Metastatic pancreatic cancer

A 69-year-old Caucasian woman who had recently been diagnosed with pancreatic cancer presented with severe low back pain associated with weakness and paresthesiae in her lower extremities. She had also developed urinary retention. She was diagnosed with spinal cord compression at T10-11 secondary to vertebral and epidural metastasis. In view of the poor prognosis, the patient was referred for palliative care. This case documents spinal cord compression secondary to bone metastasis, a rare complication of pancreatic cancer.peer-reviewe

Malignant disease in childhood : the price of cure : late physical and socioeconomic effects of treatment

The aim of cancer therapy in childhood is to achieve a lasting cure without physical and psychosocial harm and, preferably, at a low financial cost. Although cure is possible in many types of childhood cancer, this is often accompanied by complications as a consequence of intensive therapy. These late effects primarily affect fertility, the cardio-respiratory and endocrinological systems. Psychosocial adverse effects may have serious implications on the marriage and employment prospects of those patients surviving into adulthood. Furthermore, the risk of treatment-induced, secondary malignancies may increase as survival improves. With current intensive chemotherapy and radiotherapy, the attainment of cure rates in (EXC)ess of 60-70% is, inevitably, associated with significant morbidity. Indeed, recent developments in cancer therapy have focused on ways of reducing this morbidity, whilst still maintaining the overall improvement in survival.peer-reviewe

Atmospheric sulphur dioxide pollution in Malta : a preliminary study

The results of a preliminary survey of the air quality in Malta during May-December 1990 with respect to sulphur dioxide are presented. One-hour-average S02 concentrations as high as 320 ug m-3 have been measured from areas proximate to the Marsa power station. The concentration of S02 in ambient air was found to be strongly dependent on atmospheric conditions and especially on wind direction. At Paola, measured concentrations varied from below the detection limit of 25 ug m-3 to about 160 ug m-3. These preliminary results suggest that specific areas in Malta which are close to the Marsa power station may have an air pollution problem which is significantly more pronounced than that in other areas. The results also indicate the need for a thorough air monitoring programme which would allow the pollution problem to be assessed more accurately and to be followed continually.peer-reviewe

The corporate governance code and compliance by Maltese listed companies

Purpose: In this paper we lay out the evaluation of non-compliance with the Code of Principles of Good Corporate Governance and the analyses of the adequacy of the explanations provided thereof, including the overall effectiveness of the existing regulatory framework. Design/methodology/approach: To achieve the objectives of this study, a review of the non-compliance section of the corporate governance statements of each Maltese listed company was carried out for the years 2012, 2014 and 2016. Furthermore, 13 semi-structured interviews were held. Findings: The paper finds that a general insufficiency in the explanations provided for non-compliance exists. Some entities give only lip service to the provisions of the Code as they fail to realise the benefits an entity may reap from having good corporate governance structures in place. There is a lack of education and awareness in this regard, and not only on the part of companies but also on the part of shareholders who seem to make minimal use of the information provided in the corporate governance statements. Practical implications: The study raises awareness of the need of improving corporate governance practices, as well as education on corporate governance, across Maltese listed companies. It is hoped that the recommendations made may encourage entities to improve in their reporting and the regulator to provide further guidance to entities to do so. Originality/value: Prior to the amendment of existing rules, increased enforcement of the current regulatory framework and monitoring by the regulator is required. The study highlights the misconceptions on the auditor's role in corporate governance.peer-reviewe

Geochemistry of the soll facies of the Lower Globigerina Limestone formation, Malta

Rock from the "soll" seams of the Lower Globigerina Limestone Formation is distinguishable from 'franka" because of its characteristic honeycomb weathering. However, when freshly quarried, "soll" limestone, aninferior building material, is not so readily recognizable. This study was aimed at characterizing "soll" on the basis of its inorganic geochemistry. It is shown that "soll" has a significantly higher silicon content than normal "franka". The silica content of "soll', which is a measure of its clay content, is typically less than 5%. Therefore, the traditional belief that "soll" is a limestone which is rich in clay is untenable. The silicon content may be useful in differentiating "soll" limestone from 'franka ". Besides that in silicon, other elemental anomalies are found associated with the "soll" facies of the Lower Globigerina and also with "soll ahdar ", a stratigraphically related grey-green variety.peer-reviewe

The effect of shank-space on the thermal performance of shallow vertical u-tube ground heat exchangers

One parameter that may affect the performance of a ground source heat pump is the shank-space, the center-to-center distance between the two branches of a vertical U-tube used in a ground heat exchanger. A 3D steady-state computational fluid dynamics (CFD) model of a U-tube ground heat exchanger was used to investigate the influence of varying shank-space on the thermal performance of two isolated vertical shallow U-tubes, one 20 m deep and the other 40 m deep, given that most existing research focuses on systems making use of deeper boreholes. The models adopt an innovative approach, whereby the U-junction at the bottom of the U-tube is eliminated, thus facilitating the computational process. The results obtained show that, although the temperature drop across the U-tube varies for different shank-spaces and is lowest and highest for the closest and the widest shank-spaces, respectively, this temperature drop is not linear with increases in shank-space, and the thermal performance improvement drastically diminishes with increasing shank-space. This indicates that, for shallow U-tubes, the temperature drop is more dependent on the length of the pipework.peer-reviewe

The impact and challenges of the insurance distribution directive (IDD) on Maltese insurance undertakings

Purpose: With this paper the authors bring to light the impact and challenges of the Directive on the Maltese insurance undertakings. To this effect, a comprehensive examination is conducted on the insurance undertakings in Malta. Literature deals with the regulation of the single European insurance market and what led to the introduction of the Insurance Distribution Directive. Design/Approach/Methodology: To this effect, a comprehensive examination is conducted on the insurance undertakings in Malta. Literature deals with the regulation of the single European insurance market and what led to the introduction of the Insurance Distribution Directive. Furthermore, the salient requirements of the Directive are analysed. Findings: Data analyses suggest that local insurance undertakings will be facing challenges to their business model, selling practices and distribution network. In addition to the above, moderate to high costs are expected in relation to administration and training. Practical Implications: With no delegated acts yet and the limited communication issued in relation to the transposition of the Insurance Distribution Directive into local legislation/regulation, insurance undertakings have little time to fully prepare for the adaptation of the new requirements. Originality/Value: Although, all States might be represented in the decision process, the larger, than Malta, states usually take over and sometimes dictate the final decision. The concept of proportionality in regulations is not clean and is not effectively managed, at the disadvantage of the smaller states. Therefore, this paper is important since it voices the cries of smaller states and allows for an understanding of the impact and implications of new regulations to smaller jurisdictions, in this case within the EU.peer-reviewe

Solar cooling at the oenology and viticulture research centre, Buskett, Rabat

This paper describes the design, installation and testing of two solar cooling systems at the Oenology and Viticulture Research Centre, Buskett, Rabat, Malta. One system consisted of a bank of photovoltaic panels converting solar energy into electricity which was fed into the national grid and a conventional vapour compression chiller powered by electricity from the grid. The second system was based on an ammonia-water vapour absorption chiller which was driven by hot water from a bank of vacuum-tube solar collectors. Dry re-cooling was chosen as the method of heat rejection.peer-reviewe

Paramedic management of back pain : a scoping review

Background: Research examining paramedic care of back pain is limited. Objective: To describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics. Methods: We included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews. Results: From 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data. Conclusion: Paramedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain

Biomarkers of Endocannabinoid System Activation in Severe Obesity

Obesity is a worldwide epidemic, and severe obesity is a risk factor for many diseases, including diabetes, heart disease, stroke, and some cancers. Endocannabinoid system (ECS) signaling in the brain and peripheral tissues is activated in obesity and plays a role in the regulation of body weight. The main research question here was whether quantitative measurement of plasma endocannabinoids, anandamide, and related N-acylethanolamines (NAEs), combined with genotyping for mutations in fatty acid amide hydrolase (FAAH) would identify circulating biomarkers of ECS activation in severe obesity.Plasma samples were obtained from 96 severely obese subjects with body mass index (BMI) of > or = 40 kg/m(2), and 48 normal weight subjects with BMI of < or = 26 kg/m(2). Triple-quadrupole mass spectroscopy methods were used to measure plasma ECS analogs. Subjects were genotyped for human FAAH gene mutations. The principal analysis focused on the FAAH 385 C-->A (P129T) mutation by comparing plasma ECS metabolite levels in the FAAH 385 minor A allele carriers versus wild-type C/C carriers in both groups. The main finding was significantly elevated mean plasma levels of anandamide (15.1+/-1.4 pmol/ml) and related NAEs in study subjects that carried the FAAH 385 A mutant alleles versus normal subjects (13.3+/-1.0 pmol/ml) with wild-type FAAH genotype (p = 0.04), and significance was maintained after controlling for BMI.Significantly increased levels of the endocannabinoid anandamide and related NAEs were found in carriers of the FAAH 385 A mutant alleles compared with wild-type FAAH controls. This evidence supports endocannabinoid system activation due to the effect of FAAH 385 mutant A genotype on plasma AEA and related NAE analogs. This is the first study to document that FAAH 385 A mutant alleles have a direct effect on elevated plasma levels of anandamide and related NAEs in humans. These biomarkers may indicate risk for severe obesity and may suggest novel ECS obesity treatment strategies