Effects of sediment flushing operations versus natural floods on Chinook salmon survival

Flushing is a common measure to manage and reduce the amount of sediment stored in reservoirs. However, the sudden release of large volumes of sediment abruptly increases the suspended solids concentration and alters the riverbed composition. Similar effects can be produced also by natural flood events. Do flushing operations have more detrimental impacts than natural floods? To answer this question, we investigated the impact of flushing on the survival of the Chinook salmon ($\textit{Oncorhynchus tshawytscha}$) in the Sandy River (OR, USA), assuming that sediment is flushed from hypothetical bottom gates of the, now decommissioned, Marmot Dam. The effects of several flushing scenarios are analyzed with a 2D morphodynamic model, together with habitat suitability curves and stress indicators. The results show that attention has to be paid to duration: the shorter the flushing operation, the lesser the stresses on fish survival and spawning habitats. Flushing causes high stress to salmon eggs and larvae, due to unbearable levels of suspended sediment concentrations. It also decreases the areas usable for spawning due to fine-sediment deposition, with up to 95% loss at peak flow. Without the dam, the corresponding natural flood event would produce similar effects, with up to 93% loss. The study shows that well-planned flushing operations could mimic a natural impact, but only partly. In the long-term, larger losses of spawning grounds can be expected, since the removal of fine sediment with the release of clear water from the reservoir is a lengthy process that may be undesirable due to water storage reduction

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

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

A satellite-image-based method to overcome data scarcity for river morphodynamic modelling

Accepted Author ManuscriptRivers, Ports, Waterways and Dredging Engineerin

Modelling the Inundation and Morphology of the Seasonally Flooded Mayas Wetlands in the Dinder National Park-Sudan

Understanding the spatiotemporal dynamics of surface water in varied, remote and inaccessible isolated floodplain lakes is difficult. Seasonal inundation patterns of these isolated lakes can be misestimated in a hydrodynamic model due to the short time of connectivity. The seasonal and annual variability of the Dinder River flow has great impact on what is so called Mayas wetlands, and hence, on the habitats and the ecological status of the Dinder National Park. This variability produces large morphological changes due to sediment transported within the river or from the upper catchment, which affects inflows to Mayas wetlands and floodplain inundation in general. In this paper, we investigated the morphological dimension using a quasi-3D modelling approach to support the management of the valuable Mayas wetlands ecosystems, and in particular, assessment of hydrological and morphological regime of the Dinder River as well as the Musa Maya. Six scenarios were developed and tested. The first three scenarios consider three different hydrologic conditions of average, wet and dry years under the existing system with the constructed connection canal. While the other three scenarios consider the same hydrologic conditions but under the natural system without an artificial connection canal. The modelling helps to understand the effect of human intervention (connection canal) on the Musa Maya. The comparison between the simulated scenarios concludes that the hydrodynamics and sedimentology of the Maya are driven by the two main factors: a) the hydrological variability of Dinder River; and b) deposited sediment plugs in the connection canal.Water Resource

Effects of sediment flushing operations versus natural floods on Chinook salmon survival

Flushing is a common measure to manage and reduce the amount of sediment stored in reservoirs. However, the sudden release of large volumes of sediment abruptly increases the suspended solids concentration and alters the riverbed composition. Similar effects can be produced also by natural flood events. Do flushing operations have more detrimental impacts than natural floods? To answer this question, we investigated the impact of flushing on the survival of the Chinook salmon (Oncorhynchus tshawytscha) in the Sandy River (OR, USA), assuming that sediment is flushed from hypothetical bottom gates of the, now decommissioned, Marmot Dam. The effects of several flushing scenarios are analyzed with a 2D morphodynamic model, together with habitat suitability curves and stress indicators. The results show that attention has to be paid to duration: the shorter the flushing operation, the lesser the stresses on fish survival and spawning habitats. Flushing causes high stress to salmon eggs and larvae, due to unbearable levels of suspended sediment concentrations. It also decreases the areas usable for spawning due to fine-sediment deposition, with up to 95% loss at peak flow. Without the dam, the corresponding natural flood event would produce similar effects, with up to 93% loss. The study shows that well-planned flushing operations could mimic a natural impact, but only partly. In the long-term, larger losses of spawning grounds can be expected, since the removal of fine sediment with the release of clear water from the reservoir is a lengthy process that may be undesirable due to water storage reduction.ISSN:2045-232

Numerical-modelling and earth-observations for dynamic management of Old Brahmaputra offtake

Rivers, Ports, Waterways and Dredging Engineerin

Effects of sediment flushing operations versus natural floods on Chinook salmon survival

Flushing is a common measure to manage and reduce the amount of sediment stored in reservoirs. However, the sudden release of large volumes of sediment abruptly increases the suspended solids concentration and alters the riverbed composition. Similar effects can be produced also by natural flood events. Do flushing operations have more detrimental impacts than natural floods? To answer this question, we investigated the impact of flushing on the survival of the Chinook salmon (Oncorhynchus tshawytscha) in the Sandy River (OR, USA), assuming that sediment is flushed from hypothetical bottom gates of the, now decommissioned, Marmot Dam. The effects of several flushing scenarios are analyzed with a 2D morphodynamic model, together with habitat suitability curves and stress indicators. The results show that attention has to be paid to duration: the shorter the flushing operation, the lesser the stresses on fish survival and spawning habitats. Flushing causes high stress to salmon eggs and larvae, due to unbearable levels of suspended sediment concentrations. It also decreases the areas usable for spawning due to fine-sediment deposition, with up to 95% loss at peak flow. Without the dam, the corresponding natural flood event would produce similar effects, with up to 93% loss. The study shows that well-planned flushing operations could mimic a natural impact, but only partly. In the long-term, larger losses of spawning grounds can be expected, since the removal of fine sediment with the release of clear water from the reservoir is a lengthy process that may be undesirable due to water storage reduction.Rivers, Ports, Waterways and Dredging EngineeringEnvironmental Fluid Mechanic

Temporal trends and outcomes of critical limb ischemia among patients with chronic kidney disease

There is a paucity of data on the outcomes and revascularization strategies for critical limb ischemia (CLI) among patients with chronic kidney disease (CKD). Hence, we conducted a nationwide analysis to evaluate the trends and outcomes of hospitalizations for CLI with CKD. The National Inpatient Sample database (2002–2015) was queried for hospitalizations for CLI. The trends of hospitalizations for CLI with CKD were reported, and endovascular versus surgical revascularization strategies for CLI with CKD were compared. The main study outcome was in-hospital mortality. The analysis included 2,139,640 hospitalizations for CLI, of which 484,224 (22.6%) had CKD. There was an increase in hospitalizations for CLI with CKD (Ptrend = 0.01), but a reduction in hospitalizations for CLI without CKD (Ptrend = 0.01). Patients with CLI and CKD were less likely to undergo revascularization compared with patients without CKD. CLI with CKD had higher rates of in-hospital mortality (4.8% vs 2.5%, adjusted odds ratio (OR) 2.01; 95% CI 1.93–2.11) and major amputation compared with no CKD. Revascularization for CLI with CKD was associated with lower rates of mortality (3.7% vs 5.3%, adjusted-OR 0.78; 95% CI 0.72–0.84) and major amputation compared with no revascularization. Compared with endovascular revascularization, surgical revascularization for CLI with CKD was associated with higher rates of in-hospital mortality (4.7% vs 2.7%, adjusted-OR 1.67; 95% CI 1.43–1.94). In conclusion, this contemporary observational analysis showed an increase in hospitalizations for CLI among patients with CKD. CLI with CKD was associated with higher in-hospital mortality compared with no CKD. Compared with endovascular therapy, surgical revascularization for CLI with CKD was associated with higher in-hospital mortality