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

Toxic Effects of Essential Oils of Elattaria Cardamomum L. And Lambda- Cyhalothrin on Tribolium Confusum (Duval)

Toxic effect of Lambda-cyhalothrin and essential oils of cardamom seeds of Elettaria cardamomum (L.), individually or in combination, on the larva, pupa and adult stages of confused flower beetle, Tribolium confusum, through the topical application were studied. The percentages of mortality of larval stage exposed to Lambda-cyhalothrin, at concentrations of 0.25, 0.35, 0.50 and 0.75 µl/ larva were 13.33, 20, 36.67 and 46.67 % respectively. While, the percentages of mortality of pupa stage at concentrations of 0.25, 0.35, 0.50 and 0.75 µl/ pupa were 13.33, 16.67, 26.67 and 43.33 respectively. For adults, exposed to Lambda concentrations of 0.25, 0.35, 0.50 and 0.75 µl/ adult were 10.0, 13.33, 23.33 and 40.0 respectively. The percentages of mortality of larvae exposed to cardamom oil at concentrations of  0.1, 0.3, 0.5 and 1 µl/ larva were 60, 76.67, 90 and 96.67% respectively, while the mortality of pupa exposed to concentrations of  0.1, 0.3, 0.5 and 1 µl/ pupa were 46.67, 63.33, 83.33 and 90 respectively. The percentages of mortality of the adults exposed to concentrations 0.1, 0.3, 0.5 and 1 µl/ adult were 43.33, 60.0, 76.67 and 83.33 respectively. The synergistic ratios for larvae, pupae and adults exposed to mixture 1 (0.03  µl / insect cardamom oil and different concentrations of pesticide ), were  2.01, 1.70 and 1.60, respectively, where as the synergistic ratios of larvae, pupae and adults exposed to mixture 2 ( 0.07  µl / insect cardamom oil and different concentrations of pesticide) were 2.61, 2.34 and 3.10, respectively. This indicates that a combination of cardamom seeds oil with different concentrations of the insecticide Lambda produced synergistic effects

Defense tools in corporate information system, cloud computing and Blockchain

The analysis of tools in corporate information system, cloud computing and blockchain are given. Some elements of such as neural net, multi-agent systems are discussed

Fuzzy Clustering Algorithm Based on Improved Global Best-Guided Artificial Bee Colony with New Search Probability Model for Image Segmentation

Clustering using fuzzy C-means (FCM) is a soft segmentation method that has been extensively investigated and successfully implemented in image segmentation. FCM is useful in various aspects, such as the segmentation of grayscale images. However, FCM has some limitations in terms of its selection of the initial cluster center. It can be easily trapped into local optima and is sensitive to noise, which is considered the most challenging issue in the FCM clustering algorithm. This paper proposes an approach to solve FCM problems in two phases. Firstly, to improve the balance between the exploration and exploitation of improved global best-guided artificial bee colony algorithm (IABC). This is achieved using a new search probability model called PIABC that improves the exploration process by choosing the best source of food which directly affects the exploitation process in IABC. Secondly, the fuzzy clustering algorithm based on PIABC, abbreviated as PIABC-FCM, uses the balancing of PIABC to avoid getting stuck into local optima while searching for the best solution having a set of cluster center locations of FCM. The proposed method was evaluated using grayscale images. The performance of the proposed approach shows promising outcomes when compared with other related works

Digital image watermarking using discrete cosine transformation based linear modulation

Abstract The proportion of multimedia traffic in data networks has grown substantially as a result of advancements in IT. As a result, it's become necessary to address the following challenges in protecting multimedia data: prevention of unauthorized disclosure of sensitive data, in addition to tracking down the leak's origin, making sure no alterations may be made without permission, and safeguarding intellectual property for digital assets. watermarking is a technique developed to combat this issue, which transfer secure data over the network. The main goal of invisible watermarking is a hidden exchange of data and a message from being discovered by a third party. The objective of this work is to develop a digital image watermarking using discrete cosine transformation based linear modulation. This paper proposed an invisible watermarking method for embedding information into the transformation domain for the grey scale images. This method used the embedding of a stego-text into the least significant bit (LSB) of the Discrete Cosine Transformation (DCT) coefficient by using a linear modulation algorithm. Also, a stego-text is embedded with different sizes ten times within images after embedding the stego-image immune to different kinds of attack, such as salt and pepper, rotation, cropping, and JPEG compression with different criteria. The proposed method is tested using four benchmark images. Also, to evaluate the embedding effect, PSNR, NC and BER are calculated. The outcomes show that the proposed approach is practical and robust, where the obtained results are promising and do not raise any suspicion. In addition, it has a large capacity, and its results are imperceptible, especially when 1bit/block is embedded

Analysis and applications of information security in corporate information system, cloud computing and blockchain

The analysis of information security (IS) threats in the corporate information system (CIS), cloud computing environmentis executed. Separate approaches to the information protection in CIS, cloud environment, blockchain technology are considered. Separate applications for IS in CIS and cloud environments are presented. The blockchain application for use in education is considered

High-Performance Flow Classification of Big Data Using Hybrid CPU-GPU Clusters of Cloud Environments

The network switches in the data plane of Software Defined Networking (SDN) are empowered by an elementary process, in which enormous number of packets which resemble big volumes of data are classified into specific flows by matching them against a set of dynamic rules. This basic process accelerates the processing of data, so that instead of processing singular packets repeatedly, corresponding actions are performed on corresponding flows of packets. In this paper, first, we address limitations on a typical packet classification algorithm like Tuple Space Search (TSS). Then, we present a set of different scenarios to parallelize it on different parallel processing platforms, including Graphics Processing Units (GPUs), clusters of Central Processing Units (CPUs), and hybrid clusters. Experimental results show that the hybrid cluster provides the best platform for parallelizing packet classification algorithms, which promises the average throughput rate of 4.2 Million packets per second (Mpps). That is, the hybrid cluster produced by the integration of Compute Unified Device Architecture (CUDA), Message Passing Interface (MPI), and OpenMP programming model could classify 0.24 million packets per second more than the GPU cluster scheme. Such a packet classifier satisfies the required processing speed in the programmable network systems that would be used to communicate big medical data