Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case

ObjectivesThis systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings.MethodsThis literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1-17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome).ResultsOf 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings.ConclusionsSARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary

A systematic review on outbreaks of COVID-19 among children within households in the European region

Objectives This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings.Methods This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within household settings. The inclusion criteria were based on the PEO framework (P-Population, E-Exposure, O-Outcome) for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with pediatric index cases 1–17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either a SAR or the probability of onward infection (outcome).Results Of 1,819 studies originally identified, 25 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 23 studies, while there was no evidence of secondary transmission from children to other household members in two studies. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings.Conclusions SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary

Multimodal analysis of drug transporter expression in gastrointestinal tissue

Objectives: Drug transporters affect antiretroviral therapy (ART) tissue disposition, but quantitative measures of drug transporter protein expression across preclinical species are not available. Our objective was to use proteomics to obtain absolute transporter concentrations and assess agreement with corresponding gene and immunometric protein data. Design: In order to make interspecies comparisons, two humanized mouse [hu-HSC-Rag (n = 41); bone marrow-liver-thymus (n = 13)] and one primate [rhesus macaque (nonhuman primate, n = 12)] models were dosed to steady state with combination ART. Ileum and rectum were collected at necropsy and snap frozen for analysis. Methods: Tissues were analyzed for gene (quantitative PCR) and protein [liquid chromatography-mass spectrometry (LC-MS) proteomics and western blot] expression and localization (immunohistochemistry) of ART efflux and uptake transporters. Drug concentrations were measured by LC-MS/MS. Multivariable regression was used to determine the ability of transporter data to predict tissue ART penetration. Results: Analytical methods did not agree, with different trends observed for gene and protein expression. For example, quantitative PCR analysis showed a two-fold increase in permeability glycoprotein expression in nonhuman primates versus mice; however, proteomics showed a 200-fold difference in the opposite direction. Proteomics results were supported by immunohistochemistry staining showing extensive efflux transporter localization on the luminal surface of these tissues. ART tissue concentration was variable between species, and multivariable regression showed poor predictive power of transporter data. Conclusion: Lack of agreement between analytical techniques suggests that resources should be focused on generating downstream measures of protein expression to predict drug exposure. Taken together, these data inform the use of preclinical models for studying ART distribution and the design of targeted therapies for HIV eradication

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

Structure-Process-Property Relationships for LENS® and SLM Processed AlSi10Mg Alloys and the Effect of Heat Treatment

Additive manufacturing has developed as a strong tool in making parts with complex shapes and high qualities. The microstructure evolution of the AlSi10Mg alloy manufactured through Laser Engineered Net Shaping (LENS®) and Selective Laser Melting (SLM) AM techniques is studied through electron microscopy characterization. The solidified melt pools of both as-deposited samples exhibit a “fish scale” pattern that is inherent to the AM process. A very fine cellular microstructure is seen due to the high thermal gradients and cooling rates on the order of 103-106K/s. Eutectic silicon forms along the cell boundaries of the aluminum matrix. The rapid solidification and non-equilibrium conditions result in the formation of metastable phases. X-Ray Diffraction and Differential Scanning Calorimetry analysis were carried out to identify the phases in the as-deposited samples. In-situ and post-mortem TEM characterization were conducted to observe the formation of silicon and Mg2Si precipitates. The Mg2Si precipitates segregated along the cell boundaries in both of the as-deposited samples. The π-Al8Si6Mg3Fe phase was also observed to segregate along the cell boundary. High resolution transmission electron microscopy studies revealed a crystallographic orientation relationship between the [001] Al matrix and the [110] Si primary phase. A comparative study between the microstructure of the LENS® and SLM as-deposited samples revealed a finer microstructure in the as-deposited SLM sample. A conventional T6 heat treatment caused the cellular network to break down and the Si particles to coarsen. Microhardness tests were conducted on the as-deposited samples and heat-treated samples to correlate the mechanical properties with the microstructure. The hardness of the as-deposited samples was 105 HV which is higher than the hardness of a cast counterpart

Structure-Process-Property Relationships for LENS® and SLM Processed AlSi10Mg Alloys and the Effect of Heat Treatment

Additive manufacturing has developed as a strong tool in making parts with complex shapes and high qualities. The microstructure evolution of the AlSi10Mg alloy manufactured through Laser Engineered Net Shaping (LENS®) and Selective Laser Melting (SLM) AM techniques is studied through electron microscopy characterization. The solidified melt pools of both as-deposited samples exhibit a “fish scale” pattern that is inherent to the AM process. A very fine cellular microstructure is seen due to the high thermal gradients and cooling rates on the order of 103-106K/s. Eutectic silicon forms along the cell boundaries of the aluminum matrix. The rapid solidification and non-equilibrium conditions result in the formation of metastable phases. X-Ray Diffraction and Differential Scanning Calorimetry analysis were carried out to identify the phases in the as-deposited samples. In-situ and post-mortem TEM characterization were conducted to observe the formation of silicon and Mg2Si precipitates. The Mg2Si precipitates segregated along the cell boundaries in both of the as-deposited samples. The π-Al8Si6Mg3Fe phase was also observed to segregate along the cell boundary. High resolution transmission electron microscopy studies revealed a crystallographic orientation relationship between the [001] Al matrix and the [110] Si primary phase. A comparative study between the microstructure of the LENS® and SLM as-deposited samples revealed a finer microstructure in the as-deposited SLM sample. A conventional T6 heat treatment caused the cellular network to break down and the Si particles to coarsen. Microhardness tests were conducted on the as-deposited samples and heat-treated samples to correlate the mechanical properties with the microstructure. The hardness of the as-deposited samples was 105 HV which is higher than the hardness of a cast counterpart

How Platform-User Power Relations Shape Algorithmic Accountability: A Case Study of Instant Loan Platforms and Financially Stressed Users in India

Accountability, a requisite for responsible AI, can be facilitated through transparency mechanisms such as audits and explainability. However, prior work suggests that the success of these mechanisms may be limited to Global North contexts; understanding the limitations of current interventions in varied socio-political conditions is crucial to help policymakers facilitate wider accountability. To do so, we examined the mediation of accountability in the existing interactions between vulnerable users and a 'high-risk' AI system in a Global South setting. We report on a qualitative study with 29 financially-stressed users of instant loan platforms in India. We found that users experienced intense feelings of indebtedness for the 'boon' of instant loans, and perceived huge obligations towards loan platforms. Users fulfilled obligations by accepting harsh terms and conditions, over-sharing sensitive data, and paying high fees to unknown and unverified lenders. Users demonstrated a dependence on loan platforms by persisting with such behaviors despite risks of harms such as abuse, recurring debts, discrimination, privacy harms, and self-harm to them. Instead of being enraged with loan platforms, users assumed responsibility for their negative experiences, thus releasing the high-powered loan platforms from accountability obligations. We argue that accountability is shaped by platform-user power relations, and urge caution to policymakers in adopting a purely technical approach to fostering algorithmic accountability. Instead, we call for situated interventions that enhance agency of users, enable meaningful transparency, reconfigure designer-user relations, and prompt a critical reflection in practitioners towards wider accountability. We conclude with implications for responsibly deploying AI in FinTech applications in India and beyond.Comment: To appear at FAccT 202