Outpatient antibiotic prescription trends in the United States: A national cohort study

OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39–1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44–3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42–1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68–2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584–589</jats:sec

Distinguishing among Scalar Field Models of Dark Energy

We show that various scalar field models of dark energy predict degenerate luminosity distance history of the Universe and thus cannot be distinguished by supernovae measurements alone. In particular, models with a vanishing cosmological constant (the value of the potential at its minimum) are degenerate with models with a positive or negative cosmological constant whose magnitude can be as large as the critical density. Adding information from CMB anisotropy measurements does reduce the degeneracy somewhat but not significantly. Our results indicate that a theoretical prior on the preferred form of the potential and the field's initial conditions may allow to quantitatively estimate model parameters from data. Without such a theoretical prior only limited qualitative information on the form and parameters of the potential can be extracted even from very accurate data.Comment: 15 pages, 5 figure

Evolution of strangeness in equilibrating and expanding quark-gluon plasma

We evaluate the strangeness production from equilibrating and transversely expanding quark gluon plasma which may be created in the wake of relativistic heavy ion collisions. We consider boost invariant longitudinal and cylindrically symmetric transverse expansion of a gluon dominated partonic plasma, which is in local thermal equilibrium. Initial conditions obtained from the self screened parton cascade model are used. We empirically find that the final extent of the partonic equilibration rises almost linearly with the square of the initial energy density. This along with the corresponding variation with the number of participants may help us distinguish between various models of parton production.Comment: RevTex, 10 pages including 6 figures comprising 11 postscript files, text modified considerably with an added figure (Fig. 6) and this version accepted for publication in Phys. Rev.

Skewness in the Cosmic Microwave Background Anisotropy from Inflationary Gravity Wave Background

In the context of inflationary scenarios, the observed large angle anisotropy of the Cosmic Microwave Background (CMB) temperature is believed to probe the primordial metric perturbations from inflation. Although the perturbations from inflation are expected to be gaussian random fields, there remains the possibility that nonlinear processes at later epochs induce ``secondary'' non-gaussian features in the corresponding CMB anisotropy maps. The non-gaussianity induced by nonlinear gravitational instability of scalar (density) perturbations has been investigated in existing literature. In this paper, we highlight another source of non-gaussianity arising out of higher order scattering of CMB photons off the metric perturbations. We provide a simple and elegant formalism for deriving the CMB temperature fluctuations arising due to the Sachs-Wolfe effect beyond the linear order. In particular, we derive the expression for the second order CMB temperature fluctuations. The multiple scattering effect pointed out in this paper leads to the possibility that tensor metric perturbation, i.e., gravity waves (GW) which do not exhibit gravitational instability can still contribute to the skewness in the CMB anisotropy maps. We find that in a flat $\Omega =1$ universe, the skewness in CMB contributed by gravity waves via multiple scattering effect is comparable to that from the gravitational instability of scalar perturbations for equal contribution of the gravity waves and scalar perturbations to the total rms CMB anisotropy. The secondary skewness is found to be smaller than the cosmic variance leading to the conclusion that inflationary scenarios do predict that the observed CMB anisotropy should be statistically consistent with a gaussian random distribution.Comment: 10 pages, Latex (uses revtex), 1 postscript figure included. Accepted for publication in Physical Review

Non-adiabatic primordial fluctuations

We consider general mixtures of isocurvature and adiabatic cosmological perturbations. With a minimal assumption set consisting of the linearized Einstein equations and a primordial perfect fluid we derive the second-order action and its curvature variables. We also allow for varying equation of state and speed of sound profiles. The derivation is therefore carried out at the same level of generality that has been achieved for adiabatic modes before. As a result we find a new conserved super-horizon quantity and relate it to the adiabatically conserved curvature perturbation. Finally we demonstrate how the formalism can be applied by considering a Chaplygin gas-like primordial matter model, finding two scale-invariant solutions for structure formation.Comment: 11 page

Bremsstrahlung from an Equilibrating Quark-Gluon Plasma

The photon production rate from a chemically equilibrating quark-gluon plasma likely to be produced at RHIC (BNL) and LHC (CERN) energies is estimated taking into account bremsstrahlung. The plasma is assumed to be in local thermal equilibrium, but with a phase space distribution that deviates from the Fermi or Bose distribution by space-time dependent factors (fugacities). The photon spectrum is obtained by integrating the photon rate over the space-time history of the plasma, adopting a boost invariant cylindrically symmetric transverse expansion of the system with different nuclear profile functions. Initial conditions obtained from a self-screened parton cascade calculation and, for comparison, from the HIJING model are used. Compared to an equilibrated plasma at the same initial energy density, taken from the self-screened parton cascade, a moderate suppression of the photon yield by a factor of one to five depending on the collision energy and the photon momentum is observed. The individual contributions to the photon production, however, are completely different in the both scenarios.Comment: 14 pages, 4 figures, shortened version to be published in Phys. Rev.

Non-Perturbative Dilepton Production from a Quark-Gluon Plasma

The dilepton production rate from the quark-gluon plasma is calculated from the imaginary part of the photon self energy using a quark propagator that contains the gluon condensate. The low mass dilepton rate obtained in this way exhibits interesting structures (peaks and gaps), which might be observable at RHIC and LHC.Comment: 16 pages, REVTEX, 8 PostScript figure

Cosmology with CMB anisotropy

Measurements of CMB anisotropy and, more recently, polarization have played a very important role allowing precise determination of various parameters of the `standard' cosmological model. The expectation of the paradigm of inflation and the generic prediction of the simplest realization of inflationary scenario in the early universe have also been established -- `acausally' correlated initial perturbations in a flat, statistically isotropic universe, adiabatic nature of primordial density perturbations. Direct evidence for gravitational instability mechanism for structure formation from primordial perturbations has been established. In the next decade, future experiments promise to strengthen these deductions and uncover the remaining crucial signature of inflation -- the primordial gravitational wave background.Comment: Plenary talk at the IXth. International Workshop on High Energy Physics Phenomenology (WHEPP-9), Institute of Physics, Bhubaneshwar, India. Jan 3-14, 2006; To appear in the Proceedings to be published in Pramana; 12 pages, 2 figure

Cosmic Microwave Background anisotropies from second order gravitational perturbations

This paper presents a complete analysis of the effects of second order gravitational perturbations on Cosmic Microwave Background anisotropies, taking explicitly into account scalar, vector and tensor modes. We also consider the second order perturbations of the metric itself obtaining them, for a universe dominated by a collision-less fluid, in the Poisson gauge, by transforming the known results in the synchronous gauge. We discuss the resulting second order anisotropies in the Poisson gauge, and analyse the possible relevance of the different terms. We expect that, in the simplest scenarios for structure formation, the main effect comes from the gravitational lensing by scalar perturbations, that is known to give a few percent contribution to the anisotropies at small angular scales.Comment: 15 pages, revtex, no figures. Version to be published in Phys. Rev.

Ethnicity and cardiovascular health inequalities in people with severe mental illnesses: protocol for the E-CHASM study

“The final publication is available at Springer via http://dx. doi.10.1007/s00127-016-1185-8JD is funded by the Health Foundation working with the Academy of Medical Sciences. CM is supported by a European Research Council Consolidator Award (Ref: ERC-CoG- 2014-Proposal 648837, REACH). RS is funded by the NIHR Spe- cialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psy- chiatry, King’s College London. GT and FG are supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College London Foundation Trust. GT acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Unit awarded to South London and Maudsley NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. GT is supported by the European Union Seventh Framework Programme (FP7/2007–2013) Emerald project. AR is funded by the European Union Horizon 2020 pro- gramme OpenMinTeD and KConnect projects, by the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Biomedical Research Unit at South London and Maudsley NHS Foundation Trust and King’s College London, and by QBurs