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

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 years; 78.2% included were male with a median age of 37 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

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

Binary Whale Optimization Algorithm for Dimensionality Reduction

Feature selection (FS) was regarded as a global combinatorial optimization problem. FS is used to simplify and enhance the quality of high-dimensional datasets by selecting prominent features and removing irrelevant and redundant data to provide good classification results. FS aims to reduce the dimensionality and improve the classification accuracy that is generally utilized with great importance in different fields such as pattern classification, data analysis, and data mining applications. The main problem is to find the best subset that contains the representative information of all the data. In order to overcome this problem, two binary variants of the whale optimization algorithm (WOA) are proposed, called bWOA-S and bWOA-V. They are used to decrease the complexity and increase the performance of a system by selecting significant features for classification purposes. The first bWOA-S version uses the Sigmoid transfer function to convert WOA values to binary ones, whereas the second bWOA-V version uses a hyperbolic tangent transfer function. Furthermore, the two binary variants introduced here were compared with three famous and well-known optimization algorithms in this domain, such as Particle Swarm Optimizer (PSO), three variants of binary ant lion (bALO1, bALO2, and bALO3), binary Dragonfly Algorithm (bDA) as well as the original WOA, over 24 benchmark datasets from the UCI repository. Eventually, a non-parametric test called Wilcoxon&rsquo;s rank-sum was carried out at 5% significance to prove the powerfulness and effectiveness of the two proposed algorithms when compared with other algorithms statistically. The qualitative and quantitative results showed that the two introduced variants in the FS domain are able to minimize the selected feature number as well as maximize the accuracy of the classification within an appropriate time

Effective PID controller design using a novel hybrid algorithm for high order systems.

This paper discusses the merging of two optimization algorithms, atom search optimization and particle swarm optimization, to create a hybrid algorithm called hybrid atom search particle swarm optimization (h-ASPSO). Atom search optimization is an algorithm inspired by the movement of atoms in nature, which employs interaction forces and neighbor interaction to guide each atom in the population. On the other hand, particle swarm optimization is a swarm intelligence algorithm that uses a population of particles to search for the optimal solution through a social learning process. The proposed algorithm aims to reach exploration-exploitation balance to improve search efficiency. The efficacy of h-ASPSO has been demonstrated in improving the time-domain performance of two high-order real-world engineering problems: the design of a proportional-integral-derivative controller for an automatic voltage regulator and a doubly fed induction generator-based wind turbine systems. The results show that h-ASPSO outperformed the original atom search optimization in terms of convergence speed and quality of solution and can provide more promising results for different high-order engineering systems without significantly increasing the computational cost. The promise of the proposed method is further demonstrated using other available competitive methods that are utilized for the automatic voltage regulator and a doubly fed induction generator-based wind turbine systems

Improved bald eagle search algorithm for global optimization and feature selection

The use of metaheuristics is one of the most encouraging methodologies for taking care of real-life problems. Bald eagle search (BES) algorithm is the latest swarm-intelligence metaheuristic algorithm inspired by the intelligent hunting behavior of bald eagles. In recent research works, BES algorithm has performed reasonably well over a wide range of application areas such as chemical engineering, environmental science, physics and astronomy, structural modeling, global optimization, engineering design, energy efficiency, etc. However, it still lacks adequate searching efficiency and has a tendency to stuck in local optima which affects the final outcome. This paper introduces a modified BES (mBES) algorithm that removes the shortcomings of the original BES algorithm by incorporating three improvements; Opposition-based learning (OBL), Chaotic Local Search (CLS), and Transition &amp; Pharsor operators. OBL is embedded in different phases of the standard BES viz. initial population, selecting, searching in space, and swooping phases to update the positions of individual solutions to strengthen exploration, CLS is used to enhance the position of the best agent which will lead to enhancing the positions of all individuals, and Transition &amp; Pharsor operators help to provide sufficient exploration–exploitation trade-off. The efficiency of the mBES algorithm is initially evaluated with 29 CEC2017 and 10 CEC2020 global optimization benchmark functions. In addition, the practicality of the mBES is tested with a real-world feature selection problem and five engineering design problems. Results of the mBES algorithm are compared against a number of classical metaheuristic algorithms using statistical metrics, convergence analysis, box plots, and the Wilcoxon rank sum test. In the case of composite CEC2017 test functions F21-F30, mBES wins against compared algorithms in 70% test cases, whereas for the rest of the test functions, it generates good results in 65% cases. The proposed mBES produces best performance in 55% of the CEC2020 test functions, whereas for the rest of the 45% test cases, it generated competitive results. On the other hand, for five engineering design problems, the mBES is the best among all compared algorithms. In the case of the feature selection problem, the mBES also showed competitiveness with the compared algorithms. Results and observations for all tested optimization problems show the superiority and robustness of the proposed mBES over the baseline metaheuristics. It can be safely concluded that the improvements suggested in the mBES are proved to be effective making it competitive enough to solve a variety of optimization problems

Optimal power flow analysis considering renewable energy resources uncertainty based on an improved wild horse optimizer

Abstract In recent years, electricity networks across the globe have undergone rapid development, especially with the incorporation of various renewable energy sources (RES). The goal is to increase the penetration level of RES in the power grid to maximize energy efficiency. However, the optimal power flow (OPF) problem for conventional power generation with RES integration is highly complex, non‐linear, and non‐convex, and this complexity is further compounded when stochastic RES is integrated into the network. To address this problem, this article proposes an elite evolutionary strategy (EES) based on evolutionary approaches to improve the Wild Horse Optimizer (WHO), creating an enhanced hybrid technique called EESWHO. The proposed technique's effectiveness and robustness were tested on 23 numerical optimization test functions, including seven unimodal, six multimodal, and ten composite test functions. Furthermore, the EESWHO was applied to the modified IEEE‐30 bus test system to demonstrate its supremacy and efficacy in achieving the optimal solution. The simulation results show that the proposed EESWHO algorithm is highly effective and robust in achieving the optimal solution to the OPF problem with stochastic RES. This approach provides a practical solution to the challenges posed by the integration of RES into power networks, allowing for maximum energy efficiency while minimizing system complexity

Convergence comparison of ImpAO, AO, SMA, MFO and ABC algorithms for AFR system.

Convergence comparison of ImpAO, AO, SMA, MFO and ABC algorithms for AFR system.</p

Parameter values chosen for this study in various algorithms.

Parameter values chosen for this study in various algorithms.</p