Assessment of the utility of repeat stool testing for Clostridium difficile stool toxin using enzyme immunoassay

The poor performance of toxin enzyme immunoassay (EIA) for laboratory testing for Clostridium difficile (C. difficile) infection (CDI) is well acknowledged. Guidelines published in recent years state that testing solely with EIA for detecting toxins A and B is sub-optimal. As a consequence, clinicians may lose confidence in the test and submit multiple samples to offset the poor sensitivity of the toxin EIA. This leads to waste of laboratory resources and is discouraged by recent guidelines. 2,489 requests for toxin EIA submitted during one year at a state general hospital in Malta were reviewed to assess the utility of repeat stool testing for C. difficile toxin detection using toxin EIA and also to gather data on the extent of repeat samples within 28 days of a positive test. There were a total of 1,970 diarrhoeal episodes, from which a total of 302 cases (15.3%) submitted more than one sample for repeated testing. Only 2% of these repeats tested positive after having an initial negative result for the C. difficile toxin EIA test. Most recent published practice guidelines recommend a two-step or three-step testing algorithm in the diagnosis of C. difficile-associated diarrhoea, which offers a marked increase in sensitivity when compared to that of toxin A and B EIA alone. A three-step protocol is proposed which should enable the discernment of the role of C. difficile in a diarrhoeal patient.peer-reviewe

Mental Health’s Address to the Challenging Cultural Reality of Malta

Appreciation of society as being the whole made up of so many different parts in terms of groups with various interests, skills and needs is what cultural diversity is about. Culture is defined as the distinctive customs, values, beliefs, knowledge, art and language of a society. Multiculturalism has always been embedded with the Maltese reality. However, a steep increase in the country’s population since 2011 may be presenting new realities that can translate into hefty and challenging demands. This review therefore presents the following research-based evidence on how mental health can address this phenomenon, particularly in the case of Malta and similar small countries. In particular, the following aspects were highlighted, namely: cultural safety, holistic health services, multicultural awareness, sensitive lingual expression, community integrity and cultural partnership. Practical recommendations are presented

Modelling evacuation using escalators: a London Underground dataset

This paper presents a brief analysis of an escalator human factors dataset collected in a London Underground (subway) station in England. The data analysis highlights and quantifies a variety of escalator human factors. Using the buildingEXODUS evacuation software, a series of evacuation scenarios of a hypothetical underground station are then presented. The simulation results demonstrate that escalator strategies and associated human factors can have a considerably influence upon an evacuation compared to using stairs alone

High specific torque motor for propulsion system of aircraft

This paper proposes an analytical model that considers the torque characteristics for high specific torque synchronous machine with outer rotor and a Halbach permanent magnet array. The distribution of the magnetic field in the air gap is obtained with a linear assumption by solving Neumann’s problem. The analytical model presented in the paper allows preliminary estimation and fast optimization of the machine’s geometry and can be used to develop a first cut design of the machine. The application of the analytical model proposed is demonstrated via the adaptation and modification of a traction machine designed for electrical taxiing to a machine for propulsion of electric aircraft

Electrical power generation in aircraft: review, challenges and opportunities

The constant growth of air traffic, the demand for performance optimization and the need for decreasing both operating and maintenance costs have encouraged the aircraft industry to move towards more electric solutions. As a result of this trend, electric power required on board of aircraft has significantly increased through the years, causing major changes in electric power system architectures. Considering this scenario, the paper gives a review about the evolution of electric power generation systems in aircraft. The major achievements are highlighted and the rationale behind some significant developments discussed. After a brief historical overview of the early DC generators (both wind- and engine-driven), the reasons which brought the definitive passage to the AC generation, for larger aircraft, are presented and explained. Several AC generation systems are investigated with particular attention being focused on the voltage levels and the generator technology. Further, examples of commercial aircraft implementing AC generation systems are provided. Finally, the trends towards modern generation systems are also considered giving prominence to their challenges and feasibility

Influence of Insulation Thermal Aging on the Temperature Assessment in Electrical Machines

Thermal modeling and temperature assessment of electrical machines often rely on the use of lumped-parameter thermal networks. A historic limitation of analytical thermal models is their need for an experimental fine-tuning, necessary for selecting the appropriate values of thermal conductivity and convection heat transfer coefficients. This evaluation procedure is commonly carried out at the design stage of a new machine, by assuming that its thermal behavior will remain unchanged throughout its whole lifetime. This paper demonstrates, through an in-depth experimental investigation, how the capability of heat extraction from a machine's hot spot towards the coolant can be strongly affected by the level of thermal aging of its insulation system. Based on the experimental findings, a decrement of the winding equivalent thermal conductivity is noted as the thermal aging accumulates, with a corresponding progressive increment in hot-spot temperature