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

Postgraduate ethics training programs: a systematic scoping review

BACKGROUND: Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. METHODS: With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. RESULTS: The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). CONCLUSIONS: Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-021-02644-5

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

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Efficient sigma-delta beamforming techniques for ultrasound imaging application

Pre-delay reconstruction sigma-delta beamformer (SDBF) was proposed in recent years to achieve a higher level of integration in ultrasound imaging systems. The high-order reconstruction filter used in each channel of SDBF makes the beamformer highly complex. The beamformer can be simplified by reconstructing the signal only after the delay-and-sum process. It requires only one reconstruction filter for the entire beamformer. However, this post-delay reconstruction-based beamformer degrades the image quality when dynamic focusing is performed. This thesis studied the cause of the dynamic focusing artifact problem suffered by the sigma-delta beamformer. It was found that the degree of the problem is related to the pre-delay quantization noise that is present in the signal. Hence, similar performance to the conventional pre-delay reconstruction SDBF can be achieved by simply employing a simple pre-delay filter, as long as the pre-delay filter provides the required pre-delay signal-to-quantization noise ratio (SQNR). Based on this finding, a cascaded reconstruction beamformer was developed that utilizes a boxcar filter as the pre-delay filter in each channel to achieve the required pre-delay SQNR value. Simulations using real phantom data demonstrated that the proposed cascaded reconstruction beamforming method can achieve a contrast resolution comparable to that of the pre-delay reconstruction beamforming method. In addition, the savings on hardware and power can be as much as 85% and 68% respectively, as compared to the pre-delay reconstruction SDBF.DOCTOR OF PHILOSOPHY (EEE

Case study on AgFeed industries.

AgFeed Industries, Inc. is an international agribusiness with operations in the United States and China. It was founded in 1995 by four Chinese businessmen who saw great potential in the feed business in China before a series of events took place and changed the key management of the company. The business first started with Dr. Li Song Yan leading the team to set up their base in Nanchang. All the founders have vast experience in the agricultural sector and they were geared to develop their business in the feed industry. Over the years, AgFeed took up many acquisition projects in order to expand their production capacity. The team developed the feed unit and integrated vertically into the hog production segment. In 2007, the company successfully secured listing on the NASDAQ stock market. AgFeed then recognized the need for them to incorporate new technologies into their production system. With this in mind, AgFeed launched a joint venture with M2P2, a US leading hog production company, in 2009. The joint venture benefited both parties and in 2010, AgFeed proceed to acquire M2P2. As part of the acquisition agreement, John Stadler, Chairman of M2P2, joined AgFeed’s Board of Directors. Subsequently, AgFeed restructured its management team in order to better manage its business units.BUSINES

Transmitter Pulsation Control for Dynamic Wireless Power Transfer Systems

Wireless power transfer (WPT) is a convenient, flexible, and safe alternative to its wired counterpart. Due to these benefits, WPT has seen rapid growth in recent years. Typical WPT systems are usually used for static applications, where the load operates within a predefined area. On the other hand, dynamic WPT (D-WPT) is usually used to power loads which dynamically change their positions, and one of the ways to achieve this is by increasing the overall charging area via multiple transmitters (Txs). Multiple Txs require communication and control, which increases the overall complexity of the system. This paper proposes a control algorithm which aims to maintain the overall efficiency of the D-WPT system by turning on and off the Tx when the mobile receiver (Rx) approaches and departs, respectively. Transient analysis of the D-WPT system is used to derive its control variables. In addition, energy and power loss of this proposed control algorithm are also investigated. The feasibility of the proposed control algorithm is demonstrated with 1-Tx and 3-Tx experimental setups. The experimental results validate the theoretical analysis model and the proposed control algorithm, and the standby (when not charging) input power forms 7.6% of the charging input power.Accepted versio

A 16.6 μW 3.12 MHz RC relaxation oscillator with 160.3 dBc/Hz FOM

This paper presents a new RC relaxation oscillator for biomedical sensor interface circuit. A novel switch-capacitor based RC charging/discharging circuit is proposed to effectively improve the oscillator phase noise and power performance. The inverter-based comparator with replica biasing is employed and optimized to enhance the phase noise performance and to lower output dependence on the supply voltage variation. The oscillator's temperature insensitivity is also improved by resistor temperature compensation. The prototype RC relaxation oscillator circuit is designed in a commercial 65nm CMOS process. The post-layout simulation results showed 3.12 MHz output frequency, -112dBc/Hz phase noise at 100 kHz offset, and 16.6 μW power consumption under 1 V supply voltage. The frequency variation is ±0.294%/V for supply within 1 V to 1.6 V, and 11.31 ppm/°C for temperature across -40°C to 100°C. The overall circuit performance is compared favorably to the state-of-art designs, with an outstanding Figure of Merit (FOM) of 160.03 dBc/Hz at 100 kHz.ASTAR (Agency for Sci., Tech. and Research, S’pore)Accepted versio

A high-frequency transimpedance amplifier for CMOS integrated 2D CMUT array towards 3D ultrasound imaging

One transimpedance amplifier based CMOS analog front-end (AFE) receiver is integrated with capacitive micromachined ultrasound transducers (CMUTs) towards high frequency 3D ultrasound imaging. Considering device specifications from CMUTs, the TIA is designed to amplify received signals from 17.5MHz to 52.5MHz with center frequency at 35MHz; and is fabricated in Global Foundry 0.18-μm 30-V high-voltage (HV) Bipolar/CMOS/DMOS (BCD) process. The measurement results show that the TIA with power-supply 6V can reach transimpedance gain of 61dBΩ and operating frequency from 17.5MHz to 100MHz. The measured input referred noise is 27.5pA/√Hz. Acoustic pulse-echo testing is conducted to demonstrate the receiving functionality of the designed 3D ultrasound imaging system.Accepted versio