First consider this article on antimicrobial resistance....

Question

First consider this article on antimicrobial resistance. http://www.bbc.co.uk/guides/z8kccdmAntimicrobial resistance is an emerging global public health problem that has been linked to the use of antibiotics by the livestock industry, doctors over prescribing antibiotics and people not taking a full course of antibiotics.? Construct a research question that seeks to address a specific aspect of the issue of antimicrobial resistant bacteria.? Select 5 studies relevant to your research question about antimicrobial resistant bacteria (a mixture of observational and RCTs, supporting and not supporting the hypothesis).? Rank the studies according to the FORM (Hillier et al., 2011) or GRADE levels of evidence (TheGRADE Working Group, 2008).? Review the frameworks in the Learning Resources (Bonita et al., 2006, Rychetnick et al.,2006,Young & Solomon, 2009 and the critical appraisal skills program (CASP) checklist).Write a 2,500-word paper that includes:
	
Document Preview: ASSESSMENT BRIEF 
Subject Code and Title 
PUBH6005: Epidemiology 
Assessment 
Assessment 4: Critical Appraisal Essay 
Individual/Group 
Individual 
Length 
2,500 words 
This assessment addresses the following learning outcomes: 
Learning Outcomes 
1. Apply common epidemiological concepts including 
incidence and prevalence of disease, mortality and 
survival and age standardisation 
2. Recognise the role of exposure to biological, 
behavioural, social and environmental risks in disease 
patterns 
3. Differentiate between different types of research 
designs, including observation and experimental and 
mixed methods designs 
4. Assess levels of evidence and make recommendations 
5. Interpret data arising from surveillance and research 
studies, including rates and ratios 
6. Understand the difference between association and 
causation, statistical and public health significance 
7. Analyse the role of epidemiology in screening and 
prevention programs, and assess the sensitivity and 
specificity of programs 
8. Critically evaluate epidemiological studies, including 
potential for bias, confounding and chance errors 
9. Identify key health indicators and sources of data 
 
Due Sunday following the end of Module 6 at 11:55pm 
Submission 
AEST/AEDT* 
Weighting 
40% 
Total Marks 
100 marks 
*Please Note: This time is Sydney time (AEST or AEDT). Please convert to your own time zone (eg. 
Adelaide = 11:25pm).

PUBH6005_Assessment Brief 4  Page 1 of 8Instructions: 
Thousands of health and medical research studies are published each year, often reporting 
conflicting conclusions for the same issue.  Therefore, a critical appraisal of studies to determine the 
strengths and weaknesses of research articles is the cornerstone of evidence based policy 
development, program development and implementation, hospital and primary care, health 
promotion and chronic disease management.  This module builds on the last one where we learned 
to evaluate the validity of observed...

David · Accepted Answer

Introduction: Whenever a person becomes ill takes antibiotics to kill sensitive bacteria 
however resistant bacteria grows and multiply which, more harmful. Therefore, evolution of 
resistance bacteria to antimicrobial drugs consider to be the universal public health issue. As 
when antimicrobial resistance bacteria occurs, diminishes or eliminates the efficiency of 
antimicrobial drugs such as antivirals, antimalarial and antibiotics which effect standard 
treatments fruitless, infections continue and may spread to others in addition to it an 
individual stop taking antibiotics and leave the treatment in the middle. There are numerous 
reasons for Antimicrobial resistance that are harder to identify, control and which last much 
longer within the body. Antimicrobial Resistance can develop not only in bacteria but also 
develop in fungi (e.g. Candida), and viruses (e.g. HIV) and parasites (e.g. malaria). 
Background: Resistance of Antimicrobial means the microbe ability, may be in the form of 
bacteria, fungus, viruses or parasites which resist the drugs activities that destroys the 
development of sensitive bacteria or microbes causing disease. Antimicrobial resistance 
bacteria (AMR) can be develop through many factors like biological and societal reasons. 
Mutation, Selective pressure and gene transfer are biological reasons while inadequate 
diagnostics, inappropriate use, agricultural use and hospital use are basic reasons of societal 
reasons. In present scenario, due to the use of various antimicrobial agents in animal and 
gross misapplication in antimicrobials either for remedial use or to increase business like 
injections which increase AMR bacteria  and transferred to humans.in form of food products 
at alarming rate 
The environmental microbiome are also effected by the agricultural practise of antibiotics 
.The antibiotics given to cattle‘s are excreted in urine and stool, widely spread through 
fertilizer and groundwater. In addition, pesticides sprayed on fruit trees also adds micro-
organisms to grow-inhibit agents in the environment which results of increasing the 
Comment [PS1]: Possible sources:  
http://onlinelibrary.wiley.com/doi/10.1111/j.
1365-2796.2008.01940.x/full  
http://www.oie.int/doc/ged/D2005.PDF 
Comment [PS2]: Possible source:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11-
issue-10_djvu.txt 
Comment [PS3]: Possible source:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11-
issue-10_djvu.txt 
Comment [PS4]: Possible sources:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11-
issue-10_djvu.txt  
https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3366764/  
https://wwwnc.cdc.gov/eid/article/11/10/05-
1014_article  
http://stacks.cdc.gov/view/cdc/16054/cdc_16
054_DS6.txt  
http://pubmedcentralcanada.ca/pmcc/articles
/PMC3366764/  ...
Comment [PS5]: Possible sources:  
http://emerald.tufts.edu/med/apua/about_iss
ue/Antimicrobial Resistance in Bacteria.pdf  
https://www.ncbi.nlm.nih.gov/books/NBK971...
Comment [PS6]: Possible sources:  
https://www.ncbi.nlm.nih.gov/books/NBK971
26/  
https://archive.org/stream/emerging- ...
Comment [PS7]: Possible sources:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11- ...
Comment [PS8]: Possible sources:  
https://www.ncbi.nlm.nih.gov/books/NBK971
26/  
https://www.nap.edu/read/10651/chapter/7 
Comment [PS9]: Citation, sources:  
https://www.ncbi.nlm.nih.gov/books/NBK971
26/  ...
Comment [PS10]: Possible source:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue- ...
Comment [PS11]: Possible source:  
https://ec.europa.eu/health/amr/sites/amr/fil
es/amr_guidelines_prudent_use_en.pdf 
Comment [PS12]: Possible sources:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11- ...
http://www.plagscan.com/highlight?doc=115366438&source=16&cite=7&url=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1111%2Fj.1365-2796.2008.01940.x%2Ffull#jump
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percentage of resistant microorganisms. Various practices use in hospitals also increase 
antimicrobial resistance bacteria. Hospitals indeed are fertile grounds for breeding resistant 
microbes. ―Transmission of drug-resistant organisms among patients may be airborne, from a 
point source (such as contaminated equipment), or by direct or indirect contact with a 
contaminated environment or the contaminated hands of staff. Failure of health care workers 
to practice simple control measures.‖[1] Example hand washing and changing gloves. Is pre-
existing resistance bacteria through biological and societal factors is the major reason of 
antimicrobial resistance bacteria?  Few diseases like malaria parasites are transmitted through 
mosquitoe bite. Tuberculosis (TB), severe airborne disease caused by bacterial infection. 
Methicillin-Resistant Staphylococcus aureus is a bacterial infection. Gonorrhea, by sexually 
transferred disease. Escherichia coli, E. coli, is a bacterium urinary tract infection. 
Antimicrobial drug resistance, over the last few years, pathogenic bacteria from humans have 
developed. ―Emergence can result from mutations in housekeeping structural or regulatory 
genes or from acquiring foreign genetic information. Dissemination can occur at the level of 
the bacteria (clonal spread), replicons (plasmid epidemics), or of the genes 
(transposons).These 3 levels of dissemination, which coexist in nature, Clonal dissemination 
is associated with chromosome replication, plasmid conjugation with replicative transfer, and 
gene migration with replicative transposition‖ [2]. ―The spread of resistance has repeatedly 
been shown to be associated with antimicrobial drug use [3], which stresses the importance of 
the prudent use of these drugs; a notion reinforced by the observation that resistance is slowly 
reversible [4,5]. 
Keywords Antimicrobial resistance, community onset, genetic, Meta-analysis, clinical 
isolates. 
Methods: 
Comment [PS13]: Possible sources:  
https://www.ncbi.nlm.nih.gov/books/NBK971
26/  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11-
issue-10_djvu.txt  
https://www.nap.edu/read/10651/chapter/7  
http://onlinelibrary.wiley.com/doi/10.1111/j.
1365-2796.2008.01940.x/full  
http://www.oie.int/doc/ged/D2005.PDF 
Comment [PS14]: Possible source:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue- ...
Comment [PS15]: Possible source:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue- ...
Comment [PS16]: Possible source:  
http://www.ccohs.ca/oshanswers/biol_hazard
s/methicillin.html 
Comment [PS17]: Possible sources:  
https://emergency.cdc.gov/han/han00390.as
p  ...
Comment [PS18]: Possible sources:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11- ...
Comment [PS19]: Citation, sources:  
https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3366764/  
https://archive.org/stream/emerging- ...
Comment [PS20]: Possible sources:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11- ...
Comment [PS21]: Citation, sources:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11- ...
Comment [PS22]: Citation, sources:  
https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3366764/  
https://archive.org/stream/emerging- ...
Comment [PS23]: Possible sources:  
https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3366764/  
https://archive.org/stream/emerging- ...
Comment [PS24]: Possible sources:  
https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3366764/  
https://archive.org/stream/emerging- ...
Comment [PS25]: Possible sources:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11- ...
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 Antimicrobials resistance bacteria is a global problem at increasing rate and has vital 
importance in health care. Current resource of antimicrobial drugs has limited lifetime 
hence, urgently need of new drugs. Handling, resistance bacteria will require a deep 
consideration of microbial infections and the application through which resistance 
arises, as well as intensive efforts between academia and industry aimed at emerging novel 
antimicrobial agents. 
Study design: 
This study, Did pre-existing resistance bacteria developed through sectoral factors, one of the 
major reason of antimicrobial resistance bacteria world-wide. 
Strategy of Literature review : 
Web-based search through Google Scholar, and the Directory of Open Access Journals 
(DOAJ) conducted in 2017, journals from biomedical central, journals from U.S. National 
library of medicine national Institute of Health. Google search from published works with 
government documents. Relevant search results were separately downloaded and entered into 
End Note. The reference lists of the recognised studies were used. To search the related 
articles keywords Antimicrobial resistance, Predicators, Prevalence, Factors, Threats, 
antibacterial resistance. Using Boolean search technique with Key items and the search is 
based on year and language of publication.  
Selection procedures and criteria 
Study selection, executed at levels. First, the titles and abstracts of all retrieved articles were 
reviewed if they did discourse the study question then grouped ―eligible for study‖ otherwise 
―ineligible for study‖. Second, for full detail articles grouped under ―eligible for study‖, were 
reviewed. 
All articles data are based on the predetermined included criteria , they are as follows  
Comment [PS26]: Citation, source:  
https://archive.org/stream/emerging-
infectious-diseases-volume-11-issue-
10/emerging-infectious-diseases-volume-11-
issue-10_djvu.txt 
Comment [PS27]: Possible source:  
http://scialert.net/fulltext/?doi=jm.2007.216.
227 
Comment [PS28]: Citation, source:  
https://en.wikipedia.org/wiki/Antibiotic_resist
ance 
Comment [PS29]: Possible source:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7 
Comment [PS30]: Possible source:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7 
Comment [PS31]: Possible source:  
http://www.crd.york.ac.uk/prospero/display_
record.asp?src=trip&ID=CRD42016035404 
Comment [PS32]: Possible source:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7 
Comment [PS33]: Possible source:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7 
Comment [PS34]: Possible sources:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7  
http://www.crd.york.ac.uk/prospero/display_
record.asp?src=trip&ID=CRD42016035404 
Comment [PS35]: Possible source:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7 
Comment [PS36]: Possible source:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7 
Comment [PS37]: Possible source:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7 
Comment [PS38]: Possible sources:  
https://aricjournal.biomedcentral.com/article
s/10.1186/s13756-017-0243-7  ...
Comment [PS39]: Possible sources:  
https://aricjournal.biomedcentral.com/article...
Comment [PS40]: Possible source:  
https://aricjournal.biomedcentral.com/article...
Comment [PS41]: Possible sources:  
https://aricjournal.biomedcentral.com/article...
Comment [PS42]: Possible source:  
https://aricjournal.biomedcentral.com/article...
Comment [PS43]: Possible sources:  
https://aricjournal.biomedcentral.com/article...
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First consider this article on antimicrobial resistance. http://www.bbc.co.uk/guides/z8kccdmAntimicrobial resistance is an emerging global public health problem that has been linked to the use of...

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