Relation proximal point with some dynamical properties

In this paper we discussed relation proximal points with many of  dynamical properties through studied topological transformation group , and it will given  necessary condition for proximal relation to be minimal set ,and introduce  new define replete set and semi-replete set by using concept of the replete set and semi-replete set as well as  we introduce that many of  new  relations  and theorem. Key words: Proximal point, replete proximal point, syndetic set, semi-replete set, minimal set, almost periodic point             .

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Enhanced PEC characteristics of pre-annealed CuS film electrodes by metalloporphyrin/polymer matrices

High conversion efficiency (η) values have been obtained from modified CuS film electrodes electrochemically deposited onto Glass/FTO. The modification involved pre-annealing the film followed by coating with tetra(-4-pyridyl)porphyrinato manganese (MnTPyP+) ions embedded inside a polyethylene (PE) matrix. The Glass/FTO/CuS/MnTPyP/PE electrodes exhibited enhanced photo-electrochemical (PEC) characteristics under solar simulated illumination (5.6 mW/cm−2) in aqueous media, compared to the as-prepared Glass/FTO/CuS films which showed no PEC activity. Up to 17.4% efficiency and 85% fill factor (FF) values were obtained from the modified film electrodes. Such characteristics have not been widely known for metal chalcogenide based film electrodes before. Different pre-annealing temperatures were attempted and the 250 °C temperature, followed by quenching, showed favorable results. Different aqueous redox couples were studied and the environmentally safe FeCl2/FeCl3 aqueous system showed highest PEC characteristics. Effect of pre-annealing on film electrode characteristics is discussed. The MnTPyP/PE matrix behaves as charge transfer catalyst for the holes across the CuS film/liquid junction

High PEC conversion efficiencies from CuSe film electrodes modified with metalloporphyrin/polyethylene matrices

Electrodeposited CuSe film electrodes have been prepared onto FTO/glass by a facile method based on earlier methods described for other systems. The films were characterized, modified by annealing and further characterized. The films were then modified by coating with tetra(-4-pyridyl) pophyrinato-manganese (MnTPyP) complexes embedded inside commercial polyethylene (PE) matrices. The effects of modifications on different film properties, such as X-ray diffraction (XRD) patterns, surface morphology, photoluminescence (PL) spectra and electronic absorption spectra were investigated. Compared with other thin film electrode systems, very high photoelectrochemical (PEC) conversion efficiency values have been observed here. Pre-annealing the CuSe films at 150°C for 2 h, followed by attaching the MnTPyP/PE matrices remarkably enhanced their PEC characteristics. The conversion efficiency was significantly enhanced, from less than 1.0% to more than 15%. Fill factor (FF) was also enhanced from ∼30% to ∼80%. Values of open-circuit potential (VOC) and short-circuit current (JSC) were significantly enhanced. While annealing affects uniformity, particle inter-connection and surface texture of the CuSe films, the MnTPyP complex species behaves as an additional charge-transfer mediator across the film/electrolyte junction. Optimization of PEC characteristics, using different deposition times, different annealing temperatures, different annealing times and different redox couples, was also investigated

Clinical and Histochemical Response to Automated Microneedling Therapy in Treatment of Traumatic Scars

Background: Post traumatic skin injuries are challenging to manage. Patients may have erythematous, hypertrophic, or atrophic scars. Microneedling therapy is minimally invasive non-surgical and non-ablative procedure used for skin rejuvenation that relies on the principle of neocollagenesis. Aim: We aimed to assess the clinical and histochemical response to automated microneedling therapy in treatment of traumatic scars. Methods: This prospective study included twenty patients with traumatic scars. All patients received 4 monthly sessions of automated microneedling therapy. Outcome assessment included modified Vancouver Scar Scale, digital photographic documentation and patient's satisfaction. Histochemical evaluation by quantitative morphometric assessment for collagen and elastic fibers using image analyzer performed before and 3 months after treatment for Masson's trichrome and Orcein stained sections respectively.&nbsp; Results: There was statistically significant improvement in scar vascularity (p= 0.018), scar pigmentation (p= 0.008), and scar pliability (p= 0.002) and sum of mVSS (P=0.000002). Histochemically, there was significant increase in collagen content, (p= 0.023), and elastin content (p= 0.003) as quantified by image analyzer. There was no significant correlations (r: 0.158 and -0.259; p-values: 0.55 and 0.34) between micro-needling therapy and scar type (atrophic versus hypertrophic)