Presentation and management of diabetic ketoacidosis in adults in Malta

Aim: The aim of this audit was to assess adherence to local guideline in the management of Diabetic Ketoacidosis (DKA). Method: Patients admitted with DKA between April 2013 and March 2015 were identified and data was retrospectively collected from patients’ confidential files and Isoft®. Data collected included initial parameters recorded and biochemical investigations taken (initial and subsequent assessment of pH, HCO3-, blood glucose, potassium levels and urinary ketones), insulin regime started and intravenous fluid administered. Results: During the established time period 40 cases of DKA were identified in 18 patients. Median age was 33 years with a female preponderance of 60%. Six patients had newly diagnosed diabetes mellitus while 8 patients had more than one admission of DKA. All cases had capillary blood glucose monitoring (BGM) and/or venous random blood (plasma) glucose (RBG) checked and pH and HCO3- recorded on admission. 0.9% sodium chloride was the intravenous fluid started in all cases (as recommended by the guideline) and a median of 6.75L was prescribed during the first 24 hours. The median time spent on intravenous insulin infusion was 42.7 hours while the median time to pH >7.30, HCO3- >15mmol/L and negligible urinary ketones were 6.88, 12.83 and 34.5 hours respectively. Subcutaneous insulin was started at a median time of 48.21 hours from initiation of DKA protocol. Conclusion: This audit showed good adherence to local guideline. The great discrepancy between the time to pH >7.3 and the time to negligible urinary ketones highlights the need to introduce tools to measure systemic ketone production in the management of DKA with an update in the current local clinical practice guideline.peer-reviewe

MSPGI : a geoportal feasibility study - Planning Authority MSP geoportal MSP Implementation Initiative

Directive 2014/89/EU calls for Member States to apply Maritime Spatial Planning (MSP) in their marine waters. In applying this framework, Member States are required to adopt a process to analyse and organise human activities to achieve ecological, economic and social objectives. The preparation of a MSP plan is the key deliverable expected from Member States and in doing so are expected to organise the use of the best available data, and decide how to organise the sharing of information necessary for MSP plans. The availability of information for stakeholders can also contribute towards effective co-ordination at a national level particularly in regulating different maritime sectors.EASME/EMFF/2015/1.2.1.3/02/SI2.742101peer-reviewe

Design for micro milling guidelines

Miniaturisation of parts is emerging as an important approach to satisfy modern industrial and customer needs. Micro milling is one of the basic micromachining technologies used toproduce miniaturised components. It differs from conventional machining in that the handling and machining of very small features generates various problems. As a consequence, designers need to consider such problems during design to make micromilling more feasible. More emphasis thus needs to be placed on deriving design know-how from the other product life-phases. This paper reports the work undertaken by the Department of Manufacturing within the University of Malta to generate a set of Design for Micromilling (DFμM) guidelines that can contribute to the development to intelligent CAD for this domain.peer-reviewe

Case study #4 : Strait of Sicily - Malta : Western Mediterreanean

The definition of spatial limits for the Strait of Sicily - Malta Case Study have been elaborated considering needs and priorities emerged from the Initial Assessment, as well as existing knowledge on: (i) maritime uses and economic domains; (ii) ecological features; (iii) legal jurisdictions and borders and (iv) transboundary issues. The definition of the case study area’s spatial limits constitute boundaries for the purpose to foster a proper analysis on human uses, ecological processes, synergies and conflicts, governance continuity, and define recommendations to establish appropriated strategies and plans. The boundaries have been drawn according to the scope of the project (e.g. to support the implementation of Maritime Spatial Planning in EU Member States with a concrete cross-border initiative) and the activities to be developed therefore on one hand they are representative of local conditions and policies and, on the other, they take in account potential transboundary and cross-border issues of MSP. The SIMWESTMED case study for Malta is focused on the Malta-Sicily marine waters, bordering the south of Sicily and the north of the Maltese Islands and including part of the continental shelves of Italy and Malta.Grant Agreement: EASME/EMFF/2015/1.2.1.3/02/SI2.742101peer-reviewe

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially