The thumping, scuttling sounds retreated to the back of the storage room on the upper floor. The man stirred in the darkness, listening to the last, faint steps echoing away before stretching his legs and easing the stiffness in his knees. The edge of the wardrobe dug into his ribs, and the cold floor seeped into his weary bones. He broke the silence with a hushed gasp at the stabbing pain in his back — it had been years since he found himself crouched down on the floor for so long. He paused once more to listen, straining his ears for any sound from upstairs. The dimness in the bedroom began to lift, and his eyes wandered around the surroundings, before resting upon a framed photograph of himself and his wife. He smiled, his tense body relaxing for a brief instance. 

A door slammed with a crash, and the haunting pitter-patter of steps dashed to the other side of the house. He could hear and feel the slight quiver of the walls as each step landed on the floor just above him. He could make out the route his stalker took: out of the storage room, through the corridor, and into the library. The library. Dorothy! Peter shook away his thoughts and pushed past the pain. He crawled out of his hiding spot with caution and urgency — the image of his wife, hidden and alone, spurring him forward. As he emerged from behind the wardrobe, his foot caught the leg of the nightstand, toppling over a lamp as it fell to the ground with a loud crash. The footsteps came to an abrupt halt. A moment’s hesitation followed. The stalker’s attention had been distracted. 

Peter froze. In a flash, he heard the footsteps race back out into the corridor, before tumbling down the stairs with a ferocious will, until a faint light came streaming in through the bedroom door. Peter crawled forward, squeezing himself under the wooden frame of the bed. The effort proved too strenuous. His chest rose up and down, brushing against the floor. He felt trapped — stuck between the floor tiles and the bed slats digging deep into his back. The noise from outside the room rumbled on closer. A shadow flew across the door as the light dimmed momentarily. The stalker had made its way to the bedroom and now loomed in the silence — an ominous shape looking into the darkness before it. It paused there, considering, assessing, waiting. Peter’s lungs struggled to inhale in such a tight space. He winced, trying to deaden the sounds of his breathing. 

The presence stood there. He could hear its soft breath and see its bare feet, restless  — the soles tapping against the floor with impatience. It took a step forward, then hesitated, doubtful. 

A shout from upstairs caused it to spin round swiftly and dash back up with a loud banding noise. Peter heard a mocking laugh escape from its mouth as it reached the floor above once again. A shout soon followed, and then a cacophony of wails and cries curdled his blood. He thought of his wife once more. The old man pushed himself out from under the bed and staggered up, trying to regain his balance. In the dead silence, he felt the vicious pounding of his heart inside his chest and the blood rushing to his ears. His legs and back ached, but he forced himself towards the door and peered out into the dim light of the corridor. The doors leading into other rooms had been opened and left ajar. Peter’s spine tingled at the thought of some unseen presence lurking and hiding behind one of them — readying to pounce on top of him as he emerged. He leaned against the doorpost and eyed the sinister staircase just a few steps away in front of him, as it rose upwards towards an impenetrable blackness. His mind harked back to the image of his wife and the disturbance from a few moments earlier. Everything had gone quiet again. He took another cautious look at the corridor and quietly approached the stairs. 

He thought he heard a door creak from one of the rooms. He paused a moment to 

listen. Peter held on to the handrail, his grasp failing him as his hand trembled. The wooden planks groaned. His ascent felt endless, and having abandoned the light behind him, he plunged into the engulfing darkness on the top floor. Suddenly, before him stood a ghastly face staring right at him. The old man’s heart thumped faster than ever, and his legs felt faint. His mind wavered and struggled to fight off a wave of dizziness. As his eyes adjusted to the dark, the face before him became more clear. It morphed into the smooth and subtle brushstrokes of his grandfather’s portrait painting. He cursed under his breath and regained his stance, but had barely stepped off the last set of stairs when the scuttling sound came dashing round the corner. It was somewhat louder, more confused, and faster. It had taken him only a few moments to realise …  there’s two of them! More clear than ever, he could hear the fall of another pair of footsteps hurtling towards him, like some four-legged beast, ravenous in its pursuit of its prey.

Peter rounded the end of the staircase and dashed into the gloom of the library. 

‘Dororthy!’ he whispered. He pressed himself behind the open door, against the wall, a faint line of light visible in the slit between the hinges and the door frame. Peter heard the footsteps falter and come to an abrupt halt. Its breathing was heavy and hushed. A shadow appeared by the entrance before being joined by another — of the same size and height as the first. They moved forward together, stalking the inside of the library. Peter’s sweating hands grabbed the handle, pulling the door further in towards him. He glanced once more at the slit of light and recoiled in horror at the sudden appearance of another, much larger shadow than the other two — brooding and towering over the entrance. 

He felt the horror of it all overwhelm him and resigned himself to the idea of what was about to happen. He felt the door being snatched away from his grasp. He closed his eyes shut and waited …

‘Got you!’ a shrill voice screamed. 

He felt hands tugging at his clothes, pulling him and shouting. He opened his eyes as the lights in the library sprang to life.

‘Not so hidden, eh?’ said Peter. He allowed himself a sigh of relief and laughed at the sight of his grandchildren, waving and dancing in triumph at their discovery in the middle of the library.

‘So they found you too huh?’ he said, emerging from behind the door and dusting off his jumper. He looked at his wife and smiled.

‘Exactly where they found you,’ said Dorothy, arranging his shirt collar and patting him lovingly on the shoulders.

As they headed back downstairs, Peter’s hand slid without effort along the handrail. He dismounted the last step and smiled, as he heard once more the familiar footsteps of the children running around on the floor above. He had left his wife in the library to look up a book whilst he headed towards the bedroom — oblivious of the clawed hand pushing the door at the far end of the corridor wide open.

Taking the lead with patient monitoring

Patients are currently monitored using wired leads (electrocardiographic cables). This decreases patient mobility and comfort. Studies have shown that it can also lead (pun not intended) to long-term skin damage, especially with newborns. A team of researchers from the University of Malta (UM) are examining whether some of this data can be extracted through digital cameras, removing the need for cables.

What if hospitals could use ordinary digital cameras to monitor patients’ vital signs?

While monitoring patients wirelessly sounds like an almost futuristic idea, it’s precisely the line of research being investigated by an interdisciplinary team of six scientists and medical professionals at the University of Malta and Mater Dei Hospital. The formidable team, consisting of Dr Owen Falzon, Prof. Ing. Kenneth Camilleri, Dr Abdelkader Helwan, Prof. Jean Calleja Agius, Dr Nicole Grech and Dr Stephen Sciberras, is currently spearheading what they call the NIVS Project: Non-Invasive Vital Signs monitoring project.

‘Monitoring vital signs like heart and respiratory rates is essential for various reasons,’ explains anaesthesia trainee Dr Nicole Grech over a coffee one morning. ‘It’s particularly important in wards like the Intensive Care Unit (ICU) where patients are more likely to be unstable, so continuous monitoring can be a matter of life and death.’

Grech explains that heart and respiratory rates can often show that all is not well with a patient even when they are feeling fine; a situation that was quite common with COVID-19 patients over the past months for instance.

‘ECG monitor leads are considered the gold standard in terms of providing that data in real time, but they also come with a lot of issues,’ she explains. ‘First of all, there is a practicality issue, in that they tend to fall off patients and hamper their movement when they are trying to move about or even sleep. There are also issues when patients have hairy or moist skin, not to mention diseased skin that can become irritated or prevent the leads from adhering effectively.’

Grech goes on to explain that the leads can sometimes cause significant damage to the skin, particularly in premature babies, whose delicate skin could actually slough off when the adhesive leads are removed.

‘There is also a higher likelihood of infections spreading from one patient to another, regardless of how well these leads are disinfected. Hospital-transmitted infections are actually incredibly common, and they can lead to higher mortality rates, particularly in places like the ICU where patients are already vulnerable,’ Grech says.

The Word Health Organisation has prioritised research to find alternatives to contact-based devices such as monitoring leads. It wants to reduce  antimicrobial resistance, which is a global and health development threat.

Finding new solutions

The spike in global interest and the recent focus on social distancing led project lead investigator Dr Owen Falzon to set up the multidisciplinary team and attack the issue with technical and clinical solutions.

‘The inter-faculty collaboration between UM and Mater Dei Hospital allowed us access to a full suite of equipment and resources, as well as the possibility to run tests in controlled conditions and clinical settings, to give us a much deeper understanding of the systems needed,’ Falzon explains.

Falzon, together with the Director of the UM’s Centre for Biomedical Cybernetics, Prof. Ing. Kenneth Camilleri, worked to synergise medical and scientific research, a step which has so far been uncommon in Malta. The team of researchers decided to dive into the concept of photoplethysmography (PPG), which operates on the idea that changes in someone’s heart rate can be detected through skin colour changes.

‘The basic idea is that every time the heart beats, it pumps freshly oxygenated blood — which is redder in colour — to the surface of the skin,’ explains Grech. ‘This gives the patient a pinker hue. The process is invisible to the naked eye, but a basic camera can pick up the subtle change.’

Grech goes on to explain that using a camera, known as remote PPG, would be non-invasive and would ultimately enhance patient wellbeing.’The absence of leads would mean that patients can move around in their beds without fear of getting disconnected or tangled. The risk of contamination and skin damage would be lowered, and the remote data collection would also allow for more effective physiotherapy sessions as patients need not be concerned about getting disconnected from monitors during these important sessions.’

What happens to the footage?

In the interest of this project, the team has already gathered around 44 hours of footage in total; first from healthy volunteers (approximately 31.5 hours) and then from ICU patients (approximately 12 hours). But how does that translate into medical data that health professionals can interpret?

Data analyst Dr Abdelkader Helwan explains that the data and videos are being fed into a convolutional neural network — a form of Artificial Intelligence (AI) that can learn how to carry out complicated tasks based on the data it is fed. Helwan will then work on creating an algorithm that allows the machine to recognise anomalies and irregularities in patient heart rates, in the same way an ECG monitor would.

Helwan explains that AI is becoming increasingly important in the health sector, with models successfully detecting and classifying diseases like skin cancer and beating experts at determining the malignancy of tumours.

‘Our work in this particular project is very robust as we are using various video scenarios, including a variety of poses, illuminations, and distances from the camera,’ he adds. ‘Filming patients in a hospital environment will allow our AI to better overcome common issues identified in this method of data collection.’

Some of the most common challenges to remote PPG have been highlighted in medical and research journals. From the placement of the equipment to data privacy issues, this research project is trying to overcome several challenges.

‘The camera itself can be a little cumbersome, so we need to think of where we can place the equipment to effectively monitor patients without disrupting the staff if we are to use this method in a real world setting,’ Grech explains.

‘Clinical tests have also thrown up issues like light changes causing a disruption to the data collected. If there are lights flashing from various monitors or pumps around the patient, the data may become muddled,’ explains Helwan. ‘Movements of hospital staff around the patient can also cause disruption to the data collection.’

Echoing Helwan, Grech explains that this research project collected data in dim light, bright light, and even darkness to train the AI to interpret data in as varied conditions as possible. The idea was to simulate real use.

Next steps

‘Beyond the practical aspects,’ says Grech, ‘our clinical tests have shown that we need to have a wider data set to compare to. The data collected from healthy patients often does not match up to the conditions of patients in wards like the ICU.’

‘The algorithm won’t be able to recognise patients whose heart rates are perhaps outside the normal zones, so we are currently applying for ethical approval to collect data from healthy patients doing exercise. This will allow the algorithm to develop an understanding of more elevated heart rates, for instance,’ she adds.

Data privacy is another key issue. Given that this data relates to patients with severe health issues, the team had to seek approval from Mater Dei Hospital and UM Ethical Committees to ensure that the data is secure, with only the clinical and research team having access.

A further hurdle the team came up against is the expensive nature of the equipment in question, with some of the machines costing thousands of euros. To this end, the team successfully applied for funding from the Malta Council for Science and Technology for the NIVS Project.

‘As mentioned earlier, we have already identified the need to analyse more elevated heart rates and feed it into the system, but the aim is to use all this data to assess the accuracy of the system and finally test it in a real-world setting,’ Grech adds.

The hope is for the research to ultimately become widely used in hospitals. The team have opted for a broader data set than has been attempted so far in any international study. Most studies around the subject have employed exclusionary criteria and focused on specific issues like patients undergoing haemodialysis treatment or preterm infants, but the local research team has chosen to have a broader variety of patients to properly test this form of data collection.

Intensive Care Consultant Dr Stephen Sciberras and the Head of UM’s Anatomy Department Prof. Jean Calleja Agius explains that the ambitiously wide data collection will allow the team to build an estimation model that should work seamlessly in a busy hospital setting.

‘The ICU offers the best opportunity to collect as much data as possible in a clinical situation, as it incorporates a wide variety of conditions,’ Sciberras explains. ‘Patients here can be awake or asleep, some could be breathing normally while others use ventilators, and so on… This ultimately means that the system will be better calibrated for everyday use, rather than only a specific type of patient.’

With infectious energy and optimism, the team has largely completed their data collection and are now well into the data analysis stage. Should these results be favourable, the project would likely change the image of hospitals as we know them and push them into a more contact-free future, a feeling that is entirely on-brand in our post-Covid world.

The many dimensions of data

Do you feel safe walking around after dark? Does the size of the city affect how you feel? How do these feelings compare between men and women? For data analysts, these questions come with unwieldy amounts of data. Luckily, Dr Gianmarco Alberti from the Department of Criminology (Faculty of Social Wellbeing, University of Malta) has authored a free software that visually portrays data patterns in a practical way.

So how does the software work? Going back to our safety in the dark example, the data is plugged into the software. The programme then explores how the feeling of safety relates to the size of the city. In this example, we’ll split the variable ‘feeling safe after dark’ by gender and see if it’s influenced by the number of people living in the city  (‘town size’, represented at the top of the first image). The table below is small yet highly complex (see figure 1), finding any obvious pattern of association between categories is hardly an easy task.  

Table 1: presents how safe male and female participants feel after dark (column 1) compared to the population size of the city (row 1) 

Plugging this data into Alberti’s software, named ‘CAinterprTools’, provides a body of facilities that allow users to get the most of those results (see figure 2). With this image, it’s easier to understand that the bigger the town (right side along the horizontal axis), the less safe interviewees felt. Both male (identified with a M) and female (identified with a F) have the same perception of their safety in a smaller town (points in the left-hand side of the chart). However, as the size of the town increases, females start to feel less secure than men (points to the right-hand side of the chart). It is clear that this approach can provide insights into data structure and help reveal hidden patterns. 

Figure 2: shows a visual representation of the data presented in Table 1. The size of the city is marked with black points, while how safe participants felt is symbolised by the red triangles. 

The beauty of Alberti’s program is that it increases data analysis efficiency, not only to researchers (e.g criminologists, political scientists, or biologists) but also to citizens and several entities that work with data (e.g. banks, customers, or companies).  The fact that this software was developed under the free R statistical programming language means it is a free resource which can allow for an easier way to interpret data — especially for those who aren’t math oriented! Let’s hope this leads to safer streets for all!

The programme can be found on

The data used in the table was taken from the International Crime Victim Survey –

Playing with AI

Konstantinos Sfikas, student

By 2017, AI had advanced far enough for AlphaGo, a specialised AI that can play the highly complex board game Go, to beat the major Go players in the world and be awarded professional 9-dan by the Chinese Weiqi Association. Go, however, is a fully deterministic game like Chess, with no random elements. Probabilistic games like Pandemic, on the other hand, are even trickier for AI to play efficiently, as the randomness of dice rolls or shuffled cards makes it much harder for computers to crack them. This problem inspired me (Konstantinos Sfikas) to attempt to create an AI that can play the Pandemic board game.

In the summer of 2018, I started working on this problem as part of my Thesis for the MSc in Digital Games (Institute of Digital Games, University of Malta), under the supervision of Dr Antonios Liapis.

At the core of our methodology lies Rolling Horizon Evolution (RHE), a planning algorithm that makes decisions by optimising action sequences through artificial evolution (introduced by University of Essex researchers in 2013). In order to make a single decision, RHE initially composes a population of random action sequences and evaluates them by simulating their potential result. Then an iterative process of optimisation takes place: the action sequences are randomly mutated, generating a set of offspring. The offspring will either replace their parents or be discarded, based on a quality comparison. While this process repeats, the overall quality of the population tends to increase. After a predefined number of iterations, the agent simply selects the first action of the best-found sequence and applies it to the actual game. 

Based on RHE, we designed the Policy-Based Rolling Horizon Evolution Agent (PB-RHEA), which operates on a higher level of abstraction, using a set of “policies” (artificial behaviours) as an indirect encoding of action sequences. When composing or mutating sequences, PB-RHEA does not consider the full amount of potential single actions (as RHE does), but rather selects among a much smaller set of possible behaviours that translate into specific actions and approximates their probable outcome through repeated randomised simulations. Through this technique, the agent’s operation was greatly enhanced in terms of computational efficiency and overall performance.

During my thesis and the two publications that followed (both co-authored with my supervisor Dr Antonios Liapis), we performed a large number of computational experiments, analysing the agent’s behaviour and optimising its performance. One of the most challenging aspects of our research was to design a set of heuristics that approximate the quality of any given game-state, thus allowing the agent to evaluate the outcome of an action-sequence. Another challenge was to define the set of policies that the agent would use as building blocks in such a way that they are both efficient and expressive. Finally, fine-tuning the algorithm’s parameters through trial and error was another critical aspect of the agent’s degree of success. The results overall showcase that our proposed methodology exhibits a good performance against a hard problem and leaves clear avenues for further improvement.

From an academic perspective, the main contribution of our research is that it clearly expanded the knowledge on planning algorithms like RHE and, more precisely, their applicability on complex problems like Pandemic. Agents like the PB-RHEA can be used to play alongside human players in the digital versions of board games or even be used in the context of automated play-testing during the development phase of board games. Although gamers have been playing alongside AI for a long time, will game developers also adopt AI as a partner when designing their games?

This research was carried out as part of an MSc in Digital Games at the Institute of Digital Games, University of Malta, under the supervision of Dr Antonios Liapis.

Further Reading

Sfikas, K., Liapis, A., & International Conference on the Foundations of Digital Games. (2020). Collaborative Agent Gameplay in the Pandemic Board Game.

Sfikas, K., & Liapis, A. (2021). Playing against the Board : Rolling Horizon Evolutionary Algorithms against Pandemic.

Bridging the Gap: Bone grafts of the future

Better recovery for patients, reduced need for revision surgeries, and many hundreds of thousands of euros saved for public health and industry. That could be the outcome of four years’ intense work by engineers and medical professionals at the University of Malta and Mater Dei Hospital in developing biodegradable metal-based tailor-made bone scaffolds. Cassi Camilleri writes.

Healthy bones matter. They carry us through life, literally. 

But we all know that journey can be fraught with difficulties. Cancer, a bad fall, even the simple passage of time, all of it impacts our bones. And not in a good way. 

As a result, more and more people are visiting their orthopedic department at hospital, and more and more people are needing corrective procedures that involve bone implants or grafts. According to research published in 2017 by Wang and Yeung , that number lies at around 2.2 million procedures worldwide. 

The status quo, its flaws, and the need it harbours 

‘If we need to repair bone, the first option is an autologous bone graft,’ explains orthopedic surgeon Ray Gatt. With these autografts, surgeons fix the damaged area by harvesting bone from another part of the patient’s own body. While this method has obvious pros in biocompatibility, it also has cons. 

‘For the patient, it means you’re giving them one incision where the primary operation is and then another incision where you’re taking bone from. So they’re effectively having two surgeries. Occasionally, that second incision is much more painful than the first.’ 

The extent of the damage in question is another limitation to the autograft. ‘You can only harvest so much bone from a patient’s own body. It’s a finite resource,’ explains Gatt. If a bone has multiple fractures from a car accident, for example, surgeons would then turn to a combination of bone graft substitutes and permanent implants. 

These require weeks of downtime from the patient until the grafts consolidate and can bear weight on them. However, there are other issues that Gatt’s colleague Ryan Giordmaina highlights: ‘In big defects, you want to give the bone strength and support; however, when you’re doing this, you’re also taking away the bone’s ability to regrow and reform.’

Bone has a funny way of regenerating. Researcher Prof. Pierre Schembri-Wismayer explains it this way, ‘When you break a leg, surgeons put a cast on and ask you to rest for a while, then when the bone has formed a bit, you progress to weight bearing, and it’s time to start walking. The reason is that bones can feel stress passing through them and rebuild themselves according to that stress. It’s an amazing capability.’

Plates and other hardware that are implanted pose the same issue. ‘Plates carry a lot of their weight themselves,’ continues Giordmaina. ‘So the force isn’t passing through the bone, and to some extent, there can be some loss of function. This is why the current drive in revision surgery is to have more bone biology. You want the bone to grow back as much as possible.’ 

To make this happen, the medical world needs an implant that ticks a number of boxes. It has to be strong and mechanically sound. But it also needs to be porous to allow for vascularisation and nutrients to pass through. It needs to be biodegradable so the patient’s own bone could grow back, but the implant and the degradation material both need to be biocompatible and non-toxic to the patient. 

It’s a tall order, with a lot of conflicting needs at the outset. But that was the brief. And that was what the engineers needed. 

With that, and continued support from Schembri-Wismayer, Gatt, Giordmaina, and many others at the University of Malta, Knowledge Transfer Office, Project Support Office, and Mater Dei Hospital, as well as the Malta Council for Science and Technology, Prof. Joseph Buhagiar kicked off the BioSA project. 

Early days and leaving the known behind 

This particularly complicated problem-solving process started with Buhagiar and his then-student, now collaborator Christabelle Tonna experimenting with powdered metals. They wanted to replicate the net-like structure of spongy bone, and this is why they use actual, off-the-shelf washing up sponges as a way to create metal templates. 

Using different powdered metals and a slurry liquid to bind it together, they covered the sponges and then applied heat. This fuses the powdered metals together in a process called sintering, while burning the sponge off at the same time. This is what’s called the replication method, and it worked. ‘In the end, we were left with a scaffold of sorts,’ Buhagiar confirms. 

As expected from first drafts, it wasn’t perfect. ‘Among other things, the scaffold wasn’t reticulated like real bone is,’ Buhagiar explains. ‘There was a network, sure, but there were too many dead ends. Real bone isn’t like that, so we needed to find another way. But it was a start. A proof of concept we would continue to build upon.’

And build they did. 

In fact, the first few months of the project were dedicated to making leaps. The team wanted the scaffolds to be tailor-made to the patient, so the ready-made sponges had to be left behind. With Dr Arif Rochman’s help, the team looked into 3D printing solutions. 

Together, they decided to use a stereolithography 3D printer. Unlike standard filament printers, its advanced resolution would allow them to print a plastic scaffold template with small enough gaps to allow the patient’s blood supply to flow through the implant. It would even allow them to create a gyroid structure for the template instead of the straight lines we usually see in scaffolds.

The stage of scaffold preparation-3D printed polymer template, metal coating the template and sintered scaffold (from left to right)

Photos by Elisa von Brockdorff

In another part of the engineering lab, collaborator Prof. Ing. Maurice Grech was helping Buhagiar run a project in parallel to find the right powdered metal recipe for the scaffolds. Yes, metals are the best for giving the scaffold the strength it needs to bear the body’s weight, but iron can also be toxic. 

‘Iron is present in the body, but iron isn’t easily got rid of by the body,’ explains Schembri-Wismayer. ‘It stays stored, but the body can get overwhelmed. And if it does, iron damages the kidneys, heart, and liver and causes them to stop functioning. So we had to find a balance.’ 

This balance is the key to the whole project. 

‘In engineering, we’re usually working on corrosion resistance, coatings for resistance. In real life, you want to protect the item from corrosion. All our knowledge is built around that. But with BioSA, it was about increasing the rate of corrosion. The work needed us to flip all our knowledge as engineers on its head,’ Tonna explains. ‘It was a massive paradigm shift,’ nods Buhagiar. 

This mindset saw the team making more jumps as they went. Though the initial process included a binder to glue the powdered metal together, experimenting further with the polymer they were using for 3D printing brought about another option. 

‘We noted a tackiness developing in the material depending on the curing we did,’ Buhagiar says, ‘So we used this tackiness on the printed template surface to adhere the metal powder directly.’  

From there, they went on to develop a two-step heat treatment that would later be streamlined to one. It involves placing the plastic template covered in metal powder into a furnace. At 450°C, the polymer template burns away, and at 1120°C, sintering happens, and the powders join to form a solid implant.   

Trials, tests, and some road ahead 

The team is now in the process of running various tests on their new implants. Their first ‘patients’ were various pork bones bought from a butcher. The orthopaedic surgery trainees conducting the procedure, Luke Saliba and Keith Sammut, report that ‘the scaffolds were easy to handle and adjust as needed.’ 

Saliba is also working on cytotoxicity testing, which tells the team how the corroding metal in the implant is affecting live cells grown in a petri dish. The results of this work continue to help the team tweak and perfect the implant’s powder recipe.  

Meanwhile, Sammut is conducting bacterial testing. ‘Whenever you’re implanting metal work in the body, there is a risk of infection,’ Sammut explains. ‘The problem is whenever you have an indwelling device like a metal rod or plate, bacteria tend to form a biofilm. Biofilm acts like a shield for bacteria.’ Worryingly, it makes bacteria resistant to antibiotics. 

‘Antibiotics alone are not enough to tackle this problem when and if it happens, and it often necessitates the removal of the implant. An infection from a prosthetic device is devastating’. 

To solve this problem, the team has added silver to their alloy. With it, ‘there was a reduction of 92 to 98% in the biofilms when we added silver,’ Sammut reports. 

So what are the next steps for this project, you ask? 

At this point, more and more energy is shifting into solidifying the business plan and giving the team the information they need to make informed decisions on the way forward. Crucial to this is the Knowledge Transfer Office (KTO) and Nicola Camilleri. 

‘Our role as KTO is to complement the scientific team by bringing in the business mind to the development at a relatively early stage. Just like BioSA, every new invention has the potential of having a great business opportunity ingrained. However, this promising business case has to be validated and a business plan formulated, essentially alongside the technology development. So we have been working hand in hand. While the research team has been advancing the technology’s readiness, we have been advancing the market readiness of the future product. In this project, though we are still at the beginning, we just completed the filing of a patent application, which is one of the earliest possible steps on the business side.’

While this might seem like an anti-climax to some, this is the reality of product development, especially in the medical field. 

‘The way our national health service operates is that it looks at what has been tried and tested all over the world,’ explains Giordmaina, ‘so a product like this will have to go through a period in the market throughout the world and be taken on by surgeons worldwide. Only then will it be considered to be incorporated in our practice. That’s how most implants nowadays are brought into our national health service.’ 

But this is no reason to despair, as Gatt explains. ‘It’s true, I probably won’t use the BioSA scaffolds in my surgical lifetime, but what Ryan described is a necessary process that should fall into place. The reality is that the idea is the most difficult part. Getting the conception of the technology. And I think, with BioSA, that has been done. The hard part has been done. Now, we wait for all of it to pay off.’

The ideal bone scaffold 

Bone scaffolds are 3D structures, usually made of ceramic materials, used for bone reconstruction. The ideal bone scaffold should be:  

  1. Porous to allow for vascularisation and transference of nutrients and waste
  2. Strong and mechanically sound 
  3. Biodegradable  
  4. Biocompatible and non-toxic

Contributing to Malta’s research future 

The funds granted by the Malta Council for Science and Technology (MCST), a total of approximately €240,000, have been essential for the development of the BioSA scaffold as a product. They have also gone towards securing its business potential through market research, various drafts of business plans, and the patenting process. 

Somewhat less obviously, MCST’s funding has also contributed to the development of Malta’s future researchers. ‘Christabelle Tonna’s PhD, as well as Luke Saliba and Keith Sammut’s MSc by Research were made possible through this fund,’ explains Buhagiar. 

Gatt elaborates further: ‘With the research experience they have gained through the BioSA project, [Christabelle, Luke and Keith] have the tools they need to go forward, plan their own projects, and innovate themselves, creating solutions for more of the challenges we are facing in our fields.’

BioSA (R&I-2017-037T) is financed by the Malta Council for Science and Technology through the FUSION: R&I Technology Development Programme.

Further Reading

Wang, W., & Yeung, K. (2017). Bone grafts and biomaterials substitutes for bone defect repair: A review. Bioactive Materials, 2(4), 224-247.


Prof. Ing. Joseph Buhagiar

t: 2340 2439


In the Palm of our Hands

How do you help children adjust to living with diabetes? For Clayton Saliba, a Master of Fine Arts in Digital Arts graduate, the solution lies in the palm of our hands. By combining digital arts and medical information Clayton developed Digitus, an app designed to help children better understand diabetes symptoms. 

‘Ever since I was a child, I always enjoyed doing what I love, all while helping people as well. I feel that that’s where my inspiration for Digitus came from,’ explains Clayton. 

Clayton Saliba – creator of the Digitus App

Digitus can be accessed on both desktop and phone. It starts out by asking the user to input their name, age, date of birth, and to choose their avatar, much like a videogame would. The choice of avatar also changes some aesthetic details throughout the app, creating a dynamic experience. 

As Clayton points out, cartoons and avatars are appealing to children. Besides adding a personal touch, they add a face to a product, especially when they resemble the user’s appearance. 

The avatar can be personalised to suit how the child perceives themselves. Whether it’s the length of their hair, their skin tone, or their eye colour, the customisation helps the child to relate to the app. When the child chooses an avatar, the character in the scenes changes to reflect the child’s look. This entices them to engage and participate with the information given to them. 

Before settling on the final design, Clayton analysed several popular cartoons and illustrations such as Invader Zim, Teen Titans Go, and Dexter’s Lab. Clayton noted that they all use vibrant colours, and have a flat character and environmental design. Dark, yet colourful, background block colours create a contrast with the light and vivid characters. These types of design elements help children focus on the characters.

The creation of the avatars were easy for Clayton. The challenge was gathering information on diabetes. Originally, he wanted to ask people who had the condition. Due to data protection and ethical issues, he was advised to ask caregivers and healthcare workers rather than people diagnosed with the condition. 

Another hurdle Clayton needs to overcome is language accessibility. Digitus is currently in Maltese and English. Clayton wishes to make Digitus available in even more languages; he also wants his project to be a part of something bigger. Not just for diabetes, but also for other diseases such as asthma or cholesterol, as well as for psychological conditions, such as depression and anxiety. Apps like Digitus are trying to help people become more aware about their body and the signs they give us. These apps are trying to help us better understand our body’s warnings, raising awareness in both the individual and their friends and family to help tens of thousands of people in Malta who have diabetes.