What is the optimal gestational age for twin delivery

BACKGROUND: The question about outcome in twins delivered early versus late remains unanswered. The objective of this study was to evaluate the association of the timing of delivering twins and the perinatal outcome. METHODS: A prospective cohort study was carried-out in Alexandria University Maternity Hospital. We planned to examine the records of twin deliveries over 2 years. The inclusion criteria were twin deliveries with gestational age at delivery at least 36 completed weeks. Twins of mothers with chronic illness and those with congenital anomalies were excluded. Perinatal outcome parameters (morbidity and mortality) were defined and evaluated. RESULTS: Out of 273 twin sets, 197 (72.2%) met the inclusion criteria. They were classified into 3 groups according to the gestational age at delivery. Neonatal morbidity and maternal complications were higher in those delivered earlier. Twins electively delivered had worse outcome than those delivered spontaneously. In the elective group, there was no difference in the outcome between those delivered earlier or later. CONCLUSION: Twins, when the pregnancy is uncomplicated, continue to grow and mature with advancement of the gestational age. In the absence of significant maternal complications, it is advisable to deliver twins only at 38 completed weeks' gestation or later to avoid neonatal complications

Severe respiratory distress in term infants born electively at high altitude

BACKGROUND: We studied the contribution of elective delivery to severe respiratory distress syndrome (RDS) in term babies born at high altitude. METHODS: We prospectively studied the charts of term babies born in Taif Maternity Hospital (1640 m above sea level) between 1/1/2004 and 31/10/2004 who developed RDS and required mechanical ventilation. RESULTS: 8634 deliveries occurred from 37–<41 weeks; 13 (0.15%) had RDS requiring mechanical ventilation. Seven infants delivered at 37–<38 weeks, (OR for RDS = 26 95%CI -4.6 to 5.8), five delivered at 38–<39 weeks, (OR for RDS = 10 95%CI -4.9 to 5.4) and one delivered at >39 weeks. Six of 13 infants were electively delivered without documented lung maturity. CONCLUSION: Infants born at 37 and 38 weeks' gestation remain at significantly increased risk for severe RDS. Elective delivery is responsible for 50% of the potentially avoidable cases. Our data suggest that the altitude does not seem to influence the incidence of severe RDS in term infants born electively

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

Multimaterial Fibers with Nanoemitters Enable Conformal X‑ray Imaging with 3D Printed and Woven Scintillators

Multimaterial luminescent fibers featuring integrated organic, inorganic, or hybrid nanoemitters are essential elements within a multitude of photonic systems. These systems encompass critical applications, such as single photon sources, high-energy radiation and particle sensors, and wireless optical communication networks. However, the integration of highly efficient luminescent nanomaterials into fibers with predefined geometries, materials, and functionalities remains challenging. This work reports on a process for fabricating indefinitely long multimaterial polymer fibers that can be doped with different organic–inorganic hybrid emitters, such as Cs3Cu2I5 nanoparticles, Cu2I2 nanoclusters, and Mn-doped Cs4CdBi2Cl12 phosphors. This versatility allows for the creation of fibers with tunable emission colors, which enable the realization of large-area, high-performance scintillation surfaces by additive manufacturing, weaving, or rolling. These conformal scintillator screens have been used to demonstrate X-ray imaging of nonplanar complex shapes without the image distortion and resolution degradation associated with rigid planar scintillator configurations. Additive manufacturing of sophisticated three-dimensional scintillators with nanoemitters offers opportunities for personalized medical imaging platforms, particularly for breast cancer screening, as well as applications in large-area high-energy radiation and particle detection

Multimaterial Fibers with Nanoemitters Enable Conformal X‑ray Imaging with 3D Printed and Woven Scintillators

Multimaterial luminescent fibers featuring integrated organic, inorganic, or hybrid nanoemitters are essential elements within a multitude of photonic systems. These systems encompass critical applications, such as single photon sources, high-energy radiation and particle sensors, and wireless optical communication networks. However, the integration of highly efficient luminescent nanomaterials into fibers with predefined geometries, materials, and functionalities remains challenging. This work reports on a process for fabricating indefinitely long multimaterial polymer fibers that can be doped with different organic–inorganic hybrid emitters, such as Cs3Cu2I5 nanoparticles, Cu2I2 nanoclusters, and Mn-doped Cs4CdBi2Cl12 phosphors. This versatility allows for the creation of fibers with tunable emission colors, which enable the realization of large-area, high-performance scintillation surfaces by additive manufacturing, weaving, or rolling. These conformal scintillator screens have been used to demonstrate X-ray imaging of nonplanar complex shapes without the image distortion and resolution degradation associated with rigid planar scintillator configurations. Additive manufacturing of sophisticated three-dimensional scintillators with nanoemitters offers opportunities for personalized medical imaging platforms, particularly for breast cancer screening, as well as applications in large-area high-energy radiation and particle detection

Multimaterial Fibers with Nanoemitters Enable Conformal X‑ray Imaging with 3D Printed and Woven Scintillators

Multimaterial luminescent fibers featuring integrated organic, inorganic, or hybrid nanoemitters are essential elements within a multitude of photonic systems. These systems encompass critical applications, such as single photon sources, high-energy radiation and particle sensors, and wireless optical communication networks. However, the integration of highly efficient luminescent nanomaterials into fibers with predefined geometries, materials, and functionalities remains challenging. This work reports on a process for fabricating indefinitely long multimaterial polymer fibers that can be doped with different organic–inorganic hybrid emitters, such as Cs3Cu2I5 nanoparticles, Cu2I2 nanoclusters, and Mn-doped Cs4CdBi2Cl12 phosphors. This versatility allows for the creation of fibers with tunable emission colors, which enable the realization of large-area, high-performance scintillation surfaces by additive manufacturing, weaving, or rolling. These conformal scintillator screens have been used to demonstrate X-ray imaging of nonplanar complex shapes without the image distortion and resolution degradation associated with rigid planar scintillator configurations. Additive manufacturing of sophisticated three-dimensional scintillators with nanoemitters offers opportunities for personalized medical imaging platforms, particularly for breast cancer screening, as well as applications in large-area high-energy radiation and particle detection

Surface Restructuring of Hybrid Perovskite Crystals

Hybrid perovskite crystals have emerged as an important class of semiconductors because of their remarkable performance in optoelectronics devices. The interface structure and chemistry of these crystals are key determinants of the device’s performance. Unfortunately, little is known about the intrinsic properties of the surfaces of perovskite materials because extrinsic effects, such as complex microstructures, processing conditions, and hydration under ambient conditions, are thought to cause resistive losses and high leakage current in solar cells. We reveal the intrinsic structural and optoelectronic properties of both pristinely cleaved and aged surfaces of single crystals. We identify surface restructuring on the aged surfaces (visualized on the atomic-scale by scanning tunneling microscopy) that lead to compositional and optical bandgap changes as well as degradation of carrier dynamics, photocurrent, and solar cell device performance. The insights reported herein clarify the key variables involved in the performance of perovskite-based solar cells and fabrication of high-quality surface single crystals, thus paving the way toward their future exploitation in highly efficient solar cells