Polymeric (diphenylphosphinato)tetrahydro-furanlithium

In the title compound, [Li(C12H10O2P)(C4H8O)]n, the O atoms of adjacent and bridging diphenylphosphinate ligands and that from a tetrahydrofuran (thf) molecule are arranged in a tetrahedral manner around the Li atoms, resulting in a one-dimensional array (parallel to the a axis) of alternate eight-membered and rectangular planar four-membered rings [the two Li-O distances are 1.962 (6) and 1.991 (6) Å, and the Li-O-Li and O-Li-O angles are 88.3 (2) and 91.7 (2)°, respectively]. The Li-O distances for the O atoms of the phosphinate ligand are 1.992 (6) (for the -O atom) and 1.897 (6) Å, and the distance from Li to the O atom of the thf ligand is 2.028 (6) Å

Meso-1, 2-Bis (Methylazo)-1, 2-Diphenylethane

The title compound, meso-1,2-bis(methyldiazenyl)-1,2-diphenylethane, C16H18N4, is arranged in a disordered manner around an inversion point. The N—N atom distances in the azo group of 1.192 (8) and 1.195 (8) Å, and the C—C atom distances in the ethylene moiety at 1.512 (8) and 1.503 (8) Å in the two models [refined to 51.7 (6) and 48.3 (6)% occupancies] were not significantly different

2-[(1-{[3-(dimethylazaniumyl)propyl]methylamino}ethylidene)azaniumyl]­nona­hydro-closo-deca­borate dimethyl sulfoxide disolvate

The title compound, 2-B10H9NH=C(CH3)N(CH3)CH2CH2CH2N(CH3)2H·2C2H6OS or C8H29B10N3·2C2H6OS, is zwitterionic with the negative charge localized on the deca­borate cage and the positive charge on the terminal ammonium group. Two mol­ecules of dimethyl sulfoxide (DMSO) and one mol­ecule of the title compound constitute the asymmetric unit. One DMSO mol­ecule is disordered [ratio 0.739 (3):0.261 (3)]. The bonds and angles within the deca­borate cage are within the normal ranges. The amidine fragment of the ligand, which is expected to be planar, is significantly distorted from planarity as exemplified by four torsion angles [B—N—C—C = 8.4 (3), H—N—C—N = 5(2), N—C—N—C = 7.3 (3) and C—C—N—C = 14.8 (3)°] found within this portion of the mol­ecule. The crystal packing consists of head-to-tail-arranged dimers of the title mol­ecule held together by four mol­ecules of DMSO which are attached via strong N—H⋯O and weak C—H⋯O hydrogen bonds

tert-Butyl 2-(4-chloro­benzo­yl)-2-methyl­propanoate

The title compound, C15H19ClO3, is bent with a dihedral angle of 72.02 (9)° between the mean planes of the benzene ring and a group encompassing the ester functionality (O=C—O—C). In the crystal, mol­ecules related by inversion symmetry are connected by weak C—H⋯O inter­actions into infinite chains. These inter­actions involve H atoms from a methyl group of the dimethyl residue and the O atoms of the ketone on one side of a mol­ecule; on the other side there are inter­actions between H atoms of the benzene ring and the carbonyl O atoms of the ester functionality. There are no directional inter­actions between the chains

tert-Butyl 2-benzoyl-2-methyl­propanoate

The title compound, C15H20O3, is bent with a dihedral angle of 67.28 (9)° between the mean planes of the phenyl ring and a group encompassing the ester functionality (O=C—O—C). In the crystal, mol­ecules related by inversion symmetry are connected by weak C—H⋯O inter­actions into infinite chains. On one side of the mol­ecule there are two adjacent inter­actions between neighbouring mol­ecules involving the H atoms of methyl groups from the dimethyl groups and the O atoms of the ketone; on the other side, there are also two inter­actions to another adjacent mol­ecule involving the H atoms on the phenyl rings and the carbonyl O atoms of the ester functionality

tert-Butyl 2-methyl-2-(4-nitro­benzo­yl)propanoate

The title compound, C15H19NO5, is bent with a dihedral angle of 61.8 (2)° between the mean planes of the benzene ring and a group encompassing the ester functionality (O=C—O—C). The dihedral angle of 0.8 (2)° between the mean planes of the nitro group and the benzene ring indicates near coplanarity. In the crystal, each mol­ecule is linked to four adjacent mol­ecules by weak C—H⋯O hydrogen-bonding inter­actions. Both benzene H atoms ortho to the ketone O atom form C—H⋯O hydrogen bonds with the keto O atoms of two neighboring mol­ecules (of the keto and ester groups, respectively), and the two other inter­actions involve the H atoms from a methyl group of the dimethyl residue, displaying C—H⋯O inter­actions with the O atoms of the nitro groups. These four inter­actions for each mol­ecule lead to the formation of two-dimensional sheets with a hydro­philic inter­ior, held together by weak hydrogen-bonded inter­actions, and a hydro­phobic exterior composed of protruding methyl groups which interst­ack with the methyl groups in adjacent sheets

tert-Butyl 2-methyl-2-(4-methyl­benzo­yl)propanoate

The title compound, C16H22O3, is bent with a dihedral angle of 75.3 (1)° between the mean planes of the benzene ring and a group encompassing the ester functionality (O=C—O—C). In the crystal, the mol­ecules are linked into infinite chains held together by weak C—H⋯O hydrogen-bonded inter­actions between an H atom on the benzene ring of one mol­ecule and an O atom on the ketone functionality of an adjacent mol­ecule. The chains are arranged with neighbouring tert-butyl and dimethyl groups on adjacent chains exhibiting hydro­phobic stacking, with short C—H⋯H—C contacts (2.37 Å) between adjacent chain

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