Magnitude and determinants of antibiotic dispensing without prescription in Spain: a simulated patient study

Objectives: Excessive and inappropriate use of antibiotics increases antimicrobial resistance. The aim of this study was to determine the magnitude and determinants of antibiotic dispensing without prescription in Spain by the simulated patient technique. Methods: A cross-sectional study was conducted with all the pharmacies in a region of north-west Spain (n = 977), between December 2016 and January 2017. Four actors visited the pharmacies simulating a respiratory infection. Four incremental levels of pressure were used to obtain an antibiotic. The education and sex of the person who was dispensing and the area where the pharmacy was located were recorded. The effect of these independent variables on the dispensing of an antibiotic without prescription (1 = yes, 0 = no) was modelled by logistic regression. Results: An antibiotic was obtained in 18.83% (95% CI = 16.5%-21.41%) of the visits. The area influenced the dispensing of antibiotics without a medical prescription, with a greater likelihood of dispensing in rural (OR = 1.79; 95% CI = 1.20-2.68) or semi-rural (OR = 1.66; 95% CI = 1.13-2.44) areas than in urban areas. No association was found with the sex or the training of the person who dispensed the antibiotic. In the pharmacies in urban areas, a lower level of pressure was needed to obtain the antibiotic. Conclusions: This study shows that one-fifth of the pharmacies still dispense antibiotics without prescription, especially under patient pressure. A rural setting has been identified as a risk factor for dispensing without prescription, so it must be taken into account for future interventions

Three-dimensional numerical simulation of 1GeV/Nucleon U92+ impact against atomic hydrogen

The impact of 1GeV/Nucleon U92+ projectiles against atomic hydrogen is studied by direct numerical resolution of the time-dependent wave equation for the atomic electron on a three-dimensional Cartesian lattice. We employ the fully relativistic expressions to describe the electromagnetic fields created by the incident ion. The wave equation for the atom interacting with the projectile is carefully derived from the time-dependent Dirac equation in order to retain all the relevant terms.Comment: 12 pages and 7 figures included in the tex

Percutaneous mitral repair: current and future devices

Mitral regurgitation (MR) is the second most common valvular heart disease and its prevalence is increasing with population ageing. In the recent years we have witnessed the development of several transcatheter devices to correct MR in patients at high-risk for surgery. The majority of evidence regarding safety and efficacy of this new therapy comes from MitraClip studies. However, new alternatives on the field of valve repair have emerged with promising results. The aim of this review is to portrait the landscape of transcatheter mitral repair alternatives, from currently used devices to those that will have a role in the near future

From de Sitter to de Sitter

We obtain D=6, N=(1,1) de Sitter supergravity from a hyperbolic reduction of the massive type IIA* theory. We construct a smooth cosmological solution in which the co-moving time runs from an infinite past, which is dS_4\times S^2, to an infinite future, which is a dS_6-type spacetime with the boundary R^3\times S^2. This provides an effective four-dimensional cosmological model with two compact extra dimensions forming an S^2. Interestingly enough, although the solution is time-dependent, it arises from a first-order system via a superpotential construction. We lift the solutions back to D=10, and in particular obtain two smooth embeddings of dS_4 in massive type IIA*, with the internal space being either H^4\times S^2 or an H^4 bundle over S^2. We also obtain the analogous D=5 and D=4 solutions. We show that there exist cosmological solutions that describe an expanding universe with the expansion rate significantly larger in the past than in the future.Comment: Latex three times, 22 pages, references adde

Factors influencing erythrocyte sedimentation rate in adults New evidence for an old test

The erythrocyte sedimentation rate (ESR) is a routine test for inflammation. Few studies have investigated the potential influence of lifestyle factors and common metabolic abnormalities on the ESR. This study investigates the influence of demographic factors, alcohol consumption, smoking, physical activity, obesity, and metabolic syndrome on the ESR in adults.This cross-sectional study covered 1472 individuals (44.5% males; age range, 18-91 years) randomly selected from the population of a Spanish municipality. The ESR was measured using a standardized method. We assessed habitual alcohol consumption in standard drinking units, along with tobacco smoking, regular physical exercise (by questionnaire), body mass index, and variables defining metabolic syndrome. Multivariate analyses were performed, including mean corpuscular volume and hemoglobin concentration in the models.The ESR was higher in females than in males, and increased steadily with age. Median ESR of females was 2-fold higher than that of males, and median ESR of individuals aged >65 years was 2-fold higher than that of individuals in the youngest category (ages 18-35 years). Body mass index, presence of metabolic syndrome, and smoking were independently and positively associated with higher ESR values. Light alcohol drinkers and individuals with high regular physical activity displayed lower ESR values than did alcohol abstainers and individuals with low physical activity, respectively.ESR varies greatly with age and sex, and corresponding reference values are proposed. Lifestyle factors (physical activity, smoking, and alcohol consumption) and common metabolic abnormalities (obesity and related metabolic syndrome) may also influence ESR values

Prospective Study of Pre-Gravid Sugar-Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus

ObjectiveConsumption of sugar-sweetened beverages (SSBs) was related to an elevated risk of type 2 diabetes and insulin resistance in several recent studies among middle- or older-aged populations. Studies on SSB consumption and glucose intolerance among pregnant women, however, are lacking. We therefore examined the association between regular SSB consumption before pregnancy and the risk of gestational diabetes mellitus (GDM).Research design and methodsThis was a prospective study among 13,475 U.S. women who reported at least one singleton pregnancy between 1992 and 2001 in the Nurses' Health Study II. GDM was self-reported and validated by medical record review in a subsample. Cox proportional hazards models with multivariate adjustments were applied to examine the association of SSB consumption with GDM risk.ResultsDuring 10 years of follow-up, 860 incident GDM case subjects were identified. After adjustment for age, parity, race, physical activity, smoking, alcohol intake, prepregnancy BMI, and Western dietary pattern, intake of sugar-sweetened cola was positively associated with the risk of GDM, whereas no significant association was found for other SSBs and diet beverages. Compared with women who consumed <1 serving/month, those who consumed >or=5 servings/week of sugar-sweetened cola had a 22% greater GDM risk (relative risk 1.22 [95% CI 1.01-1.47]).ConclusionsFindings from this study suggest that prepregnancy higher consumption of sugar-sweetened cola (>or=5 servings/week) is associated with an elevated GDM risk, whereas no significant association with GDM risk was observed for other SSBs and diet beverages

Phases of Braneworlds, Spinning D3-branes and Strongly-Coupled Gauge Theories

A spinning nonextremal D3-brane undergoes a phase transition to a naked singularity which, from the braneworld point of view, corresponds to the apparent graviton speed passing from subluminal to superluminal. We investigate this phase transition from the dual perspectives of braneworld scenarios and holography. We discuss the relevance of the thermodynamic stability domains of a spinning D3-brane to the physics of braneworld scenarios. We also describe various gravitational Lorentz violations which arise from static D3-branes.Comment: 18 pages, 6 figures, LaTeX, additional comment and reference