Public health medicine in Malta : past, present and future

This article highlights some of the significant developments in public health including the pattern of disease in past centuries when emphasis was on sanitation and control of epidemics. The improved social conditions as well as health care developments during the past decades have not only changed this pattern, but have also modified the approach to public health. The future presents us with challenges which we must face through appreciation of the issues involved and the use of appropriate strategies.peer-reviewe

Hypercentral constituent quark model and isospin dependence

The constituent quark model based on a hypercentral approach takes into account three-body force effects and standard two-body potential contributions. The quark potential contains a hypercentral interaction, to which a hyperfine term is added. While the hypercentral potential supplies good values for the centroid energies of the resonance multiplets and a realistic set of quark wave functions, the hyperfine splittings are sometimes not sufficient to account for the observed masses. In this work we have introduced an improved form of the hyperfine interaction and an isospin dependent quark potential. The resulting description of the baryon spectrum is very good, also for the Roper resonance, specially thanks to the flavour dependent interaction.Comment: 12 pages, 2 figures, accepted by Eur. Phys. J.

Extra S11 and P13 in the Hypercentral Constituent Quark Model

We report on the recent results of the hypercentral Constituent Quark Model (hCQM). The model contains a spin independent three-quark interaction which is inspired by Lattice QCD calculations and reproduces the average energy values of the SU(6) multiplets. The splittings within each multiplet are obtained with a SU(6)-breaking interaction, which can include also an isospin dependent term. All the 3- and 4-stars resonances are well reproduced. Moreover, as all the Constituent Quark models, the hCQM predicts ``missing'' resonances ({\em e.g.} extra $S11$ and $P13$ states) which can be of some help for the experimental identification of new resonances. The model provides also a good description of the medium $Q^2$-behavior of the electromagnetic transition form factors. In particular the calculated helicity amplitude $A_{{1/2}}$ for the $S_{11}(1535)$ resonance agrees very well with the recent CLAS data. More recently, the elastic nucleon form factors have been calculated using a relativistic version of the hCQM and a relativistic quark current.Comment: 7 pages,3 figures, Talk given at NStar 2002 workshop on the physics of excited nucleons, Pittsburgh, Pennsylvania, October 9-12, 200

Electromagnetic Form Factors and the hCQM

We briefly report on results about the electromagnetic form factors of the nucleon obtained with different models and then we concentrate our attention on recent results obtained with the hypercentral constituent quark model (hCQM).Comment: 12 pages, 5 figures, Invited talk at 27th Symposium on Nuclear Physics, Taxco, Guerrero, Mexico, 5-8 Jan 200

Major incident triage: development and validation of a modified primary triage tool

Introduction A key principle in the effective management of a major incident is triage, prioritising patients on the basis of their clinical acuity. However, existing methods of primary major incident triage demonstrate poor performance at identifying the Priority One patient in need of a life-saving intervention. The aim of this thesis was to derive an improved triage tool. Methods The first part of the thesis defined what constitutes a life-saving intervention. Then using a retrospective military cohort, the optimum physiological thresholds for identifying the need for life-saving intervention were determined; the combination of which was used to define the Modified Physiological Triage Tool (MPTT). The MPTT was validated using a large civilian trauma database and a prospective military cohort. Subsequently, to describe the safety profile of the MPTT, an analysis of the implications of under-triage was undertaken. Finally, pragmatic changes were made to the MPTT (MPTT-24) - in order to provide a more useable method of primary triage. Statistical analysis was conducted using sensitivities and specificities, with triage tool performance compared using a McNemar test. Results 32 interventions were considered life-saving and the optimum physiological thresholds to identify these were a GCS <14, 12 < RR <22 and a HR < 100. Within both the military and civilian populations, the MPTT outperformed all existing methods of triage with the greatest sensitivity and lowest rates of under-triage, but at the expense of over-triage. Applying pragmatic changes, the MPTT-24 had comparable performance to the MPTT and continued to outperform existing methods. Conclusion The priority of primary major incident triage is to identify patients in need of life-saving intervention and to minimise under-triage. Fulfilling these priorities, the MPTT-24 outperforms existing methods of triage and its use is recommended as an alternative to existing methods of primary major incident triage. The MPTT-24 also offers a theoretical reduction in time required to triage and uses a simplified conscious level assessment, thus allowing it to be used by less experienced providers