Community-Acquired Pneumonia : what is new in aetiology and treatment

Community-Acquired Pneumonia (CAP) remains a considerable problem in terms of morbidity, mortality and use of hospital resources despite the remarkable advances in antibiotic therapy. This study describes the changes in the pattern of pneumonias, as manifested by new diseases, new modes of transmission and new manifestations of old diseases.peer-reviewe

Interstitial lung disease in Malta

Aim: To establish the prevalence, management and response to treatment of interstitial lung disease (ILD) in Malta. Methodology: The personal files of 102 living and 26 deceased patients with ILD under the care of 4 respiratory physicians were reviewed retrospectively. The investigations utilised for reaching the diagnosis, patient management and response to treatment were analysed. Results: The prevalence of ILD was estimated at 24.9 per 100,000 population. Pulmonary function tests were performed at least once in 109 patients (n=128, 85%), and pletysmography and exercise oximetry in 36 patients (n=128, 28%). A chest x-ray (CXR) was performed in 120 patients (n=128, 93.7%), of which 8 (n=120, 6.66%) were normal, a computed tomography scan of the thorax in 113 patients (n=128, 88.3%), all of which showed fibrotic changes and a DTPA scan in 17 patients (n=128, 13.3%). Regarding more invasive investigations, bronchoalveolar lavage was performed in 10 patients (n=128, 7.8%), open lung biopsy in 4 patients (n=128, 3.1 %), video-assisted thoracoscopic surgery in 4 patients (n=128, 3.1%) and transbronchial lung biopsy in 7 patients (n=128, 5.5%). Corticosteroids were the most common drugs prescribed in 64 patients (n=128, 50%) followed by azathioprine in 23 patients (n=128, 18%) and cyclophosphamide in 3 patients (n=128, 2.3%). There was a definite worsening in lung function associated with increasing age. There was no standardisation of follow up for these patients. Conclusion: The method of diagnosis, management and follow up of patients with ILD locally requires improvement to optimise standards of care and hence compare with proposed international guidelines.peer-reviewe

Oxygen prescription and administration at the Emergency Department and medical wards in Mater Dei Hospital

Aims: The aim of this study was to audit current practices on oxygen prescription in the Emergency Department (ED), and on accurate oxygen administration in the wards of Mater Dei Hospital. Method: Two hundred and forty eight adult patients attending the ED with diagnoses most likely to require oxygen therapy (mainly cardio-respiratory conditions) were randomly selected during 5 winter weeks. Data were collected on oxygen saturation, arterial blood gases, oxygen administration at the ED, oxygen prescription and its documentation, and oxygen administration in wards. The z-test was used to assess statistical significance of results and Fisher’s exact test was used to determine the effect of oxygen prescription documentation in treatment charts. Results: Oxygen treatment was indicated in 85 of the 248 patients. Of these, documented oxygen administration at the ED was only present in 23.5% (p<0.0001). Formal instructions on oxygen use were documented in 85.9% (p<0.0001), however in 51.8% of these there were incomplete details. Only 7.1% of patients in whom oxygen treatment was prescribed received oxygen therapy in the wards according to instructions (p<0.0001). It was also found that documenting oxygen prescription in treatment charts made no significant difference to the number of patients who actually received oxygen correctly in the ward. Conclusion: This study shows that there is need for better prescription, documentation and administration of oxygen in our hospital. Introduction of simple standardized oxygen charts may ensure that oxygen prescription and monitoring in the ED is carried out properly and that these instructions are then faithfully carried out in our wards.peer-reviewe

Health and the Economy : a statement of concern

The relationship between health and the economy is an intimate and complex one. The economy of health and the apportioning of funds to different medical services and health care programs are issues that depend on the health profile of a given community as well as the expectations of its members. Decisions ultimately depend on available resources and political priorities. Health and the economy cannot be isolated and contrasted, as the integrity of a given economic system clearly depends on the state of health of the community both at an individual level as well as at a population level.peer-reviewe

The effect of a hospital oxygen therapy guideline on the prescription of oxygen therapy

Aim: To assess the effect of a hospital oxygen therapy guideline on oxygen prescription and administration at the emergency Department (ED) and medical wards of Mater Dei Hospital, Malta. Methods: Patients admitted to medical wards through the ED with conditions most likely to require oxygen therapy were recruited over 2 months in 2011. Data was collected on oxygen therapy prescription and administration. A hospital guideline on oxygen therapy was introduced and disseminated in 2015, following which data was collected again and compared to the 2011 data. A p value <0.05 was deemed to be statistically significant. Results: 248 and 293 patients were recruited in 2011 and 2015 respectively. Oxygen therapy was indicated in 34.3% and 31.4% of patients respectively (p=0.47). Oxygen saturation on air was not documented in 14.1% (2011) and 4.4% (2015) (p<0.01). In patients in whom oxygen therapy was indicated, correct documentation (including delivery device and flow rate) of oxygen therapy administered at ED improved from 23.5% to 73.9% (p<0.01), and correct oxygen therapy prescription in the management plan improved from 34.1% to 76.1% (p<0.01). In the medical wards, correct oxygen therapy administration according to prescription improved from 7.1% to 48.9% (p<0.01). 56.8% of patients in whom oxygen therapy was not indicated were prescribed oxygen anyway in 2011, improving to 27.1% after the guideline (p<0.05). Conclusion: Oxygen saturation, oxygen therapy prescription and documentation at the ED and oxygen therapy administration in the medical wards improved significantly at Mater Dei hospital, Malta, after a hospital guideline was introduced.peer-reviewe

Detection of conflicts in electronic contracts

Today’s trend towards service-oriented architectures, in which different decoupled services distributed not only on different machines within a single organisation but also outside of it, provides new challenges for reliability and trust. Since an organisation may need to execute code provided by third parties, it requires mechanisms to protect itself. One of such mechanisms is the use of contracts. Since services are frequently composed of different subservices, each with its own contract, there is a need to guarantee that each single contract is conflict-free. Moreover, one needs to ensure that the conjunction of all the contracts is also conflict-free —meaning that the contracts will never lead to conflicting or contradictory normative directives.peer-reviewe

The effect of a hospital oxygen therapy guideline on the prescription of oxygen therapy

Aim: To assess the effect of a hospital oxygen therapy guideline on oxygen prescription and administration at the emergency Department (ED) and medical wards of Mater Dei Hospital, Malta. Methods: Patients admitted to medical wards through the ED with conditions most likely to require oxygen therapy were recruited over 2 months in 2011. Data was collected on oxygen therapy prescription and administration. A hospital guideline on oxygen therapy was introduced and disseminated in 2015, following which data was collected again and compared to the 2011 data. A p value <0.05 was deemed to be statistically significant. Results: 248 and 293 patients were recruited in 2011 and 2015 respectively. Oxygen therapy was indicated in 34.3% and 31.4% of patients respectively (p=0.47). Oxygen saturation on air was not documented in 14.1% (2011) and 4.4% (2015) (p<0.01). In patients in whom oxygen therapy was indicated, correct documentation (including delivery device and flow rate) of oxygen therapy administered at ED improved from 23.5% to 73.9% (p<0.01), and correct oxygen therapy prescription in the management plan improved from 34.1% to 76.1% (p<0.01). In the medical wards, correct oxygen therapy administration according to prescription improved from 7.1% to 48.9% (p<0.01). 56.8% of patients in whom oxygen therapy was not indicated were prescribed oxygen anyway in 2011, improving to 27.1% after the guideline (p<0.05). Conclusion: Oxygen saturation, oxygen therapy prescription and documentation at the ED and oxygen therapy administration in the medical wards improved significantly at Mater Dei hospital, Malta, after a hospital guideline was introduced.peer-reviewe

Energy & crack tip stress interactions in mixed mode I/III fracture of DX51 steel sheets

DX51D sheet is subjected to mixed mode I/III loading in a purposely designed fixture apparatus. The resulting stable crack-tip growth, direction, slant angle and typical factory-roof crack were observed and discussed as the loading mixity was varied. The total essential work of fracture or fracture toughness, for each mixity loading, was evaluated adopting energy methods during experimentation, whilst theory details how the total may be separated into its individual mode components. The fracture type and direction of crack path were based on the von Mises failure theory and the fracture criteria of maximum shear stress, maximum hoop stress and maximum normal stress along with the application of Hill’s theory. The findings described clearly establish the link between the applications of the energy based equations governing crack initiation and propagation and the equations describing the stress field surrounding the crack tip in the mixed mode I/III field.peer-reviewe

Model checking concurrent assembly algorithms

Model checking has been used in various domains, to enable automatic verification of properties for a given model. Especially in cases when the correctness of the the model is not evident due to the complex nature of the description, model checking can be an indispensable tool. One such domain is the use of concurrent assembly algorithms for lowlevel synchronisation, which can be notoriously difficult to check their correctness or even test. In this paper we look at this domain, and explore the use of model-checking in verifying a number of such algorithms, such as barrier synchronisation and wait-free CSP channel communication. We tackle the state explosion problem inherent in model checking by making use of abstraction techniques to remove rendundant information in the the model, and partial-order techniques to remove redundant interleavings of actions. Finally, we also investigate the use of structural induction to reason about families of systems of arbitrary size. Making use of symmetry and induction, we verify algorithms with an unbounded number of identical participating tasks.peer-reviewe

Conflict analysis of deontic contracts

Industry is currently pushing towards Service Oriented Architecture where code execution is not limited to the organisational borders but may extend outside of the organisation to which the sources are typically not accessible. In order to protect the interests of the organisation contracts are used which can be seen as a list of obligations, permissions and prohibitions. The composition of different services with different con- tracts, and the combination of service contracts with local contracts can give rise to conflicts, exposing the need for automatic techniques for contract analysis. In this paper we investigate how conflict analysis can be performed automatically for contracts specified in the contract language CL.peer-reviewe