Search

Background: Anterior T wave inversion (TWI) is frequent in healthy adolescent individuals (juvenile ECG pattern), normalising after puberty. Its clinical implications are uncertain., Aim: This study assessed a) national prevalence of anterior TWI, b) ST segment morphology, c) proportion of individuals with a juvenile ECG pattern whose ECG normalises and d) factors predicting TWI persistence >16 years., Methods: Adolescents (mean 15y) in Malta were systematically invited to enrol in a cardiac screening program. Subjects completed a health questionnaire and an ECG at their school. Participants with TWI were labelled as TWI in V 1 -V 2 or extended TWI (V 1 -V 3 / 4 ). The latter were followed at 1 year with a repeat ECG. Those with persistent extended anterior TWI were offered evaluation and surveillance., Results: The prevalence of isolated anterior TWI was 5.0%, commoner in females (6.3%) independent of athletic ability. Extended TWI was commoner in female athletes (4.2%, non-athletes 2.1%). Females often had shallow TWI without overt ST segment abnormalities. Deep TWI and ST segment changes were more frequent in males. Only 0.2% of cases persisted ≥16 years of age. ST segment characteristics were not able to predict T wave normalisation. No events took place during follow up (40 ± 9 months)., Conclusion: Anterior TWI is a frequent phenomenon in adolescents, especially in females. Female athletes are also more likely to have extended anterior TWI. Only 0.2% of cases have persistent anterior TWI at 16 years of age. Chest wall anatomy may explain this phenomenon in females. It is uncommon in males, hence why surveillance is more prudent., Competing Interests: Declaration of Competing Interest The authors report no relationships that could be construed as a conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objectives: COVID-19 is a health burden threatening the elderly and those with comorbidities. Malta is an ageing and cardiometabolic country. The study depicts how Malta protected the elderly and the effect of vaccination on this subpopulation., Study Design: Observational study with quantitative analyses., Method: Data were obtained from Malta's COVID dashboard, Institute for Health Metrics and Evaluation and Maltese newspapers. The case-fatality ratio (CFR) and Years of Life Lost (YLLs) for COVID were calculated. Comparisons were made between COVID-19 mortality and YLL to the pre-COVID leading mortality causes. Comparative observations were made between positive and mortality cases stratified by age groups in relation to the cumulative vaccination doses., Results: The elderly were cocooned during the first wave (CFR 0.98) through the Vulnerable Act, with only 10.80% of positive cases and seven out nine deaths above 65 years. The Vulnerable Act was not reinstated again, with 13.68% of positive cases and 91.34% (n = 369) of deaths above 65 years during the second wave (CRF 1.39). The elderly were given priority in COVID-19 vaccination rollout leading to an inverse relationship between positive cases/mortality and vaccination coverage., Conclusion: The elderly should be protected with timely restrictions to reduce morbidity, mortality and burden on healthcare systems. Vaccination is key to protecting the elderly, although mitigation measures, such as physical distancing, are still required to prevent the resurgence of infections and hospitalizations, especially in this group., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Introduction: Assisted reproductive technology (ART) is increasingly used to overcome growing rates of infertility and subfertility. Perinatal and maternal morbidity and mortality are elevated in ART conceptions even in vaginally delivered singletons. Malta is a small archipelago with comprehensive national data. This study was carried out in order to investigate ART rates in Maltese deliveries for 2000-2019 inclusive., Methods: Anonymous data was obtained from the Malta National Obstetric Information System (NOIS). For this study all ART methods were aggregated into one group. Deliveries refer to single pregnancies. A p value ≤0.05 was taken to represent statistically significance., Results: This study analysed 82,356 deliveries over the period with overall 2% ART. There was a significant rising trend in all deliveries (ART plus non-ART) with time (p = 0.012). Of these, 1262 were twin deliveries (18% ART) and 56 were triplet deliveries (66% ART). Multiple deliveries (ART plus non-ART) also rose significantly (p = 0. 00035). The proportion of ART deliveries rose significantly overall and individually, for singletons (3.4-4.6%) since 2018, and over a quarter of such deliveries since 2013 for twin and further multiples., Discussion: The Maltese rate of twins and triplets plateaued before reaching the peaks experienced by other countries and it may be that more infertile couples were and are only having one embryo transferred. In smaller countries with only one neonatal unit, ART services should strive to produce a smooth throughput so as to minimize surges and strains on downstream neonatal services which may have deleterious effects on outcomes, especially neonatal., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Influenza spreads globally annually with significant paediatric and adult attack rates and considerable morbidity, mortality and the exacerbation of extant chronic disease. In the northern and southern hemispheres, outbreaks occur mainly in the respective winter seasons. Influenza vaccination is available but only partially effective. In the absence of a vaccine, in winter, novel coronavirus COVID-19 will also circulate in parallel with seasonal influenza. Thus far it appears that with the current strains of these two viruses, the clinical outcome of co-infection is not significantly worse than infection with COVID-19 alone. However, several strains of influenza circulate, including strains still to come. Similarly, COVID-19 has several strains, with probably more to come. This paper discusses these issues and estimates ideal minimum influenza vaccination coverage based on an estimated influenza Basic Reproduction Number (R0) of 0.9-2.1 so as to obtain herd immunity or approach it. There is a strong argument for attempting near universal population coverage with the annual influenza vaccine leading up to next winter., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Machine intelligence, whether it constitutes Strong artificial intelligence (AI) or Weak AI, may have varying degrees of independence. Both Strong and Weak AIs are often depicted as being programmed with safeguards which prevent harm to humanity, informed by Asimov's programs called the Laws of Robotics. This paper will review these programs through a reading of instances of machine intelligence in Star Trek, and will attempt to show that these "ethical subroutines" may well be vital to our continued existence, irrespective of whether the machine intelligences constitute Strong or Weak AI. In effect, this paper will analyse the machine analogues of conscience in Star Trek, and will do so through an analysis of the android Data and the Emergency Medical Hologram. We will argue that AI should be treated with caution, lest we create powerful intelligences that may not only ignore us but also find us threatening., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The first collection of Star Trek (ST) papers in this journal concentrated on the various doctors that appeared in ST in chronological screening order. This second collection will demonstrate that depictions of certain characters in ST harkens back to the high-ranking Nazis Adolf Eichmann and Josef Mengele, cautionary tales, lest we allow history to repeat itself and such atrocities to be relived. Artificial Intelligence (AI) is also explored as well as issues pertaining to AI in the medical field and ST's introduction of "ethical subroutines" that attempt to ensure that artificial beings (including doctors) are created with the machine analogues of a conscience. Nanotechnology in ST is also shown to be a potential field that can be applied not only for medical benefit but also with malevolent intentions. These narratives also serve as cautionary tales with regard to the potential unintended consequences of completely unfettered research. Finally, another paper will review the role of nurses in the Star Trek universe and will show that while nursing as a profession has striven for autonomy, in ST, the nurse continues to be overshadowed by the medical doctor. It is hoped that this collection of papers may help us to understand where it is that medicine may be heading and what are our best options are for averting problems, tragedy and outright disaster/s., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Adolf Eichmann and Josef Mengele were high-ranking Nazis, two among many who were tasked with implementing the Final Solution. Eichmann's eventual trial evidenced a dull ordinariness that was famously defined as the banality of evil by the political theorist Hannah Arendt who covered the proceedings. Star Trek's Deep Space 9 commences with the Cardassian relinquishment of Bajor. One particular episode ("Duet") focuses on a presumed high-ranking Cardassian labour camp commander who turns out to have been a filing clerk seeking atonement and closure for the deeds he witnessed, on behalf of his race. Yet another episode ("Nothing Human") in Star Trek Voyager highlights the ethical dilemmas that arise when accessing trials and treatments that were obtained immorally by unethical medical experimentation, and this is reminiscent of callous experimentation by Josef Mengele in the Auschwitz death camp. This paper will explore these subjects and will compare the fictional concentration camp commander and the fictional doctor with Adolf Eichmann and Josef Mengele respectively. Both episodes serve as reminders, cautionary tales lest we allow history to repeat itself and such atrocities to be relived., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Nanotechnology is defined as the study, creation and utilisation of structures ranging in size between 1 and 100 nm. Nanotechnology in Star Trek has been used by both the benevolent Federation (to which humanity belongs) and the Borg, a malevolent cybernetic horde intent on assimilating all individuals into a collective hive mind with complete loss of individuality. Manichaeism is a dualistic philosophy which maintains that principles and actions are either intrinsically good or evil. This paper will demonstrate that the utilisation of nanotechnology by these two Star Trek groupings reveals the Manichean nature of the struggle between the Federation and the Borg. While the Federation utilises nanotechnology for medical purposes, the Borg use this technology solely to forcibly assimilate individuals to serve as "drones," mindless slaves. These narratives also serve as cautionary tales with regard to the potential unintended consequences of unconsidered actions and completely unfettered research., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Artificial Intelligence (AI) is based on accurate decision-making processes which can be carried out independently by a machine. AI may be subdivided into strong AI (with consciousness and intentionality) and weak AI (lacking both and programmed to perform specific tasks only). With AI currently making rapid progress in all domains, including those of healthcare, physicians face possible competitors. Various types of AI programs are already available as consultants to the physician, and these help in medical diagnostics and treatment. At the time of writing, extant programs constitute weak AI. This paper will explore the development of AI and robotics in medicine, and will refer to Star Trek's "Emergency Medical Hologram", who is portrayed as a strong AI program. This paper will also briefly explore the issues pertaining to AI in the medical field and will show that weak AI should not only suffice in the demesne of healthcare, but may actually be more desirable than strong AI., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Nurses worldwide have striven to establish nursing as a profession, autonomous but complementary to the medical profession. Literature as far back as the Renaissance demonstrates an overall derogatory attitude toward the nurse's role. The modern notion of the nurse working side by side the medical practitioner continues to be overshadowed by the heroic medical doctor. This paper will discuss Christine Chapel and Alyssia Ogawa, who arguably are the only two nurses on board Star Trek's Enterprise, given prominent roles. In various and multiple episodes, their roles reveal a recurrence of the subservient attitude to the medical practitioner. Yet, there seems to be a shift toward a more multi-disciplinarian approach a century later in the ST time-line. The general concept of the nurses' role is similar and parallels real life - a role subsumed by and subservient to the medical doctor., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Doctors are crucial crewmembers in Star Trek. This paper will discuss the medic who is arguably the most well-known of all of the gesamtkunstwerk's doctors, Leonard Horatio McCoy in Star Trek: The Original Series (1966-69). The core trio of Captain Kirk, the alien Science Officer Spock and Dr. McCoy comprise a command troika modelled on classical mythology. McCoy's humanity was used to deliberately balance science officer Spock's cold and inhuman logic. It was thus that McCoy, despite his occasional curmudgeonly crankiness became the human conscience of the ship and its de facto (if not de jure) ethics officer, a role that would be reprised by all of the successive doctors in Star Trek., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Doctors in Star Trek's Federation are invariably depicted as benign and adherent to the ethical tenets that we are all so accustomed to. This does not appear to be the case in alien/other doctors where the narrative changes, such that these alien medics are not bound by the moral strictures to which human doctors are expected to adhere. It is difficult to ascertain why this should be but it may be part of the episode creators' attempts to impute and reinforce inhumanity and alienness in other non-human species., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This paper will review Dr. Beverly Crusher in the television series Star Trek: The Next Generation (1987-1994) and in subsequent films. This formidable woman epitomizes the rise of feminism in the 1980s and 1990s, with the subsequent feminization of all of the professions, including medicine. She is a widowed single mother, a beautiful woman and an extremely competent medic who delivers care with compassion. Her sense of ethics is boundless and her abilities also include command capacity, with the ability to take control of the starship if required. Crusher is a role model not only for female health care providers, but for us all., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Since Dr. McCoy in The Original Series, Star Trek has had a doctor in every subsequent series. Star Trek: Enterprise ran between 2001 and 2005. In this series, the alien humanoid Doctor Phlox was the chief medical officer of the starship Enterprise NX-01. Phlox is truly alien, both biologically and in his cultural norms. However he is tolerant of human mores and customs and indeed, embraces them. His very alienness occasionally saves the crew from attacks which exploit human vulnerabilities. It is also this alienness, with very little sleep requirements, that permits him to be almost always available to his patients. Furthermore, Phlox frequently used an array of exotic alien flora and fauna in his medical treatments, but he does not eschew modern medicine, professionally utilising the typical gamut of futuristic instruments and devices to which Star Trek audiences are accustomed. He is thus the "the prototype of the multicultural homeopathic physician of the future, comfortable with technology but knowledgeable regarding the more natural means of healing". It is these two traits which endear him to modern viewers, availability and naturalistic treatments. He is a truly unique doctor who furthers the vision of Star Trek's creator, Gene Roddenberry, of a multicultural bridge crew, since the inception of The Original Series in 1966., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Doctors are frequently depicted as important protagonists in science fiction, including in the science fiction franchise Star Trek. This paper will profile Drs. Philip Boyce and Mark Piper from the first two Star Trek pilot episodes. These doctors are interdisciplinarians with a variety of skills that permit them to cope with exotic maladies and biological afflictions of all kinds. However, they are also humanists who befriend their captains and act as psychological counselors whenever needed. Despite their brief appearances in only one episode each, this trope is later carried over to all of their other medical successors in the Star Trek timeline, as will be shown in the rest of the papers in this collection., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Dr. Helen Pulaski served as Chief Medical Officer aboard the Starship Enterprise in the 24th century (in the second season of Star Trek: The Next Generation). She was depicted as a grumpy and curmudgeonly character in the mould of Dr. "Bones" McCoy in the original series from the 1960s. Like all other Star Trek Doctors, her skills are legion and she is an excellent medic with a highly evolved sense of ethics., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

COVID-19 (SARS-CoV-2) is currently a global pandemic. This paper will attempt to estimate global infection rates and potential resultant mortality in the absence of effective treatment and/or vaccination. Calculations are based on World Health Organisation data from Wuhan in China: 14% of infected cases are severe, 5% require intensive care and 4% die. Estimated infection rates and mortality rates at the level of continents and some individual countries (when these are of sufficient size) are tabulated. This pandemic may cause close to half a billion deaths, i.e. 6% of the global population - and potentially more. At the risk of sounding sensational, but with a sober sense of realism, healthcare risks being plunged into the Middle-Ages if the public do not do their part. Infection cannot occur in the absence of contact. The only way to mitigate these numbers is to apply social distancing and take the standard precautions so frequently reiterated by Public Health: hand washing, avoid touching the face and so on. These measures are crucial as the human cost is going to be unthinkable even in the best-case scenarios that epidemiologists are modelling., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Homophobia, prejudice against homosexuals, and heteronormativity the belief that heterosexuality is normative, have both decreased over the decades. Until recently, both were common in Star Trek. This is surprising since while ostensibly writing about the future, cultural norms from the 20th and 21st centuries were still imposed on these narratives. Star Trek: Discovery is the most recent series in the francise (commenced in 2017) and is set circa a decade before Captain Kirk's five year mission in the Star Trek timeline. This is the first series to deliberately include homosexual couples within the Star Trek universe for the first time in its decades of existence. Discovery depicts the ship's chief engineer and ship's physician as a happily married male couple who are acknowledged and accepted in their marriage, with their own living quarters. This a simple and highly effective way to include queer people. Once again, the doctor has taken the series into an avenue where no other Star Trek series has gone before., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Doctors are important characters in Star Trek. After a disaster that strands the starship Voyager on the other side of the galaxy and kills all of the medical personnel, the ship is forced to rely solely on the Emergency Medical Hologram, a sentient piece of holographic technology. The EMH is programmed with all known medical knowledge making him a formidable medic. He is initially patronizing, superior, vain, pompous and arrogant. However, he becomes cognizant of his lack of compassion, becoming more humble and humane. Indeed, it can be argued that the Doctor evolved into a post-hologram state, with true consciousness and a desire to improve himself. Thus, over the seven course of the series, the Doctor acquires Bildung with the series serving as a Bildungsroman for a holographic being who is initially unevenly enculturated, grasping some points of expected social behavior or cultural understandings suitable to a given framework while completely missing others. Along the way, the Doctor also gains personal development, a multitude of abilities, and the respect of his colleagues. An additional bonus is the hardware and software never need to rest, with 24/7 availability - the patients' ideal! The EMH is truly a unique doctor., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Doctors are pivotal characters in Star Trek. This paper will review Dr. Julian Bashir, a unique medic who is genetically engineered to superhuman capacities while deliberately designed to have human failings, which he successfully overcomes. His genetic enhancements allow him to excel in whatever he does and although initially portrayed as callow, arrogant, brash and naïve, his open mind permits him to eventually discard these negative traits to become a more rounded, if superhuman, doctor, who forms staunch friendships among the crew of the space station. Like all other Trek doctors, Bashir has firm deontological ideals and ethics that lead him to side with and protect his patient, come what may. He is compassionate but cool and collected, performing brilliantly under pressure. This doctor reflects a patient's ideal: a superhuman who knows it all. It is abundantly clear that we, the viewers and prospective patients, wish our doctors to boldly go where no medic has gone before - just as long as we are cured!, Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2020 Elsevier B.V. All rights reserved.)