Assessment of prescribing pattern and cost analysis of topical steroids for skin disorders in dermatological outpatient department of a tertiary care hospital

Background: Topical steroid is most commonly prescribed in non-infective dermatological conditions. Periodical Prescription audit is mandatory for the effective management. Hence the present study is designed to assess the prescribing pattern and cost analysis of topical steroids for various skin disorders in the dermatology OPD of a teaching hospital.Methods: This is a prospective observational study conducted in dermatology OPD of a teaching hospital from Jan-Mar 2019 in patients prescribed with topical steroids in all age groups after obtaining IEC approval. Data was analyzed for prescription pattern and cost analysis using descriptive statistics and expressed in percentage.Results: A total of 90 prescriptions were analyzed among which males were 45% and females were 55%, the common indications were eczema-27.7%, atopic dermatitis-25.5%, psoriasis-16.6%, dermatoses-13.3%, lichen planus-7.77% etc. Topical steroids commonly prescribed were super potent (Clobetasol 34.4% and Halobetasol 22.2%). Cream and ointment formulation were commonly used. Common adverse reactions were skin atrophy, hypopigmentation, acne. In prescribing pattern, specification of strength and quantity were lacking whereas instructions regarding area of application-44.4%, route of administration-83.3%, frequency and duration-91% were noted. In cost analysis, comparison is made between similar potency and clinical outcome. Of which, Clobetasol 0.05% and Betamethasone 0.01% is found to be cost effective compared to Halobetasol 0.05% and Mometasone 0.1% respectively.Conclusions: This study provides a limelight on prescribing pattern of topical steroids and emphasize periodic audit to rationalize the prescription with cost effectiveness

Dust retention in protoplanetary disks

Context: Protoplanetary disks are observed to remain dust-rich for up to several million years. Theoretical modeling, on the other hand, raises several questions. Firstly, dust coagulation occurs so rapidly, that if the small dust grains are not replenished by collisional fragmentation of dust aggregates, most disks should be observed to be dust poor, which is not the case. Secondly, if dust aggregates grow to sizes of the order of centimeters to meters, they drift so fast inwards, that they are quickly lost. Aims: We attempt to verify if collisional fragmentation of dust aggregates is effective enough to keep disks 'dusty' by replenishing the population of small grains and by preventing excessive radial drift. Methods: With a new and sophisticated implicitly integrated coagulation and fragmentation modeling code, we solve the combined problem of coagulation, fragmentation, turbulent mixing and radial drift and at the same time solve for the 1-D viscous gas disk evolution. Results: We find that for a critical collision velocity of 1 m/s, as suggested by laboratory experiments, the fragmentation is so effective, that at all times the dust is in the form of relatively small particles. This means that radial drift is small and that large amounts of small dust particles remain present for a few million years, as observed. For a critical velocity of 10 m/s, we find that particles grow about two orders of magnitude larger, which leads again to significant dust loss since larger particles are more strongly affected by radial drift.Comment: Letter accepted 3 July 2009, included comments of language edito

Planetesimal Formation In Self-Gravitating Discs

We study particle dynamics in local two-dimensional simulations of self-gravitating accretion discs with a simple cooling law. It is well known that the structure which arises in the gaseous component of the disc due to a gravitational instability can have a significant effect on the evolution of dust particles. Previous results using global simulations indicate that spiral density waves are highly efficient at collecting dust particles, creating significant local over-densities which may be able to undergo gravitational collapse. We expand on these findings, using a range of cooling times to mimic the conditions at a large range of radii within the disc. Here we use the Pencil Code to solve the 2D local shearing sheet equations for gas on a fixed grid together with the equations of motion for solids coupled to the gas solely through aerodynamic drag force. We find that spiral density waves can create significant enhancements in the surface density of solids, equivalent to 1-10cm sized particles in a disc following the profiles of Clarke (2009) around a solar mass star, causing it to reach concentrations several orders of magnitude larger than the particles mean surface density. We also study the velocity dispersion of the particles, finding that the spiral structure can result in the particle velocities becoming highly ordered, having a narrow velocity dispersion. This implies low relative velocities between particles, which in turn suggests that collisions are typically low energy, lessening the likelihood of grain destruction. Both these findings suggest that the density waves that arise due to gravitational instabilities in the early stages of star formation provide excellent sites for the formation of large, planetesimal-sized objects.Comment: 11 pages, 8 figures, accepted for publication in MNRA

Possible planet-forming regions on submillimetre images

Submillimetre images of transition discs are expected to reflect the distribution of the optically thin dust. Former observation of three transition discs LkHa330, SR21N, and HD1353444B at submillimetre wavelengths revealed images which cannot be modelled by a simple axisymmetric disc. We show that a large-scale anticyclonic vortex that develops where the viscosity has a large gradient (e.g., at the edge of the disc dead zone), might be accountable for these large-scale asymmetries. We modelled the long-term evolution of vortices being triggered by the Rossby wave instability. We found that a horseshoe-shaped (azimuthal wavenumber m=1) large-scale vortex forms by coalescing of smaller vortices within 5x10^4 yr, and can survive on the disc life-time (~5x10^6 yr), depending on the magnitude of global viscosity and the thickness of the viscosity gradient. The two-dimensional grid-based global disc simulations with local isothermal approximation and compressible-gas model have been done by the GPU version of hydrodynamic code FARGO (GFARGO). To calculate the dust continuum image at submillimetre wavelengths, we combined our hydrodynamical results with a 3D radiative transfer code. By the striking similarities of the calculated and observed submillimetre images, we suggest that the three transition discs can be modelled by a disc possessing a large-scale vortex formed near the disc dead zone edge. Since the larger dust grains (larger than mm in size) are collected in these vortices, the non-axisymmetric submillimetre images of the above transition discs might be interpreted as active planet and planetesimal forming regions situated far (> 50 AU) from the central stars.Comment: 13 pages, 14 figures, accepted for publication in MNRA

Planetary population synthesis

In stellar astrophysics, the technique of population synthesis has been successfully used for several decades. For planets, it is in contrast still a young method which only became important in recent years because of the rapid increase of the number of known extrasolar planets, and the associated growth of statistical observational constraints. With planetary population synthesis, the theory of planet formation and evolution can be put to the test against these constraints. In this review of planetary population synthesis, we first briefly list key observational constraints. Then, the work flow in the method and its two main components are presented, namely global end-to-end models that predict planetary system properties directly from protoplanetary disk properties and probability distributions for these initial conditions. An overview of various population synthesis models in the literature is given. The sub-models for the physical processes considered in global models are described: the evolution of the protoplanetary disk, the planets' accretion of solids and gas, orbital migration, and N-body interactions among concurrently growing protoplanets. Next, typical population synthesis results are illustrated in the form of new syntheses obtained with the latest generation of the Bern model. Planetary formation tracks, the distribution of planets in the mass-distance and radius-distance plane, the planetary mass function, and the distributions of planetary radii, semimajor axes, and luminosities are shown, linked to underlying physical processes, and compared with their observational counterparts. We finish by highlighting the most important predictions made by population synthesis models and discuss the lessons learned from these predictions - both those later observationally confirmed and those rejected.Comment: 47 pages, 12 figures. Invited review accepted for publication in the 'Handbook of Exoplanets', planet formation section, section editor: Ralph Pudritz, Springer reference works, Juan Antonio Belmonte and Hans Deeg, Ed

The Gaia-ESO Survey::the present-day radial metallicity distribution of the Galactic disc probed by pre-main-sequence clusters

Context. The radial metallicity distribution in the Galactic thin disc represents a crucial constraint for modelling disc formation and evolution. Open star clusters allow us to derive both the radial metallicity distribution and its evolution over time. Aims. In this paper we perform the first investigation of the present-day radial metallicity distribution based on [Fe/H] determinations in late type members of pre-main-sequence clusters. Because of their youth, these clusters are therefore essential for tracing the current interstellar medium metallicity. Methods. We used the products of the Gaia-ESO Survey analysis of 12 young regions (age < 100 Myr), covering Galactocentric distances from 6.67 to 8.70 kpc. For the first time, we derived the metal content of star forming regions farther than 500 pc from the Sun. Median metallicities were determined through samples of reliable cluster members. For ten clusters the membership analysis is discussed in the present paper, while for other two clusters (i.e. Chamaeleon I and Gamma Velorum) we adopted the members identified in our previous works. Results. All the pre-main-sequence clusters considered in this paper have close-to-solar or slightly sub-solar metallicities. The radial metallicity distribution traced by these clusters is almost flat, with the innermost star forming regions having [Fe/H] values that are 0.10−0.15 dex lower than the majority of the older clusters located at similar Galactocentric radii. Conclusions. This homogeneous study of the present-day radial metallicity distribution in the Galactic thin disc favours models that predict a flattening of the radial gradient over time. On the other hand, the decrease of the average [Fe/H] at young ages is not easily explained by the models. Our results reveal a complex interplay of several processes (e.g. star formation activity, initial mass function, supernova yields, gas flows) that controlled the recent evolution of the Milky Way

Connecting Planetary Composition with Formation

The rapid advances in observations of the different populations of exoplanets, the characterization of their host stars and the links to the properties of their planetary systems, the detailed studies of protoplanetary disks, and the experimental study of the interiors and composition of the massive planets in our solar system provide a firm basis for the next big question in planet formation theory. How do the elemental and chemical compositions of planets connect with their formation? The answer to this requires that the various pieces of planet formation theory be linked together in an end-to-end picture that is capable of addressing these large data sets. In this review, we discuss the critical elements of such a picture and how they affect the chemical and elemental make up of forming planets. Important issues here include the initial state of forming and evolving disks, chemical and dust processes within them, the migration of planets and the importance of planet traps, the nature of angular momentum transport processes involving turbulence and/or MHD disk winds, planet formation theory, and advanced treatments of disk astrochemistry. All of these issues affect, and are affected by the chemistry of disks which is driven by X-ray ionization of the host stars. We discuss how these processes lead to a coherent end-to-end model and how this may address the basic question.Comment: Invited review, accepted for publication in the 'Handbook of Exoplanets', eds. H.J. Deeg and J.A. Belmonte, Springer (2018). 46 pages, 10 figure

Planetary Migration in Protoplanetary Disks

The known exoplanet population displays a great diversity of orbital architectures, and explaining the origin of this is a major challenge for planet formation theories. The gravitational interaction between young planets and their protoplanetary disks provides one way in which planetary orbits can be shaped during the formation epoch. Disk-planet interactions are strongly influenced by the structure and physical processes that drive the evolution of the protoplanetary disk. In this review we focus on how disk-planet interactions drive the migration of planets when different assumptions are made about the physics of angular momentum transport, and how it drives accretion flows in protoplanetary disk models. In particular, we consider migration in discs where: (i) accretion flows arise because turbulence diffusively transports angular momentum; (ii) laminar accretion flows are confined to thin, ionised layers near disk surfaces and are driven by the launching of magneto-centrifugal winds, with the midplane being completely inert; (iii) laminar accretion flows pervade the full column density of the disc, and are driven by a combination of large scale horizontal and vertical magnetic fields

Disk Weather

Recent years have shown that accretion disks around young stars have extended regions, which are too low ionized to couple to magnetic fields and thus the nature of the underlying turbulence cannot be exclusively magnetic. We also found that disks have in general a baroclinic density and temperature structure which means that a typical disk is radially buoyant and has a vertical velocity gradient also known as thermal wind. Here we show that the expected entropy gradients in observed accretion disks around young stars are in fact steep enough and that the thermal relaxation times are sufficiently short to allow for efficient amplification of vortices