SIDS and infant sleeping position : audit on the advisory campaign in Malta

Background: The baby’s sleeping position is the most important modifiable risk factor in Sudden Infant Death Syndrome (SIDS). The “back to sleep” position is safer than side or prone position. Objectives: To determine what advice midwives and nurses at St Luke’s Hospital give to new mothers about the baby’s sleeping position; and whether the practice has changed following a series of lectures on SIDS and a focused circular issued by the Department of Health in February 2007. Methods: A questionnaire-based, descriptive, and crosssectional before-after trial. Results: In 2007, 81% of midwives/nurses advised exclusive back sleeping position, compared to 38% in 2006 (p<0.0001). Conclusion: The audit demonstrates a notable increase in the number of midwives/nurses giving correct advice to the new mothers.peer-reviewe

The outcome of the follow-up of consolidations on chest radiographs in a Maltese population, presenting from the community, aged 50 or over : a retrospective study

Background: The British Thoracic Society (BTS) guidelines for community-acquired pneumonia (CAP) suggest a repeat chest radiograph 6 weeks after treatment for patients over the age of 50 to screen for lung malignancy. The benefit of this practice is not well determined. Method: We conducted a retrospective study involving patients from the community over 50 years old with consolidations on chest radiography. These patients presented in Mater Dei Hospital, Gozo General Hospital and Maltese Health Centres during the months of January 2013-2017 and August 2013-2016. The occurrence of follow-up imaging and subsequent diagnosis of lung malignancy was documented. All chest radiographs were reviewed by a radiologist. Results: 402 patients met our inclusion criteria. Follow-up imaging was done in 214 patients (53.2%) within 12 weeks. There was no statistical significance in the follow-up rates when matched for the presenting month, whether radiologists recommended repeat imaging, whether patients were admitted to hospital, and for the patients’ age and gender. The diagnostic yield of lung malignancy was 1.74% (7 patients) within 12 weeks with all malignancies being at an advanced stage at diagnosis (lowest stage being IIIA) when detected. All seven patients had a smoking history. Conclusion: 53.2% of community-acquired pneumonia patients over the age of 50 had follow-up imaging within 12 weeks. No clinical variables explaining this low rate could be identified. This practice results in a low diagnostic yield. Moreover, the diagnosis of lung malignancy is achieved at an advanced stage, making it a poor screening tool.peer-reviewe

Effects of rarefaction on cavity flow in the slip regime

The Navier-Stokes-Fourier equations, with boundary conditions that account for the effects of velocity-slip and temperature-jump, are compared to the direct simulation Monte Carlo method for the case of a lid-driven micro-cavity. Results are presented for Knudsen numbers within the slip-flow regime where the onset of nonequilibrium effects are usually observed. Good agreement is found in predicting the general features of the velocity field and the recirculating flow. However, although the steady-state pressure distributions along the walls of the driven cavity are generally in good agreement with the Monte Carlo data, there is some indication that the results are starting to show noticeable differences, particularly at the separation and reattachment points. The modified Navier-Stokes-Fourier equations consistently overpredict the maximum and minimum pressure values throughout the slip regime. This highlights the need for alternative boundary formulations or modeling techniques that can provide accurate and computationally economic solutions over a wider range of Knudsen numbers

Micro-scale cavities in the slip - and transition - flow regimes

Differences between Navier-Stokes-Fourier (NSF) slip/jump solutions and direct simulation Monte-Carlo (DSMC) computations are highlighted for a micro lid-driven cavity problem. The results indicate a need for better modelling techniques which at the same time retain low computational cost of NSF models. We also highlight the fact thatmany micro-flows that have been considered are simple planar flows and typical classification systems are defined on such flows. We show that for complex flows, such as thedriven cavity, non-equilibrium effects are more appreciable and their onset occurs at lower Knudsen numbers than expected

Validation of a competence profile for MR radiographers using a formal research process

Owing to the limited time for continuous professional development available and hence the impossibility of covering all the knowledge, skills and competences required for the full range of MR techniques available today, it’s important that competence profiles are context specific. This study sought to develop and validate a context specific competence profile for MR radiographers that would be necessary and sufficient to deliver the MR service portfolio and care pathway in Malta. The study forms part of a wider study on continuous professional development for MR radiographers in Malta.peer-reviewe

Exploring the effects of speed and scale on a ship's form factor using CFD

The problem of predicting a ship's form factor and associated scale effects has been subject to many investigations in recent years. In this study, an attempt is made to investigate whether the form factor is influenced by a change in the ship's speed by numerically modelling a geosim series of the KCS hull form by means of a RANS solver. The turbulence dependence of the problem is also studied by altering the closure model among three widely used approaches (the k-ω, k-ω SST, and k-ε models). The results show that at very low speeds (Froude numbers in the range of 0.02–0.06) the numerical model predicts changes in the form factor of a ship between 10% and 20%, depending on the turbulence model and scale factor choices. As the speed is increased further, the form factor exhibits little change, usually in the range of 1% or less. Simulations where the Reynolds number is changed by approximately two orders of magnitude, achieved by altering the value of viscosity, confirmed that the form factor can be considered Froude-dependent only for low speeds, predicting essentially identical values when high speed cases are considered

Numerically analysing liquid-cargo sloshing diminishment in partitioned rectangular tanks

This study puts forward an analysis of the influence of liquid sloshing upon oscillating vessels by means of numerical modeling. Rectangular cross-sectional tanks incorporating an open-bore and partitioned setups at 20%, 40%, and 60% fill-volume levels were implemented to establish the torque and static pressure exerted solely by the fluid dynamics upon oscillation within the tanks. Through verification of dam-break dynamics, the sloshing models coupled the explicit volume-of-fluid and non-iterative time-advancement schemes within a computational fluid dynamic solver. Utilising an oscillatory frequency of 1 Hz, the resultant liquid impact reduced within the partitioned setup due to the suppression of wave dynamics

A numerical analysis of dynamic slosh dampening utilising perforated partitions in partially-filled rectangular tanks

Conventional liquefied natural gas (LNG) cargo vessels are imposed with tank-fill limitations as precautions to prevent structural damage and stability-loss due to high-impact sloshing, enforcing cargo volume-fills to be lower than 10% or higher than 70% of the tank height. The restrictions, however, limit commercial operations, specifically when handling spot trades and offshore loading/unloading at multiple ports along a shipping route. The study puts forward a computational fluid dynamic (CFD) sloshing analysis of partially-filled chamfered rectangular tanks undergoing sinusoidal oscillatory kinetics with the use of the explicit volume-of-fluid and non-iterative time-advancement schemes utilising the commercial solver ANSYS-Fluent. Establishing a 20% to 60% fill-range, the sloshing dynamics were acknowledged within an open-bore, partitioned, and perforated-partitioned tank when oscillating at frequencies of 0.5 Hz and 1 Hz. The overall torque and static pressure induced on the tank walls were investigated. High-impact slamming at the tank roof occurred at 40% and 60% fills, however, the implementation of the partition and perforated-partition barriers successfully reduced the impact due to suppression and dissipation of the wave dynamics.peer-reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London