Maltese Experience Research Articles

Laparoscopic inguinal hernia repair in children: Article review and the preliminary Maltese experience

BackgroundIn the past two decades, laparoscopy has provided an alternative approach to inguinal hernia repair. The aim of this review is to carry out a retrospective systematic analysis of articles dealing with laparoscopic hernia repair in children and a review of the Maltese experience. MethodsData was obtained from publications from 2002 to 2019. The endpoints include: patient demographics, clinical presentations, laparoscopic tools, ports, suture used, technical remarks, length of surgery, hospital stay, complications and follow-up. Results32 studies were included with a total of 10,183 patients. Most articles documented the use of 1 port. Length of surgery ranged from an average of 10 to 138 min. Ipsilateral recurrences were reported in 0.83% of cases, while 0.17% required conversion to open. Preliminary Maltese ExperienceIn our centre, a population of 514, 564 is covered (16% under the age of 18). A total of 14 cases of laparoscopic inguinal hernia repair were carried out from August 2018 till October 2020. The neonatal laparoscopic set-up involves a 30⁰ laparoscope, inserted via a 5 mm umbilical port, with 2 stab incisions allowing the use of 3 mm devices. Intra-corporeal purse string suture technique is used. The length of surgery ranged from 1 hr to 2 hr 30 min. There was 1 case of ipsilateral recurrence and another requiring conversion to open surgery. ConclusionsLaparoscopic inguinal hernia repair in children is a versatile and safe procedure that can be carried out with minimal complications and low reoperation rates.Level of Evidence: Level IV

The Evolution of Internal Auditing at a Central Bank: The Maltese Experience

Purpose: The main objectives of this article are to assess how the governance and operational structures that constitute the internal Audit Function (IAF) of the Central Bank of Malta (CBM), have evolved and grown over the years. Design/Methodology/Approach: This study adopted a qualitative, mixed-method approach to ascertain the achievement of these objectives. Semi-structured interviews were carried out with six major players who, to varying degrees, acted as catalysts fuelling such evolution. The selection encompassed both current and ex-IAF officials deployed in various hierarchical positions. These interviews were then backed by an analysis of the CBM Annual Reports and any available unpublished internal audit documentation. Findings: The findings indicate that the core objectives of the IAF remained, in essence, unchanged over the years except for being broadened to enhance organisational value, to meet increasing client expectations and closely align with developments in the profession. As a result, stakeholder perceptions of the IAF improved from being negative and invasive to becoming generally respectful and appreciative. Practical Implications: Audits had to decrease in number over the years as most audits had become considerably more complex and therefore more labour intensive and time-consuming. Staff turnover decreased when more emphasis was placed on staff development, training and career management. Originality/value: The vicissitudes of the IAF history to date, particularly the major historical milestones found to have spurred the various stages in the IAF evolution, may also prove insightful for the IAFs of other financial institutions.

Institutional Transformation and Managerialism in Cultural Heritage: Heritage Malta

Building on the literature on managerial reforms in public sector and cultural heritage, this paper aims at exploring, understanding, and reconstructing managerial change at the organizational level. The institutional transformation of the cultural sector in Malta - driven by a call for managerial innovation - is investigated here. The main changes in discourse and practices are analysed; transformation processes are reconstructed on the basis of self-reported narratives by participants, and critically revisited through a longitudinal analysis of documents. Finally, the Maltese experience is then compared with two additional cases of institutional transformation in the cultural heritage field: the British Museum and the Autonomous Superintendence of Pompeii. Common patterns and distinctive features of the three public management reforms are discussed. The contribution of the paper focuses on a crucial phenomenon in public sector reforms: institutional transformation. From a methodological point of view the rhetorical nature of these debates is addressed, while providing a more detailed reading of individual components of change processes. The need/benefit of comparison - particularly international comparison - is underlined.

Insights into secular trends of respiratory tuberculosis: The 20th century Maltese experience.

Over half a century ago, McKeown and colleagues proposed that economics was a major contributor to the decline of infectious diseases, including respiratory tuberculosis, during the 19th and 20th centuries. Since then, there is no consensus among researchers as to the factors responsible for the mortality decline. Using the case study of the islands of Malta and Gozo, we examine the relationship of economics, in particular, the cost of living (Fisher index) and its relationship to the secular trends of tuberculosis mortality. Notwithstanding the criticism that has been directed at McKeown, we present results that improvement in economics is the most parsimonious explanation for the decline of tuberculosis mortality. We reaffirmed that the reproductively aged individuals were most at risk of dying of tuberculosis, seeing that 70 to 90% of all deaths due to tuberculosis occurred between the ages of 15 and 45. There was a clear sex differential in deaths in that, prior to 1930, rates in females were generally higher than males. During times of extreme hardship, the sex differential was exacerbated. Over the course of World War I, the sex gap in tuberculosis rates increased until peaking in 1918 when there was also the influenza pandemic. The heightened differential was most likely a result of gendered roles as opposed to biological differences since female tuberculosis rates again surpassed male rates in 1945 during World War II. Respiratory tuberculosis in both urban and rural settlements (in Malta proper) was significantly influenced by the Fisher index, which explains approximately 61% of the variation in TB death rates (R = 0.78; p<0.0001). In Gozo, there was no significant impact on respiratory tuberculosis (R = 0.23; p = 0.25), most likely a consequence of the island’s isolation, a self-sufficient economy and limited exposure to tuberculosis.

Can rheumatologists diagnose and manage Giant Cell Arteritis better than non-rheumatologists? The Maltese Experience.

OBJECTIVES:Giant Cell Arteritis (GCA) remains a challenge both in terms of diagnosis and management as patients may present to several different specialists. The objectives were to determine incidence of biopsy-proven GCA in Malta and to compare the management between rheumatologists and non-rheumatologists.METHODS:This was a retrospective observational population study of patients with suspected GCA who underwent a temporal artery biopsy (TAB) between 2012 and 2015. Data collected consisted of demographics, presenting symptoms, TAB histology reports, treatment and outcome. The British Society for Rheumatology (BSR) 2010 guidelines were used as standard of care.RESULTS:136 patients underwent a TAB for suspected GCA of which 26 were positive. The incidence of biopsy-proven GCA in Malta was 3.82 per 100,000 patient years in the over 50 population. There were 63 patients who were treated as GCA. Only 43.3% of confirmed cases had rheumatology input. TABs requested by rheumatologists were twice more likely to be positive compared to requests by non-rheumatologists (30.5% vs. 14.1%).The majority of patients were started on a Prednisolone dose between 40–60mg. Rheumatologists maintained patients on high doses for at least 1 month in 54% of cases as opposed to 20% under non-rheumatologists. Monitoring was more regular for cases followed up by rheumatologists (40% vs. 21%).CONCLUSIONS:Malta has a low incidence of biopsy proven GCA. Although rheumatologists are more likely to adhere to the recommended guidelines, improvement is needed. Rheumatologists should take the lead to minimise variation and optimise management of GCA.

The innovative face of psychiatry – integrating chemical and talking therapies

Psychiatry is associated with chemical interventions as much as psychotherapy is with verbal ones. These professions tend to be positioned at opposite ends of a therapeutic continuum by those who practice them. Yet, theory indicates that mental health can only be defined within its socio-cultural context, that cognition, behaviour and emotions are interdependent with physical well-being. Work-based observations indicate that a holistic approach to mental health leads to more successful outcomes. Why then do difficulties arise when attempting integration? This article suggests that while difficulties are multi-factorial, they include personal resistance to changing professional mindset/identity which subsequently impacts negatively on the building of collaborative relationships at hum an level. They may manifest through the language used, the resources available, the power retained and ways of doing things of the various professionals involved. We shall attempt to illustrate this suggestion by narrating the Maltese experience of setting up of a postgraduate psychiatry specialists training course, including a strong psychotherapeutic component, which brought about interesting culture changes. This article intends to share how this course came about, the line of thought behind its contents, the efforts made to co-create a mutual understanding between psychotherapy trainers and psychiatry trainees and the impact it had on all stakeholders. It suggests that when attempting to create an integrated approach one needs to concentrate on developing a common language between professionals facilitating the building of healthy relationships and increasing collaboration. Believing in influence by example, this article is co-written by a psychiatrist and a psychotherapist who would like to promote collegial collaboration, a holistic approach and the use of a common language.

Total reduplication: The areal linguistics of a potential universal by Thomas Stolz, Cornelia Stroh, and Aina Urdze (review)

Reviewed by: Total reduplication: The areal linguistics of a potential universal by Thomas Stolz, Cornelia Stroh, and Aina Urdze Anne Zribi-Hertz Total reduplication: The areal linguistics of a potential universal. By Thomas Stolz, Cornelia Stroh, and Aina Urdze. (Studia typologica 8.) Bremen: Akademie, 2011. Pp. 620. ISBN 9783050051734. €128. The project that led to this volume was triggered by previous research (Stolz 2004) revealing total reduplication (TR) as a characteristic feature of the Circum-Mediterranean area, shared by such genetically different languages as Turkish, Hebrew, Maltese, Greek, Italian, and Basque. This result turned out to be at odds with Rubino's (2005a,b) claim that TR is globally absent from Europe (with a few exceptions). Finding that TR is also attested in various other European languages, Thomas Stolz, Cornelia Stroh, and Aina Urdze (SS&U) decided to embark on a systematic areal study of TR on the Old Continent. The general picture that emerges from their research is that TR is a phenomenon of its own, that TR-languages are, as a whole, the norm, and TR-avoiders the exception, and that contrary to Rubino's (2005a,b) claims, TR is a widespread phenomenon in Europe, with TR-languages located in the south and east, and TR-avoiders in the north and center. European TR-constructions are shown to share the formal and semantic properties of the TR-constructions found in countries bordering Europe to the east and south. This areal distribution suggests that European TR-languages are part of larger, intercontinental isoglosses. The book is subdivided into four parts. Part A, 'How to approach total reduplication', is a general advanced course on reduplication, which after a brief introduction (section 1) surveys (section 2) contemporary general textbooks and specialized literature on the chosen topic, and proposes an explicit definition of TR: a prototypical instance is characterized as involving two identical, complete, adjacent occurrences of a meaningful expression, whose doubling conveys some specific linguistic function. The identity criterion crucially involves both phonological and categorial identity (this excludes cognate objects from TR, for example). TR is distinguished from partial reduplication (where completeness does not obtain) and from repetition (a mere, unrestricted, stylistic device). TR is also distinguished from the accidental adjacency of two identical words brought about by syntactic recursivity. Section 3, 'History', surveys theories of reduplication since the beginning of the nineteenth century. Section 4, 'Universal vs. areal', discusses the universal character of TR assumed by Moravcsik (1978) and introduces the view that TR is a 'potential' rather than 'absolute' universal. Section 5 discusses the linguistic functions of TR (e.g. intensification, diminution, number, distributivity, reciprocity, indefiniteness), their respective statuses with respect to the grammar vs. discourse dichotomy, and the issue of iconicity (here the authors adopt Stolz's (2007) model, according to which TR generally signals a deviation with respect to some norm). [End Page 375] Part B, 'Total reduplication: The Maltese experience', presents a detailed description of TR in Maltese, based on an array of written corpora. TR in this language is shown to target adjectives, adverbs, verbs (finite or nonfinite, mostly imperfective and intransitive), and cardinals. The functions of TR are claimed to include intensification, absoluteness, secondary predication, adverbialization, duration, the prolative, the distributive, and lexicalization. Part C, 'Total reduplication: The European perspective', presents an in-depth areal study of European languages with respect to TR, which disconfirms Rubino's (2005a,b) claim that Europe is the only region of the globe that is practically TR-free. According to Rubino, the only TR-languages of Europe are Abkhaz, Armenian, Georgian, Hungarian, and Turkish. SS&U lay out their quantitative methodology, centrally based on the comparative scrutiny of multilingual translations of Saint-Exupéry's Petit prince and J. K. Rowling's Harry Potter and the philosopher's stone. Quantitative results show that TR is productively attested in Europe not only in the five languages acknowledged by Rubino, but also in many others. Within Europe, TR is less frequent in Indo-European than in non-Indo-European languages. However, neither Indo-European nor non-Indo-European languages behave homogeneously with respect to TR. Some Indo-European languages are TR-avoiders (e.g. Germanic, Slavic), while some have productive...

The promotion of emotional literacy through Personal and Social Development: the Maltese experience

This paper intends to explore emotional literacy (EL) in relation to Personal and Social Development (PSD) as implemented in the Maltese Islands. Self-empowerment, emotional literacy, and self-expression contribute to a good quality of life of self and others. These are addressed in Maltese schools during timetabled statutory PSD sessions. The authors argue the concept of EL as opposed to emotional intelligence and explain how and why EL is embedded in the methodology used in the Maltese PSD model. This includes the processing stage within the experiential learning cycle. They note that EL is so important that it should not only form part of the PSD syllabus but should also be a whole school approach.

The process of teacher education for inclusion: the Maltese experience

This paper discusses major challenges for the development of teacher education for inclusion through an analysis of relevant recent experience in Malta. Inclusion in society and in education has been explicitly on the Maltese national agenda for the past two decades. The Faculty of Education of the University of Malta has been one of the main actors of the inclusion initiative and has also taken a European initiative through the recent co‐ordination of a seven‐country, 3‐year European Union Comenius project on preparing teachers for responding to student diversity. This paper is based mostly on the reflective experience of the author at the Faculty of Education over the past several years. A brief picture of the Maltese education system is followed by a description of the challenges that have been encountered in the promotion of inclusion. These include the development of a rights‐based approach to the education of persons with disability and the widening of its application to all minority or disadvantaged groups, and the impact of political and social contexts on the development of inclusive schools. These developments are then related to intertwined initiatives for teacher education for diversity that were further influenced by the leadership of deans and heads of the department in the faculty of education. Finally, four current issues are highlighted, namely: the strategic balance between the education of specialist educators and that of all teachers for diversity, and between specific and infusion models for such education, and, finally, the pedagogic balance between the academic and experiential learning about inclusion, and between the theory and practice of inclusive teaching.

Institutional transformation and managerialism in cultural heritage: Heritage Malta

This paper builds on the literature on managerial reforms in the public and cultural heritage sectors with the aim of exploring, understanding, and reconstructing managerial change at the organizational level. It investigates the reform of the cultural sector in Malta – driven by a call for managerial innovation. The main changes in discourse and practices are analyzed; transformation processes are reconstructed on the basis of reported narratives by participants, and critically revisited through a longitudinal analysis of documents. Finally, the Maltese experience is then compared with two other cases of institutional transformation in the cultural heritage field: the British Museum and the Autonomous Superintendence of Pompeii. Common patterns and distinctive features of the three cases are discussed. The paper focuses on a crucial phenomenon in public sector reforms – institutional transformation. From a methodological point of view, the rhetorical nature of these debates is addressed, while providing a more detailed reading of individual components of change processes. The need/benefit of comparison – particularly international comparison – is underlined.

The Parish Community in Eighteenth-Century Malta

Making use of a wealth of primary sources, author provides numerous insights into role of Maltese community in life of eighteenth-century Church across liturgical year, exploring social, cultural, and gender differences that separated different sectors of society in residents' religious behavior. The author emphasizes democratic responsibility of wardens in administering parish, participation and patronage of lay parishioners, and all-important cult of Mary and saints. As parish church was considered centerpiece of community, residents contributed materially to its erection, embellishment, and upkeep. Historians working in Great Britain and North America have offered detailed insights into English parish life. The faithful, we have been told, considered parish church as their own to point that they paid incumbent for his liturgical services with their personal funds.1 However, history of parish is a subject that has attracted interest across Europe. Marc R. Forster demonstrated this openness of parochial organization to ordinary people in Southwest Germany.2 Henry Kamen confirmed such popular control of local church in Catalonia,3 while among French historians, Alain Lottin has shown that at LiUe, parish offered people a platform for exercise of an unusual degree of responsibility and political power.4 This essay analyzes Maltese experience in eighteenth century, using fine run of 117 volumes of churchwardens' reports (conti) at bishop's archives. 1. When Knights Hospitallers came to Malta in 1530, they took firm control of governing of islands. The consiglio popolare, or local self-government, remained in existence only in name.5 A handful of inhabitants did succeed in reaching positions of authority within government-the judiciary was recruited invariably from Maltese lawyers, for example6-but majority of people had no place in it. Yet, if central government seemed remote and unapproachable, Maltese parish was central to lives of people and emphatically belonged to them. However, parish was not a socially homogeneous entity. On contrary, it was a heavily stratified society, as was evidenced by precedence taken by procedures of processions and disputes that arose on such public occasions.7 As an attentive author has put it, there always lurked the destabilizing fault lines of continuous social tensions.8 The community consisted of men and women from every social class, and these social and sexual distinctions were reflected in parish church itself. The parishioners, as recorded in Thomas More's Utopia,9 were seated in different places: nave was reserved for women while men sat in transepts.10 The sexes were differentiated not only in their seating11 but also at their deaths. At Citta Pinto, three peals (mote) were sounded for men but only two for women.12 Since death was an occasion for stressing one's status in community, at Zabbar, major bell distinguished a person of first order from another of an inferior condition.13 If most of people were buried in common graves, privileged few had their own burial sites if not their chapels.14 The church fostered social distinctions in other ways and mirrored formal social structure of community. Attendance at church was a social occasion, so that those who did not have proper apparel15 heard morrow Mass purposely said at dawn for their convenience.16 Others, like Veronica ta' l-Ghawdxija (the Gozitan woman's daughter), went to a filial instead of parochial church for want of decent clothing.17 Preaching also was tinged with status consciousness. The elite heard sermons in Italian in mornings, but rest of population were catechized in Maltese in afternoons.18 Confraternities further serve to underline a graded society. …

Towards the learning community: a Maltese experience

As demand for school reform have grown in Malta in recent years we have noticed increased focus being given to quality issues. As a result the education authorities, due to two main policy initiatives – the introduction of the National Minimum curriculum and school development planning – are encouraging a decentralised form of governance that emphasises the empowerment of teachers in educational decision‐making. The road towards increased collaboration amongst teachers and between schools in which they work, has been a long, arduous and tortuous journey, yet it can also be a vehicle for positive change and development. This paper explores a theoretical rationale for a teacher led approach to school improvement. It then explores the initial collaboration between the author and one local school. It presents the main findings of a strategic analysis undertaken to understand the current situation facing the school. This case study helps to highlight the importance and positive effects behind capacity building and shared leadership. It is argued that this case study can serve as an example to establish higher education and school partnerships and the introduction of a school‐based accreditation scheme.

Maltese experience in the application of desalination technology

This paper is intended to describe some of the experiences in Malta in the application of desalination technology. This is put in the context of its relevance to national development and the economy, to the technology environment where it fitted and to its contribution to and impact on integrated water management.

A New Creation or an Image and Likeness? The Maltese Experience of Establishing Local Government in a Centralized Micro-State

Small states vary among themselves as to whether they have significant local government systems. While government in Malta has been historically a very centralized activity, a network of local councils was established in the early 1990s as part of a more general public sector reform movement. Unlike some other small states, Malta has strong political parties, and they have played an important part in the affairs of the local councils as well as of the central government. Their establishment has therefore done little to reduce political polarization or promote decentralist values, as was hoped when they were first established.