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Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.
Retrospective observational study.
Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.
Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).
Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.
(i) To assess diagnostic accuracy of mid-upper arm circumference (MUAC) for screening thinness and severe thinness in Indian adolescent girls aged 10–14 and 15–19 years compared with BMI-for-age Z-score (BAZ) <−2 and <−3 as the gold standard and (ii) to identify appropriate MUAC cut-offs for screening thinness and severe thinness in Indian girls aged 10–14 and 15–19 years.
Cross-sectional, conducted October 2016–April 2017.
Four tribal blocks of two eastern India states, Chhattisgarh and Odisha.
Girls (n 4628) aged 10–19 years. Measurements included height, weight and MUAC to calculate BAZ. Standard diagnostic accuracy tests, receiver–operating characteristic curves and Youden index helped arrive at MUAC cut-offs at BAZ < −2 and <−3, as gold standard.
Mean MUAC and BMI correlation was positive (0·78, P = 0·001 and
r2 = 0·61). Among 10–14 years, MUAC cut-off corresponding to BAZ < −2 and BAZ < −3 was ≤19·4 and ≤18·9 cm. Among 15–19 years, corresponding values were ≤21·6 and ≤20·7 cm. For both BAZ < −2 and BAZ < −3, specificity was higher in 15–19 v. 10–14 years. State-wise variations existed. MUAC cut-offs ranged from 17·7 cm (10 years) to 22·5 cm (19 years) for BAZ < −2, and from 17·0 cm (10 years) to 21·5 cm (19 years) for BAZ < −3. Single-age area under the curve range was 0·82–0·97.
Study provides a case for use of year-wise and sex-wise context-specific MUAC-cut-offs for screening thinness/severe thinness in adolescents, rather than one MUAC cut-off across 10–19 years, depending on purpose and logistic constraints.
To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India.
Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall.
High-altitude region of Nainital District, Uttarakhand State, North India.
Community-dwelling geriatric subjects (n 981) aged 60 years or above.
We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0–29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work.
There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.
Motivated by the results of Scott and Patel about “untangling” closed geodesics in finite covers of hyperbolic surfaces, we introduce and study primitivity, simplicity and non-filling index functions for finitely generated free groups. We obtain lower bounds for these functions and relate these free group results back to the setting of hyperbolic surfaces. An appendix by Khalid Bou–Rabee connects the primitivity index function fprim(n, FN) to the residual finiteness growth function for FN.
Zinc oxide (ZnO) thin film deposited onto indium tin oxide (ITO) coated Corning glass substrates using pulsed laser deposition (PLD) technique has been used as a matrix for realization of an efficient urea biosensor after immobilization of urease (Urs) enzyme onto the surface of ZnO. The bioelectrode (Urs/ZnO/ITO/glass) is found to be exhibiting an enhanced sensitivity of 22μΑmΜ−1cm−2 towards urea over a wide detection range of 5-200 mg/dl. The relatively low value of Michaelis menten constant (Km= 0.94mM) indicates high affinity of the immobilized urease towards the analyte (urea). The prepared biosensor retains 90% of its activity for more than 10 weeks. The observed enhanced response characteristics of bioelectrode are attributed to the growth of the matrix (highly c-axis oriented ZnO thin film) with desired surface morphology and high electron communication feature. The results confirm the promising application of PLD grown ZnO thin film as an efficient matrix for urea detection.
SnO2 based sensor structures prepared by rf magnetron sputtering technique have been studied for detecting H2 gas. Pd catalyst was integrated onto the SnO2 thin film in the form of clusters and nano-particles to obtain enhanced sensing response characteristics. The prepared sensor structures have been studied over a temperature range of 50-250°C for sensing response towards 500 ppm H2 gas. The sensor with Pd catalyst dispersed in the form of nanoparticles was found to exhibit an enhanced sensing response of 1.9×103 at a relatively low operating temperature of 150°C with a fast response time of 2 s and recovery time of 65 s towards 500 ppm H2 gas. The origin of enhanced sensing response is identified in the light of the enhanced spill over of H2 gas molecules on the uncovered surface of SnO2 thin film.