Audit on the use of radiological investigations in the management of rhinosinusitis

Objectives: The aim of this audit is to establish the cost to the Maltese health system from the use of radiological imaging in managing rhinosinusitis and to identify areas in which these costs can be minimised by following guidelines on the management of rhinosinusitis. Methods: All plain radiographs and computed tomography scans (CT) of the paranasal sinuses requested in the Mater Dei Hospital over a one year period were analysed. Data was collected regarding: the quantity of investigations ordered, age of the patients, cost and requesting department. Results: Over one year: 205 CT scans and 113 sets of plain radiographs of the paranasal sinuses were requested, costing a total of euro103,440. The majority (73%) were elective requests made by ENT consultants. Five percent of CT scans were requested for patients less than 10 years of age. Conclusion: Rhinosinusitis is diagnosed clinically, only requiring radiological investigation in more complex cases best managed by specialists in ENT. Plain radiographs have limited use in the management of rhinosinusitis. Judicious use of imaging requests whilst following clinical guidelines is required to save money and minimise patient exposure to ionising radiation.peer-reviewe

The potential of low-intensity and online interventions for depression in low- and middle-income countries

The World Health Organization (WHO) reports that low- and middle-income countries (LMICs) are confronted with a serious ‘mental health gap’, indicating an enormous disparity between the number of individuals in need of mental health care and the availability of professionals to provide such care (WHO in 2010). Traditional forms of mental health services (i.e. face-to-face, individualised assessments and interventions) are therefore not feasible. We propose three strategies for addressing this mental health gap: delivery of evidence-based, low-intensity interventions by non-specialists, the use of transdiagnostic treatment protocols, and strategic deployment of technology to facilitate access and uptake. We urge researchers from all over the world to conduct feasibility studies and randomised controlled studies on the effect of low-intensity interventions and technology supported (e.g. online) interventions in LMICs, preferably using an active control condition as comparison, to ensure we disseminate effective treatments in LMICs

Environmental effects on the incidence of spontaneous pneumothorax

Spontaneous pneumothorax (SP) is a common occurrence especially in young male asthmatics and smokers. Several studies have shown that this condition occurs in clusters although other reports showed the contrary. There is evidence that clustering of cases occur as a result of severe changes in atmospheric pressure. The literature is however very limited with regards to the relationship between air pollution and spontaneous pneumothorax. Methodology: Observational study on consecutive patients admitted with SP from January 2010 to December 2014. The data regarding dates of admissions, gender, age, residential address, smoking history, relevant medical history and sequential management of the pneumothorax were collected and tabulated. The admission dates were analysed to test for clustering of admissions of patients. The patients were identified by location to assess the incidence of SP in different locations or areas. The Environment and Resources Agency (ERA) of Malta supplied daily particulate data from 3 different sites in the archipelago for the years 2010-1014. Results: There were 112 patients presenting with 134 episodes of SP. The mean age was 29 years and 86.6% were males. No admission date clustering occurred and therefore linkage to atmospheric pressure changes cannot be made. There was however a very significant increase in incidence in patients hailing from the harbour area (p < 0:00001). ERA data shows that there was a similarly significant increase in particulate material in the air of the harbour locality when compared to non- harbour areas. Discussion and Conclusion: SP is commoner in men and smokers. There was no evidence of admission day clustering but areas with increased air particulate matter had an increased incidence of patients with SP. Increased air pollution seems to increase the incidence of SP either directly or indirectly.peer-reviewe

An assessment of the distribution and abundance of dugongs and in-water, large marine turtles along the Queensland coast from Cape York to Hinchinbrook Island

This report includes recommendations based on key findings. The objective of this project was to assist the Reef Authority and Queensland Government address requirements of the Reef 2050 Long-Term Sustainability Plan

Chapter 08: Vulnerability of seagrasses in the Great Barrier Reef to climate change

Seagrasses are flowering plants and, along with mangroves, have greater affinities to terrestrial plants than other marine macrophytes such as algae. Approximately 55 species of seagrass occur in five different plant families and represent at least three independent evolutionary lineages. Thus, seagrasses are not a taxonomically unified group but a ‘biological’ or ‘ecological’ group85,149. The evolutionary adaptations required for survival in the marine environment have led to convergence in morphology. Seagrasses evolved under differing ambient CO2 and temperature conditions so may have different tolerances to changing environmental conditions. A wide range of tolerances across marine environments exist amongst the extant diversity of seagrasses, reflecting their substantial adaptive capacity as a group.This is Chapter 8 of Climate change and the Great Barrier Reef: a vulnerability assessment. The entire book can be found at http://hdl.handle.net/11017/13

An investigation of the effects of stage of ensilage on Nassella neesiana seeds, for reducing seed viability and injury to livestock

The noxious weed Nassella neesiana is established on a wide range of productive land throughout southeastern Australia. N. neesiana seeds, when mature, are sharp, causing injury to livestock, thus posing a problem in fodder bales. To reduce infestations of agricultural weeds in situ, production of silage from weed-infested pastures is practised as part of integrated weed management (IWM). However, there is little data to demonstrate whether this process is useful to reduce infestations or the harmful properties of N. neesiana. Therefore, the minimum duration of ensilage required to reduce the viability of N. neesiana seeds was investigated, both with and without addition of ensilage inoculants in this process. Also, the decreasing propensity of the seeds to injure livestock, after various times and conditions of ensilage, was assessed. Ensilage inoculant reduced seed germination probability to zero after 35 days. When no inoculant was added, zero viability was achieved after 42 days. A qualitative assessment of the hardness of ensilaged seeds found seed husks were softer (and therefore safer) after 42 days, whether inoculant was used or not. Therefore, we suggest that both the viability of N. neesiana seeds and hardness of seed casings are significantly reduced after 42 days, thereby reducing the risks of seed dispersal and injury to livestock

Design for micro milling guidelines

Miniaturisation of parts is emerging as an important approach to satisfy modern industrial and customer needs. Micro milling is one of the basic micromachining technologies used toproduce miniaturised components. It differs from conventional machining in that the handling and machining of very small features generates various problems. As a consequence, designers need to consider such problems during design to make micromilling more feasible. More emphasis thus needs to be placed on deriving design know-how from the other product life-phases. This paper reports the work undertaken by the Department of Manufacturing within the University of Malta to generate a set of Design for Micromilling (DFμM) guidelines that can contribute to the development to intelligent CAD for this domain.peer-reviewe

Considerations on the Numerical Modeling and Performance of Axial Swirlers Under Relight Conditions

Numerical modeling of aero engine combustors under relight conditions is a matter of continuously increasing importance due to the demanding engine certification regulations. In order to reduce the complexity and the cost of the numerical modeling, common practice is to replace the atomizer&apos;s swirlers with velocity profiles boundary conditions, very often scaled down from nominal operating conditions assuming similarity of the swirler flowfield. The current numerical study focuses on the flowfield characteristics of an axially swirled atomizer operating within a windmilling engine environment. The scalability of the velocity profile from higher power settings is examined. Observations on the performance of the axial swirler under relight conditions are also made. Experimental data was used as a validation platform for the numerical solver, after a grid sensitivity study and a turbulence model selection process. Boundary conditions for simulating the windmilling environment were extracted from experimental work. The swirler axial and tangential velocity profiles were normalized using the swirler inlet velocity. Results showed that both profiles are only scalable for windmilling conditions of high flight Mach number (! 0.5). At low flight Mach numbers, the actual profile had a lower velocity than that predicted through scaling. The swirl number was found to deteriorate significantly with the flight velocity following a linear trend, reducing significantly the expected flame quality. As a consequence the burner is forced to operate at the edge of its stability loop with low certainty regarding its successful relight

Towards energy aware cloud computing application construction

The energy consumption of cloud computing continues to be an area of significant concern as data center growth continues to increase. This paper reports on an energy efficient interoperable cloud architecture realised as a cloud toolbox that focuses on reducing the energy consumption of cloud applications holistically across all deployment models. The architecture supports energy efficiency at service construction, deployment and operation. We discuss our practical experience during implementation of an architectural component, the Virtual Machine Image Constructor (VMIC), required to facilitate construction of energy aware cloud applications. We carry out a performance evaluation of the component on a cloud testbed. The results show the performance of Virtual Machine construction, primarily limited by available I/O, to be adequate for agile, energy aware software development. We conclude that the implementation of the VMIC is feasible, incurs minimal performance overhead comparatively to the time taken by other aspects of the cloud application construction life-cycle, and make recommendations on enhancing its performance