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An audit on the consumption of inhalational anaesthetic agents at Mater Dei Hospital
Get PDFBACKGROUND: Inhalational anaesthetic agents carry a considerable cost, both economic and environmental. Consumption of such medications is related to the fresh gas flow, which is controlled by the attending anaesthetic team.METHOD: Data was collected over a period of twelve weeks with intermittent, random observations of fresh gas flow rate and anaesthetic agent concentration performed by an investigator not being actively involved in the anaesthesia delivery. The type of procedure performed, time from induction, age of the patient and the type of airway device used were also collected.RESULTS: A total of three hundred and thirty-eight visits were made. The median FGF observed was 2L/min. Sevoflurane was the commonest anaesthetic gas used at a median MAC of 1.25.CONCLUSION: A more economical use of anaesthetic agents is possible, with a potential reduction of FGF from 2L/min to 1L/min or less.peer-reviewe
Going beyond the de Larosière Doctrine : effectiveness with proportionality
Get PDFThis paper explores the European Union’s (EU) approach to regulation and supervision in the field of banking following the 2008 Great Financial Crisis (GFC). The
GFC exposed significant deficiencies in the EU’s financial regulatory framework,
leading to a series of unprecedented reforms. Central to these changes was the de
Larosière report, which advocated for a higher degree of harmonisation of regulation
and the establishment of new supervisory agencies to enhance oversight and prevent
future crises. Referred to by the authors as the “de Larosière Doctrine,” these reforms
emphasise cross-border supervision, unified regulatory standards, and macroprudential oversight. The analysis focuses on how the de Larosière Doctrine has reshaped
EU banking regulation, fostering trends like regulatory harmonisation, centralised
supervision and supervisory convergence. While these developments have increased
the resilience of the EU’s financial system, the paper argues that they may also have,
in certain instances, resulted in excessive regulation, potentially stifling competition,
innovation, and consumer choice. This argument is supported by a comprehensive
review of literature and insights from discussions with banking officials, enriched by
the authors’ extensive experience in financial regulation. The paper makes a number
of proposals for the refinement of the de Larosière Doctrine and is structured in three
parts, examining the European Single Rulebook, macroprudential oversight, and centralised supervision, concluding with a collective assessment of the current regulatory
landscape.peer-reviewe
Survival of European children, adolescents and young adults diagnosed with haematological malignancies in the period 2000-2013 : results from EUROCARE-6, a population-based study
Get PDFWhile cancer survival has steadily improved over time for adolescents and young adults (AYAs),
previous studies have shown poorer survival in AYAs compared to children with leukaemia and
lymphomas. In this study, we provided updated European 5-year relative survival (RS) estimates for
AYAs with hematologic malignancies compared to children and assessed improvements in survival
over time.peer-reviewe
A nation-wide support system for lepers in 14th century France
Get PDFFear of contagion of leprosy had throughout the centuries led to the forced segregation of infected victims into communities supported by municipal or ecclesiastical authorities. These establishments or Lazar-houses often functioned in isolation of one another managed according to defined regulations based on a monastic life. The Crusader movement of the twelfth century led to the establishment of a widespread organization referred to the fratres Sancti Lazari extra muros Jerusalem leprosis that managed establishments according to a common rule. The expulsion of the Christian forces from the Outremer led to changes in how municipal and ecclesiastical authorities in France looked at the fratres Sancti Lazari, and events during 1320-21 led to an attempt to dismantle the organization in an effort to appropriate the supporting benefices of the establishment.peer-reviewe
Basic respiratory physiology in the use of ECMO in critically-ill COVID-19 patients
Get PDFThe use of ECMO may help sustain extracorporeal life support in cases where regular less-invasive modalities failed to adequately assist the body in maintaining basic life mechanisms. The authors synthesized information from articles found in trusted search engines using predetermined keywords. Typically, VV-ECMO is used in life-threatening respiratory failure. However, experts must consider relative contraindications, answering the question: ‘Will the patient really benefit from this treatment, or will it only add emotional and economic burden, also exposing the patient to various risks of complications?’. The physiology of oxygenation within the lungs, tissues, and ECMO machine, is a modification of the basic principles of respiratory physiology. In typical VV-ECMO cannula insertion, drainage cannula is inserted via the right femoral vein percutaneously and is guided upwards through inferior vena cava with its tip 10 cm below cavoatrial junction while the reinjection cannula will be inserted through the intrajugular vein. This places the artificial lungs in series with the normal lungs rather than in a parallel form. The artificially-oxygenated blood was then returned and mixed with the native venous blood. It is important to measure maximum drainage flow to prevent shunting of the veins by setting the ECMO to the highest flow. Frequent complications during ECMO initiation due to critical COVID-19 manifestations include co-infection up to sepsis and coagulopathy up to complications following it. Therefore, it is always beneficial to acquire multidisciplinary judgement, particularly with hematologists, intensivists, and infectious disease specialists prior, during, and post-ECMO use.peer-reviewe
Unilateral pulmonary oedema secondary to anterior mitral valve leaflet prolapse
Get PDFCardiogenic unilateral pulmonary oedema (UPE) is an uncommon clinical condition which is often mistaken for lower respiratory tract infection (LRTI). It is typically caused by asymmetric systolic flow reversal in the right pulmonary veins due to severe mitral valve regurgitation (MR). We describe the case of a 41-year-old woman with a history of undifferentiated chronic mixed connective tissue disease, Raynaud’s disease and pituitary adenoma who presented with acute shortness of breath (SOB), chest tightness, orthopnoea and paroxysmal nocturnal dyspnoea. A computerized tomography pulmonary angiogram (CTPA) showed signs consistent with pulmonary oedema secondary to congestive heart failure. This prompted urgent echocardiography which revealed a flail and prolapsing A2 leaflet of the mitral valve with a posteriorly-directed MR jet, resulting in systolic flow reversal in the pulmonary veins which is consistent with severe MR. The patient underwent an urgent mitral valve (MV) replacement and optimization of medical therapy, resulting in clinical and radiographic improvement.peer-reviewe
Opportunity seekers and value creators : a new framework for understanding small-state diplomacy
Get PDFSmall states offer valuable insights by demonstrating how agency, strategy, and
adaptability can enhance diplomatic standing. This paper introduces the Opportunity-Seeking and
Value-Creation Framework, explaining how small states can enhance their diplomatic standing by
acting as opportunity seekers and value creators. Opportunities arise from structural, material,
ideational, or technological shifts, but require entrepreneurial action—harnessing new means,
setting new ends, or introducing novel means-ends combinations—to generate value. The
framework systematizes how small states can "punch above their weight," demonstrating that
agency and strategic action are essential for converting opportunities into lasting diplomatic gains.
Greece’s diplomatic comeback after a decade-long economic crisis highlights this dynamic. Once
dismissed as Europe’s weakest link, Greece strategically repositioned itself by capitalizing on its
pandemic response and green transition, among others, aligning national priorities with broader
European and global agendas. By seizing opportunities and generating value, Greece not only
addressed domestic vulnerabilities but also strengthened its diplomatic standing.peer-reviewe
Insight into the structural integrity assessment of the European DEMO fusion reactor divertor (Part II : application examples)
Get PDFThe DEMO fusion reactor Divertor design group within the EUROfusion consortium use RCC-MRx as the main analysis code for the Divertor's structural integrity assessment. Analysis has been carried out within the same group using an in-house developed Finite Element Analysis post processing script which follows the Design by Elastic Analysis rules of RCC MRx. A number of stress classification lines (SCLs) were placed in the Divertor component regions which are susceptible to Type P and Type S damage. This paper focuses on two of these stress classification lines. One is located in the region of a stress singularity while the other is in a region of high stress where the temperature is above the creep threshold along part of the SCL. Design by Analysis was performed using a spreadsheet application. The purpose was to highlight difficulties encountered in using the RCC-MRx elastic design methodology applied to the DEMO divertor. Issues mainly arose because of stress singularities in the geometry, because of the inherent non-axisymmetric geometry and loading of the divertor and because of limited material data for Eurofer97 steel which is the main material used for the DEMO Divertor. This paper is Part II of a companion paper and compliments it by considering the two SCLs as application examples and case studies. In the companion paper (Part I), general discussions on the difficulties and issues encountered are presented including some theoretical background on the phenomenon of elastic follow up and on Neuber's hyperbola rule that addresses plasticity and stress relaxation. An additional outcome of this work emphasises the need to further develop the in-house Finite Element Analysis post processing script and to incorporate within it best practice in implementing the RCC-MRx Design by Elastic Analysis rules for the Divertor components. The post processing tool development would improve the assessment reliability and productivity in order to suggest timely Divertor design modifications.peer-reviewe
From biographical disruption to reconstruction : intersectionality between, law, medicine and the self. The case of Drug Courts in Malta
Get PDFThis research explores the lived experience of persons undergoing rehabilitation for hard drug dependence under Malta’s Drug Court through the Drug Offenders Rehabilitation Board (DORB). The research adopts an Interpretative Phenomenological Approach through intensive interviewing with drug dependents following the Drug Courts rehabilitation programme. Through such qualitative approach, the research investigates the trajectories of drug addicts during rehabilitation and highlights the transition from biographical disruptions to biographical reconstructions of the self. The findings point to the significance of the intersectionality of law, medicine and the self, arising from the DORB functions under the Drug Dependence (Treatment not Imprisonment) Act (Cap. 537). This Act primarily filled in the gap for this intersectional approach by providing a supervisory role for legal, medical and social services. The research provides recommendations for improved service provision by informing policymakers and practitioners on intersectional prevention and intervention, and the enhancement of the Drug Court system.peer-reviewe
Modern radiology eBook
Get PDFUndergraduate teaching of radiology in Europe is provided according to national schemes and may vary considerably from one academic institution to another. Sometimes, the field of radiology is considered as a “crosscutting discipline” or taught within the context of other clinical disciplines, e.g., internal medicine or surgery. This e-book has been created in order to serve medical students and academic teachers throughout Europe to understand and teach radiology as a whole coherent discipline, respectively. Its contents are based on the Undergraduate Level of the ESR European Training Curriculum for Radiology and summarize the so-called core elements that may be considered as the basics that every medical student should be familiar with. Although specific radiologic diagnostic skills for image interpretation cannot be acquired by all students and rather belong to the learning objectives of the Postgraduate Levels of the ESR Training Curricula, the present eBook also contains some further insights related to modern imaging in the form of examples of key pathologies, as seen by the different imaging modalities. These are intended to give the interested undergraduate student an understanding of modern radiology, reflecting its multidisciplinary character as an organ-based specialty. We would like to extend our special thanks to the authors and members of the ESR Education Committee who have contributed to this eBook, to Carlo Catalano, Andrea Laghi and Andras Palko, who initiated this project, and to the ESR Office, in particular Bettina Leimberger and Danijel Lepir, for all their support in realising this project. We hope that this eBook may fulfil its purpose as a useful tool for undergraduate academic radiology teaching. [Preface by Minerva Becker & Vicky Goh]peer-reviewe