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

Pharmaceutical companies information and antibiotic prescription patterns: A follow-up study in Spanish primary care

OBJECTIVES: To assess the impact of sources of drug information on antibiotic prescribing patterns (quantity and quality) among primary care physicians. METHODS: We conducted a cohort study on primary care physicians who were actively engaged in medical practice in 2010 in a region in north-west Spain (Galicia), fulfilling inclusion criteria (n = 2100). As the independent variable, we took the perceived utility of 6 sources of information on antibiotics, as measured by the validated KAAR-11 questionnaire. As dependent variables, we used: (1) a quality indicator (appropriate quality, defined as any case where 6 of the 12 indicators proposed by the European Surveillance of Antimicrobial Consumption Network [ESAC-Net] were better than the mean values for Spain); and, (2) a quantity indicator (high prescribing), defined as any case where defined daily doses (DDD) per 1 000 inhabitants per day of antibacterials for systemic use were higher than the mean values for Spain. The adjusted odds ratio for a change in the interquartile range (IqOR) for each sources of information on antibiotics was calculated using Generalized Linear Mixed Models. RESULTS: The questionnaire response rate was 68%. Greater perceived utility of pharmaceutical sales representatives increases the risk of having high prescribing (1/IqOR = 2.50 [95%CI: 1.63-3.66]) and reduces the probability of having appropriate quality (1/IqOR = 2.28 [95%CI: 1.77-3.01]). Greater perceived utility of clinical guidelines increases the probability of having appropriate quality (1/IqOR = 1.25 [95%CI: 1.02-1.54]) and reduces the probability of high prescribing (1/IqOR = 1.25 [95%CI: 1.02-1.54]). CONCLUSIONS: Sources of information on antibiotics are an important determinant of the quantity and quality of antibiotic prescribing in primary care. Commercial sources of information influence prescribing negatively, and clinical guidelines are associated with better indicators.Instituto de Salud Carlos IIIThe European Regional Development Fund (ERDF)Mutua Madrileñ

Thurston Geometries from Eleven Dimensions

In three dimensions, a `master theory' for all Thurston geometries requires imaginary flux. However, these geometries can be obtained from physical three-dimensional theories with various additional scalar fields, which can be interpreted as moduli in various compactifications of a higher-dimensional `master theory'. Three Thurston geometries are of the form N_2 x S^1, where N_2 denotes a two-dimensional Riemannian space of constant curvature. This enables us to twist these spaces, via T-duality, into other Thurston geometries as a U(1) bundle over N_2. In this way, Hopf T-duality relates all but one of the geometries in the higher-dimensional M-theoretic framework. The exception is the `Sol geometry,' which results from the dimensional reduction of the decoupling limit of the D3-brane in a background B-field.Comment: Latex, 8 pages, improved presentation in abstract, introduction and section 2, references adde

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

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

Characterization of New Proteomic Biomarker Candidates in Mucopolysaccharidosis Type IVA

Mucopolysaccharidosis type IVA (MPS IVA) is a lysosomal storage disease caused by mutations in the N-acetylgalactosamine-6-sulfatase (GALNS) gene. Skeletal dysplasia and the related clinical features of MPS IVA are caused by disruption of the cartilage and its extracellular matrix, leading to a growth imbalance. Enzyme replacement therapy (ERT) with recombinant human GALNS has yielded positive results in activity of daily living and endurance tests. However, no data have demonstrated improvements in bone lesions and bone grow thin MPS IVA after ERT, and there is no correlation between therapeutic efficacy and urine levels of keratan sulfate, which accumulates in MPS IVA patients. Using qualitative and quantitative proteomics approaches, we analyzed leukocyte samples from healthy controls (n = 6) and from untreated (n = 5) and ERT-treated (n = 8, sampled before and after treatment) MPS IVA patients to identify potential biomarkers of disease. Out of 690 proteins identified in leukocytes, we selected a group of proteins that were dysregulated in MPS IVA patients with ERT. From these, we identified four potential protein biomarkers, all of which may influence bone and cartilage metabolism: lactotransferrin, coronin 1A, neutral alpha-glucosidase AB, and vitronectin. Further studies of cartilage and bone alterations in MPS IVA will be required to verify the validity of these proteins as potential biomarkers of MPS IVA

Validation of Calprotectin As a Novel Biomarker For The Diagnosis of Pleural Effusion: a Multicentre Trial

Discriminating between malignant pleural effusion (MPE) and benign pleural effusion (BPE) remains difficult. Thus, novel and efficient biomarkers are required for the diagnosis of pleural effusion (PE). The aim of this study was to validate calprotectin as a diagnostic biomarker of PE in clinical settings. A total of 425 patients were recruited, and the pleural fluid samples collected had BPE in 223 cases (53.7%) or MPE in 137 patients (33%). The samples were all analysed following the same previously validated clinical laboratory protocols and methodology. Calprotectin levels ranged from 772.48 to 3,163.8 ng/mL (median: 1,939 ng/mL) in MPE, and 3,216-24,000 ng/mL in BPE (median: 9,209 ng/mL; p < 0.01), with an area under the curve of 0.848 [95% CI: 0.810-0.886]. For a cut-off value of </= 6,233.2 ng/mL, we found 96% sensitivity and 60% specificity, with a negative and positive predictive value, and negative and positive likelihood ratios of 96%, 57%, 0.06, and 2.4, respectively. Multivariate analysis showed that low calprotectin levels was a better discriminator of PE than any other variable [OR 28.76 (p < 0.0001)]. Our results confirm that calprotectin is a new and useful diagnostic biomarker in patients with PE of uncertain aetiology which has potential applications in clinical practice because it may be a good complement to cytological methods