Public health priority: Type 2 diabetes mellitus

Blood testing
What is Malta doing to address this very prevalent problem? Dr Sarah Cuschieri writes about a project called SAĦĦTEK.
Dr Sarah Cuschieri

In Malta, diabetes has been a health concern since 1886. In 1981, the World Health Organization performed the first national diabetes study in Malta and reported that the total prevalence of type 2 diabetes mellitus (T2DM) is 7.7% (5.9% previously known diabetics and 1.8% newly diagnosed diabetics).  

Since then, we have seen that percentage increase through self-reported questionnaire studies such as 2008’s Maltese European Health Interview Survey, which reported a T2DM prevalence of 8.3% in the population aged between 20 and 79. In 2010, it rose again to 10.1%, according to the Maltese European Health Examination Survey. And while this information is definitely useful, it cannot help researchers and doctors investigate what elements contribute to the diabetes epidemic in Malta.  

The economic boom over the last four decades has permanently changed the Maltese Islands. With it came a change in lifestyle habits, like car use and diet, and an influx of different cultural and ethnic populations settling on the islands, which meant that it was time to update our understanding of T2DM in Malta; its prevalence, determinants, and risk factors. 

I undertook the project “SAĦĦTEK – The University of Malta Health and Wellbeing study” to find out more about T2DM in Malta. SAĦĦTEK was a cross-sectional study that will effectively act like a snapshot in time.

The study population included a randomised sample of adults that had been living in Malta for at least six months and held a permanent Maltese identification card, irrelevant of their country of origin.

How is your health? 

Top row: Ayrton Borg Axisa, Bernard Schembri, Ryan Camilleri Middle row: Bader A. Ali, Russell Bonnici, Andrew Chilton Bottom row: Angeline Sapiano, Sarah Cuschieri, Fatemah Abdullah

The survey took place between November 2014 and November 2015, and involved 4,000 people (18 to 70 years of age) who were statistically chosen from the national registry. We set up examination hubs in each town where the participants came in to complete socio-demographic questionnaires. While participants were there, we also took several measurements, including blood pressure, weight, height, and waist circumference. Finally, we took blood samples to check for their glucose levels during fasting periods, genetic analysis, and lipid profile (cholesterol and fats in the blood). 

In the end, 47.15% of the invited adults actually attended the health survey. From these, we found that the prevalence of type 2 diabetes was 10.39%, with males being more affected than females. From the total T2DM group, 6.31% were known diabetics, while the remaining 4.08% were newly diagnosed with T2DM during the study. The numbers mean that over the past couple of decades there has been a rise in the diabetes rate in adults. Higher levels of T2DM mean that related diseases, such as obesity and heart problems, will also be more common. 

In fact, study participants were often overweight (35.66%) or obese (34.11%). The weight increase is very relevant because it puts pressure on the body’s organs, including the pancreas, which has a direct link to T2DM development.

An increase in weight increases waist size, and this too comes with its own set of problems called the metabolic syndrome—increased blood pressure being one of many. A third of survey participants reported a high blood pressure (30.12%), again with a male majority.

Tobacco smoking was also prevalent at 24.3% (male majority). Smoking is linked to T2DM development, increased blood pressure, and stroke.

What are the implications?

The survey results are a major public health concern. An unhealthier population means higher demands on Malta’s healthcare services.

In 2016 diabetes cost Malta an estimated €29 million, while obesity cost an estimated €24 million. The increased disease rate identified means that Malta’s bills are set to rise.

Men seem to have a worse health profile than women. Older males with a high body mass index (BMI) were more likely to suffer from high blood pressure. The majority had normal levels of glucose but abnormal lipid profiles, so even though the sugar levels were normal, they were still at risk when it came to acquiring diseases such as heart problems. Those diagnosed with a metabolic syndrome were five-fold more likely to also have T2DM. There is no denying—the gender gap is a concern.

The survey shows that more public health research is in dire demand. Malta’s underlying problem appears to be the increasing overweight-obesity problem. A number of initiatives have already been put in place by the Health Promotion and Disease Prevention Directorate as well as the establishment of “Dar Kenn Għal Saħħtek”, but there is more to be done.

Gender sensitive action is needed. Government, private entities, communities, and NGOs all need to work together to change the harmful lifestyle choices that have become the norm today. Sedentary lifestyles need to change and high intakes of fat, sugar, and salt need to decrease to alleviate Malta’s weight and diabetes problem. A diabetes screening programme also needs to be introduced to help citizens help themselves. 

Early diagnosis of this disease will benefit all of Malta’s health and wellbeing and safeguard its health services. What more could we hope for? 

Read more:

Cuschieri, S., Vassallo, J., Calleja, N., Pace, N., & Mamo, J. (2016). Diabetes, pre-diabetes and their risk factors in Malta: A study profile of national cross-sectional prevalence study. Global Health, Epidemiology and Genomics, 1. https://doi.org/10.1017/gheg.2016.18

Cuschieri, S., Vassallo, J., Calleja, N., et al. (2016). The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study. Arch Public Health; 74: 52.

Cuschieri, S., Vassallo, J., Calleja, N., et al. (2016). Prevalence of obesity in Malta. Obes Sci Pract 2016; 2: 466–470. 

Busting out of the box

Magic wand
Aesthetic physician and artistic consultant Dr Joanna Delia traces her journey from medical student to successful business owner, telling Teodor Reljić that her experience at the University of Malta helped her resist excessive industry specialisation.  

Modern life is rigidly compartmentalised. Perhaps this is more true of the West than anywhere else, where the materialist, rationalist models that have aided efficiency and technological advancement also require us to absorb vast amounts of knowledge early on, and specialise later.  

Many educational systems reflect this tendency and the Maltese model is no exception. From a very young age, exams come in thick and fast, and cramming to pass them replaces a more holistic education. 

Dr Joanna Delia is not a fan of the word ‘holistic’—preferring the term ‘polyhedral’ for reasons that will be explained later—and has enjoyed a career trajectory that has flouted excessive specialisation. A doctor turned aesthetic physician with an interest in the world of contemporary art, Delia’s journey is an affront to such restrictive notions.

While she assures me that her own time at the University of Malta (UM) was nothing short of amazing, in recounting the roots of her intellectual curiosity, she is compelled to go even further back. 

‘Like every excited little girl, my dreams used to alternate and metamorph somewhere between wanting to be a writer like Emily Brontë or Virginia Woolf and a scientist who would make incredible discoveries and change the world like Marie Curie,’ Delia recalls. ‘I also wanted to be a doctor who would cure people in war-torn countries, yet fantasised about being Alma Mahler or a young Chanel surrounded by philosophers, drenched in fine clothes and surrounded by white rose bouquets…’

Delia recounts this awareness that we’re shaped to view these inclinations as contradictory. But for her, the intuitive desire to learn about and closely observe scientific phenomena matched the heights of aesthetic appreciation.

Vella’s own student enthusiasm did not come as immediately as all that, however. While she is now secure in her three-pronged role as writer, performer, and translator (also acknowledging her former role as a lecturer), forging an early path as a student meant first squinting through the fog. 

‘I just loved learning the science subjects… figuring out protein synthesis and DNA replication literally made me feel giddy, light headed, downright euphoric! I was a real geek,’ Delia says with disarming self-deprecation. ‘To me, it was just the same as reading an incredible work of literature or staring at a work of contemporary art alone in one of the silent, perfectly lit halls of a museum.’

Given this internal push-pull across various disciplines, Delia confesses that in terms of pursuing the later strands of her formal education, she ‘floated into medical school’ without feeling the need to strategise things much further. It was only upon graduation that the realities of being slotted into a specialised discipline dawned on her with an ominous pall.  

‘The day I graduated I felt a suffocating feeling: the thought that I had somehow sealed my fate,’ Delia says, though the sense of regret which followed did not linger for much longer.

‘Looking at one’s future through a tunnel vision perspective based on the imaginary restrictions of one’s degree is just that a self-imposed illusion,’ Delia observes. 

Her University years were active and inspiring, with Delia having happily taken on extra-curricular activities and also quietly rebelled against the notion of boxed-in specialised disciplines.

University and beyond  

‘University was amazing! I would repeat those years ten times over,’ Delia unapologetically enthuses. Though she does acknowledge that the Medicine course was challenging to begin with—citing the ‘competition among students’ as an additional factor—she looks back on both her time there, and her association with the UM’s Medical School, with immense pride. 

‘My lecturers were charismatic and experts in their field, which of course garners respect and made us feel honoured to be part of that system,’ Delia says, while also recalling her involvement in additional campus activities.

‘I was the chair of the environmental committee at KSU and served two terms as the Officer for the Sub-Committee on Refugees and Peace within MMSA. I loved my time on campus, and encourage all students to participate in campus affairs. We never stopped organising fairs, events, fundraisers, workshops, and outreach programmes with the community…’

Hinting at an essential discomfort with the idea of overbearing specialisation, Delia believes ‘the Maltese education system does not proactively encourage sharing knowledge’, but also notes that she did find hope, solidarity, and inspiration among her peers, from various faculties.’ I socialised with students from the architecture department, and attended their workshop parties. I was invited to history of art lectures and tours. I organised panel discussions to reduce car [use] on campus and lobby for [a] paperless [campus],’ Delia says. All these activities contributed to ‘a feeling of a hopeful future’. 

Adjacent to Delia’s academic efforts were her course-related travels abroad, which contributed to expanding her horizons. ‘I did internships in Rio De Janeiro and travelled to India and Nepal through the Malta Medical Students’ Association (MMSA), both of which were incredible experiences.’ During this time, she gained a keener interest in art.

‘My sister was studying history of art and eventually read for a Ph.D. in Museology. I followed her as closely as I could; her subjects fascinated me and a lot of her excitement about art rubbed off on me…’ 

But first, her early medical career needed seeing to. Delia admits that medical students in Malta are somewhat privileged since they enjoy a relatively smooth changeover from academic to professional life. However, the change happens very rapidly.

‘Young doctors in Malta have the advantage of an almost flawless transition into a job. This also turns out to be the toughest time in your life, but at least there there is a continuity of support at the start of your profession,’ Delia says, citing the diligence and discipline instilled into her and her peers by their University tutors and lecturers. This rigour was crucial to ensure that those early years went on as smoothly as possible.

Pausing to reflect, Delia feels compelled to add that a culture that leaves more breathing room for exploration and enquiry could only be beneficial for the future of Maltese medicine. ‘I wish we had a stronger culture of research and publication in Malta. We need to somehow find time for it as it will not only improve the reputation of the institution but also nurture us as students, alumni, and professionals, and keep us on our toes,’ Delia says, adding that these ideas reflect the same culture of hard work that her course promoted, which rewards diligence and depth. ‘I believe in constantly keeping astride with knowledge by reading publications and actively pursuing ‘continued medical education’. I wish that the institution instilled more of this into its alumni,’ Delia muses.

This approach of constant enquiry arguably gave Delia a fount of knowledge and inspiration to draw from when she found herself at a forking road in her medical career. 

Expanding horizons  

”After a few years of working at the general hospital, I was lucky enough to be chosen to pursue some level of surgical training, but by that point I had realised that the life of a surgeon was not for me…’ 

This was an ‘extremely tough decision’, with regret once again raising its ugly head. ‘However, the 80-hour weeks, and above all the realisation that my professional life would be all about facing and treating ill and dying people, forced me to make a decision to leave the hospital,’ Delia says.

This pushed Delia to explore other careers, and she now juggles her love of both medicine and aesthetics in a sustainable way.

‘After I stopped working as a hospital doctor, there were too many things I was hungry to explore – one of them was medical aesthetics. I started pursuing training in London and Paris, and essentially spent years of salary training with the best doctors I could find.’

Joanna at work as an aesthetic physician Photo: People & Skin

After working at a reputable local clinic, Delia finally managed to go at it independently, opening up her own place.

‘It was nothing short of a dream come true. I had to search hard within myself and build up entrepreneurial and management skills. I learnt the hard way sometimes, business-wise, but I was also fortunate to find help from my friends who excel in other fields like marketing, photography and architecture, to help me build my brand and clinic,’ Delia recalls.

In the end, her resistance to rigid specialisation helped her to open a thriving business called Med-Aesthetic Clinic People & Skin. She couples this work to her position as head of the Advisory Board at the newly-opened Valletta Contemporary, a boutique showcase for local and international contemporary art run by artist and architect Norbert Francis Attard. 

Which brings her story back to a ‘polyhedral’ conception of the world. 

‘I believe everything in life is polyhedral. I prefer polyhedral to ‘holistic’. Every square, or rather, every cube we think we’re trapped in, can be pushed out and reconfigured to welcome other disciplines. I don’t believe any of us purposely split the two fields, but I believe we don’t allocate enough time to explore all the wonders we could discover if we used both their lenses to analyse the world. After all, even Einstein believed that the most important thing in science is creativity…’ 

A healing touch

Research
Emerging research suggests that mild sensory stimulation like touch can protect the brain if delivered within the first two hours following a stroke. Laura Bonnici speaks with experimental stroke specialist Prof. Mario Valentino to find out how uncovering the secrets of this ‘touch’ may have life-changing implications for stroke patients worldwide.
Prof. Mario Valentino

Stroke is universally devastating. Often hitting like a bolt from the blue, it is the world’s third leading cause of death. In Malta, over 10% of the deaths recorded in 2011 were due to stroke. But stroke inflicts suffering not only through a loved one’s passing. As the most common cause of severe disability, stroke can instantly rob a person of their independence and dignity—even their very personality. This impact, individually, socially, and globally, makes stroke research a top priority. 

Yet while scientists know the risk factors, signs, symptoms, and causes of both main types of stroke—whether ischemic, in which clots stop blood flow to the brain, or haemorrhagic, where blood leaks into the brain tissue from ruptured vessels—they have yet to find a concrete solution. 

A dedicated team at the Faculty of Medicine (University of Malta) hopes to change that. Using highly sophisticated technology and advanced microscopic laser imaging techniques, Dr Jasmine Vella and Dr Christian Zammit, led by Prof. Mario Valentino, can follow what happens in a rodent’s brain as a stroke unfolds in real-time. 

‘We use powerful lasers and very sensitive detectors coupled with special lenses, which allow us to capture the very fast events that unravel when a blood clot interrupts the blood supply in the brain,’ explains Valentino. ‘We observe what happens to the neighbouring blood vessels, nerve cells, and support cells, and the limb movements of the rodent throughout.’ Their aim is to find out how sensory stimulation might then help protect the brain. 

The idea stems from an accidental discovery in 2010 by members of the Frostig Group at the University of Irvine, USA. The scientists found that when the whiskers of a rodent were stimulated within a critical time window following a stroke, its brain protected itself by permanently bypassing the blocked major artery that commonly causes stroke in humans. The brain’s cortical area is capable of extensive blood flow reorganisation when damaged, which can be brought about by sensory stimulation.

The human brain can bypass damage. For example, blind individuals have limited use of their visual cortex, so the auditory and somatosensory cortex expands, giving them heightened sensitivity to hearing and touch. For stroke patients, this means that the brain can compensate for its loss of function by boosting undamaged regions in response to light, touch, or sound stimulation.

‘This accidental discovery could be life-changing for stroke patients. The key is to figure out the mechanism involved in how sensory stimulation affects stroke patients, and then establish the best ways to activate that mechanism. Perhaps touching a stroke victim’s hands and face could have a similar beneficial effect, and this is what this latest research study hopes to define,’ says Valentino. 

‘The team is now painstakingly correlating the data obtained during this brain imaging with the rodent’s movement and trajectory,’ he continues. ‘Using a motion-tracking device fitted under a sophisticated microscope, we can record the behaviour of the rodent during high-precision tactile stimulation, such as stroking their whiskers, and detect any gain of [brain] function through behavioural and locomotor readouts whilst ‘looking’ inside the brain in real-time.’

If they can prove that any protection is the direct cause of new blood vessels (or other cells) resulting from the electrical activity inspired by the sensory stimulation, then the next step would be to explore ways of redirecting these blood vessels to the affected brain area. 

The team’s track record is encouraging. In collaboration with scientists from the University Peninsula Schools of Medicine and Dentistry, UK, they made another recent breakthrough that was published in Nature Communications, identifying a new drug, QNZ-46, that could protect the rodent brain following a stroke.

‘That project was about neuroprotective agents – to create a drug that will substantially block or reduce the injury, and so benefit a wider selection of patients,’ elaborates Valentino. ‘The study identified the source and activity of the neurotransmitter glutamate, which is the cause of the damage produced in stroke. This led to the discovery that QNZ-46 prevents some damage and protects against the toxic effects of the glutamate. This is potentially the first ever non-toxic drug that could prevent cell death during a stroke, and the results from this research could lead to pharmaceutical trials.’

The use of two-photon laser-scanning microscopy allows the measurement of blood flow in single vessels concurrent with indicators of cellular activity deep within the rodent brain. Whisker stimulation evokes electrical activity that can be monitored by the use of genetically engineered calcium-sensitive and light-emitting neurons that sense the propagating waves of electrical activity.

While ongoing research in these projects has been supported through a €150,000 grant from The Alfred Mizzi Foundation through the RIDT, Valentino points out that globally-significant discoveries such as these are in constant need of support.

‘The funding of such projects is so important. This money is life-changing for people in such a predicament. Health research changes everything—our lifestyle, our quality of life, our longevity. And yet, government funding for research is still lacking. It’s only thanks to private companies and the RIDT, who realise the global potential of our work, that these projects can continue to try to change the lives of people all over the world,’ says Valentino.

And while Malta may be a small country with limited resources, the work conducted within its shores is reaching millions globally, proving that when it comes to knowledge, every contribution counts. We must continue striving for more to leave our best mark on the world. 

Help us fund more projects like this, as well as research in all the faculties, by donating to RIDT.

Link: researchtrustmalta.eu/support-research/?#donations

Crafting business from hobbies: The HUSKIE story

Put a physicist and an engineer together and what do you get? A brewery. Obviously. Cassi Camilleri sits down with Jean Bickle and Miguel Camilleri to talk about entrepreneurship, beer, and how variety really is the spice of life.

As you read this, a warehouse in a Qrendi quarry is bustling, undergoing hefty conversions as it morphs into a dream brewery. Water and electricity supply is solid, the walls have a fresh lap of white and the steel housings are in place. Now, the countdown begins until the tanks are set up. But they’re used to it. This waiting business.

The Huskie Craft Beer company was but a twinkle in their eye when Jean Bickle and Miguel Camilleri first met as workmates during a stint in Leeds, which is where they discovered a thriving craft beer scene. 

‘We were part of a club at the Wharf Chambers,’ Bickle remembers. ‘It’s what we did after work. We played table soccer and tried beers.’ Learning about the process, the recipes, and the different flavours that are possible to incorporate in a beer, planted a seed in them both. ‘Eventually, when we came back home, we wanted to give brewing a shot ourselves,’ Bickle adds. And so they did.

Getting the basics down 

Their first investment was in education. ‘We spent quite a bit on books and materials to learn how to brew,’ Jean says. They had the ingredients down—water, malt, yeast, and hops. Hops being the flowers of the hop plant which are used as a bittering, flavouring, and stability agent in beer. They understood the role temperature played and gained plenty of experience with identifying flavours through taste tests. Beyond this, however, they also needed to be familiar with how these ingredients interact with one another and the techniques involved in creating a beer. 

They were more careful with their purse strings when building their first set up in early 2017. ‘We could have very easily gone online and found these home brewing kits. But you have to spend a lot of money to get those. And this was all coming from our own pockets. So, with Miguel being an engineer, we just bought stainless steel tanks and sheets, shaped them, and welded the parts together. We even built the control panel and electronics ourselves. Everything was done from scratch.’ 

This is not to say that it was all smooth sailing. ‘Sometimes you get ahead of yourself. You start rushing in your eagerness to try out new things. Which is fine. But sometimes you have to take a step back and go back to basics. We keep each other in check,’ Jean notes, smiling. ‘We both come up with radical ideas on how to approach the task at hand, but you can’t do everything at once, otherwise you get careless.’ 

‘You’ve also got to be adaptable and not follow others’ rules to the dot. Malta’s ambient conditions and accessible raw materials make brewing harder than in many other countries. With the right technique though, it’s definitely possible,’ Miguel points out.

Creative thinking meets business

Initially, it was all about making beer. ‘Our focus was that the quality of the process should be done to a certain standard,’ Jean says, but the creative element soon started becoming a priority. ‘Now we have shifted to the actual product being top quality. You have loads of recipes online if you want to find them, but we wanted to create our own.’

From a business standpoint, finding what makes you unique is an essential part of building a company. What is the value you are bringing to your client base that others are not?

Huskie’s approach harkens back to the reason the boys started the company. They loved beers and wanted to continuously try new ones. When they had the brewing process perfected, it was time to start being experimental. 

‘We started thinking about creating recipes we hadn’t seen before, with flavours we hadn’t seen anyone use before. We made beers using Maltese strawberries for example, and we also produced a range of beers inspired by the flavours of the traditional qagħaq ta’ l-għasel (honeyring).’ Of course this isn’t as simple as adding some extra water to a cake mix.

‘Experimentation brings about its own set of challenges. Some ingredients have their own sugars, so including them in the beer recipe drives the yeast crazy.’ And when Jean says crazy, he means it. ‘If we don’t get everything right, the pressure in the bottle can build up and they literally explode. We’ve had this happen a few times,’ Jean admits. ‘We call them molotovs,’ Miguel grins.

But even with the added cleaning time, all’s well that ends well. This curiosity has given Huskie a very niche service they can provide to clients. ‘We can create beers exclusive to our clients. If someone comes along and tells me I like cinnamon or whatever, we can create something specifically for them.’

Coming up with each new recipe involves another process of trial and error, tinkering, and perfecting. ‘When we come up with a new recipe, we usually come up with three different versions and we taste each different beer on the same day. We write down notes, we compare, and if there is some kind of consensus, we move onto that.’ Now, Jean and Miguel have a spreadsheet with all the beers they produce, each marked with a rank. So far, over the course of two years, they’ve already finalised 11 beer recipes and released four to the market!

No to mass markets

The culture behind craft beer is one that is very close to Jean and Miguel’s hearts. This is not about making three beers, sticking to them, and selling them en masse. They want to keep the personal touch, the Maltese identity in their product, while pushing boundaries and trying new things. ‘So our philosophy is get this beer now because it won’t be around in six months. We want to continue creating.’ 

Of course, this isn’t always easy. And Jean is the first to say it. ‘It’s hard letting go of a good beer,’ he admits. ‘Even we fall in love with some of the recipes. But you have to come from a place of abundance. We know we can continue to create good beers. And we will.’ 

Now they’re in the growing phase. Setting themselves up to expand their brewing power. With the new brewery they’ll soon be able to increase production tenfold. ‘Then it’s about creating our own events. Entering competitions abroad. We want to put Malta on the map.’ 

‘We’ve already spent a year working on the new brewery, so we’ve had a lot of time to think about what we want to do and where we want to go, and this is essential in building a business that is sustainable. You have to do things right and really think about things properly,’ Miguel asserts. 

This measured attitude has definitely worked in Huskie’s favour. Research led to new funding opportunities. ‘Miguel found out about [the] TAKEOFF [business incubator] and we met Joe Bartolo. He really motivated us and was of great help in the vital early stages,’ Jean says. After a few months Huskie was awarded a TOSFA fund that they used to purchase more equipment, allowing them to try more recipes and scale up production. They followed this up with some EU funding applications. ‘We [obtained] funding to purchase more equipment for the brewery,’ he notes. 

Jean is quick to mention the help and support from their family and friends.

‘We got a lot of help. Really a lot. Miguel’s father helped us with the building of the brewery. His uncle did all the electricity. And Connie, Miguel’s mum is a star. Miguel did all the planning, plumbing, and the majority of the rest. He’s even got the scars to prove it! I painted a wall. It was a real team effort,’ Jean laughs.

Maintaining Balance

For such a new business, Huskie is already growing with leaps and bounds. But hours in the day are limited and questions about priorities and goals are already circling. ‘Managing Huskie at its current level already takes up loads of our time, and we’ve had to sacrifice a lot from our private lives,’ Jean says. ‘But in doing that, Miguel and I manage to run it whilst still holding full time positions. Where it will take us in the future—well, who knows? We wouldn’t mind employing people to take care of logistics and cleaning for example. We’re also looking into hiring a driver to take care of distribution for us.’ 

The love they have for medical physics has in no way diminished. ‘Miguel and I both love what we do. Working in healthcare is extremely satisfying and keeps us well in check on life’s priorities,’ Jean says. ‘And that is just as much our passion as brewing beer is. But I believe that if you work hard enough at something, and if you love it enough, you’ll find the time for it.’ 

‘Everybody will say you’ll enjoy it once you get there. But for us it’s more important to enjoy what we’re doing while getting there. God forbid Miguel and I weren’t friends. We’d kill each other with all the time we spend in the same room. For us, the brewing thing works because it’s part of the development of our friendship. We brew, drink, chat, and joke. It’s about enjoying the process. Not just tunnel vision towards the end goal. 

Science and coffee, anyone?

In an age of misinformation, having a grasp on current affairs and research is essential for us to be active, responsible citizens. Gillianne Saliba writes about the dire need for more dialogue and engagement from citizens and scientists alike.
Gilliane Saliba

For many, science is far removed. It’s just a subject they had to take at school. Or the star of crazy stories on newspapers, or videos and memes on social media. Opposing views are a dime a dozen. And sometimes it’s very hard to discern between them; what’s right? what’s wrong? ‘It’s complicated,’ they say, ‘it’s hard’, and so most people move on, letting others do all the talking. As a result, science and citizens have had a rocky relationship. But when the issues being discussed relate to health, technology, and our environment, that is, when they affect us directly, we need to be able to engage. 

Science Communication (SciComm for short) can offer a solution to this problem. 

SciComm can take many forms. Articles, films, museum exhibitions; you name it. In the wake of a scientific knowledge-gap in the community, SciComm has taken root and has been rapidly growing over the last 40 years. Researchers want to share their ideas and get citizens’ input, gauge interest, and see what others have to say. 

Enter Malta Café Scientifique. 

To create a safe space where people can chat about science, Malta Café Sci organises monthly science communication events in Valletta where researchers and professionals discuss topics of interest with attendees. Entrance is completely free and open to all, which attracts a diverse audience. 

What makes Malta Café Sci special is how it prioritises the public, putting their learning experience first. The events are tailored to them. Speakers keep their talks short and succinct, taking complex scientific concepts and breaking them down, discussing how the research can impact society. The Q&A session that follows is often far longer than the talk itself, opening up a dialogue within the audience. The elitist mantra of ‘it’s complicated’ is so far gone that talks, and the following question and answer portion of the evening, are put to bed with closing drinks where speakers and audience members can have one-on-one time, discussing the topic of the day. 

I have been volunteering as an organiser with Malta Café Scientifique for the last nine months. Through the experience, I have gained marketing and public speaking skills.

More importantly, I have had the privilege of a front row seat to pivotal moments in people’s lives—the moment when perception shifts. 

I’ve often had audience members come up to me after an event to tell me how the talk changed their ideas. How they are learning to be more receptive but also critical about what they learn and read online. Some point out how they usually steer clear of such events, with many wrongly thinking they aren’t smart enough for them, only to find that they not only understand, but can also participate.

Aside from all this, Malta Café Scientifique is also conducting its own research. Led by Café Sci’s project manager Danielle Martine Farrugia, we are evaluating and interviewing different science communicators about their practices. We’re also evaluating the initiative to understand its contribution to science communication in Malta. 

What we can already see is that Malta Café Sci is living, breathing proof of how people can come together when dialogue is open and welcoming. It is empowering local researchers to share their findings with citizens while giving community members the chance to learn and weigh in on work that may have ramifications for them. Where a learning process is no longer from expert to layman, but a continuous sharing of information in both directions.  

Note: For more about Malta Café Scientifique’s next events, or if you want to get involved, see its Facebook page or Instagram @maltacafesci. Or email us on cafesci@mcs.org.mt. 

Enter the swarm

Author: Jean Luc Farrugia 

Jean Luc Farrugia

Once upon a time, the term ‘robot’ conjured up images of futuristic machines from the realm of science fiction. However, we can find the roots of automation much closer to home.

Nature is the great teacher. In the early days, when Artificial Intelligence was driven by symbolic AI (whereby entities in an environment are represented by symbols which are processed by mathematical and logical rules to make decisions on what actions to take), Australian entrepreneur and roboticist Rodney Brooks looked to animals for inspiration. There, he observed highly intelligent behaviours; take lionesses’ ability to coordinate and hunt down prey, or elephants’ skill in navigating vast lands using their senses. These creatures needed no maps, no mathematical models, and yet left even the best robots in the dust. 

This gave rise to a slew of biologically-inspired approaches. Successful applications include domestic robot vacuums and space exploration rovers. 

Swarm Robotics is an approach that extends this concept by taking a cue from collaborative behaviours used by animals like ants or bees, all while harnessing the emerging IoT (Internet of Things) trend that allows technology to communicate.

Supervised by Prof. Ing. Simon G. Fabri, I designed a system that enabled a group of robots to intelligently arrange themselves into different patterns while in motion, just like a herd of elephants, a flock of birds, or even a group of dancers! 

Farrugia’s robots in action.

I built and tested my system using real robots, which had to transport a box to target destinations chosen by the user. Unlike previous work, the algorithms I developed are not restricted by formation shape. My robots can change shape on the fly, allowing them to adapt to the task at hand. The system is quite simple and easy to use.

The group consisted of three robots designed using inexpensive off-the-shelf components. Simulations confirmed that it could be used for larger groups. The robots could push, grasp, and cage objects to move them from point A to B. To cage an object the robots move around it to bind it, then move together to push it around. Caging proved to be the strongest method, delivering the object even when a robot became immobilised, though grasping delivered more accurate results.

Collective transportation can have a great impact on the world’s economy. From the construction and manufacturing industries, to container terminal operations, robots can replace humans to protect them from the dangerous scenarios many workers face on a daily basis. 

This research project was carried out as part of the M.Sc. in Engineering (Electrical) programme at the Faculty of Engineering. A paper entitled “Swarm Robotics for Object Transportation” was published at the UKACCControl 2018 conference, available on IEEE Xplore digital library.

https://www.facebook.com/ThinkUM/videos/493872941442263/

Saving the Maltese freshwater crab from extinction

Author: Clayton Sammut

Clayton Sammut

A considerable amount of endemic species inhabit the Maltese Islands. The Maltese freshwater crab (Qabru in Maltese) is one of them. In the 50s, the invertebrate was so abundant that freshwater crab soup was a common Maltese delicacy. And up until Malta adopted the Euro, it graced the Maltese five cent coin. The Maltese freshwater crab is unique to our heritage, but it is now threatened with extinction. 

Under the supervision of Dr Adriana Vella and the University of Malta’s conservation research group, I used various population and biological parameters to analyse the data and produce conservation recommendations.

To estimate the crab population size and density, I used two techniques known as the capture–recapture method and distance sampling in a number of repeated surveys in different sites throughout the dry (August to mid-September) and wet season (October to January). I then measured the crabs to determine their life stage and sex. This revealed more information about the reproductive population size and recruitment at each study site.

What we found was that there was an imbalance in the number of female to male breeding adults, which resulted in a small amount of offspring. This means the population cannot sustain itself, putting the species in grave danger.

Beyond health and numbers, we also directed attention to the crabs’ natural habitat. We wanted to find out whether hydrological and chemical parameters, such as water depth and water acidity, are also having an impact. As it happens, the freshwater crab’s population density is affected significantly by a water stream’s depth, width, velocity, and acidity (pH). We also found that specific sites and seasons also had an impact.

Direct water extraction, excessive use of fertilisers, and water stream channelisation are creating severe drought that suffocates the crabs during summer. So much so that adult male crabs were seen preying on their own juvenile crabs.

Looking at the rapid decline of watercourses around the Maltese Islands throughout the years, and the abuse that goes ignored and unchecked, the freshwater crab will not have a future unless we act immediately.

There are three things that we can do to undo some damage. We can fund research to determine if a reintroduction programme would work in sites which previously hosted the crab. We can also create new engineered habitats which can host the crab and bolster the population. Finally, the highly diverse habitats that are now hosting the crab can be turned into protected nature reserves. The nature reserves could engage citizens with Maltese organisms. If run as a social enterprise, it could generate funds to support important research. Protecting the animals that call our islands home is our duty as responsible citizens, but it goes beyond that. Protecting them means protecting our surroundings, our home, from a path that severs us from our roots. Protecting them is protecting ourselves. 

Voices for freedom and choice

Author: Dr Alexander Clayman

Dr Alexander Clayman

Abortion is a criminal offence in Malta. This means Maltese women who wish to end their pregnancy have severely limited choices. Those more affluent can pay to terminate their pregnancy abroad. Those who do not have the money can either continue the pregnancy against their will or terminate locally under unsafe conditions, risking both their health and freedom. 

Any woman who undertakes an abortion potentially faces three years in jail. Anybody who assists, such as a doctor, could also be sentenced to four years behind bars. This flies in the face of best medical practice which states that safe abortion services should be accessible to women who need them. 

A few weeks ago a group of doctors, including myself, came together to set up Doctors for Choice Malta in order to advocate for sexual and reproductive health. This includes comprehensive sex education (NOT abstinence-only education) and access to free contraception (condoms, pills, and intrauterine devices). Increased use of contraception alone results in fewer unwanted pregnancies and subsequent abortions. Putting contraceptives in the hands of comprehensively sex-educated individuals can do even more. This said, abortion still needs to be available to those people who need it. 

As a doctor, I feel I have a duty to use my knowledge and skills to better my community’s health. Together with Doctors for Choice, we are basing our efforts not on opinions or morality, but on years of medical and sociological research which shows that sex education, contraception, and accessible abortions make a society healthier. 

The irony was not lost on me when comments accusing me of being a baby-killing-mad-axe-murderer-who-doesn’t-understand-what-a-real-doctor-is started rolling in. Luckily for me, forewarned is forearmed, and the negativity failed to penetrate very deep. 

What did strike me was the contrast between the way people communicate their derision and their support. Abusive comments come in fast, prominent, and loud. Supportive comments are usually sent in private. At present, it’s clearly very easy to be openly anti-choice, but very difficult to be openly pro-choice. 

To those afraid to raise their voice and speak the truth, I say: whatever dogma, tradition, or a battalion of angry keyboard lieutenants might tell us, those who advocate for reproductive choice have nothing to be ashamed of. We are on the right side of history. 

Read more: Marston, C., & Cleland, J. (2003). Relationships between Contraception and Abortion: A Review of the Evidence. International Family Planning Perspectives, 29(1), 6. https://doi.org/10.2307/3180995

Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S. PLoS ONE, 6(10), e24658. https://doi.org/10.1371/journal.pone.0024658

Research to business plan: A metamorphosis

Author: Michelle Cortis

Michelle Cortis

In recent years, there has been a shift in the relationship between research and commercial industries. Commercial viability almost always comes into question for ongoing research. Commercialisation can be a boon. When a research project has demonstrated its potential to become a viable business, funding opportunities increase, meaning the research can be turned into a product or service that people can use.

In 2018, as part of a Masters in Knowledge-Based Entrepreneurship, I analysed the commercial potential of an ongoing University of Malta project. I conducted an in-depth market feasibility study on Prof. Ing Joseph Cilia’s Smart Micro Combined Heat and Power System, a device that can be fitted into homes and offices to deliver heat as a by-product of electricity, reducing energy costs. Many EU countries are setting up incentives to make these systems more feasible and attractive to consumers. 

For my dissertation, I developed a business plan for the research team. An engineer myself, and having earned a Masters by Research back in 2014, this was different to anything I had done before. My supervisors, Prof. Russell Smith and Dr Ing. Nicholas Sammut, helped me find the right balance between utilising my technical knowledge whilst also analysing the product’s commercial potential. Even my language changed through the process; I began to speak of ‘euros per day’ rather than ‘kilowatt hours’. I learnt to differentiate between technological features and what real benefits future users would gain.

Being presented with a physical product, initially one may assume that it is to be sold to customers, or protected through a patent and licensed to the private sector. However, my market analysis revealed new target audiences that had not been thought of before. Selling the device was not the only way to exploit the project’s commercial potential. What if we leased the product instead of selling it? Should we continue developing the product or is it already innovative enough? What if we developed a spin-out—would it be too expensive or is it worth the investment?  

By analysing a project through a commercial lens, all these questions arise, pointing out potential ways to make a good project great. But what makes a good business plan great is when all these questions are answered. 

The Project ‘A Smart Micro Combined Heat and Power System’ is financed by the Malta Council for Science & Technology, for and on behalf of the Foundation for Science and Technology through the FUSION: R&I Technology and Development Programme. 

Are you carrying out research at the University of Malta which you think may have commercial potential? If so, contact the Knowledge Transfer Office on knowledgetransfer@um.edu.mt

HERCULE project

The taxes of every citizen in the European Union (EU) contribute to the EU’s immense budget, and measures are needed to ensure these funds are used properly. Benjamin Charles Cassar talks to Prof. Ivan Sammut and Dr Jelena Agranovska, who are studying the effectiveness of such measures at a national level.

The EU’s Institutions operate throughout the continent on a massive scale, and in the 51 years since its conception, the scope of the EU has expanded to affect each and every one of our daily lives. The world would be very different without the Union. 

But this progress has not been without its hiccups. As Brexit’s deadline creeps closer, other countries, such as Hungary and Poland are experiencing political turbulence and rising Euroscepticism. Come the European Elections in May, these issues will bare their teeth. 

Despite this, the EU has had momentous victories in its pursuit of continental integration. Take, for example, the Common Market allowing for easy trade, the Schengen jurisdiction that simplifies travel, and the much-lauded mandate for free data roaming. The EU has also been moving towards harmonising its efforts to protect its financial interests.

Prof. Ivan Sammut and Dr Jelena Agranovska

In view of this, over the past few months, Prof. Ivan Sammut and Dr Jelena Agranovska (Faculty of Laws, University of Malta) have been leading the Hercule Project, a comparative study that looks into the implementation and enforcement of European Criminal Law. Together, they are investigating the development of legislation, focusing on the recent PIF (Protection of the Union’s Financial Interests) Directive. The aim is to increase people’s confidence in EU institutions and ensure that funds are managed transparently and appropriately. 

Apart from the legislative side, the study will also look into the bodies that work to protect the EU’s (and thus all its citizens’) financial interests—namely the European Public Prosecutor’s Office (EPPO), the European Anti-Fraud Office (OLAF), and Europol. 

To this end, Sammut and Agranovska selected 12 countries based on their size, geography, and legal system to gauge each state’s reception of European legislation. These countries include Germany and Malta, among a number of others. 

Each country report is being handled and written up by a local expert, with the team at the University of Malta offering guidelines and template questions. However, in practice, each team is given free reign on how to conduct their studies, as long as they stay true to purpose.

Recently, I had the opportunity to sit down with Sammut and Agranovska. They offered insight into its reasoning as well as the practical implications for citizens uninitiated in the intricacies of European law—myself included.

‘It affects everyone at the end of the day,’ Sammut notes. With blockchain and cryptocurrencies rapidly gaining interest, financial and IT crime protection are becoming more relevant to everyday life. ‘However, many times member states are only concerned when there is fraud with their own sources,’ Sammut continues. The PIF Directive will fit into existing national legal systems and balance out the field.

The project so far has revealed discrepancies in the uptake of legislation between Member States. Unsurprisingly, Sammut is quick to point out Germany as being at the forefront of implementation. Indeed, Angela Merkel is very proactive in most EU-level discussions. However, states such as Lithuania continue to lag behind, with standards seemingly lower than the rest of Europe. The election cycle can also complicate matters, as is the case with Poland. Initially eager to be part of EPPO, since their elections, this has become increasingly unlikely, with the Law and Justice Party consistently at odds with the European Union.

Diving deep into the implications for each state is impossible. However, the team noted these differences in implementation during a one-day workshop held in Valletta in October, when rapporteurs from each of the 12 participating countries came together to discuss their findings thus far. 

Dr Stefano Filletti, Malta’s rapporteur in the study, points out the issue with parallel administrative and criminal investigations. As things stand now, OLAF begins an administrative investigation, passes on the information to the Attorney General’s office, who in turn prompts the Maltese Police Force to begin its own investigation. This criminal investigation works independently of the previous administrative investigation, disregarding its findings and starting anew. The problem is efficiency. The two investigations should be synthesised, working in tandem, particularly because when investigating activities with a financial interest, speed is key. Dual investigations work against this goal. Filletti notes that while the PIF Directive should keep this goal at heart, it instead focuses on the definitions of offences, while remaining ‘completely silent’ on recovery.

Filletti notes the language barrier as one obstacle. For example, the Italian term sparizione dei soldi literally translates to ‘disappearance of funds’. However, this does not correlate to any Maltese law. So should we consider it as related to fraud? Or perhaps misappropriation?  

Prof. Jaan Ginter of Estonia echoes Filletti’s concerns on dual administrative and criminal investigations, raising the issue of non bis in idem, or double jeopardy. This relates to the concept that a person should not be tried twice for the same crime, which the PIF directive seemingly ignores, allowing for concurrent administrative and criminal proceedings. 

Harmonisation of penalties is also a concern for Ginter, as in some Member States (particularly Eastern members) a €1,000 penalty would be deemed steep, while others, such as Germany or Luxembourg, would see it as negligible.

In France, Dr Araceli Turmo notes that while politicians, judges and practitioners are approaching the legislation positively, a multitude of agencies need to show a more coordinated effort.

Agranovksa, serving a dual role as Latvia’s rapporteur, expects PIF Directive implementation to go smoothly, as many of its provisions are already in place. However, money laundering remains rife in the country, with the accusation this year that ABLV, Latvia’s third largest bank, has been perpetrating large-scale money laundering. Following the scandal, a law was urgently implemented outlawing shell companies. Further implementations will follow, and they are unlikely to encounter much opposition.

The general consensus remains that most national legal systems are not adequately prepared to take on European Law. However, this is partly why this study is taking place—to give states the tools they need to equip themselves. 

Sammut, Agranovska and their European counterparts have barely scratched the surface, and the implications of their work will certainly go far in understanding the limitations of the EU’s Member States. While the EU is faced with the immeasurable task of legislating for an incredibly diverse membership, it cannot continue going from strength to strength without considering this reality. Member states are not on a level playing field, and everyone needs to work together to adapt to this reality. 

Note: In June 2019, Sammut and Agranovska will be discussing the implications and scope of the study at a conference entitled 

EU & national criminal law in Fraud, Corruption, Blockchains: friends or foes? For more information, email Elisa Attard on elisa.attard@um.edu.mt.