Clinical outcomes in typhoid fever: adverse impact of infection with nalidixic acid-resistant Salmonella typhi

BACKGROUND: Widespread use of fluoroquinolones has resulted in emergence of Salmonella typhi strains with decreased susceptibility to fluoroquinolones. These strains are identifiable by their nalidixic acid-resistance. We studied the impact of infection with nalidixic acid-resistant S. typhi (NARST) on clinical outcomes in patients with bacteriologically-confirmed typhoid fever. METHODS: Clinical and laboratory features, fever clearance time and complications were prospectively studied in patients with blood culture-proven typhoid fever, treated at a tertiary care hospital in north India, during the period from November 2001 to October 2003. Susceptibility to amoxycillin, co-trimoxazole, chloramphenicol, ciprofloxacin and ceftriaxone were tested by disc diffusion method. Minimum inhibitory concentrations (MIC) of ciprofloxacin and ceftriaxone were determined by E-test method. RESULTS: During a two-year period, 60 patients (age [mean ± SD]: 15 ± 9 years; males: 40 [67%]) were studied. All isolates were sensitive to ciprofloxacin and ceftriaxone by disc diffusion and MIC breakpoints. However, 11 patients had clinical failure of fluoroquinolone therapy. Infections with NARST isolates (47 [78%]) were significantly associated with longer duration of fever at presentation (median [IQR] 10 [7-15] vs. 4 [3-6] days; P = 0.000), higher frequency of hepatomegaly (57% vs. 15%; P = 0.021), higher levels of aspartate aminotransferase (121 [66–235] vs. 73 [44–119] IU/L; P = 0.033), and increased MIC of ciprofloxacin (0.37 ± 0.21 vs. 0.17 ± 0.14 μg/mL; P = 0.005), as compared to infections with nalidixic acid-susceptible isolates. All 11 patients with complications were infected with NARST isolates. Total duration of illness was significantly longer in patients who developed complications than in patients who did not (22 [14.8–32] vs. 12 [9.3–20.3] days; P = 0.011). Duration of prior antibiotic intake had a strong positive correlation with the duration of fever at presentation (r = 0.61; P = 0.000) as well as the total duration of illness (r = 0.53; P = 0.000). CONCLUSION: Typhoid fever caused by NARST infection is associated with poor clinical outcomes, probably due to delay in initiating appropriate antibiotic therapy. Fluoroquinolone breakpoints for S. typhi need to be redefined and fluoroquinolones should no longer be used as first-line therapy, if the prevalence of NARST is high

IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians.

INTRODUCTION: South Asians have high rates of cardiovascular disease (CVD) and its risk factors (hypertension, diabetes, dyslipidaemia and central obesity). Left ventricular (LV) hypertrophy and dysfunction are features of these disorders and important predictors of CVD mortality. Lower birth and infant weight and greater childhood weight gain are associated with increased adult CVD mortality, but there are few data on their relationship to LV function. The IndEcho study will examine associations of birth size, growth during infancy, childhood and adolescence and CVD risk factors in young adulthood with midlife cardiac structure and function in South Asian Indians. METHODS AND ANALYSIS: We propose to study approximately 3000 men and women aged 43-50 years from two birth cohorts established in 1969-1973: the New Delhi Birth Cohort (n=1508) and Vellore Birth Cohort (n=2156). They had serial measurements of weight and height from birth to early adulthood. CVD risk markers (body composition, blood pressure, glucose tolerance and lipids) and lifestyle characteristics (tobacco and alcohol consumption, physical activity, socioeconomic status) were assessed at age ~30 years. Clinical measurements in IndEcho will include anthropometry, blood pressure, biochemistry (glucose, fasting insulin and lipids, urinary albumin/creatinine ratio) and body composition by dual energy X-ray absorptiometry and bioelectrical impedance. Outcomes are LV mass and indices of LV systolic and diastolic function assessed by two-dimensional and Doppler echocardiography, carotid intimal-media thickness and ECG indicators of ischaemia. Regression and conditional growth models, adjusted for potential confounders, will be used to study associations of childhood and young adult exposures with these cardiovascular outcomes. ETHICS AND DISSEMINATION: The study has been approved by the Health Ministry Steering Committee, Government of India and institutional ethics committees of participating centres in India and the University of Southampton, UK. Results will be disseminated through scientific meetings and peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN13432279; Pre-results

Capturing User Tests in a Multimodal, Multidevice Informal Prototyping Tool

Interaction designers are increasingly faced with the challenge of creating interfaces that incorporate multiple input modalities, such as pen and speech, and span multiple devices. Few early stage prototyping tools allow non-programmers to prototype these interfaces. Here we describe CrossWeaver, a tool for informally prototyping multimodal, multidevice user interfaces. This tool embodies the informal prototyping paradigm, leaving design representations in an informal, sketched form, and creates a working prototype from these sketches. CrossWeaver allows a user interface designer to sketch storyboard scenes on the computer, specifying simple multimodal command transitions between scenes. The tool also allows scenes to target different output devices. Prototypes can run across multiple standalone devices simultaneously, processing multimodal input from each one. Thus, a designer can visually create a multimodal prototype for a collaborative meeting or classroom application. CrossWeaver captures all of the user interaction when running a test of a prototype. This input log can quickly be viewed visually for the details of the users ’ multimodal interaction or it can be replayed across all participating devices, giving the designer information to help him or her analyze and iterate on the interface design

Visually Prototyping Perceptual User Interfaces through Multimodal Storyboarding

We are applying our knowledge in designing informal prototyping tools for user interface design to create an interactive visual prototyping tool for perceptual user interfaces. Our tool allows a designer to quickly map out certain types of multimodal, cross-device user interface scenarios. These sketched designs form a multimodal storyboard that can then be executed, quickly testing the interaction and collecting feedback about refinements necessary for the design. By relying on visual prototyping, our multimodal storyboarding tool simplifies and speeds perceptual user interface prototyping and opens up the challenging space of perceptual user interface design to non-programmers

Tribological studies of microplasma sprayed hydroxyapatite coating at low load

For bioactive prosthetic implant applications, the present work reports the tribolgical behaviour of the recently developed, microplasma (e.g. plasmatron power < 1.5 kW) sprayed (MIPS) hydroxyapatite (HAp) coatings on Ti6Al4V substrates at low constant normal load, e. g. 200 mN. Conventionally, the macroplasma (e. g. plasmatron power < 25 kW) sprayed (MAPS) HAp coatings are used for such purpose. The phase analysis and microstructural studies of the HAp coatings were carried out by X-ray diffraction, scanning electron microscopy and energy dispersive spectroscopy. Further, the single pass scratch tests were conducted on both the bare substrates and the HAp coatings at an applied normal load of 200 mN. The average coefficient of friction (COF, mu) of the HAp coatings developed by MIPS (e.g. mu similar to 0.7) was slightly higher than that (e.g. mu similar to 0.5) of the bare Ti6Al4V substrates. The characteristic, high variability of the m data of the HAp coatings developed by MIPS; was explained in terms of the intrinsic microstructural heterogeneity and the local differences in orientations of the splats

Multimodal Theater: Extending Low Fidelity Paper Prototyping to Multimodal Applications

Low-fidelity paper prototyping has proven to be a useful technique for designing for graphical user interfaces [1]. Wizard of Oz prototyping for other input modalities, such as speech, is also becoming more common [2]. Yet to surface are guidelines for low-fidelity prototyping of multimodal applications, those that use multiple and sometimes simultaneous combination of different input types. This paper describes our recent research in low fidelity, multimodal, paper prototyping and suggests guidelines to be used by future designers of multimodal applications

Isotopic signatures of moisture recycling and evaporation processes along the Western Ghats orography

The water isotopic composition (delta O-18 and delta H-2) of humid tropical mountain belts is influenced by the limited isotopic elevation effect due to the narrow temperature gradient, high relative humidity, and the moisture feedback processes. The Western Ghats mountain forest ecosystem, recognized as a biological hotspot, contributes significantly to characterizing the hydrological and weather patterns over its windward and leeward sides. The Indian Summer Monsoon southwesterly winds advancing towards the Indian subcontinent through the Arabian Sea between June to September are obstructed by this mountain belt and get orographically uplifted, producing heavy rainfall. The present study intends to improve understanding of the variation of precipitation isotopic composition along multiple stations located at different elevations of the heavily regulated Periyar river basin (PRB), southern Western Ghats, and a coastal station (TRV). The delta O-18 variation with elevation across PRB reveals an abrupt depletion at the highland station and a pseudo-elevation effect due to the supply of evaporated local moisture from reservoirs and lakes. The contribution of recycled precipitation estimated using back trajectories suggests a maximum of 8.5% of locally recycled rainfall over midland station towards the September month, the daily contribution reaching a maximum of 50.7%. Though this approach did not show any signatures of moisture recycling in the highland station, the surface water (reservoirs and lakes) lc-excess (line-conditioned excess), and the d-excess (deuterium excess) values of precipitation suggest the higher rates of evaporation from large water bodies and their successive role in generating local rainfall. Statistically significant amount effects visible only along coastal stations with lower rates of precipitation and higher temperature indicate that precipitation along the Ghats region (midland and highland) is significantly controlled by orographic uplift of air moisture and the contribution from locally recycled moisture. This is further supported by the significant correlation of delta O-18 with regional convective processes along the Arabian Sea till midland station and further decrease towards the highland. The present study provides important information on the moisture feedback mechanism in the Western Ghats and the factors controlling the isotopic signatures over the region.11Nsciescopu

MultiPoint: A Case Study of Multimodal Performance

MultiPoint is a speech and pen user interface for building presentations, implemented as an add-on to Microsoft . In this study, we compared users&apos; performance between building presentations with MultiPoint and with PowerPoint. We also compared participants&apos; performance between using Wizard of Oz (WOz) speech recognition and computer speech recognition. In aggregate, six participants with WOz recognition completed tasks in about the same time and with about the same number of errors, as they did using PowerPoint alone. Six participants with computer speech recognition took twice the time and committed four times as many errors, as they did using PowerPoint