Referral tickets to secondary healthcare : is communication effective?

Communication between primary and secondary health care relies primarily on referral tickets. They determine how patients’ details are conveyed and hence the quality of care. The aim of this study was to assess the quality of referral tickets at the Surgical Outpatients at Mater Dei Hospital in Malta and to develop recommendations for improvement. Consecutive referral tickets between the 7th February and 4th March 2015 were prospectively included in the study and analysed for completeness. The data was entered into a proforma which was revised after the first ten entries. A total of 351 referral tickets were included in the study. Names and surnames were present in all reports and identification number in 99.42% of cases. 44.16% of referrals were inappropriate according to clinical details. The majority of the forms had a history of presenting complaint (98.29%) while the past history, drug history / allergies and examination findings were available in 69.23%, 67.81% and 76.64% respectively. The source of referral was not clear in 56.13%. Only 69.23% of all referral tickets were completely legible while 30.77% were partly legible. This study shows the need for an overhaul in the referral system. Recommendations include the use of electronic referrals and the introduction of feedback letters by hospital specialists.peer-reviewe

The Feasibility Problem -- the family F{\cal F}(G)(G) of all induced GG-free graphs

An infinite family of graphs ${\cal F}$ is called feasible if for any pair of integers $(n,m)$, $n \geq 1$, $0 \leq m \leq \binom{n}{2}$, there is a member $G \in {\cal F}$ such that $G$ has $n$ vertices and $m$ edges. We prove that given a graph $G$, the family ${\cal F}$$(G)$ of all induced $G$-free graphs is feasible if and only if $G$ is not $K_k$, $K_k\backslash K_2$, $\overline{K_k}$, $\overline{K_k\backslash K_2}$, for $k \geq 2$

A review of amputation and revascularisation rates in a small European state

Background: Until 2007 vascular services in Malta were provided by general surgeons with a vascular interest. In late 2007 a vascular specialist was recruited to contribute to the service. This catered for a gradual transfer of services to a pure vascular specialist service in 2014. The aim was to assess the impact of the introduction of vascular specialist services on lower limb major and minor amputation rates and open revascularisation procedures in Malta. Methodsː This is a retrospective analysis of prospectively collected data. Data from the Hospital annual surgical operation reports and the Vascular Database was analysed between 2002 and 2014. Data was analysed by time period (Period 1: 2002-2007 – no vascular specialist service; Period 2: 2008-2013 - partial vascular specialist service; Period 3 – January to December 2014 complete vascular specialist service). Resultsː There was a significant drop in the average rate of major amputations/year between Period 1 and Period 2 (120 vs 96; p=0.008) and between Period 1 and Period 3 (120 vs 64; p<0.001). A significant increase in minor amputations/year between period 1 and period 2 (102 vs 242; p<0.001) and between period 1 and period 3 (102 vs 449; p<0.001) was noted. There was significant increase in open revascularisation rates between period 1 and period 2 (21.5 vs 73.2; p<0.001) and between period 1 and period 3 (21.5 vs 144; p<0.001). Conclusionː The employment of vascular specialists can lead to a significant increase in lower limb open revascularisation rates and a concomitant significant reduction in lower limb major amputation rates.peer-reviewe

Raman spectroscopy of gallium ion irradiated graphene

The successful integration of graphene in future technologies, such as filtration and nanoelectronics, depends on the ability to introduce controlled nanostructured defects in graphene. In this work, Raman spectroscopy is used to investigate the induction of disorder in graphene via gallium ion beam bombardment. Two configurations of CVD-grown graphene samples are used: (i) graphene supported on a Si/SiO2 substrate, and (ii) graphene suspended on porous TEM grids. It is observed that the supported graphene experiences more damage in response to lower beam doses than suspended graphene. This phenomenon is attributed to the behaviour of the energetic ions impinging the sample. In suspended graphene, the ions pass through the graphene membrane once and disperse to the atmosphere, while in supported graphene, the ions embed themselves in the substrate causing swelling and backscattering events, hence increasing the induced disorder. In supported graphene, the ratio between the Gaussian D and G peaks attributed to amorphous carbon, and the Lorentzian D and G peaks attributed to graphene, (IDG/IDL) and (IGG/IGL), are suggested to be used to quantify the degree of amorphization. The results are relevant to the development of nanostructured graphene-based filtration or desalination membranes, as well as for graphene-based nanoelectronics.JRC.F.2-Consumer Products Safet

An advective mechanism for Deep Chlorophyll Maxima formation in southern Drake Passage

We observe surface and subsurface fluorescence-derived chlorophyll maxima in southern Drake Passage during austral summer. Backscatter measurements indicate that the deep chlorophyll maxima (DCMs) are also deep biomass maxima, and euphotic depth estimates show that they lie below the euphotic layer. Subsurface, offshore and near-surface, onshore features lie along the same isopycnal, suggesting advective generation of DCMs. Temperature measurements indicate a warming of surface waters throughout austral summer, capping the winter water (WW) layer and increasing off-shelf stratification in this isopycnal layer. The outcrop position of the WW isopycnal layer shifts onshore, into a surface phytoplankton bloom. A lateral potential vorticity (PV) gradient develops, such that a down-gradient PV flux is consistent with offshore, along-isopycnal tracer transport. Model results are consistent with this mechanism. Subduction of chlorophyll and biomass along isopycnals represents a biological term not observed by surface satellite measurements which may contribute significantly to the strength of the biological pump in this region

The impact of COVID-19 on fitness behaviour amongst a sample of the Maltese population

Background. COVID-19 has brought significant changes all over the world, including Malta. These changes might have impacted people's health and lifestyle. Such changes might have limited health and fitness behaviours such as frequency of exercise, intensity of exercise and water intake. Therefore, this study aims to examine and explore how the COVID-19 pandemic has impacted fitness behaviours amongst a sample of the Maltese population.Methods. The sample (n = 995)was selected through convenience sampling. Data was collected through an online 38-item survey which was dispersed on social media during April and May 2020. The questions measured the frequency of health behaviours to provide a comparison between the participant's health behaviours in November 2019 and April 2020, during the COVID-19 pandemic.Results. The data was analysed through Factor Analysis which was conducted for dimension reduction. Factor analysis resulted in 1 factor composed of 3 variables (frequency of exercise, intensity of exercise and water consumption). Further analyses were conducted using a paired samples t-test on SPSS. Following analysis, the results showed that there was an increase in exercise frequency amongst the sample population, whereas there was a decrease in exercise intensity and water consumption. These results confirm that there was a change in health behaviours amongst the study's sample.Conclusion. This study recommends further investigation as to understand this difference in behaviours and its attributes. This can help inform health behaviours should there be further waves of the pandemic or other lockdowns.peer-reviewe

An advective mechanism for Deep Chlorophyll Maxima formation in southern Drake Passage

We observe surface and subsurface fluorescence-derived chlorophyll maxima in southern Drake Passage during austral summer. Backscatter measurements indicate that the deep chlorophyll maxima (DCMs) are also deep biomass maxima, and euphotic depth estimates show that they lie below the euphotic layer. Subsurface, offshore and near-surface, onshore features lie along the same isopycnal, suggesting advective generation of DCMs. Temperature measurements indicate a warming of surface waters throughout austral summer, capping the winter water (WW) layer and increasing off-shelf stratification in this isopycnal layer. The outcrop position of the WW isopycnal layer shifts onshore, into a surface phytoplankton bloom. A lateral potential vorticity (PV) gradient develops, such that a down-gradient PV flux is consistent with offshore, along-isopycnal tracer transport. Model results are consistent with this mechanism. Subduction of chlorophyll and biomass along isopycnals represents a biological term not observed by surface satellite measurements which may contribute significantly to the strength of the biological pump in this region

elearning improves allied health professionals\u27 knowledge and confidence to manage medically unexplained chronic fatigue states: A randomized controlled trial

Objectives: To evaluate the impact of eLearning by allied health professionals on improving the knowledge and confidence to manage people with medically unexplained chronic fatigue states (FS). Methods: Using a parallel randomized controlled trial design, participants were randomized 1:1 to a 4-week eLearning or wait-list control group. Knowledge and self-reported confidence in clinical skills to implement a therapeutic intervention for patients with FS were assessed at baseline, post-intervention and follow-up. Secondary outcomes (adherence and satisfaction with online education, knowledge retention) were also assessed. Data was analyzed using intention-to-treat. Results: There were 239 participants were randomized (eLearning n = 119, control n = 120), of whom 101 (85%) eLearning and 107 (89%) control participants completed baseline assessments and were included in the analysis. Knowledge (out of 100) improved significantly more in the eLearning group compared to the control group [mean difference (95% CI) 8.6 (5.9 to 11.4), p \u3c 0.001]. Knowledge was reduced in the eLearning group at follow-up but was still significantly higher than baseline [6.0 (3.7 to 8.3), p \u3c 0.001]. Median change (out of 5) in confidence in clinical skills to implement the FS intervention was also significantly greater in the eLearning group compared to the control group [knowledge: eLearning (1.2), control (0); clinical skills: eLearning (1), control (0.1); both p \u3c 0.001)]. Average time spent on the eLearning program was 8.8 h. Most participants (80%) rated the lesson difficulty as at the “right level”, and 91% would recommend it to others. Conclusions: eLearning increased knowledge and confidence to manage FS amongst allied health professionals and was well-accepted. Registration: ACTRN12616000296437 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370222&isReview=true

Covid-19 pandemic lockdown : Uncovering the hard truth on lower limb ischaemic outcomes? A single centre observational study

The COVID-19 pandemic disrupted hospital services worldwide and Malta was no exception. This was especially true for vascular surgery where societies issued recommendations on how to adjust their services during the first wave of the pandemic. Malta has one tertiary hospital, with a vascular unit that was established in 2007. Since then, all lower limb procedures have been registered in the Maltese vascular registry (MaltaVasc), which has been internationally validated. In Malta, COVID-positive patient zero was recorded on 7 March 2020. The closure of the only airport was carried out on 21 March and a partial intelligence lockdown was started on 27 March, whereby vulnerable patients were advised to stay home and avoid going to work. On 5 June 2020, the government of Malta and Public Health authorities eased the lockdown for vulnerable patients and on 1 July 2020 the airport was opened to 19 destinations, with a gradual opening to other countries. Despite the partial lockdown, patients with hospital appointments were advised to keep their appointments unless they were cancelled by medical staff. Elective lists were reduced and non-urgent surgeries postponed. During this time, it was noted that few patients were presenting to hospital with signs and symptoms of chronic limb threatening ischaemia (CLTI). Furthermore, it was felt that patients with CLTI were presenting to hospital late, requiring either palliation or major amputation, and more patients required major amputation than in previous years. The primary aim of this study was to analyse the number of major and minor amputations, elective and/or urgent and emergency revascularisation procedures during the first wave of the COVID-19 pandemic. The secondary aims were to compare the number of lower limb procedures with the previous year and also to compare the rates of major amputations with the prevascular unit time period where few lower limb revascularisations were carried by the same authors.peer-reviewe

Mechanical properties of pristine and nanoporous graphene

We present molecular dynamics simulations of monolayer graphene under uniaxial tensile loading. The Morse, bending angle, torsion and Lennard-Jones potential functions are adopted within the mdFOAM library in the OpenFOAM software, to describe the molecular interactions in graphene. A well-validated graphene model using these set of potentials is not yet available. In this work, we investigate the accuracy of the mechanical properties of graphene when derived using these simpler potentials, compared to the more commonly used complex potentials such as the Tersoff-Brenner and AIREBO potentials. The computational speed-up of our approach, which scales O(1.5N), where N is the number of carbon atoms, enabled us to vary a larger number of system parameters, including graphene sheet orientation, size, temperature and concentration of nanopores. The resultant effect on the elastic modulus, fracture stress and fracture strain is investigated. Our simulations show that graphene is anisotropic, and its mechanical properties are dependant on the sheet size. An increase in system temperature results in a significant reduction in the fracture stress and strain. Simulations of nanoporous graphene were created by distributing vacancy defects, both randomly and uniformly, across the lattice. We find that the frac- ture stress decreases substantially with increasing defect density. The elastic modulus was found to be constant up to around 5% vacancy defects, and decreases for higher defect densities