Optimización de la medición de emisiones de NH3 de purines por el método de trámpas ácidas húmedas in vitro RESUMEN

[EN] Ammonia (NH3) emissions from pig production contribute relevantly to acidification and eutrophication of the environment. In order to reduce these emissions it is necessary to use standardized measurement protocols. One of the methods requiring standardization is in vitro measurement of potential NH3 emissions. In this method, the emission from an emitting source under controlled conditions is trapped in an acidic solution to be later analyzed. The objectives of this study were (i) to determine the variation of the emission of NH3 between replicates of the same sample; (ii) to characterize relationships between partial (one or few days of measurements) and cumulative emissions; (iii) to analyze the effect of varying the frequency of replacement of the acidic solution of the impingers on the precision of the results of emissions; and (iv) to evaluate the capture efficiency of the acid traps NH3 and its relationship with the collected solution pH and the concentration of NH3. For this study, a total of 167 pig slurry samples were used, from which emissions were measured during 15 days. The variation of NH3 emission accumulated during 15 days, among replicates of the same sample, was 6.29%. For daily periods, variations between replicates ranged between 9.44% and 16.52%. A positive correlation was observed between partial NH3 emissions (one or few days) and accumulated to 15 days. On the other hand it was observed that in most samples emission tended to be relatively constant in time. However, despite different emission dynamics were observed, in all samples the NH3 emission process continued beyond 15 days. Reducing NH3 measurement frequency (1 to 2 days) did not significantly affect the accuracy of estimates for periods of 48 hours and 15 days (P> 0.7), which could reduce the number of measurements without affecting the precision of the results. Regarding NH3 capture efficiency by this method, the first acid trap retained on average 99.9% of total ammonia retained in the system. This efficiency was affected neither by the concentration of ammonia in the incoming air nor by the frequency of replacing of the acidic solution (1 or 2 days), However, a direct relationship was found between the pH and the amount of NH3 trapped in the solutions.[ES] Las emisiones de amoniaco (NH3) en la ganadería porcina suponen una contribución importante a la eutrofización y acidificación del medio. Para poder establecer formas de reducción es necesario disponer de protocolos de medida estandarizados. Uno de los métodos que requieren estandarización son los ensayos in vitro en que el amoniaco emitido por una muestra en condiciones controladas es retenido en un medio ácido que es posteriormente valorado. Los objetivos fueron (i) determinar la variación de la emisión de NH3 entre réplicas de una misma muestra; (ii) caracterizar las relaciones entre las emisiones parciales (uno o varios días de medida) y acumuladas; (iii) analizar el efecto de la variación de la frecuencia de reemplazo de la disolución ácida de los borboteadores sobre la precisión de los resultados de las emisiones; y (iv) evaluar la eficiencia de captura del NH3 de las trampas ácidas y sus relaciones con el pH de la disolución colectada y la concentración de NH3 capturado. Para cumplir estos objetivos se utilizaron un total de 167 muestras de purín de las cuales se determinaron las emisiones de NH3 in vitro durante 15 días. La variación de la emisión de NH3 acumulada en 15 días entre réplicas de una misma muestra de purín fue 6.29%. Si se consideran las emisiones diarias en vez de las acumuladas, las variaciones entre réplicas fluctuaron entre 9.44% y 16.52%. Se observó una correlación positiva entre las emisiones de NH3 parciales (medidas a 1 o varios días) y acumuladas a 15 días. De otro lado se observó que en la mayor parte de muestras la emisión es relativamente constante durante los 15 días de estudio, si bien cada muestra de purín evidencia su propia dinámica de emisión. En cualquier caso, se observa que el proceso de emisión de NH3 continúa más allá de los 15 días. Referente a la reducción en la frecuencia de medición de NH3, esta no afectó significativamente a la precisión de las estimaciones para periodos de 48 horas y 15 días (P>0.7), por lo que se podría reducir el número de medidas sin afectar a la precisión de los resultados. Respecto a la eficiencia de captura de NH3, la primera trampa ácida retuvo en promedio el 99.9% del total retenido entre las dos trampas. Esta eficiencia no se vio afectada por la concentración de amoniaco en el aire muestreado ni por la frecuencia de reemplazo de la disolución ácida (1 o 2 días). Sin embargo se evidenció una relación directa entre el pH y la cantidad de NH3 atrapada en las disoluciones. Puede concluirse que la metodología analizada en este estudio es adecuada para medir las emisiones potenciales de NH3, pudiéndose reducir la frecuencia de cambio de ácido.Antezana Julián, WO. (2014). Optimización de la medición de emisiones de NH3 de purines por el método de trámpas ácidas húmedas in vitro RESUMEN. http://hdl.handle.net/10251/47385Archivo delegad

Análisis de los factores que influyen en las emisiones de amoniaco y metano de purines porcinos: composición del purín y factores nutricionales

Tesis por compendio[EN] This PhD Thesis focuses on characterizing potential emissions of ammonia (NH3) and methane (CH4) from pig slurries. In particular, it analyses the relationships between nutrient consumption and excretion, slurry composition and potential NH3 and CH4 emissions, as well as the potential fertilizer value of slurries. Besides, the methodologies to determine in vitro potential NH3 and CH4 emissions are analysed and optimization alternatives are proposed. The objectives of this PhD Thesis are to: i) Characterize the composition, potential NH3 and CH4 emissions, and potential fertilizer value of slurries from Spanish commercial farms, ii) Evaluate the influence of incorporating to feedstuffs a fat source (calcium soap of palm fatty acid distillate, CSP) and fibre source (citrus pulp, CP) on slurry composition and potential NH3 and CH4 emissions in growing pigs, and iii) Optimize the in vitro measurement techniques of potential NH3 and CH4 emissions from pig slurries. The results of this Thesis show that physicochemical characteristics of slurries from Spanish commercial farms vary widely, and the type of animal (e.g. sows against growing animals) affect in a relevant way the contents of total nitrogen, ammonia nitrogen, potassium, calcium, cupper, sodium, zinc, volatile fatty acids, as well as the pH of slurries. Consequently, the type of animal also affected potential NH3 and CH4 emissions. Therefore, the optimum utilization of slurries from commercial farms, either as fertilizer or as feedstock for biogas production, requires a previous characterization. On the other hand, it was found that management factors and feedstuff waste probably influenced the slurry characteristics and potential NH3 and CH4 emissions. Including CSP as fat source and CP as fibre source in growing pig diets changed significantly slurry composition. Including CSP increased the excretion of ether extract and crude protein. Regarding gaseous emissions from slurries, including CSP increased potential CH4 emissions and reduced NH3 emissions. Including CP affected faecal composition, but potential emissions were not affected. On the other hand, evidences were found that lower crude protein consumptions (-14% CP) could be associated to higher reductions of NH3 emissions (-66%). The same tendency was found regarding the effect of crude energy intake on CH4 emissions: a 20% reduction of crude energy would be associated to 46% reductions of CH4 emissions. Additionally, the evaluation of in vitro measurement techniques for potential NH3 and CH4 emissions from pig slurries suggest that it could be possible to reduce up to 50% the resources (time and material) which are used following the standard procedures, without significant effects on the results. Additionally, prediction models of potential NH3 and CH4 emissions are proposed, based on the physicochemical characteristics of slurries and the dynamics of in vitro emissions. In overall, this PhD Thesis provides valuable information to improve the use of pig slurries, to mitigate the associated NH3 and CH4 emissions, and to optimize in vitro measurement methods for potential NH3 and CH4 emissions. Additionally, evidences were found on how to optimize the use of protein and energy in growing pigs from a sustainable perspective both in economic and environmental terms.[ES] La presente Tesis Doctoral está enfocada a la caracterización de las emisiones potenciales de amoniaco (NH3) y metano (CH4) a partir de purines porcinos. En concreto, estudia la relación entre el consumo y la excreción de nutrientes, la composición de los purines y las emisiones potenciales de NH3 y CH4 y el valor agrícola potencial de los purines. Además, evalúa las metodologías de medición de las emisiones potenciales de NH3 y CH4 in vitro y propone estrategias para su optimización. Los objetivos de la presente Tesis Doctoral son: i) Caracterizar la composición, el potencial de emisión de NH3 y CH4 y el valor agrícola potencial de purines de granjas comerciales de España, ii) Evaluar la influencia de la inclusión en el pienso de una fuente de grasa (jabón cálcico de palma) y una fuente de fibra (pulpa de naranja) sobre la composición del purín y emisiones potenciales de NH3 y CH4 en cerdos en crecimiento y iii) Optimizar las técnicas de medición de las emisiones potenciales de NH3 y CH4 in vitro de purines de cerdo. Los resultados de esta Tesis indican que las características fisicoquímicas de purines de granjas comerciales de España varían ampliamente y el tipo de animal (madres vs. animales en crecimiento) afecta de forma relevante a los contenidos de nitrógeno total, nitrógeno amoniacal, potasio, calcio, cobre, sodio, zinc, ácidos grasos volátiles y el pH de los purines, y en consecuencia afectan también sus emisiones potenciales de NH3 y CH4. Por lo tanto, la utilización óptima de purines de granjas comerciales como fertilizante agrícola o como insumo para la producción de biogás requiere su previa caracterización. Por otra parte, es probable que factores de manejo y el desperdicio del pienso por los cerdos en granjas comerciales influyan de forma relevante sobre las características de los purines y como tal sobre sus emisiones de NH3 y CH4. La inclusión de jabón cálcico de palma (como fuente de grasa) y pulpa de naranja (como fuente de fibra) en dietas de cerdo de engorde produjo cambios significativos en la composición de purín. La inclusión de jabón cálcico de palma provocó mayores excreciones de extracto etéreo y proteína bruta, así mismo causó mayores emisiones de CH4 y menores emisiones de NH3. La inclusión de pulpa de naranja alteró la composición fecal, pero no afectó significativamente a las emisiones de NH3 y CH4. Por otro lado, se encontró evidencias de que menores consumos de proteína bruta (PB) (-14% de PB) permitiría reducir proporcionalmente mayores cantidades de emisiones de NH3 (-66%). Esta misma tendencia se encontró entre la ingesta de energía bruta y las emisiones de CH4, de forma que reducciones de -20% en la ingesta de energía bruta permitiría reducciones de -46% de emisiones de CH4. Por otra parte, los resultados de la evaluación de las metodologías de mediciones de las emisiones potenciales de NH3 y CH4 in vitro de purines de cerdo sugieren la posibilidad de reducir hasta en un 50% los recursos (tiempo y reactivos) dedicados a la medición de las emisiones potenciales de NH3 y CH4 in vitro. Adicionalmente, se proponen modelos de predicción de las emisiones potenciales de NH3 y CH4 basados en las características fisicoquímicas de purines y en las dinámicas de emisión in vitro. En su conjunto, la presente Tesis Doctoral proporciona información que permitirá mejorar la utilización de los purines de cerdos, mitigar las emisiones de NH3 y CH4, optimizar las mediciones de las emisiones de NH3 y CH4 in vitro. Al mismo tiempo se encontraron evidencias que indican la posibilidad de optimizar la utilización de la proteína y la energía en la alimentación de cerdos de engorde con una perspectiva sostenible económica y ambientalmente.[CA] La present Tesi Doctoral està enfocada en la caracterització de les emissions potencials d'amoníac (NH3) i metà (CH4) a partir de purins porcins. En concret, estudia la relació entre el consum i l'excreció de nutrients, la composició dels purins i les emissions potencials de NH3 i CH4 i el valor agrícola potencial dels purins. A més, avalua les metodologies de mesurament de les emissions potencials de NH3 i CH4 in vitro i proposa estratègies per a la seua optimització. Els objectius de la present Tesi Doctoral són: i) Caracteritzar la composició, el potencial d'emissió de NH3 i CH4 i el valor agrícola potencial de purins de granges comercials d'Espanya, ii) Avaluar la influència de la inclusió en el pinso d'una font de greix (sabó càlcic de palma) i una font de fibra (polpa de taronja) sobre la composició del purí i emissions potencials de NH3 i CH4 en porcs en creixement i, iii) Optimitzar les tècniques de mesurament de les emissions potencials de NH3 i CH4 in vitro de purins de porc. Els resultats d'aquesta Tesi indiquen que les característiques fisicoquímiques de purins de granges comercials d'Espanya varien àmpliament i el tipus d'animal (mares vs. animals en creixement) afecta de forma rellevant als continguts de nitrogen total, nitrogen amoniacal, potassi, calci, coure, sodi, zinc, àcids grassos volàtils i el pH dels purins, i en conseqüència afecten també les seues emissions potencials de NH3 i CH4. Per tant, la utilització òptima de purins de granges comercials com a fertilitzant agrícola o com entrada per a la producció de biogàs requereix una caracterització prèvia. D'altra banda, és probable que factors de maneig i el desaprofitament del pinso pels porcs en granges comercials influïxen de forma rellevant sobre les característiques dels purins i com a tal sobre les seues emissions de NH3 i CH4. La inclusió de sabó càlcic de palma (com a font de greix) i polpa de taronja (com a font de fibra) en dietes de porc d'engreix va produir canvis significatius en la composició del purí. La inclusió de sabó càlcic de palma va provocar majors excrecions d'extracte eteri i proteïna bruta, així mateix va causar majors emissions de CH4 i menors emissions de NH3. La inclusió de polpa de taronja va alterar la composició fecal, però no va afectar significativament les emissions de NH3 i CH4. D'altra banda, es van trobar evidències que menors consums de proteïna bruta (PB) (-14% de PB) permetria reduir proporcionalment majors quantitats d'emissions de NH3 (-66%). Aquesta mateixa tendència es va trobar entre la ingesta d'energia bruta i les emissions de CH4, de manera que reduccions de -20% en la ingesta d'energia bruta permetria reduccions de -46% d'emissions de CH4. D'altra banda, els resultats de l'avaluació de les metodologies de mesuraments de les emissions potencials de NH3 i CH4 in vitro de purins de porc suggereixen la possibilitat de reduir fins un 50% els recursos (temps i reactius) dedicats al mesurament de les emissions potencials de NH3 i CH4 in vitro. Addicionalment, es proposen models de predicció de les emissions potencials de NH3 i CH4 basats en les característiques fisicoquímiques de purins i en les dinàmiques d'emissió in vitro. En el seu conjunt, la present Tesi Doctoral proporciona informació que permetrà millorar la utilització dels purins de porcs, mitigar les emissions de NH3 i CH4, optimitzar els mesuraments de les emissions de NH3 i CH4 in vitro. Al mateix temps es van trobar evidències que indiquen la possibilitat d'optimitzar la utilització de la proteïna i l'energia en l'alimentació de porcs d'engreix amb una perspectiva sostenible econòmica i ambientalmentAntezana Julián, WO. (2016). Análisis de los factores que influyen en las emisiones de amoniaco y metano de purines porcinos: composición del purín y factores nutricionales [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/68050TESISCompendi

Analysis Of Factors Affecting Ammonia And Methane Emissions From Pig Slurries: Slurry Composition And Dietary Factors

Reducing crude protein is a recommended technique to reduce nitrogen excretion and ammonia emissions. Greenhouse gas emissions from slurry are also affected by nutrient composition. However, there are interactions among nutrients in feeds still not clarified. The objective of this study was to evaluate the impacts of different diets on nitrogen (N) and energy balances. A total of 13 diets were evaluated in digestibility trials using 78 animals. Diets were formulated to fulfil commercial standards, although differing in ingredient composition. Nutrient intake, excretion and potential NH3 and CH4 (Biochemical methane potential) emissions from slurry were measured. Animal weight was also monitored. Correlations between emissions and nutrient balance components were done. An analysis of variance was conducted to assess differences in nutrient balance of low, medium and high emitting animals, expressing animals per kg of live weight increased. For the N balance, a two-fold range in faeces to urine N excretion ratio was found throughout the experiments, even considering the low crude protein variations (from 15 to 16%). This was related to the ammonia emissions from slurry (r = -0.60, p<0.001). In fact, the amount of crude protein ingested to increase 1 kg of metabolic weight was positively correlated with the associated emissions (r=0.58, p<0.001). However, this was more related to the consumption by the animal than to the crude protein, which was relatively stable among diets. The difference between animals associated with high or low NH3 emissions per weight gain was therefore related to urine losses due to excess N intake. The energy balance shows that methane potential from slurry was mainly related to the excretion of indigested feed components, mainly the fibrous fraction (particularly the soluble fibre). It was clear that animals emitting high amounts of methane were those with higher dry matter and energy ingestion. The results of this study demonstrate relevant effects on N and energy balances at diets formulated according to commercial standards

Development of a Mobile Open-Circuit Respiration Head Hood System for Measuring Gas Exchange in Camelids in the Andean Plateau

[EN] Peru has the largest inventory of alpacas worldwide. Despite their importance as a source of net income for rural communities living at the Andean Plateau, data on energy requirements and methane (CH4) emissions for alpacas are particularly lacking. In 2019, the International Panel on Climate Change (IPCC; 2006, and Refinement 2019) outlined methods for estimating CH4 emissions from enteric fermentation and no methane (CH4) conversion factors were reported for camelids. IPCC has since updated its guidelines for estimating CH4 emissions from the enteric fermentation of livestock at a national scale. For greenhouse gas (GHG) inventory purposes, conversion factors were developed for ruminants but not for domestic South American camelids (SAC), with this category including alpacas. A mobile open-circuit respirometry system (head hood) for the rapid determination of CH4 and CO2 production, O2 consumption, and thereafter, heat production (HP) for camelids was built and validated. In addition, an experimental test with eight alpacas was conducted for validation purposes. The average HP measured by indirect calorimetry (respiratory quotient (RQ) method) was close to the average HP determined from the carbon-nitrogen balance (CN method); 402 kJ/kg BW0.75 and 398 kJ/kg BW0.75, respectively. Fasting HP was determined by the RQ method and 250 kJ/kg BW0.75 was obtained. The metabolizable energy requirement for maintenance (MEm) was calculated to be 323 kJ/kg BW0.75 with an efficiency of energy utilization of 77%. When intake was adjusted to zero energy retention by linear regression, the MEm requirement increased to 369 kJ/kg BW0.75 and the efficiency decreased up to 68%. The CH4 conversion factor (Ym) was 5.5% on average. Further research is required to gain a better understanding of the energy requirements and CH4 emissions of alpacas in conditions of the Andean Plateau and to quantify them with greater accuracy.This research was funded by the Universidad Nacional de San Antonio Abad del Cusco University through the Yachayninchis Wiñarinanpaq program and the Project Desarrollo y validación de metodologías de evaluación de la actividad metabólica (utilización energética y proteica) y la emisión de gases de efecto invernadero en alpacas , a Framework Agreement between the UNSAAC and the Peruvian funding bodies CONCYTEC and FONDECYT, with the collaboration of the project: 011-2020-FONDECYT-BM-INC-INV.Rios Rado, WM.; Chipa Guillen, PK.; Huamán Borda, D.; Velez Marroquin, V.; Gere, JI.; Antezana Julián, WO.; Fernández Martínez, CJ. (2023). Development of a Mobile Open-Circuit Respiration Head Hood System for Measuring Gas Exchange in Camelids in the Andean Plateau. Animals. 13(6). https://doi.org/10.3390/ani1306101113

Parámetros morfométricos del espermatozoide de alpaca (Vicugna pacos), obtenidos por tres métodos de colección

Sperm morphology is essential in evaluating seminal quality and important for fertility prediction in breeding males. The aim of this study was to compare the morphometric parameters of alpaca sperm, collected using three methods of semen extraction, recovery of the vas deferens (DCD), electro ejaculation (EE) and vaginal aspira-tion (VA). The collection was made of 3 animals by each method. The mobility, concentration, vitality, mem-brane functionality and sperm morphometry parameters were determined in a computerized semen analysis kit – ISAS® CASA - Morph. For morphometric parameters, semen samples were processed with a Hemacolor® stain-ing kit and viewed under a phase-contrast microscope. For each sample, at least 200 sperm were captured at random, with an image resolution of 0.08 μm per pixel on the horizontal and vertical axes. The comparison of the morphometric parameters between the collection method and the animal was carried out using a random block design. Total motility was 16.27±11.96%, 14.68±11.21% and 12.44±7.27%; the sperm concentration of 247±186.70x106EPZ/mL, 67.92±67.92x106EPZ/mL and 100.32±56.13x106EPZ/mL, the vitality was 62.86 ±15.92%, 63±15.21% and 70.16±14.33% in sperm collected by DCD, EE and AV respectively. Regarding the morphometric parameters, a length of 5.49±0.43μm, 5.53±0.41μm and 5.75±0.53μm was found, area 14.30±2.00 μm2, 15.05±1.77 μm2 and 15.88±2.00 μm2, perimeter of 16.10±1.31μm, 17.11±1.20μm and 17.41 ± 1.43, width of 3.22±0.27μm, 3.30±0.32μm and 3.33±0.25μm and the acrosome percentage of 52.22±7.82μm, 49.52±7.47μm and 47.44±5.77μm in sperm collected by DCD, EE and AV respectively. The morphometric parameters of the size and shape of the sperm head and the intermediate piece showed significant statistical differences (p &lt;0.01) between the collection methods and between the animals. In conclusion, the morphometric parameters of alpaca spermatozoa were influenced by collection method, and show variations between animals.La morfología espermática es esencial en la evaluación de la calidad seminal e importante para la predicción de la fertilidad de machos reproductores. El objetivo del presente estudio fue comparar los parámetros morfométri-cos de espermatozoides de alpaca, obtenidos por tres métodos de extracción de semen, la recuperación del con-ducto deferente (DCD), electroeyaculación (EE) y aspiración vaginal (AV). La colección se realizó de 3 anima-les por cada método. Se determinó la movilidad, concentración, vitalidad, funcionalidad de membrana y paráme-tros de morfometría espermática, con un equipo de análisis computarizado de semen - ISAS® CASA - Morph. Para los parámetros morfométricos, las muestras de semen se procesaron con un kit de tinción Hemacolor® y se observaron en un microscopio de contraste de fases. Por cada muestra, se capturaron al menos 200 espermato-zoides al azar, con resolución de imágenes de 0.08 μm por píxel en los ejes horizontal y vertical. La motilidad total fue de 16.27±11.96%, 14.68±11.21% y 12.44±7.27%, la concentración espermática de 247±186.70 x 106EPZ/mL, 67.92±67.92 x 106EPZ/mL y 100.32±56.13 x 106EPZ/mL, la vitalidad fue 62.86±15.92%, 63±15.21% y 70.16±14.33% en espermatozoides colectados por DCD, EE y AV respectivamente. En cuanto a los parámetros morfométricos se encontró una longitud de 5.49±0.43 μm, 5.53±0.41μm y 5.75±0.53μm, área 14.30±2.0μm2, 15.05±1.77μm2 y 15.88±2.0μm2, perímetro de 16.10±1.31μm, 17.11±1.20μm y 17.41±1.43μm, ancho de 3.22±0.27μm, 3.30±0.32μm y 3.33±0.25 μm y el porcentaje de acrosoma de 52.22±7.82%, 49.52±7.47% y 47.44±5.77% en espermatozoides colectados por DCD, EE y AV respectivamente. La compara-ción de los parámetros morfométricos entre método de colecta y animal se realizó mediante un diseño de bloques alzar. Los parámetros morfométricos del tamaño y forma de la cabeza de espermatozoide, y pieza intermedia mostraron diferencias estadísticas significativas (p&lt;0.01) entre métodos de colección y entre animal. En conclu-sión, los parámetros morfométricos del espermatozoide de alpaca son influidos por el método de colección, y muestran variación entre animales

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

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

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

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice