intervention to the soma, but do so in order to expand the outcome of the intervention to include the enhancement of society writ large. By attending as well to more critical engagements with neuroscience in policy documents, our analysis demonstrates the importance of being mindful of the limits to the deployment of a neurobiological idiom within policy settings. Accordingly, we contribute to increased empirical specificity concerning the impacts and translation of neuroscientific knowledge in contemporary society whilst refusing to take for granted the idea that the neurosciences necessarily have a dominant role (to play)