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

Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

Background: Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. Methods: A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. Results: In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. Conclusion: Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. Level of Evidence: III

A research on modular product development in wedding gown production

Recent developments in production management gave way to the “mass customization” strategies, by which companies claim to solve the dilemma of meeting customer's unique needs still benefiting from scale economies.Delayed product differentiation (DPD) as a design strategy is implemented in agile manufacuring systems. Modularity is one of the key strategies in mass customization as it enables component commonality of products, thus differentiation of the products can be postponed to the assembly stage.In this research, production process of wedding gown is examined in this aspect and possibility of applying platform based modularity in wedding gown production is tested. The process flow and processing times of most basic wedding gowns were recorded to determine the stage in which the customization will take place. It had been tested whether there will be parts that can be standardized as modules or not. According to this preliminary examination, it will be possible to decide if the customization can be postponed to a later stage. © 2018 Ege Universitesi. All rights reserved

A study on analysis and improvement of trouser fabrics used for primary school uniforms

The basic requirement for garments is, not to cause discomfort for the consumer. In order to produce a garment from fabric, fabric should provide body movement, sensorial and thermophysiological comfort. As well as user expectations from a garment varies in a wide range, appearance, handle, performance and price criteria can never be disregarded. In many cases, compliance with the terms of use and feeling comfortable are more important than physical appearance. Primary school students spend half of their days, according to the education state of school, by wearing school uniforms. Therefore school uniform should be comfortable in both physical and psychological areas and also they should be worn fondly. In most of the schools, male students wear gray classic trousers. This paper presents an experimental study about physical properties of trouser fabrics used for/in school uniforms. By evaluating the results of tests, ideal trouser fabric for primary school students was decided

Simultaneous determination of silver and gold nanoparticles by cloud point extraction and total reflection X-ray fluorescence analysis

17th International Conference on Total Reflection X-Ray Fluorescence Analysis and Related Methods (TXRF) -- SEP 19-22, 2017 -- Brescia, ITALYWOS: 000453493300003While the nanoscale dimensions give metallic nanoparticles unique physical and chemical properties, their potential release in the environment and subsequent effects on ecosystem health are becoming an increasing concern. In the present contribution, for the first time, a novel and simple analytical approach has been developed for the simultaneous quantification of silver and gold nanoparticles (AgNPs, AuNPs) in aqueous samples. The method combines a sample preparation and enrichment step based on cloud point extraction (CPE) with total reflection X-ray fluorescence spectrometry (TXRF) detection. Experimental conditions enabling the simultaneous extraction and detection of AgNPs and AuNPs were studied in detail. Under the best analytical conditions, limits of detection for AgNPs and AuNPs were 0.3 and 0.2 mu g L-1, respectively. Due to the lack of suitable certified references materials, accuracy of the CPE-TXRF method was tested by analysing several types of spiked water samples, including mineral, tap, river and sea water. Percentage recoveries achieved for the analysis of spiked samples were in all cases in the range of 82-100% for both types of studied NPs, suggesting that the existence of natural colloids, ionic Ag+ and Au3+ species, and other components in environmental waters have little influence on the quantitative determination of AgNPs and AuNPs. The only exception was the recovery obtained in the analysis of the spiked sea water sample that was around 40-50%. However, for salty aqueous samples, the developed analytical approach might still be feasible if the standard addition method is used for calibration purposes. In an attempt to provide additional information on AgNPs and AuNPs behaviour in the environment, the CPE-TXRF method was also applied to study the influence of organic matter content in waters as well as the influence of soil matrix on AgNPs and AuNPs stability.Spanish Ministry of Economy and Competitiveness [CGL2013-48802-C3-2-R]; Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [1059B191600371]The Spanish Ministry of Economy and Competitiveness financed this work through the project CGL2013-48802-C3-2-R. Zekeriyya Bahadir acknowledges The Scientific and Technological Research Council of Turkey (TUBITAK) for the 2219-International Postdoctoral Research Grant (2016/1, application number: 1059B191600371) and also his own sincere gratitude to Girona University for laboratory facilities

Influence of rock cradle block geometry on rebound hardness

The Schmidt hammer (SH) testing of cylindrical rock cores requires the use of a cradle block (core holder) to hold the cores firmly during the test. For this purpose, the related International Society for Rock Mechanics (ISRM)-suggested method and American Society for Testing and Materials (ASTM) standard suggest the use of an 'arch-shaped' or a 'V-shaped' cradle block. However, there is little or no detailed quantitative information in the literature regarding the potential influence of cradle block type on the measured rebound values (R values). With this in view, an investigation was carried out regarding the influence of cradle block geometry on R values, by employing the two cradle blocks specified in the preceding Standards. Using an L-type Digi-Schmidt hammer, SH tests were performed on NX-size cylindrical cores of 20 different rock varieties, both in 'oven-dry' and 'wet' state. Although the observed differences were usually small, results showed that the magnitudes of the mean rebound values determined in the arch-shaped block (R (A)) were higher than those determined in the V-shaped block (R (V)), except in one case. For the oven-dried samples, lowest and highest differences between the means of R (A) and R (V) values were 0.37 and 5.92, respectively. In the case of wet samples, the differences ranged from a low of 0.33 to a high of 4.70 in R-units. Statistically significant positive linear correlations were observed between R (A) and R (V) values, although the degree of correspondence was relatively lower for rocks having uniaxial compressive strength < 50 MPa. The results of additional SH tests carried out on two different engineering materials also indicated that higher mean rebound values could be attained in the arch-shaped block. The results of the present study did not confirm the findings of a previous study where it was found that the V-shaped cradle block gave consistently higher mean rebound values than the arch-shaped one. The possible reasons for this discrepancy were discussed

Determination of trace amounts of hexavalent chromium in drinking waters by dispersive microsolid-phase extraction using modified multiwalled carbon nanotubes combined with total reflection X-ray fluorescence spectrometry

Soylak, Mustafa/0000-0002-1017-0244; Margui, Eva/0000-0003-4630-1530; Hidalgo, Manuela/0000-0002-4450-3772WOS: 000354155100023A methodology based on the combination of dispersive microsolid-phase extraction (DMSPE) with total reflection X-ray fluorescence (TXRF) spectrometry is proposed for the determination of hexavalent chromium in drinking waters. Multiwalled carbon nanotubes (MWCNTs) modified with the anionic exchanger tricaprylmethylammonium chloride (Aliquat 336) were used as solid sorbents. After the sorption process of Cr(VI) on the modified MWCNTs, the aqueous sample was separated by centrifugation and the loaded MWCNTs were suspended using a small volume of an internal standard solution and analyzed directly by a benchtop TXRF spectrometer, without any elution step. Parameters affecting the extraction process (pH and volume of the aqueous sample, amount of MWCNTs, extraction time) and TXRF analysis (volume of internal standard, volume of deposited suspension on the reflector, drying mode, and instrumental parameters) have been carefully evaluated to test the real capability of the developed methodology for the determination of Cr(VI) at trace levels. Using the best analytical conditions, it was found that the minimum Cr(VI) content that can be detected in an aqueous solution was 3 mu g L-1. This value is almost 20 times lower than the maximum hexavalent chromium content permissible in drinking waters, according to the World Health Organization (WHO). Recoveries for spiked tap and mineral water samples were, in most cases, in the range of 101-108% which demonstrates the suitability of the TXRF methodology for monitoring Cr(VI) at trace levels in drinking watersamples. (C) 2015 Elsevier B.V. All rights reserved.Spanish National Research Program [CGL2010-22168-C03-01]; Higher Education Institution (YOK) in TurkeyMinistry of National Education - TurkeyThis work was supported by the Spanish National Research Program (Project ref. CGL2010-22168-C03-01). Zekeriyya Bahadir wishes to thank the Higher Education Institution (YOK) in Turkey for the International Postgraduate Research Scholarship and also his own sincere gratitude to Girona University for laboratory facilities

Cr speciation in water samples by dispersive liquid-liquid microextraction combined with total reflection X-ray fluorescence spectrometry

Soylak, Mustafa/0000-0002-1017-0244WOS: 000369213400007A novel method based on dispersive liquid-liquid microextraction (DLLME) and total-reflection X-ray fluorescence spectrometry (TXRF) is proposed for the determination and preconcentration of inorganic Cr species (Cr(VI) and Cr(III)) in water samples. Parameters affecting the extraction procedure for Cr speciation (pH, sample volume, disperser solvent, complexing agent, organic solvent, temperature) and TXRF conditions (sample volume, drying mode, measurement time, internal standardization) have been carefully evaluated to ensure the highest sensitivity for Cr determination. It was found that the minimum Cr content that can be detected was 0.8 mu g L-1. This value is significantly lower than the maximum Cr content permissible in drinking waters and it is better or comparable with those obtained in other published works based on the use of solid phase extraction or liquid phase microextraction in combination with atomic absorption spectrometry techniques. A good linearity (R-2 = 0.9937) was obtained in the range of 5 to 4000 mu g L-1 demonstrating the suitability of the DLLME + TXRF for both the analysis of drinking and waste water samples. Additional advantages of the DLLME-TXRF systems indude the use of very small amount of reagents and the simplicity and low cost of operation of the benchtop instrument used (no cooling, media and gas consumption are needed). (C) 2015 Elsevier B.V. All rights reserved.Spanish National Research Program [CGL2010-22168-C03-01, CGL2013-48802-C3-2-R]; Higher Education Institution (YOK) in TurkeyMinistry of National Education - TurkeyThe authors want to thank the financial support for this project from the Spanish National Research Program (Project ref. CGL2010-22168-C03-01 and Project ref. CGL2013-48802-C3-2-R). Zekeriyya Bahadir acknowledges Higher Education Institution (YOK) in Turkey for the International Postgraduate Research grant and also his own sincere gratitude to Girona University for laboratory facilities