Potential health impacts of heavy metals on HIV-infected population in USA.

Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States. We used the National Health and Nutrition Examination Survey (NHANES) 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects. In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03) after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates. Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Minimal information for studies of extracellular vesicles 2018 (MISEV2018):a position statement of the International Society for Extracellular Vesicles and update of the MISEV2014 guidelines

The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV-associated functional activities. Finally, a checklist is provided with summaries of key points

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Millennial Leadership Development: Building Competencies with Best Practices

The purpose of this poster is to develop an understanding of Millennial leadership development, gain insights on how managers can use prevailing program approaches to address future leadership gaps in organizations, and provide decision-makers with recommendations when using best practice. programs to affect Millennial leadership developmentMillennial Leadership Development: Building Competencies with Best Practices Problem • Approximately 50% of the current Federal workforce is nearing retirement age (U.S. Department of Labor Bureau of Labor Statistics, 2013) • Nearly 1/3 of the Federal employees are Millennials (U.S. OPM, 2015) • Competency gaps exist in leading employees, change management, and building and mending relationships (Gentry et al., 2011) • There is no “one-size-fits-all” program that fills identified gaps to assist managers with building leadership competencies (Keller, 2009; Zingheim, 1996) • Millennial’s desire for hands-on learning and training activities make them a special group for human resource managers to develop (Kultalahti & Viitala, 2015) • Succession planning poses an incredible leadership challenge as the Baby Boomer generation retires with far fewer college-educated workers that are prepared to replace them (Groves, 2007) A leader’s organizational legacy is best preserved through actions that demonstrate care for developing a professional and competent work force (Kouzes & Posner, 2008) Purpose • Develop an understanding of Millennial leadership development • Gain insights on how managers can use prevailing program approaches to address future leadership gaps in organizations • Provide decision-makers with recommendations when using best practice programs to affect Millennial leadership development How can managers use current best practice program approaches to positively affect Millennial leader development (MLD)? Research Question What shortfalls or competency gaps (e.g., leading change, leading people, results driven, business acumen, building coalitions) can managers fill by using the best practice program approaches (e.g., 360-degree, coaching, mentoring, networking, job assignments, action learning, authentic learning) to affect Millennial leadership development? Methodology Studies identified for each program approach area: 360 (3) Coaching (4) Mentoring (5) Job Assignment (2) Networking (3) Action Learning (10) Authentic Learning (3) Implications for Practitioners Educate managers to use best practice program approaches for MLD succession and growth planning to fill leadership gaps Select program approaches that support planned MLD by specific department, sector, or organizational area Implications for Future Research Research comparing effectiveness of program approaches for MLD Conduct primary research to more clearly discern the role of the program approaches for MLD Examine how MLD influences current competency gap shortfalls Investigate how MLD changes the organizational needs for developing future generations of leaders (e.g., Generation Z) Gentry et al. (2011) U.S. OPM (2012) Conceptual Framework “How do you build organizations that merit the gifts of creativity, passion, and initiative?” (Gary Hamel, 2008) 1. What are the leadership competencies that organizations need to develop in their rising Millennial workforce? 2. What types of leadership programs perform best in producing Millennial leaders to develop the required competencies? 3. How can managers use best practice programs to develop Millennials? n=30 Studies 5 Case Studies 5 Systematic Reviews 17 Qualitative 2 Meta-analysis 1Theoretical Review i Systematic Review Thematic Analysis Engaged Stakeholders Gough et al. (2012) Briner et 2009) EBR Rigorous/Iterative Evidence Based Research (EBR) supported by engaged stakeholders throughout the systematic review process PRISMA RESULT Evidence identified specific program areas that were best for Millennial leadership development 1. Plan U.S. OPM’s(2012) core competencies aligned with Gentry et al.’s (2011) Millennial leadership practice competencies Included Studies Supporting Evidence Authors support MLD as an outcome of using the program approach Leading Change (9) Leading People (15) Results Driven (18) Business Acumen (4) Building Coalitions (4) If the program approach is: Then managers can expect: Supporting Literature by Author(s) 360-Degree Feedback Leading Change Externbrink & Inceoglu (2014); Johnson et al. (2012); Leading People Nowack & Mashihi (2012) Results Driven Coaching Leading Change Jantti & Greenhalgh (2012); Kombarakaran et al. (2008); Leading People Peet (2012); Perkins (2009) Results Driven Business Acumen Building Coalitions Mentoring Leading Change Chaudhuri & Ghosh (2012); Chen (2013); Chen (2014); Leading People Eby et al. (2013); Marcinkus Murphy (2012) Results Driven Networking Leading People Griffiths & Arenas (2014); Groves (2007); Markuns et al. Results Driven (2010) Job Assessment Results Driven McCauley et al. (1995); Zaccaro & Banks (2004) Action Learning Leading Change Brown and Czerniewicz (2010); Hirst et al. (2004); Kennedy et al. (2010); Kubiatko (2013); Leonard & Lang (2010); Narasuman et al. (2011); Shear et al. (2014); Valtonen et al. (2010); van den Beem et al. (2011); Venkatesh et al. (2014) Leading People Results Driven Business Acumen Building Coalitions Authentic Learning Leading People Jones & McCann (2005); Tennant et al. (2012); Venne & Results Driven Coleman (2010) •Drive for results •Deciding/Initiating Action •Goal setting/Prioritization •Analyzing •Technology •IT Competency Engag al. (Evidence and Synthesis Moher et al. (2009) Day (2000); Day et al. (2014) Findings and Conclusions Technical knowledge is a significant antecedent of the results driven competency for Millennials (Jones & McCann, 2005) Developing the results driven competency underpins leadership development of the Millennial cohort (Jantti & Greenhalgh, 2012) Coaching and action learning approaches act to enhance developing all five core competencies (U.S. OPM, 2012) Reverse mentoring capitalizes on Millennial interpersonal capabilities and preferences to develop leading people competencies through direct exposure to Baby Boomers (Marcinkus Murphy, 2012) Action learning can be tailored, and used with other approaches to build specific competencies while developing organizational leadership skills (Leonard & Lang, 2010) Leadership programs should be informed by the best available scientific evidence (Externbrink & Inceoglu, 2014

STATISTICAL PHONE DURATION MODELING TO FILTER FOR INTACT UTTERANCES IN A COMPUTER-ASSISTED PRONUNCIATION TRAINING SYSTEM

We study the use of a statistical phone duration model for separating intact utterances from corrupted ones in a computer-assisted pronunciation training system. Our system performs forced alignment between the input utterance and the canonical transcription of the prompted text. Intact utterances contain spoken content that correspond to the text prompt. For these utterances, our system performs detailed phonetic analysis of the alignment and generates corrective feedback to highlight the occurrence of phonetic errors. Corrupted utterances result from disfluencies, truncated recordings, or spoken content that does not correspond to the text prompt. For these cases, the appropriate feedback is to invite the user to record again. We develop a filtering mechanism for intact input utterances by means of phone duration modeling. The likelihood-ratiotest involving the phone-specific duration probability and an antimodel probability gave the best EER of 17.16%, which is a 20 % relative improvement over the baseline approach that incorporates phone-posterior probabilities. Index Terms — computer-aided pronunciation training, phone duration modeling, user interface 1