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

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

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

Ancestral diversity improves discovery and fine-mapping of genetic loci for anthropometric traits - the Hispanic/Latino Anthropometry Consortium

Hispanic/Latinos have been underrepresented in genome-wide association studies (GWAS) for anthropometric traits despite their notable anthropometric variability, ancestry proportions, and high burden of growth stunting and overweight/obesity. To address this knowledge gap, we analyzed densely-imputed genetic data in a sample of Hispanic/Latino adults to identify and fine-map genetic variants associated with body mass index (BMI), height, and BMI-adjusted waist-to-hip ratio (WHRadjBMI). We conducted a GWAS of 18 studies/consortia as part of the Hispanic/Latino Anthropometry (HISLA) Consortium (Stage 1, n=59,771) and generalized our findings in 9 additional studies (HISLA Stage 2, n=10,538). We conducted a trans-ancestral GWAS with summary statistics from HISLA Stage 1 and existing consortia of European and African ancestries. In our HISLA Stage 1+2 analyses, we discovered one BMI locus, as well as two BMI signals and another height signal each within established anthropometric loci. In our trans-ancestral meta-analysis, we discovered three BMI loci, one height locus, and one WHRadjBMI locus. We also identified three secondary signals for BMI, 28 for height, and two for WHRadjBMI in established loci. We show that 336 known BMI, 1,177 known height, and 143 known WHRadjBMI (combined) SNPs demonstrated suggestive transferability (nominal significance and effect estimate directional consistency) in Hispanic/Latino adults. Of these, 36 BMI, 124 height, and 11 WHRadjBMI SNPs were significant after trait-specific Bonferroni correction. Trans-ancestral meta-analysis of the three ancestries showed a small-to-moderate impact of uncorrected population stratification on the resulting effect size estimates. Our findings demonstrate that future studies may also benefit from leveraging diverse ancestries and differences in linkage disequilibrium patterns to discover novel loci and additional signals with less residual population stratification

Use of Incineration MSW Ash: A Review

This study reviews the characteristics of municipal solid waste incineration (MSWI) ashes, with a main focus on the chemical properties of the ashes. Furthermore, the possible treatment methods for the utilization of ash, namely, separation processes, solidification/stabilization and thermal processes, are also discussed. Seven types of MSWI ash utilization are reviewed, namely, cement and concrete production, road pavement, glasses and ceramics, agriculture, stabilizing agent, adsorbents and zeolite production. The practical use of MSWI ash shows a great contribution to waste minimization as well as resources conservation

Use of Incineration MSW Ash: A Review

This study reviews the characteristics of municipal solid waste incineration (MSWI) ashes, with a main focus on the chemical properties of the ashes. Furthermore, the possible treatment methods for the utilization of ash, namely, separation processes, solidification/stabilization and thermal processes, are also discussed. Seven types of MSWI ash utilization are reviewed, namely, cement and concrete production, road pavement, glasses and ceramics, agriculture, stabilizing agent, adsorbents and zeolite production. The practical use of MSWI ash shows a great contribution to waste minimization as well as resources conservation.municipal solid waste; fly ash; incineration; waste management; waste utilization; hazardous waste

Health assessment of tree trunk by using acoustic-laser technique and sonic tomography

Abstract An innovative tree defect detection scheme, which combines acoustic-laser technique and sonic tomography, is studied. A new sensor distribution can be adopted based on the near-surface response detected by acoustic-laser technique, and a more reliable image of the tree trunk can be observed by sonic tomography. By using such hybrid detection scheme, the near-surface defects (bark detachment, cracks, decay) can be revealed at the early stages of defect development. The accuracy of defect detection during advanced tree risk assessment is therefore highly improved. As a newly developed detection technique for detecting the near-surface defect in tree trunk, the measurement results of acoustic-laser technique in tree trunk are comprehensively discussed, especially toward the detectable depth beneath the tree surface. The experimental results demonstrated that the acoustic-laser technique can identify the presence of near-surface defects in a tree trunk that are normally overlooked by the conventional sonic tomography measurements with random distribution of sensors

Effects of inorganic and organic nitrogen and phosphorus on the growth and toxicity of two Alexandrium species from Hong Kong

The effects of three nitrogen (N) and two phosphorus (P) inorganic and organic forms on the growth, toxin content and composition, toxin production, and chemical composition of Alexandrium catenella and Alexandrium tamarense isolated from coastal waters of Hong Kong were determined. The toxin production rate and cellular toxin content for A. catenella were at least 10-fold higher than A. tamarense. The highest net production rate (R-tox) of the two Alexandrium species was generally achieved in the exponential phase. However, the highest cellular toxin content occurred in the stationary phase in all cultures, partly due to the enhancement of cell volume caused by P limitation, except for urea grown cultures where cellular toxin content remained low throughout the growth stage. For A. catenella, NH4 induced the highest growth rate (0.59 d(-1)), toxin production rate (mu(tox), 1.0 mu mol L-1 d(-1); NH4 2.5 pmol cell(-1) d(-1)) and cellular toxin content (2.8 pmol cell(-1)) among the three nitrogen sources regardless of inorganic and organic P. The form of phosphorus had limited effect on A. catenella. In contrast, the response of A. tamarense to different forms of nitrogen and phosphorus was more complex. NH4 induced the highest cellular toxin content (445 fmol cell-1), while NO3 yielded the highest toxin production rate (mu(tox), 0.71 nmol L-1 d(-1); R-tox, 140 fmol cell(-1) d(-1)) and urea produced the highest growth rate (0.57 d(-1)). For A. tamarense, the highest toxin production rate occurred under organic phosphorus. The relationship between toxin accumulation and the form of nitrogen varied with the phosphorus source. A. catenella cultures grown on NO3 and NH4 have about 80-90% C1/2 toxins and 5-15% GTX 1/4 toxins compared to 65-75% C1/2 toxins and 25-35% GTX 1/4 toxins in cultures grown on urea. Our results suggest that during summer when Alexandrium uses NH4 from local sewage effluent as its preferred nitrogen source, it might become more toxic in combination with episodically occurring P limitation in Hong Kong waters. (C) 2012 Elsevier B.V. All rights reserved

Hydrogen and electric power generation from liquid microjets: Design principles for optimizing conversion efficiency

Liquid water microjets have been successfully employed for both electrical power generation and gaseous hydrogen production, but the demonstrated efficiencies have been low. Here, we employ a combination of a modified Poisson-Boltzmann description, continuum hydrodynamic equations, and microjet electrokinetic experiments to gain detailed insight into the origin of the streaming currents produced in pure water. We identify the contributions to the streaming current from specific ion adsorption at the solid/liquid interface and from long-ranged electrostatic interactions, finding that the portion originating from the latter dominate at charged surfaces. The detailed understanding afforded by theory and the close agreement with experimental results elucidates design principles for optimizing hydrogen production and power generation. Changing the sign of the surface charge density through targeted use of surface coatings via silanization switches the primary charge carrier between hydronium and hydroxide and therefore switches the corresponding production of molecular hydrogen to oxygen at the target electrode. Moreover, hydrophobic surface coatings reduce dissipation due to fluid/solid friction, thereby increasing the conversion efficiency