A CMOS compatible ultracompact silicon photonic optical add-drop multiplexer with misaligned Sidewall Bragg gratings

We experimentally and via simulations demonstrate ultracompact single-stage and cascaded optical add-drop multiplexers using misaligned sidewall Bragg grating in a Mach-Zehnder interferometer for the silicon-on-insulator platform. The single-stage configuration has a device footprint of 400 μm × 90 μm, and the cascaded configuration has a footprint of 400 μm × 125 μm. The proposed designs have 3-dB bandwidths of 6 nm and extinction ratios of 25 dB and 51 dB, respectively, and have been fabricated for the transverse electric mode. A minimum lithographic feature size of 80 nm is used in our design, which is within the limitation of 193 nm deep ultraviolet lithography

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

Environmental Assessment of Potentially Toxic Elements Using Pollution Indices and Data-Driven Modeling in Surface Sediment of the Littoral Shelf of the Mediterranean Sea Coast and Gamasa Estuary, Egypt

Coastal environmental assessment techniques have evolved into one of the most important fields for the long-term development and management of coastal zones. So, the overall aim of the present investigation was to provide effective approaches for making informed decisions about the Gamasa coast sediment quality. Over a two-year investigation, sediment samples were meticulously collected from the Gamasa estuary and littoral shelf. The inductively coupled plasma mass spectra (ICP-MS) was used to the total concentrations of Al, Fe, Ti, Mg, Mn, Cu, P, V, Ba, Cr, Sr, Co, Ni, Zn, Pb, Zr, and Ce. Single elements environmental pollution indices including the geoaccumulation index (Igeo), contamination factor (CF), and enrichment factor (EF), as well as multi-elements pollution indices comprising the potential ecological risk index (RI), degree of contamination (Dc), and pollution load index (PLI) were used to assess the sediment and the various geo-environmental variables affecting the Mediterranean coastal system. Furthermore, the Dc, PLI, and RI were estimated using the random forest (RF) and Back-Propagation Neural Network (BPNN) depending on the selected elements. According to the Dc results, all the investigated sediment samples categories were considerably contaminated. Cr, Co, Ni, Cu, Zr, V, Zn, P, and Mn showed remarkable enrichment in sediment samples and were originated from anthropogenic sources based on the CF, EF, and Igeo data. Moreover, the RI findings revealed that all the samples tested pose a low ecologically risk. Meanwhile, based on PLI, 70% of the Gamasa estuary samples were polluted, while 93.75% of littoral shelf sediment was unpolluted. The BPNNs -PCs-CD-17 model performed the best and demonstrated a better association between exceptional qualities and CD. With R2 values of 1.00 for calibration (Cal.) and 1.00 for validation (Val.). The BPNNs -PCs-PLI-17 models performed the best in terms of measuring PLI with respective R2 values of 1.00 and 0.98 for the Cal. and Val. datasets. The findings showed that the RF and BPNN models may be used to precisely quantify the pollution indices (Dc, PLI, and RI) in calibration (Cal.) and validation (Val.) datasets utilizing potentially toxic elements of surface sediment

Health Risk Assessment of Hazardous Heavy Metals in Two Varieties of Mango Fruit (<i>Mangifera indica</i> L. var. Dasheri and Langra)

The spatial assessment of four heavy metals (Cd, Cr, Pb, and As) in two mango fruit (Mangifera indica L.) varieties (Dasheri and Langra) collected from the Saharanpur district, Uttar Pradesh, India, was investigated in this study. The samples of ripe mango fruits were collected from the orchards of 12 major towns in the Saharanpur district from May to June 2022. Heavy metal analysis using atomic absorption spectroscopy (AAS) showed the presence of all selected heavy metals. Specifically, the concentration (mg/kg dry weight basis) range of Cd (0.01–0.08), Cr (0.11–0.82), Pb (0.02–0.15), and As (0.01–0.14) did not exceed the safe limits. The geospatial variation in the heavy metal concentration was significantly (p < 0.05) different as indicated by the inverse distance weighting (IDW) interpolation and analysis of variance (ANOVA) results. The multivariate statistical analysis using principal component (PC) and agglomerative hierarchical cluster (AHC) analyses revealed that the Saharanpur city location had the highest levels of selected heavy metals out of the 12 sampling locations. In this, the Dasheri variety was identified to have higher heavy metal concentrations in comparison to the Langra variety. Moreover, the health risk study using the target hazard quotient (THQ) confirmed that the levels did not exceed the safe health risk index (HRI) limit of 1. However, the health risk assessment for the child group showed relatively high HRI values (<0.35) compared to those of the adult group (<0.09). Therefore, considering the importance of the Saharanpur district in massive mango fruit production, this study provides vital information regarding the biomonitoring of heavy metals in the two most consumed varieties