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

New Hierarchical Clustering Algorithm for Protein Sequences Based on Hellinger Distance

Protein sequences clustering based on their sequence patterns has attracted lots of research efforts in the last decade. The principal idea of most clustering systems is how to represent and interpret protein sequences, which principally determines the performance of classifiers. In this paper, we proposed a new methodology, that definite a new descriptor to represent and interpret each sequence using its Probability Densities Functions (PDF). The Hellinger distance is used to measure the similarity between the sequences. Afterward, a hierarchical algorithm is applied to clustering proteins sequences using the Hellinger distance. Two of protein data sets are using for the experiments; the first is a mixed between Influenza and Ebola virus and the second is a set of Influenza. We compare between a two Hierarchical Clustering Algorithms, The first based on similarity measure is to use methods with sequences alignments (HCAWSA). The second is the proposed approach to the similarity measure is to use methods without sequences alignments.( HCAWOSA). The experiments result show that the proposed methodology is feasible and achieves good accuracy

A novel statistical approach for detection of suspicious regions in digital mammogram

AbstractIn this paper, we propose a novel algorithm to detect the suspicious regions on digital mammograms that based on the Fisher information measure. The proposed algorithm is tested different types and categories of mammograms (fatty, fatty-glandular and dense glandular) within mini-MIAS database (Mammogram Image Analysis Society database (UK)). The proposed method is compared with a different segmentation based information theoretical methods to demonstrate their effectiveness. The experimental results on mammography images showed the effectiveness in the detection of suspicious regions. This study can be a part of developing a computer-aided decision (CAD) system for early detection of breast cancer

The importance of cultural dimensions in the design process of the vernacular societies

Reviewing the thought of modernity and its impacts on architecture is based on the reconsideration of cultural differences among communities. It is an approach to remedy the consequences of applications of modern architectural theories in dealing with the vernacular societies. This research focuses on the significant role that cultural characteristics play in creating designs for such communities. Therefore, it represents the concept of considering patterns of events in the employment of the communal psychological dimension through the process of design. This research is divided into two phases: highlighting the various definitions of the key terms in the study, and analyzing the mechanism that considers the cultural characteristics of represented communities; Shibam in Yemen, Edfu in Upper Egypt, and Draa in Morocco. The main objective of the research is to use the vernacular prototypes and patterns to reach a design that is most culturally and environmentally adapted. Keywords: Cultural characteristics, Vernacular communities, Patterns of event

A Lightweight CNN and Class Weight Balancing on Chest X-ray Images for COVID-19 Detection

In many locations, reverse transcription polymerase chain reaction (RT-PCR) tests are used to identify COVID-19. It could take more than 48 h. It is a key factor in its seriousness and quick spread. Images from chest X-rays are utilized to diagnose COVID-19. Which generally deals with the issue of imbalanced classification. The purpose of this paper is to improve CNN’s capacity to display Chest X-ray pictures when there is a class imbalance. CNN Training has come to an end while chastening the classes for using more examples. Additionally, the training data set uses data augmentation. The achievement of the suggested method is assessed on an image’s two data sets of chest X-rays. The suggested model’s efficiency was analyzed using criteria like accuracy, specificity, sensitivity, and F1 score. The suggested method attained an accuracy of 94% worst, 97% average, and 100% best cases, respectively, and an F1-score of 96% worst, 98% average and 100% best cases, respectively