Considering Local Integration for Refugees in Indonesia

This study discusses refugees who have been stranded in a transit country for years. These protracted refugees have to deal with a reality that the chance of getting resettlement in a third country has become slim, and the option of returning to their country of origin will only jeopardize their lives. Indonesia is not a state party to the 1951 Refugee Convention that lays a responsibility to assimilate refugees in the resettlement countries. Indonesia, however, has opened its door for refugees based on humanity’s solidarity and the fact that Indonesia’s legal framework on human rights acknowledges the right to seek asylum in other countries and abides by the non-refoulement principle. The situation has become problematic when the number of refugees coming to Indonesia has continued to increase, but Indonesia does not have a comprehensive refugee policy to support them. By looking at the case of refugees living in Pekanbaru, this study concludes that Indonesia should consider the local integration option as one of the viable solution to the protracted refugee situations in Indonesia

Integrating vernier spectrum with fano resonance for high sensitivity of an all-optical sensor

Vernier and Fano resonances are promising approaches for enhancing the sensitivity of an all-optical sensor. A theoretical analysis was performed to integrate a Fano-like resonance shape with a Vernier resonance by considering the presence of partially reflective end facets at a double microring resonator waveguide. The system was developed based on scattering matrix and optical transfer function. The all-pass racetrack microring resonator (ARMRR) and the double racetrack microring resonator (DRMRR) were compared with and without the end facet at the waveguide to analyze the dynamic change of the output resonance spectrum. The spectrum was analyzed based on the free spectral range and resonance pattern. The resonator systems were applied to a refractive index-based sensing protocol, which was operated by a resonance wavelength shift with a refractive index change. The sensitivity was optimized by varying the configuration parameters such as the radius of the ring, the distance between the end facet, and the coupling coefficients. Integrating Vernier spectrum with Fano resonance improved the sensitivity for ARMRR configuration by 5.16% and the sensitivity for DRMRR configuration by 6.31%. The recorded limit of detection (LOD) of the DRMRR was 3.30 × 10-

Assessing indoor air quality using chemometric models

The objectives of this study are to identify the significant variables and to verify the best statistical method for determining the effect of indoor air quality (IAQ) at 7 different locations in Universiti Sultan Zainal Abidin, Terengganu, Malaysia. The IAQ data were collected using in-situ measurement. Principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), linear discrimination analysis (LDA), and agglomerative hierarchical clustering (AHC) were used to classify the significant variables as well as to compare the best method for determining IAQ levels. PCA verifies only 4 out of 9 parameters (PM10, PM2.5, PM1.0, and O3) and is the significant variable in IAQ. The PLS-DA model classifies 89.05% correct of the IAQ variables in each station compared to LDA with only 66.67% correct. AHC identifies three cluster groups, which are highly polluted concentration (HPC), moderately polluted concentration (MPC), and low-polluted concentration (LPC) area. PLS-DA verifies the groups produced by AHC by identifying the variables that affect the quality at each station without being affected by redundancy. In conclusion, PLS-DA is a promising procedure for differentiating the group classes and determining the correct percentage of variables for IAQ

Nutrien dan Morfologi Membran Kerabang Telur Ayam Kampung sebagai Bahan Baku Produksi Kolagen

Collagen derived from the eggshell membrane, is an increasingly popular functional material. Native chicken is one of the leading local commodities whose industrial waste has the potential to be used as collagen raw material. This study aimed to evaluate the nutrients and morphology of the eggshell membrane of native chicken eggs as raw material for collagen production. The parameters observed were morphology using electron scanning microscopy, mineral composition, and collagen nutrient content (water and protein). SEM observations showed that the eggshell membrane of native chicken eggs was fibrous. The meshed fiber form represents the extracellular matrix present in collagen proteins. The eggshell membrane contains Cl, K, Ca, P, and Mg macrominerals at 1.696%, 1.796%, 14.30%, 0.437%, and 0.146%, respectively. Microminerals I and Mo were also found at 0.00034% and 0.00014%, respectively. The moisture content of the superior native chicken eggshell membrane decreased by 13.05% after the collagen extraction (p<0.05), with a crude protein content of 25.32% after the extraction. It was concluded that the eggshell membrane of native chicken eggs produces fibrous morphological characteristics that are meshed and contain high minerals so that they have the potential to be used as raw materials for collagen production in various applications.   Keywords: collagen, eggshell, eggshell membrane, native chicken, morpholog

COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study

Background Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. Its efficacy as a barrier protection in addition to the use of a standard personal protective equipment (PPE) is not fully known. We performed a simulated study to investigate the relationship between aerosol box usage during intubation and contaminations on healthcare workers pre-doffing and post-doffing of PPE. Methods This was a randomised cross-over study conducted between 9 April to 5 May 2020 in the ED of University Malaya Medical Centre. Postgraduate Emergency Medicine trainees performed video laryngoscope-assisted intubation on an airway manikin with and without an aerosol box in a random order. Contamination was simulated by nebulised Glo Germ. Primary outcome was number of contaminated front and back body regions pre-doffing and post-doffing of PPE of the intubator and assistant. Secondary outcomes were intubation time, Cormack-Lehane score, number of intubation attempts and participants’ feedback. Results Thirty-six trainees completed the study interventions. The number of contaminated front and back body regions pre-doffing of PPE was significantly higher without the aerosol box (all p values<0.001). However, there was no significant difference in the number of contaminations post-doffing of PPE between using and not using the aerosol box, with a median contamination of zero. Intubation time was longer with the aerosol box (42.5 s vs 35.5 s, p<0.001). Cormack-Lehane scores were similar with and without the aerosol box. First-pass intubation success rate was 94.4% and 100% with and without the aerosol box, respectively. More participants reported reduced mobility and visibility when intubating with the aerosol box. Conclusions An aerosol box may significantly reduce exposure to contaminations but with increased intubation time and reduced operator’s mobility and visibility. Furthermore, the difference in degree of contamination between using and not using an aerosol box could be offset by proper doffing of PPE

Determination of selected heavy metals in airborne particles in industrial area: a baseline study

This study focuses on airborne heavy metal pollution in the industrial area. Eight points from Paka and Gebeng Industrial Area respectively were selected for this study within two monsoon seasons. The samples were analysed for heavy metals (Cd, As, Cu, Fe, Ni, Pb, and Zn) by using inductively coupled plasma mass spectrometry (ICP-MS). The results showed that the mean concentration value of As, Pb and Cd for Paka were 0.005 mg/L ± 0.001, 0.107 mg/L ± 0.088, and 0.010 mg/L ± 0.008, respectively and Gebeng were 0.004 mg/L ± 0.002, 0.069 mg/L ± 0.059 and 0.005 mg/L ± 0.004, respectively in the southwest monsoon - much higher than the target value by European Commission in Directive 2004/107/EC and Directive 2008/50/EC. It could be concluded that the industrial and transportation emission were the major source of heavy metals in the atmosphere along the Paka and Gebeng Industrial Area

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

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care