Application of the MESMA framework. Case study : Strait of Sicily

This deliverable D2.2 comprises a manual containing the protocol for the application of the generic framework to the MESMA case studies. The generic framework (deliverable D2.1) is the central document for the subsequent work packages of MESMA. It provides a best practice guide for monitoring and evaluation of Spatially Managed Areas (SMA) in seven distinctive and clearly outlined steps which comprise 1) setting the context, 2) collation of existing information and mapping, 3) setting of targets, 4) risk analysis and state assessment, 5) assessment of findings against operational objectives, 6) evaluation of the effectiveness of management measures and 7) adaptation of the current management regime based on the outcome of the assessments (for details see D2.1). Although the framework has been developed as a generic tool for use by a range of people involved in evaluating SMAs, the first version of the manual was specifically tailored (in certain areas) for use by the case studies (WP3 of MESMA). It was designed to be an aid to the case studies applying the framework. Thus, feedback on the performance of the framework and manual is guiding the production of a revised framework and manual (D2.3) to be delivered in November 2012. The revised versions will be made available to the wider scientific community and management bodies. This document is the third version of the original document D2.2. As outlined in more detail in D2.1, we have identified several links between the WP2 framework on the one hand and a structured governance analysis (WP6) on the other. These links are indicated in the respective framework steps. The MESMA generic framework and manual does not accommodate for a comprehensivec governance analysis. Therefore the MESMA case study research has two streams – the MESMA framework and the governance research analysis. Governance issues in all MESMA case studies will be analysed through the WP6 Governance Analytical Structure. Further guidance on governance research has been developed and is available in a separate document entitled ‘Guidelines for MESMA WP6 Governance Research’. The WP6 governance research essentially aims to address the following questions: 1) What are the governance approaches and incentives being adopted in a given existing initiative with spatial elements, and how effective are the incentives and governance approaches in that particular context in achieving a particular priority objective? 2) What are the potential incentives and governance approaches that could be implemented to improve effectiveness in achieving the specific objective of an existing initiative and addressing related conflicts? 3) How do wider issues, such as top-down/bottom-up balance, inter-sectoral integration and power, cross-border issues, justice and different levels of knowledge, affect the effectiveness of existing initiatives? This ‘two stream’ approach will provide a clear way forward for combining the MESMA framework and governance research to the case studies in an integrated and coherent manner. As a result, in depth governance analysis covered by the governance work package is outlined briefly in the introduction of each framework step together with specific actions which will be largely carried out under the governance research. Further details on the WP6 governance analysis and on how the two streams of work will be linked from a WP6 governance perspective can be found in the document ‘Guidelines for MESMA WP6 Governance Research’, and Appendix 1 of this document shows a visualisation of the linkages between the two streams of work. It should be noted that in order to be able to link and integrate WP2 and WP6 research, both of the following conditions should be met: 1) Both WP2 and WP6 research are about analysing an existing initiative. Such an initiative may be an integrated marine spatial plan or part of the integrated plan; or if there is no integrated marine spatial plan in place, an existing initiative with spatial elements (e.g. sectoral management plan with spatial restrictions) which may be linked or offer valuable lessons to the future development of an integrated marine spatial plan. 2) WP2 and WP6 research should focus on the same priority objective for at least one run of the WP2 framework. The practical implementation of the framework is also linked to specific tools which will be identified and developed in WP4 and the data handling standards specified in WP5. A revised version of the manual should then interlink the actions underneath each framework step with a set of practical tools comprising technical and conceptual tools.peer-reviewe

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