Swollen limbs and bone pain : a case report

A 50 year old man presented with peripheral oedema, abdominal distension and a pulmonary opacity on CXR. He subsequently perforated his sigmoid colon as a complication of diverticulitis with pericolic abscess. After colectomy his postoperative period was marked by severe hypokalaemia, metabolic alkalosis, hyperglycaemia and recurrent chest infections. Paraneoplastic Cushing's syndrome was diagnosed after finding elevated serum cortisol and ACTH levels. CT-guided biopsy of the lung lesion revealed small-cell carcinoma. Bone scan disclosed collapse of numerous thoracic vertebrae possibly due to osteoporosis or oncogenic osteomalacia. Treatment with steroid-synthesis blockers was commenced but the patient died before tumour-directed therapy could be started. Ectopic ACTH syndrome and oncogenic osteomalacia are discussed.peer-reviewe

Innovative Responses to the Healthcare Challenges Confronting India

Is India’s healthcare system keeping pace with India’s rate of economic growth? Opinions vary, but the general consensus is that India’s health system, while not falling behind, has to accelerate its reach, depth, and quality to avoid becoming an anchor on continued economic growth. There is, of course, a parallel question: To what extent can access to quality care be available to citizens of all socioeconomic levels? These universal and perennial questions are not unique to India but have a special urgency in the rapidly developing nation because progress in healthcare availability and health equity – or the lack thereof – will accelerate or deter growth as well as determine the future of political leaders.1 This chapter seeks to lay the groundwork for this book by elucidating the broad spectrum of challenges to the Indian healthcare system, and in turn their impact on society and the economy. The underlying purpose of the chapter, however, is to explore some of the creative approaches to addressing these challenges and to stimulate further innovative thinking into each of the challenges confronting India

A Hierarchal Planning Framework for AUV Mission Management in a Spatio-Temporal Varying Ocean

The purpose of this paper is to provide a hierarchical dynamic mission planning framework for a single autonomous underwater vehicle (AUV) to accomplish task-assign process in a limited time interval while operating in an uncertain undersea environment, where spatio-temporal variability of the operating field is taken into account. To this end, a high level reactive mission planner and a low level motion planning system are constructed. The high level system is responsible for task priority assignment and guiding the vehicle toward a target of interest considering on-time termination of the mission. The lower layer is in charge of generating optimal trajectories based on sequence of tasks and dynamicity of operating terrain. The mission planner is able to reactively re-arrange the tasks based on mission/terrain updates while the low level planner is capable of coping unexpected changes of the terrain by correcting the old path and re-generating a new trajectory. As a result, the vehicle is able to undertake the maximum number of tasks with certain degree of maneuverability having situational awareness of the operating field. The computational engine of the mentioned framework is based on the biogeography based optimization (BBO) algorithm that is capable of providing efficient solutions. To evaluate the performance of the proposed framework, firstly, a realistic model of undersea environment is provided based on realistic map data, and then several scenarios, treated as real experiments, are designed through the simulation study. Additionally, to show the robustness and reliability of the framework, Monte-Carlo simulation is carried out and statistical analysis is performed. The results of simulations indicate the significant potential of the two-level hierarchical mission planning system in mission success and its applicability for real-time implementation

Note on the diet of a Grey Long-eared Bat, Plecotus austriacus (Fischer, 1829) from Mdina. Malta (Chiroptera, Vespertilionidae)

The diet of a Grey Long-eared Bat, Plecotus austriacus, residing in a small room at the National Museum of Natural History in Mdina was analysed seasonally (spring and autumn) during a two-year period (2000-2001). Twenty-three species of moth were identified in the bat's prey remains.peer-reviewe

Healthcare Innovation Across Sectors: Convergences and Divergences

All of the sectors analyzed in this volume face the same dual challenge: the invention of new technology and assuring its long-term clinical adoption by customers. These challenges are neither easy nor inexpensive. For many of the sectors, the technology and the underlying science have encountered the same phenomenon as other technology development in other endeavors, namely convergence of many skills. Pharmaceutical and biotechnology firms – long accustomed to both random discovery and synthesis of bioactive chemicals or recombination of known active proteins – are now relying on genomic and proteomic foundations for drug discovery. These new sciences are just the first steps in the long process of drug development wherein tools such as bioinformatics must be integrated. As companies in the sector pursue new avenues of discovery and development, and as the associated costs spiral ever upward, healthcare systems throughout the world seek to rationalize care and lower overall costs. The industry has the added burden, therefore, of demonstrating the economic advantages of new drugs, thus giving rise to yet another new discipline, pharmaco-economics

On the introduction of Paranthrene tabaniformis (Rottemburg, 1775) in Malta (Insecta : Lepidoptera : Sesiidae)

The introduction of Paranthrene tabaniformis (Rottemburg) in· the Maltese Islands, an insect that is mainly associated with poplar trees (Populus sp.), is documented. Brief information is provided on the moth family Sesiidae with particular reference to the biology of P. tabaniformis. A brief overview of Maltese Sesiidae is included; previous records of Bembecia scopigera (Scopoli) were found to be incorrect as this material is B. albanensis tunetana (Le Cerf).peer-reviewe

The development of public mental health in Malta

Public health practitioners in Malta have been drivers of public mental health reform throughout the last twenty-five years. However, early political and financial support for the implementation of policy and strategy dwindled over the years. Whilst services continued to expand, these were not matched with the adequate injection of human and financial resources. Twenty years later, the mental health service is still experiencing problems of underfinancing as reflected by the dire state of the psychiatric hospital infrastructure, poor leadership, management and accountability structures, and a largely insufficient albeit dedicated workforce. In 2012, the enactment of the new Mental Health Act and the establishment of a Commissioner for Mental Health recharged a national focus on mental health. Mental health is now a subject for the local media, the public is more receptive, NGOs and professionals are more vocal, the significance of mental health in schools, homes, and the workplace is taking root, and the subject has gained increasing political will, culminating with the launch of a Mental Health Strategy document for consultation in December 2018. This is our window of opportunity to ensure that policies and strategies are now translated into resources and action that reap sustained improvement in population mental health and well-being for this and future generations.peer-reviewe

Perspectives on Developing Healthcare Managers in Africa: The Strathmore Business School's Healthcare Management Programme

A substantial shortage of qualified healthcare professionals in Africa continues, but it is now apparent that professionally trained healthcare managers are an equally important need. Health facilities in Africa typically promote physicians into the role of general manager, but physicians and their lay counterparts routinely admit to being ill-prepared for roles as leaders of health systems, healthcare facilities and other services. Few, if any, degree programmes for healthcare management—be they master's in hospital administration or specialized MBA programmes— are available in these regions. And while many master's in public health programmes exist, inclusion of healthcare management content is often an afterthought. This article presents a prototype programme that was designed to address this gap. This comprehensive healthcare management MBA programme that was established at the Business School of Strathmore University in Nairobi, Kenya in 2013 was built around the “Leadership Competencies for Health Care Managers” as promulgated by the International Hospital Federation. The article further presents the development, structure and innovations of the programme, thus providing a blueprint for the development of similar programmes throughout the continent, aimed at addressing the substantial shortage of professionally trained healthcare managers

Radio direction finding for maritime search and rescue

Melbourne, VI

Report on the radiometric analysis of the Ghar Dalam fossil specimens prepared for the Ghar Dalam Museum

Uranium is a radioactive element emitting mainly alpha rays, but its daughter elements Th and Ra are gamma ray emitters. A high resolution gamma ray spectrometry system can be used to determine gamma-emitting radionuclides with energies ranging from 1 keV to 10 MeV depending on the type of detector in a large variety of sample matrices. The simultaneous detection of several gamma radionuclide emitters in the sample material was carried out with a coaxial germanium detector of high resolution connected to a multichannel analyser. Automatic processing of the collected spectral data was controlled by a computer system with selected software. Sources of error in the technique may be caused by improper spectral identities, changes in background, errors in calibration and/or geometry, and lack of homogeneity in samples. Since the samples tested were not in a standardised geometry, some variation in the readings could be expected due to the difference in sample homogeneity. The results obtained for the various samples were standardised as a ratio of 40K, on the assumption that the high solubility of potassium salts would result in a steady equilibrium in all samples. Several fossil specimens kept in the Ghar Dalam Museum were borrowed by courtesy of Dr. G. Zammit Maempel. The specimens had unfortunately no information as to the level they were excavated from, and their providence could not be reliably confirmed.peer-reviewe