Study of rationality and utilization pattern of antimicrobials in ear, nose, throat outpatient department of Tertiary Care Hospital, Nanded

Background: Antimicrobials are most commonly prescribed drugs worldwide. Around 50% of the prescriptions of antimicrobial drugs are either not needed, inappropriate or in wrong doses. With the widespread use of antimicrobial agents (AMAs), the prevalence of resistance has increased. To evaluate the prescription pattern and utilization of AMA in ear, nose, throat (ENT) outpatient department (OPD) of Tertiary Care Hospital, Nanded.Methods: This prospective study was conducted in ENT OPD of Dr. Shankarrao Chavan Government Medical College, Nanded over a period of 3 months. During this period, approximately 1100 patients visited ENT OPD and 600 prescriptions were evaluated. The excluded patients were of post-operative follow-up and of patients undergoing medical examination for fitness and handicap certificate. Data were collected by using specially designed case report form. Appropriateness of AMA was assessed by Kunin’s modified criteria.Results: Total 600 prescriptions were analyzed out of which (91%) consist of AMA. Most of them reported with upper respiratory tract infections (URTI) (30.4%), chronic suppurative otitis media (21.4%), acute suppurative otitis media (10.4%), tonsillitis (3.3%), sinusitis (2.7%), and others (15%). Amoxicillin (43.9%) was preferred AMA followed by ciprofloxacin (30.6%), cotrimoxazole (5.8%), azithromycin (3.2%), doxycycline (3.2%) cefixime + clavulanate (3.2%), and amoxicillin + clavulanate (1.8%). Single antibiotic was preferred in all prescriptions. In the concomitant medications, antihistaminics were prescribed in 97.22% of patients, non-steroidal anti-inflammatory drugs in 94.96% of patients, and antacids in 87.76% of patients. Fixed-dose combinations were used in 10% of prescriptions. Brand names of AMA were used in 10% of prescriptions. As per the Kunin’s modified criteria, 83% of patients received AMA therapy appropriately, while 17% patients inappropriately.Conclusions: Amoxicillin is the most common AMA prescribed and URTI is the most common diagnosis made. All AMAs should be prescribed only when needed and should be used in proper dose and for proper duration. Institution wise antibiotic policy should be used to contain resistance. Proper training and regular orientation programs of the juniors’ doctors for judicial use of AMAs will foster the habit of rational prescribing of AMA

Flow induced by a sphere settling in an aging yield-stress fluid

We have studied the flow induced by a macroscopic spherical particle settling in a Laponite suspension that exhibits a yield-stress, thixotropy and shear-thinning. We show that the fluid thixotropy (or aging) induces an increase with time of both the apparent yield stress and shear-thinning properties but also a breaking of the flow fore-aft symmetry predicted in Hershel-Bulkley fluids (yield-stress, shear-thinning fluids with no thixotropy). We have also varied the stress exerted by the particles on the fluid by using particles of different densities. Although the stresses exerted by the particles are of the same order of magnitude, the velocity field presents utterly different features: whereas the flow around the lighter particle shows a confinement similar to the one observed in shear-thinning fluids, the wake of the heavier particle is characterized by an upward motion of the fluid ("negative wake"), whatever the fluid's age. We compare the features of this negative wake to the one observed in viscoelastic shear-thinning fluids (polymeric or micelle solutions). Although the flows around the two particles strongly differ, their settling behaviors display no apparent difference which constitutes an intriguing result and evidences the complexity of the dependence of the drag factor on flow field

Multifractal Scaling, Geometrical Diversity, and Hierarchical Structure in the Cool Interstellar Medium

Multifractal scaling (MFS) refers to structures that can be described as a collection of interwoven fractal subsets which exhibit power-law spatial scaling behavior with a range of scaling exponents (concentration, or singularity, strengths) and dimensions. The existence of MFS implies an underlying multiplicative (or hierarchical, or cascade) process. Panoramic column density images of several nearby star- forming cloud complexes, constructed from IRAS data and justified in an appendix, are shown to exhibit such multifractal scaling, which we interpret as indirect but quantitative evidence for nested hierarchical structure. The relation between the dimensions of the subsets and their concentration strengths (the "multifractal spectrum'') appears to satisfactorily order the observed regions in terms of the mixture of geometries present: strong point-like concentrations, line- like filaments or fronts, and space-filling diffuse structures. This multifractal spectrum is a global property of the regions studied, and does not rely on any operational definition of "clouds.'' The range of forms of the multifractal spectrum among the regions studied implies that the column density structures do not form a universality class, in contrast to indications for velocity and passive scalar fields in incompressible turbulence, providing another indication that the physics of highly compressible interstellar gas dynamics differs fundamentally from incompressible turbulence. (Abstract truncated)Comment: 27 pages, (LaTeX), 13 figures, 1 table, submitted to Astrophysical Journa

Multifractality of the quantum Hall wave functions in higher Landau levels

To probe the universality class of the quantum Hall system at the metal-insulator critical point, the multifractality of the wave function $\psi$ is studied for higher Landau levels, $N=1,2$, for various range $(\sigma )$ of random potential. We have found that, while the multifractal spectrum $f(\alpha)$ (and consequently the fractal dimension) does vary with $N$, the parabolic form for $f(\alpha)$ indicative of a log-normal distribution of $\psi$ persists in higher Landau levels. If we relate the multifractality with the scaling of localization via the conformal theory, an asymptotic recovery of the single-parameter scaling with increasing $\sigma$ is seen, in agreement with Huckestein's irrelevant scaling field argument.Comment: 10 pages, revtex, 5 figures available on request from [email protected]

Breakdown of Simple Scaling in Abelian Sandpile Models in One Dimension

We study the abelian sandpile model on decorated one dimensional chains. We determine the structure and the asymptotic form of distribution of avalanche-sizes in these models, and show that these differ qualitatively from the behavior on a simple linear chain. We find that the probability distribution of the total number of topplings $s$ on a finite system of size $L$ is not described by a simple finite size scaling form, but by a linear combination of two simple scaling forms $Prob_L(s) = 1/L f_1(s/L) + 1/L^2 f_2(s/L^2)$, for large $L$, where $f_1$ and $f_2$ are some scaling functions of one argument.Comment: 10 pages, revtex, figures include

Multifractality of Drop Breakup in Air-blast Nozzle Atomization Process

The multifractal nature of drop breakup in air-blast nozzle atomization process has been studied. We apply the multiplier method to extract the negative and the positive parts of the f(alpha) curve with the data of drop size distribution measured using Dual PDA. A random multifractal model with the multiplier triangularly distributed is proposed to characterize the breakup of drops. The agreement of the left part of the multifractal spectra between the experimental result and the model is remarkable. The cause of the distinction of the right part of the f(alpha) curve is argued. The fact that negative dimensions arise in the current system means that the spatial distribution of the drops yielded by the high-speed jet fluctuates from sample to sample. On other words, the spatial concentration distribution of the disperse phase in the spray zone fluctuates momentarily showing intrinsic randomness

Correlation Exponent and Anomalously Localized States at the Critical Point of the Anderson Transition

We study the box-measure correlation function of quantum states at the Anderson transition point with taking care of anomalously localized states (ALS). By eliminating ALS from the ensemble of critical wavefunctions, we confirm, for the first time, the scaling relation z(q)=d+2tau(q)-tau(2q) for a wide range of q, where q is the order of box-measure moments and z(q) and tau(q) are the correlation and the mass exponents, respectively. The influence of ALS to the calculation of z(q) is also discussed.Comment: 6 pages, 3 figure

Partitioning Schemes and Non-Integer Box Sizes for the Box-Counting Algorithm in Multifractal Analysis

We compare different partitioning schemes for the box-counting algorithm in the multifractal analysis by computing the singularity spectrum and the distribution of the box probabilities. As model system we use the Anderson model of localization in two and three dimensions. We show that a partitioning scheme which includes unrestricted values of the box size and an average over all box origins leads to smaller error bounds than the standard method using only integer ratios of the linear system size and the box size which was found by Rodriguez et al. (Eur. Phys. J. B 67, 77-82 (2009)) to yield the most reliable results.Comment: 10 pages, 13 figure

Size-selective concentration of chondrules and other small particles in protoplanetary nebula turbulence

Size-selective concentration of particles in a weakly turbulent protoplanetary nebula may be responsible for the initial collection of chondrules and other constituents into primitive body precursors. This paper presents the main elements of this process of turbulent concentration. In the terrestrial planet region, both the characteristic size and size distribution of chondrules are explained. "Fluffier" particles would be concentrated in nebula regions which were at a lower gas density and/or more intensely turbulent. The spatial distribution of concentrated particle density obeys multifractal scaling}, suggesting a close tie to the turbulent cascade process. This scaling behavior allows predictions of the probability distributions for concentration in the protoplanetary nebula to be made. Large concentration factors (>10^5) are readily obtained, implying that numerous zones of particle density significantly exceeding the gas density could exist. If most of the available solids were actually in chondrule sized particles, the ensuing particle mass density would become so large that the feedback effects on gas turbulence due to mass loading could no longer be neglected. This paper describes the process, presenting its basic elements and some implications, without including the effects of mass loading.Comment: 34 pages, 7 figures; in press for Astrophys. J; expected Jan 01 2001 issu

Multifractal burst in the spatio-temporal dynamics of jerky flow

The collective behavior of dislocations in jerky flow is studied in Al-Mg polycrystalline samples subjected to constant strain rate tests. Complementary dynamical, statistical and multifractal analyses are carried out on the stress-time series recorded during jerky flow to characterize the distinct spatio-temporal dynamical regimes. It is shown that the hopping type B and the propagating type A bands correspond to chaotic and self-organized critical states respectively. The crossover between these types of bands is identified by a large spread in the multifractal spectrum. These results are interpreted on the basis of competing scales and mechanisms.Comment: 4 pages, 6 figures To be published in Phys. Rev. Lett. (2001