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

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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Information and communication technology for control and management in power systems smart grid

Architectures of modern electric power sector are fast becoming smarter in their mode of operations. Smart grid (SG) operations have potential capability to cover all the areas of generation, transmission and distribution of electrical energy. With the integration of computer technology, information and communication management in present day, grid system architecture is designed such that it is possible to solve many problems related to energy demand, supply and management constraints. As a promising technology, it is envisaged that SG will help in troubleshooting some of the present challenges such as cost of energy reduction, reliability monitoring and system stability improvement taken the advantages presented by the evolution of digital technologies. An overview of information and communication control and management in electricity smart grid system using wireless and other advanced electronic-based technologies is presented in this paper. The concept of smart grid as it is different from the existing power system utility architecture and its logical advancement presented for effective system monitoring, optimization and management functions are also introduced. In addition, different types of energy management smart grid communication systems are also discussed. In conclusions, some critical issues concerning the effective realization of the full intelligent nature of smart grid systems are discussed and areas for future work and further research suggeste

Severe acute respiratory syndrome Coronavirus-2 infection: A synopsis of the host immune responses and viral immune evasion strategies involved

The novel coronavirus designated as SARS-CoV-2 is the etiological agent of coronavirus disease 2019 (COVID-19), which rendered the care of the global health powerless and plunged the world economy into a historic decline. This disease is characterized by different clinical pictures; ranging from asymptomatic mild phase to severe illness with acute respiratory distress syndrome (ARDS), in addition to having no specific therapy. The protective immunity involving solid CD4+ T-cells, viral specific CD8+ T-cells and the neutralizing immunoglobulins have been established in most of the convalescent COVID-19 individuals. On the other hand, the host immune response to severe COVID-19 infection has been attributed to the inflammatory cytokine storm, and to influx of the activated immune cells to the lungs; leading to severe pneumonia, extensive ARDS and finally to death. Despite of this, the protective and pathogenic aspects of the human immunity have not been fully elucidated. Recent attempts conducted by several published research works have focused on information derived from the immune responses to the severe acute respiratory syndrome-related coronavirus diseases (mainly; SARS and MERS). However, these works lack sufficiency due to variations in the transmissibility, virulence, host-virus interactions and the immune evasion mechanisms. Hence, adequate understanding of the host immune response mechanisms to SARS-CoV-2 will generate the impetus towards effective control and preventive measures. The objectives of this article were to provide an overview of the host immune responses to SARS-CoV-2 infection, the viral immune evasion strategies, and to define certain knowledge gaps that require further studies

Energy-aware message distribution algorithm for enhance FANET pipeline surveillance reliability

Features such as the communication scheme, energy awareness, and task distribution amongst others are the key component that characterizes the Flying Ad-hoc Network (FANET). The operational efficiency in FANET surveying a specific region is affected by the nature of the UAVs' node placement, routing protocol, energy-aware task distribution, and node interaction amongst others. In this paper, Drone 1 (D1), Master Drone (DM), and Drone 2 (D2) were used to survey a pipeline of length 12.2 m. This paper aims at minimising energy use by drones during surveillance using energy-aware node exchange technique, task interaction and distribution scheme for each UAV. Due to fast energy depletion of DM due to packets aggregation, its election is based on the UAV with the highest energy before take-off. For two different simulations, 14,697.0 J and 14,836.6 J were obtained for DM. To avoid system failure due to fast energy loss of DM, the drones swapped positions and status. First swapping command comes up when DM loses 50% of its energy, while the second command occurs when it further loses 15%. Return to base threshold energy is computed for the three UAVs to avoid crash due to insufficient energy during surveillance. DM returns to base threshold energy for both single and double swapping simulation were 658.105 J and 652.456 J respectively. From the results obtained the algorithms were able to exchange nodes to maximize energy usage and perform an interaction-based task distribution for cooperative task sharing during surveillance. This translates into longer surveillance time and effective telemetry data aggregation