https://www.um.edu.mt/library/oar/handle/123456789/325 2026-05-02T05:24:46Z https://www.um.edu.mt/library/oar/handle/123456789/145456 Title: Rethinking hospital sustainability : integrating circular and green economy principles within strategic corporate social responsibility and management frameworks Authors: Tomaselli, Gianpaolo; Macassa, Gloria; Borg, Karen Maria; Couto, Jose Guilherme; Portelli, Jonathan L.; Borg Grima, Karen; Buttigieg, Sandra C. Abstract: Hospitals play a central role in promoting health and well-being, yet they are also among the most resource-intensive institutions, contributing significantly to environmental degradation through high energy and water consumption, extensive waste generation, and reliance on single-use materials. This conceptual paper explores how principles of the circular economy and green economy can be integrated into hospital operations through a strategic Corporate Social Responsibility (CSR) framework, reframing sustainability as a strategic management issue rather than a compliance-driven activity. Drawing on environmental economics, sustainability studies, and institutional theory, the paper develops an integrated conceptual model structured around the environmental, social, and economic pillars of sustainability. Within this framework, four interconnected operational domains are identified: waste management and circular practices, energy consumption and renewable integration, sustainable procurement and circular supply chains, and economic and policy incentives. The social dimension explicitly encompasses healthcare staff and patients, addressing issues of workforce well-being, health education, safety, quality of life, and equitable care delivery. This advances theory by positioning strategic CSR as a function of circular and green economy, yielding a new model for hospitals, S-CSR = f(CE, GE). The paper also examines institutional and cultural barriers that constrain sustainability implementation and highlights the role of strategic leadership, governance, and system-wide innovation in overcoming these challenges. While not empirical, the study provides a theoretical foundation to inform future research, policy development, and strategic decision-making aimed at advancing sustainable, low-carbon, and resilient healthcare systems. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145226 Title: Beyond the bleeding : predicting pregnancy outcomes after threatened miscarriage Abstract: This three-phase research project examined pregnancy outcomes following first-trimester threatened miscarriage (TM). Phase 1 (retrospective epidemiological analysis) established local prevalence and outcome patterns in Malta for 2019. Phase 2 (scoping review) mapped existing ultrasound and biochemical markers for predicting miscarriage. Phase 3 (prospective case-control study) developed and validated predictive models using multivariate logistic regression (AUC 0.89 on test data) and Random Forest (AUC 0.97 on test data). Key predictive markers identified were progesterone, mean gestational sac diameter (MGSD), β-hCG, crown-rump length (CRL), cervical length, maternal age (35–46 years), fetal heart rate (FHR), and sFlt-1:PlGF ratio. The study provides the first Malta-specific data and a clinically usable algorithm to improve risk stratification and counselling for women experiencing early-pregnancy bleeding. 2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145225 Title: Improving early pregnancy outcomes : predictive tools for threatened miscarriage Abstract: This presentation is aimed to develop predictive tools for pregnancy outcomes in cases of threatened miscarriage through a three-phase approach. The retrospective phase analysed local Maltese data on first-trimester bleeding. The scoping review evaluated existing ultrasonographic and biochemical markers. The prospective case-control study developed and validated a Random Forest model that incorporates progesterone, MGSD, β-hCG, CRL, cervical length, maternal age, FHR, and the sFlt-1:PlGF ratio. The model achieved 93% accuracy and an AUC of 0.96, and provides a solid foundation for the development of clinical decision-support tools. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145224 Title: Understanding the prevalence of threatened miscarriage in Malta Abstract: Threatened miscarriage (TM) is vaginal bleeding before 20 weeks of pregnancy with a detectable fetal heartbeat and closed cervical os. This retrospective cohort study quantified the prevalence of TM and pregnancy outcomes in Malta. All 711 women presenting with first-trimester vaginal bleeding at Mater Dei Hospital’s Accident & Emergency department in 2019 were analysed. Outcomes were: 241 (33.9 %) live births beyond 22 weeks’ gestation, 396 (55.7 %) confirmed miscarriages, 10 (1.4 %) ectopic pregnancies, 6 (0.84 %) molar pregnancies, and 58 (8.16 %) unknown. Successful birth rates were significantly lower in mothers aged 35–46 years, and neonates showed a tendency toward low birth weight. The study provides the first national prevalence data for TM in Malta and forms the basis for a future prospective study on pregnancy outcomes following TM. 2024-01-01T00:00:00Z