Young hearts run free

For the first time in Malta, a cardiac screening programme for young people aims to identify who among them are most at risk of sudden cardiac death. Here, Laura Bonnici chats with Dr Mark Abela to learn more about the Beat It project and the impact it is having on young lives across Malta. 

There are times in life when death haunts us all. It is most tragic when it strikes down our youth. This year, Italian footballer Davide Astori and Belgian cyclist Michael Goolaerts made headlines after they died unexpectedly. Also making headlines was sudden cardiac death (SCD). 

Ischaemic heart disease is the most common cause of cardiac deaths, its likelihood increasing with age. A blockage in one of the arteries supplying the heart starves it of oxygen and nutrients, leading to heart attacks, sometimes resulting in cardiac arrest, in which there is sudden and unexpected loss of electrical heart function. But SCD in young people is very different from cardiac death later in life. 

Dr Mark Abela

Much like Astori and Goolaerts, SCD victims are generally presumed to be in good health. Early symptoms are often incorrectly attributed to other issues or life changes. The result is a horrendous loss for the sufferer and their family and friends, who also have to weather biological, psychological, and social repercussions. Seeing these events unfold, specialist trainee in Cardiology Dr Mark Abela felt the time was right to offer an SCD screening programme to young people in Malta. He called the project Beat It. 

The idea behind Beat It was inspired by the UK-based NGO Cardiac Risk in the Young [CRY], Abela notes. ‘CRY offers screening to young people between 14 and 35 to identify those who might be prone to heart disease. They then give follow-up advice, support, and evaluations accordingly. I realised that a similar programme would be very beneficial to young people here in Malta,’ says Abela. 

In Malta, the Beat It project has focused mainly on fifth form students between the ages of 14 and 16. The cardiac screenings attempt to identify those who may be susceptible to SCD, with those prone to it referred to hospital for further tests to catch the condition before it can strike.

‘Because athletes are believed to be at a higher risk for SCD, we need to have routine screening across all sporting disciplines,’ says Abela. ‘Sport has shown the medical community that young individuals who are susceptible to genetic heart disease are still at risk of SCD. Screening helps decrease this burden. Current evidence also supports that this risk is present for non-athletic youths—so why neglect these youngsters?’ 

Launched officially in October 2017, the Beat It project saw nine doctors, accompanied by a team of technicians and nurses, going into schools and running screenings. Students filled in a simple questionnaire and took an Electrocardiogram (ECG) test on the spot. ‘We analysed the results in the hope of identifying heart disease in the early stages, then advised the young people if they should consider some lifestyle changes,’ says Abela. This included advice ranging from easing up on tennis, to which career choices might be most appropriate for the student based on their health. The team also advised further medical treatment and organised follow-up appointments with specialists Dr Mark Sammut, Dr Tiziana Felice, and Dr Melanie Burg in some instances. In the end, the project screened 2,700 of the 4,300 eligible fifth form students across Maltese schools, all with the support of the school administrators and teachers, who ensured that everything ran smoothly. 

The significance of this project could also reach well beyond the lives of the young people themselves. ‘Since the country is so small and families are often inter-connected, genetic diseases in Malta tend to be more prominent,’ Abela emphasised. ‘The discovery of susceptibility to hereditary cardiac disease in any young person therefore also suggests that their parents or siblings may be at risk of SCD. With appropriate testing, the ripple effect of Beat It could preempt problems in entire families, maybe even saving someone’s life in the process.’

The project boosted awareness of cardiac disease and SCD for Maltese young people, their parents, and their teachers. UK data reports that eight out of 10 young deaths do not report symptoms beforehand. There is also a tendency for symptoms to be downplayed by educators who are not aware of potential problems. With this in mind, Beat It will also act as a learning platform. Since young people with cardiac abnormalities are at higher risk for exercise-related symptoms, physical education teachers are now more aware about potential red flags.

Celebrating the completion of the Beat It project, Abela expressed his gratitude for the team who made it possible. ‘The incredible dedication and teamwork of everyone involved has helped Beat It to effect positive change in young people’s lives, potentially saving some in the process.’  

Note: The Beat It project is a collaboration between the Cardiology Department at Mater Dei Hospital, the Ministry of Education, the University of Malta, and the Malta Heart Foundation and is supported by corporate sponsors including Cherubino Ltd.  through the Research, Innovation and Development Trust (RIDT) and TrioMed.

Author: Laura Bonnici

Talking Toys

While speech development starts early in life, the course of acquiring and processing language in a bilingual country like Malta is challenging. Engineers and language experts at the University of Malta have teamed up to build a toy that will help children overcome that hurdle. Words by Emanuel Balzan.

Toys and play are critical in children’s lives. It is through play that children learn how to interact with their environment and other people while developing their cognitive, speech, language, and physical skills. 

The way children play reveals many things including whether or not they are hitting particular development milestones. Play is also used by professionals who intervene when those skills are not acquired. Speech and language pathologists (SLP) use toys to tailor tasks based on their objectives for the child, determined following their assessment. For this reason, toys are vital tools. 

With technology moving at the rate it is, electronic components are easier and cheaper to access. As a result, a lot of smart, educational toys are now available on the market. However, Dr Ing. Philip Farrugia (Department of Industrial and Manufacturing Engineering, Faculty of Engineering, UM) honed in on a gap in the market—a smart toy that supports English and Maltese. 

Front left to right: Dr Ing. Owen Casha, Loridana Buttigieg, Emanuel Balzan, Dr Ing. Philip Farrugia, Prof. Helen Grech, Anthony Demanuele, Prof. Simon Fabri. Missing from the photo: Dr Daniela Gatt and James Attard.

To make this happen, Farrugia recruited a team of researchers from the university. Engineers Prof. Simon Fabri and Dr Owen Casha joined the effort. Researchers Prof. Helen Grech and Dr Daniela Gatt brought their expertise in speech and language acquisition and disorders. The team was finally complete when game development company Flying Squirrel Games stepped into the picture.

Getting down to business

The SPEECHIE project is divided into three stages. During the first phase, we sought to understand the process of speech and language acquisition, assessment, and therapy. We involved users through workshops that allowed us to observe children’s play and their toy preferences. We also conducted focus groups with parents to identify what they most wanted from toys. During these sessions, one parent noted how ‘there are not any [educational] toys in Maltese our little ones can play and interact with.’ Others agreed with this observation. Parents also raised concerns about children’s attraction to tablets and smartphones, noting how they interfered with social interaction. On the tail end of this discussion, one parent quickly added that ‘the toy must have something to make it feel like a toy and not a gadget.’

With further questioning, we also came to realise that different parents have different criteria when deciding to buy a toy. One parent told us that before buying a toy for her daughter, she would ‘try to see for how long she will play with it and what the toy will give her in return.’ Another parent, concerned about toys’ safety, checks for the CE mark (Conformité Européene) prior to purchasing the toy, saying that he associates the mark with better quality. However, he also confessed that ‘in the hands of children, nothing remains of quality. Give them something which is unbreakable and they will manage to break it in one way or another.’

Since our toy is intended for use in speech therapy, we went ahead and organised more focus groups with SLPs. Outlining the role of toys in their clinics, SLPs said ‘[they] are normally used as a reward. If you know that this child likes blocks, then you use them to motivate the child.’ Toys are also used as part of the language tasks SLPs give. ‘We use objects to put a grammatical structure in a sentence. Many times you find something that represents a noun, a verb, an object and then put them together’ to model the appropriate sentence construction. This prolific use of toys, however, brings with it a very practical problem. One SLP explained how challenging things can get on a day-to-day basis due to the lack of multipurpose toys. ‘We are always carrying toys… we are always carrying things around with us. Even our cars… it is like I have ten kids,’ she said.  

To address this issue, SLPs emphasised how useful it would be to have a flexible toy with multiple functions. One that does not bore children and which they can use to target different speech and language therapy goals. They also drew our attention to a prevalent but damaging mentality that they are trying to address. ‘Unfortunately, the majority of Maltese parents have a mentality that the more money they spend and the more therapy sessions for their children, the sooner the problem is alleviated, but in reality this is not true. The work needs to continue at home on a daily basis. It is not solely our responsibility,’ the SLP said. Much like when we practice daily to learn to play an instrument, speech and language therapy works the same way.

Sharon Borg, an experienced occupational therapist from the government’s Access to Communication and Technology Unit, said that the toy we had in mind could provide a simple way for parents to engage with their children and work at home on related exercises. Borg’s colleague, Ms May Agius, also noted the need for the toy to offer ‘surprises’, saying that ‘anticipation and elements of surprise draw kids and keep them engaged.’

Here we have only touched the surface of all the ideas brought forth. However, by considering the children’s, therapists’, and parents’ needs early in the engineering design process, we should be able to reduce the number of design iterations we have in future.

Reaching out

Design is key. Based on the feedback from the focus groups, we have now started working on the hardware and the software. But the journey is not straightforward. One issue we needed to deal with was the lack of compatibility between the 3D modelling software Flying Squirrel Games used and the technology used by the UM. From an academic point of view, because of the innovative nature of the toy we are making, we needed flexibility, so we modified Flying Squirrel’s virtual model to add different mechanisms which involve moving parts. These alterations now allow us to create support to fix electronic components within the device and ensure that no moving part is impeded by another part. As a result, assembly is much easier. 

Emanual Balzan and Dr Ing. Philip Farrugia

We have also made the decision to build SPEECHIE software using modular blocks. This will enable us to switch parts and functions around so we can widen the idea of who might enjoy our product. The toy will not only be of use to children with speech and language impairments, but also to others. This approach was inspired by a meeting with behavioural economist Dr Marie Briguglio who warned us that labelling the toy could be stigmatising. She explained that it should not become ‘an isolated toy which kind of becomes a label: because I have this toy, that means I have speech impairment.’  

Despite the aversion some parents felt towards technological devices, as said during focus groups, Borg also encouraged us not to shy away from using them. She said children with autism responded very well to technology, and therapists will make the best choice for the child to improve their skills. To hit a sweet spot in between these views, we are incorporating functions that will allow for a kinesthetic learning experience that involves physical activities rather than passive consumption of instructions. We want to mix different modes of play to encourage effective learning. We do not want kids to sit and watch their toy, but to move around, dance, and sing with other children. 

With all of these choices under our belt, we now have a working prototype. But the SPEECHIE toy is not yet complete. In fact, the coming months will see us working on the mechanisms and the interfacing of electronics. 

Towards the end of the year, we will start putting the toy into preschoolers’ hands to determine its effectiveness and efficiency in regard to speech and language therapy. To do this, we will compare the progress of children who use SPEECHIE with those who only use traditional SLP methods.

What we hope is that this toy will encourage parent-and-child interaction through play. We want to enable more frequent use of both Maltese and English and allow children to be safely exposed to technology and to a fantastic learning experience—all while having a ball.  

Note: We are excited to share these insights about SPEECHIE with the public, and if you would be interested in joining on this journey by participating in the evaluations, get in touch here: speechie-web@um.edu.mt

This research is financed by the Malta Council for Science and Technology (MCST) through the FUSION Technology Development Programme 2016 (R&I-2015-042-T).

Author: Emanuel Balzan

Spotting marine litter

Serena Lagorio

Marine litter is a problem found across the world. As well as being directly deposited in seas and oceans, plastic, wood, rope, and other items are accumulating on land and making their way into bodies of water. On the Maltese Islands, such littering happens frequently. Last summer the Physical Oceanography Research Group (Faculty of Science, University of Malta [UM]) took a step towards tackling the issue.

Under the supervision of Prof. Alan Deidun and Adam Gauci, I sought to harness innovative techniques and create a monitoring programme that would begin to identify what kind of litter is on Malta and Gozo’s beaches.

The national Marine Strategy Framework Directive was followed to ensure good data collection and meeting of the ‘Good Environmental Status’ by 2020. The study used images captured by a drone in three coastline areas: the north east Marine Protected Area of Malta, Qawra Point, and the eastern and western points of Baħar Iċ-Ċagħaq. Flying at an altitude of 30 meters, the drone was programmed to spot specific categories of marine and coastal litter. These included plastic, wood, rope, rubber, and other miscellaneous items such as washing machines and mattresses.

Apart from characterising marine litter, the project aimed to observe whether hydrodynamical phenomena, such as wind and currents, are also influencing the accumulation of litter. However, results showed that the difference between the areas of study was not due to dynamics of coastal currents and coastal topography, but to human activities. In Baħar iċ-Ċagħaq, for example, categories such as wood and plastic were found on land at considerable distances from the shoreline, close to points easily accessible by cars.

We also used statistical analyses to confirm that parameters such as tourism, lack of public knowledge, and lack of environmental consciousness are affecting the accumulation of marine litter, laying the blame firmly on human activities.

The remedy to the situation is in Maltese citizens’ hands. Only we have the power to turn things around. It’s time to clean up our act.

This research was carried out as part of a Masters in Physical Oceanography, Faculty of Science, UM.

Author: Serena Lagorio

Mapping in 3D

Drones have rapidly gained popularity in recent years. They are now commonly used by photographers and videographers, law enforcement, the military, and criminologists. At the University of Malta (UM), they are being used as a part of CloudIsle.

Msida monument

CloudIsle, a project headed by Prof. Saviour Formosa (Faculty for Social Wellbeing, UM), is using drones kitted out with laser scanning tools, ground-penetrating radar, and surveying equipment to create 3D maps of Malta. Using billions of data points, the fine details of above and below-ground features can be recorded. This includes precise detail on buildings, as well as the intricacies of the island’s labyrinth of underground caves. The technology will even be used to uncover underwater artefacts at up to 500m depth. The legendary Um El-Faroud and the Xlendi-Karwela-Cominoland trio of wrecks, now transformed into artificial reefs and popular diving sites, are currently under review.

This data’s real-world applications are vast. It can be used to aid Malta’s Planning Authority and ensure building stability, as well as analyse extreme weather and monitor climate change. The Department of Criminology (Faculty for Social Wellbeing, UM) is also employing these tools in environmental enforcement, as well as for spatial forensics and crime reconstruction in scenes related to bombings and homicides.

Fort St. Elmo

CloudIsle is already reaping rewards. The team has discovered and named the Għariebel doline land feature off the Selmunett Islands. They have also created a baseline map of Malta and its seas that can be used to integrate new 3D spatial data.  

Author: Professor Savoiur Formosa

Classical Hebrew undying

Dr Abigail Zammit

Classical Hebrew is the Hebrew of the Tanakh, the Jewish Scriptures, the very source of the Christian Old Testament. Its first appearance in the historical record dates back to the 10th century BCE, and like the other semitic languages from which it emerged, it was written from right to left and comprises only consonants. By the turn of the Common or Current Era, its use as a spoken language was quickly being superseded by Aramaic and Greek. A few centuries later it was a linguistic relic, its use limited to liturgical and literary contexts, not so different from the use of Latin much later in the Christian west.

‘Dead’ languages bring up the question of relevance. They are limited in their vocabulary, especially when compared to their contemporaries; the Classical Hebrew lexicon amounts to just about 10,000 words. Today, they could not be used for communication, on official documents, or for most conventional things. However, there is one function ancient languages fulfill in a far superior manner—interpreting ancient texts.

Modern translations cannot quite capture the nuance of ancient texts. Translators can only convey ideas after making countless choices in the understanding and rendering of words, all while being consciously or unconsciously guided by their own ideological leanings. Translations are essentially interpretative exercises. Armed with knowledge of the original language, a reader can identify the original authors’ ideology, emphasis, word order, and tone. All of these features could easily be lost in translation. For example, should the word ‘meshihu’ in Psalm 2:2 be translated as ‘his Messiah’ or ‘his Christ’ or ‘his Anointed One’? A choice needs to be made, and that choice does make a difference.

Archaeologists use the same concept when studying ancient artefacts, as do epigraphists, the specialists who study inscriptions. Understanding the inscribed language on items leads to a clearer, more colourful picture of its context and origins. The Malta Government Scholarship Scheme supported me in carrying out such an epigraphic study for my doctoral research at the University of Oxford. My project dealt specifically with a group of inscribed pottery sherds discovered at Lachish (modern Tell ed-Duweir) in Israel. Combined with an archaeological and contextual reassessment, these inscriptions provided valuable insight into the socio-political history of early 6th-century BCE Judah, including scribal culture and the mastery of the contemporary Hebrew language, as well as military operations and prophetic activity, all of which strike similarities with the Book of Jeremiah.

Studying Classical Hebrew can be a rigorous mental workout that instills an appreciation for detail: an insight useful across innumerable fields. Not only does it provide a solid foundation for Modern Hebrew, but it offers a fresh perspective for those wishing to read biblical texts in a critical manner. After all, the Bible remains an iconic cultural artefact in the western world, vital when discussing not only ideology but even cinema, literature, music, and art.

Ancient languages give a voice to our history and the people who shaped it, all the while providing food for thought for those in the present.

For more information: The Department of Oriental Studies (Faculty of Arts, University of Malta) offers study-units on Classical Hebrew grammar, syntax, and readings at undergraduate level.

Author: Dr Abigail R. Żammit

Lighting the way to darker skies

Dr Joseph Caruana

As the sun sets and the sky darkens, a black velvety curtain adorned with flecks of twinkling lights is drawn across the heavens, and a milky white band of fuzzy glow stretches majestically overhead. Unfortunately, this experience is nowadays denied to us thanks to artificial lighting. The sky is often left awash in a cold, jarring glow, making Malta one of only five countries whose citizens are denied the possibility of observing the Milky Way from their home.

A few select coastal sites remain where we can see the Milky Way. But even those are under continuous threat. In 2002 the Malta Environment and Planning Authority designated a number of sites in Gozo and Comino as Dark Sky Heritage Areas, stating that ‘reflective signs shall be employed to guide driving at night, whilst the installation of lighting which is not related to aerial or maritime navigation, shall be strongly discouraged.’ Since then, light pollution has still been increasing and is seriously impinging upon these areas.

To some, the ability to appreciate and study the night sky might be less of a priority, but light pollution affects our lives in many more ways. Our night-time environment is fast becoming a vista of blindingly cold light, and we need to act now to reverse this. Badly designed lighting can result in glare, which is especially dangerous while driving. Light trespassing into people’s homes creates a myriad of problems, ranging from mild discomfort to serious sleep disruption. Studies have linked bright LED lighting with adverse health effects, as it can interfere with our circadian (daily) rhythm. Light pollution also disturbs wildlife. For example, conserving colonies of birds that make their home at the cliffs of Dwejra, like Scopoli’s Shearwater and Yelkouan Shearwater, depends heavily on our efforts to curb light pollution.

The solution is not as drastic as switching off all our lights, but adopting full cutoff lighting in streets to illuminate the ground without spilling light everywhere else.

Luckily, light pollution is a reversible problem. Authorities can choose to bring about positive change, sometimes requiring little effort. Do we really need our public monuments, churches, building facades, and playing fields to be illuminated all night long, oftentimes with skyward-pointing floodlighting? When planning new lights for a road or a public space, should we not consider the impact the proposed lighting will have on the surrounding community and environment?

Conservation of our natural environment is not diametrically opposed to human activity and business interests. Other countries have long recognised the night sky’s potential for eco-tourism.

The Department of Physics (Faculty of Science, University of Malta [UM]) and Institute of Space Sciences and Astronomy (UM) are currently embarking on a new study of our islands’ night sky’s brightness. Interested parties, authorities, and non-governmental organisations alike are most welcome and encouraged to get in touch. It is only through awareness, dedication, and proper coordination that we can help ensure that future generations can still enjoy the peaceful beauty of the Maltese night sky.

Further reading: Falchi et al., ‘The new world atlas of artificial night sky brightness’, Science Advances, vol. 2, no. 6, 2016, e1600377

Author: Dr Joseph Caruana

Onfoħ

Breathing moves air in and out of the lungs. Oxygen goes in, carbon dioxide is flushed out. An exchange occurs within our internal environment. Onfoħ is an installation that explores the phenomenon of carbon emissions through human respiration.

Carbon emissions are loosely defined as the release of greenhouse gases and their precursors into the atmosphere over a specified area and time. This notion is usually linked to the burning of fossil fuels like natural gas, crude oil, and coal. In short—human activity.

From the very beginning, humans have altered their environment. In fact, an average person takes 12 to 20 breaths per minute, amounting to an average of 23,040 breaths per day. The world’s population collectively breathes out around 2500 million tonnes of carbon dioxide each year, around 7% of the annual carbon dioxide tonnage produced by burning fossil fuels.

Although the carbon dioxide produced through breathing is part of a closed loop in which our output is matched by the input from the food we eat, it can be used as a metaphor to visualise other unseen outputs from other man-made sources: transportation, electricity, heating, water consumption, food production.

Onfoħ was designed to engage citizens and address an overwhelmingly challenging environmental problem of our time—our inability to visualise our own carbon footprint. The work does this by showing that which is usually unseen—the physical manifestation of carbon emissions.

The installation consisted of five plinth-like structures, each housing a glass container of lime water. Stencilled onto the pillars were illustrations of lungs, each consecutive pair having decreased surface areas, conveying a sense of degeneration. When the audience interacted with the installation, breathing into the lime water and adding carbon dioxide, they triggered a chemical reaction that produced insoluble calcium carbonate. The clear solution turned milky, making the invisible visible.

Humans contribute constantly to carbon-based, hazardous waste production, and the installation demanded that they face that reality.

Note: The installation was displayed as part of a collective exhibition entitled Human Matter, hosted by the Malta Society of Arts at the end of last year. David Falzon, Matthew Schembri and Annalise Schembri teamed up to work on this artwork as soon as they finished reading for an MFA in Digital Arts (Faculty of Media and Knowledge Sciences, University of Malta).

Author: David Falzon

Hailing a new era for ocean literacy

Prof. Alan Deidun

The Maltese Islands, despite their miniscule terrestrial extent, have always managed to punch way above their weight when it comes to aquatic matters. Hosting the International Ocean Institute, the Islands also have a pivotal role in the formulation of the Law of the Sea through the Maltese representative to the United Nations, Arvid Pardo. The ‘father of the law of the sea’, as he is affectionately known, delivered a prophetic speech to the UN General Assembly on November 1st, 1967. He described the sea as ‘the common heritage of mankind’, a phrase which still resonates to this very day, and which is enshrined within Article 136 of the United Nations Convention on the Law of the Sea.

Europe’s seas are currently being assessed more than ever for their potential, as Blue Growth (the long term strategy to support sustainable growth in the marine and maritime sectors as a whole) gains greater traction throughout the continent. We are plumbing our seas to greater depths in the search for elusive minerals, cures, genetic resources, energy sources, and a plethora of other untapped assets. In the race to unlock more of the ocean’s secrets, ocean literacy assumes a compelling role—to revise the paradigm of human impacts on our ocean so far. In fact, in the history of human exploitation of the ocean, we first exerted deleterious impacts on the ocean environment, only to become aware of those impacts and resort to ocean literacy to generate further awareness, control, and change.

The challenge now is to anticipate developments. A precautionary approach is needed to soften impacts when venturing into unchartered grounds. Some might label this utopic, I prefer to call it ‘foresight.’ For us to reach this stage, governments and institutions must invest heavily in ocean literacy to ensure more responsible use and treatment of that 70% of our planet. It is imperative for potential investors to have a grounding in ocean literacy principles, with the aim of paralleling the considerable success being had introducing ocean literacy concepts within school curricula and initiatives across Europe.

We are gearing up towards the International Decade of Ocean Science for Sustainable Development. Proposed by UNESCO last June  at the Ocean Conference in New York, it will span from 2021 until 2030. The considerable number of abstracts submitted for the European Marine Scientists Educators Association (EMSEA) Malta conference, now approaching the 70 mark, is testimony to the profile that EMSEA has managed to achieve since its establishment a decade ago. It also confirms the status that ocean literacy now holds across the European continent and beyond. Let’s keep the momentum going!

Author: Prof. Alan Deidun
Read more here: http://www.emsea.eu/