ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

Analyzing risks posed by climate change on ports: A fuzzy approach

This chapter provides a contribution on the impacts of climate change that can affect Canal operation or result in the Canal\u27s closure. This constitutes the background for any analysis aiming at quantifying the economic benefits of further adaptation measures to be implemented in the Canal region. The Panama Canal Authority includes climate-change-related risk assessment procedures as part of the expansion of environmental impact studies, and an integrated adaptation programme is developed as part of the expansion plan. A climate-change-induced cargo transit reduction through the Canal could have a substantial impact on the Canal, as in 1997-98. Climate change can affect agriculture production and by modifying trade patterns also reduce the use of the Canal, as grain carriers constitute one-quarter of Canal ship passages. The economic consequences of disruptions in the operation of the Panama Canal depend on the gravity and type of the disruption as well as the length of time the disruption would affect operations

Climate change and the adaptation strategies of ports: The Australian experiences

Abstract Being nodal points along supply chains, ports affected by climate change would create substantial costs to the global economy and welfare, and thus it is extremely important to ensure that ports can develop effective adaptation strategies. However, there are many uncertainties, as the dynamics between climate change and ports can diversify between different regions. Against this background, through exploratory case studies of four ports in Australia, this paper investigates climate change and the adaptation strategies of ports, with a special focus on port infrastructures and the day-to-day operational impacts. Research findings indicate that, while port managers recognize climate change as an issue which requires closer attention, adaptation strategies have remained segregated and piecemeal. This highlights the fact that effective adaptation solutions are not just about physical layouts and engineering projects, but the need to fundamentally transform the current management and planning practices of ports. It is a timely reminder to port policymakers and managers on the need to refine how effective decisions should be made for the challenges posed by climate changes in the future. In this regard, further research on this topic is urgently required

Climate change and adaptation planning for ports

As key links in transportation and supply chains, the effect of climate change on seaports has broad implications for the development prospects of the global economy. However, the picture is very uncertain because the impacts of climate change will be felt very differently around the world, both positively and negatively. This book addresses the need for quality theoretical analysis, highly innovative assessment methodologies, and insightful empirical global experiences so as to identify the best international practices, planning and appropriate policies to effectively adapt to, develop resilience, and indeed benefit from, the impacts posed by climate change on transportation and supply chains. This book comprises of theories, methodologies and case studies from five continents (Asia, Europe, Latin America, North America, and Oceania) addressing climate change and the adaptation planning of ports and transportation infrastructures. With reputable contributors from academic, policymaking and professional sectors, it critically analyses the recent attempts by ports in establishing adaptation plans and strategies so to enhance ports and other transportation infrastructures’ resilience to the climate change risks. This is the first book of its kind to focus on climate change adaptation for ports. It offers useful and comprehensive guidance to senior policymakers, industrial practitioners and researchers who are eager to understand the dynamics between climate change, adaptation planning of ports and transportation infrastructures

Time to act: The criticality of ports in adapting to the impacts posed by climate change

This chapter explores a model for the assessment of green port development through the identification of the key indexes in the model. It investigates assessment grades for each criterion, converts quantitative criteria to qualitative ones by employing a fuzzy membership function and applies the evidential reasoning (ER) approach to synthesize the assessment results. The assessment model consists of three levels. The top level reflects the model\u27s goal, which is to assess the development level of green ports. The second level is constructed according to the drivers, pressures, states, impacts, and responses (DPSIR) framework which was introduced in the late 1990s and then applied in the evaluation of sustainable development. This framework enabling the integration of different types of indexes concerning environmental, social and economic issues, has been successfully implemented in the evaluation of the modernization of inland port and shipping management. The indexes in the bottom level are chosen in terms of their associated elements in the upper level

Health and environmental consequences of crop residue burning correlated with increasing crop yields midst India's Green Revolution

The Green Revolution (GR) enhances crop yields significantly that contributes greatly to the social and economic development of many less developed countries. However, the increasing crop yields might rise crop residue biomass burning, leading to adverse environmental and health consequences. We assess the impact of crop residue burning associated with the GR-induced growing crop yields on benzo[a]pyrene (BaP) pollution, a congener of polycyclic aromatic hydrocarbons with strong carcinogenicity. We find a significant increasing trend of BaP emission and contamination from crop residue biomass burning from the mid-19605 to 2010s in India, coinciding with the growing crop yields occurring during the GR. Our results reveal that agricultural BaP emission driven lifetime lung cancer risk (ILCR) in India increased 2.6 times from the onset of GR in the mid-1960s to 2014 and the 57% population in India was exposed to the BaP level higher than the India national standard (1 ng m(-3)). We show that the reduction of open crop residue burning during the rice and wheat residue burning period would be a very effective measure to reduce BaP environmental contamination and health risk

Impacts of Large-Scale Land-Use Change on the Uptake of Polycyclic Aromatic Hydrocarbons in the Artificial Three Northern Regions Shelter Forest Across Northern China

This study quantifies the influence of large-scale land-use change induced by the artificial Three-Northern Regions Shelter Forest (TNRSF) across northern China on the environmental cycling of organic chemicals. Atmospheric removal and long-term trends of two polycyclic aromatic hydrocarbon (PAH) species, phenanthrene (PHE) and benzo­[<i>a</i>]­pyrene (BaP), resulting from increasing vegetation coverage and soil organic carbon in the TNRSF over the last two decades were examined. Field sampling data and modeling result showed that the total atmospheric removal of PHE by TNRSF increased from 36.4 tons in 1990 to 76.8 tons in 2010, increasing at a rate of 5.6% yr^–1, and BaP from 2.2 to 4.5 tons, increasing at a rate of 5.2% yr^–1. Three model scenarios were designed to distinguish the effects of atmospheric emissions, and with and without TNRSF on the environmental fate of PAHs. Approximately 1–4% of PHE and BaP emitted in northern China were removed by the TNRSF during 1990–2010. Model simulations revealed that the TNRSF enhanced atmospheric removal of PHE by 29% and BaP by 53% compared with the simulation without the TNRSF, manifesting marked contributions of land-use change by the artificial TNRSF, the largest afforestation activity in human history, to the atmospheric removal of organic chemicals

Impacts of Large-Scale Land-Use Change on the Uptake of Polycyclic Aromatic Hydrocarbons in the Artificial Three Northern Regions Shelter Forest Across Northern China

This study quantifies the influence of large-scale land-use change induced by the artificial Three-Northern Regions Shelter Forest (TNRSF) across northern China on the environmental cycling of organic chemicals. Atmospheric removal and long-term trends of two polycyclic aromatic hydrocarbon (PAH) species, phenanthrene (PHE) and benzo[a]pyrene (BaP), resulting from increasing vegetation coverage and soil organic carbon in the TNRSF over the last two decades were examined. Field sampling data and modeling result showed that the total atmospheric removal of PHE by TNRSF increased from 36.4 tons in 1990 to 76.8 tons in 2010, increasing at a rate of 5.6% yr(-1), and BaP from 2.2 to 4.5 tons, increasing at a rate of 5.2% yr(-1). Three model scenarios were designed to distinguish the effects of atmospheric emissions, and with and without TNRSF on the environmental fate of PAHs. Approximately 1-4% of PHE and BaP emitted in northern China were removed by the TNRSF during 1990-2010. Model simulations revealed that the TNRSF enhanced atmospheric removal of PHE by 29% and BaP by 53% compared with the simulation without the TNRSF, manifesting marked contributions of land-use change by the artificial TNRSF, the largest afforestation activity in human history, to the atmospheric removal of organic chemicals