Pharmacist Provision of Contraception Services in Kentucky: Opinions and Policy Interventions

Unintended pregnancy continues to be a prevalent issue across the United States, impacting millions of women annually. While several states have enacted policies expanding pharmacist services to allow for provision of hormonal contraception, Kentucky has yet to do so. Likewise, although provision of nonprescription hormonal contraception could be authorized under Kentucky regulation, prior to this study, this had yet to be done. The objectives of this study were to 1) understand the opinions of Kentucky pharmacists and student pharmacists regarding provision of hormonal contraception services through a board-authorized protocol, 2) understand the opinions of Kentucky pharmacists and student pharmacists regarding provision of nonprescription emergency contraception services through a board-authorized protocol, and 3) identify and implement policy-based solutions to increase access to nonprescription emergency contraception. Two questionnaires, both approved by the University of Kentucky Institutional Review Board (IRB) were developed via REDCap with questions pertaining to pharmacists and student pharmacists, respectively. The pharmacist questionnaire was disseminated via email or private Facebook group post to a convenience sample of Kentucky pharmacists. The student pharmacist questionnaire was disseminated via Canvas to first through third professional year (PY1-PY3) students at the University of Kentucky College of Pharmacy. Surveys were analyzed using descriptive statistics. A multivariable logistic regression model was used for both surveys to identify any significant differences in odds of support for provision of hormonal contraception across various demographic factors. Additionally, McNemar’s test was used for both surveys to identify any significant differences in support between dosage forms. A protocol for provision of emergency contraception was created and presented for approval to the Kentucky Board of Pharmacy. Development of a training program was initiated and plans for future implementation strategies were begun. Pharmacists were found to be generally supportive of provision of hormonal contraception, with support being highest for oral (61%) and transdermal (54%) dosage forms. While lower, support was existent for provision of injectable (38%) and vaginal (47%) dosage forms as well. Students, however, were largely supportive of oral (91%), transdermal (82%), vaginal (73%), and injectable (66%) dosage forms. Support regarding provision of emergency contraception via board-authorized protocol was high for both pharmacists (65%) and student pharmacists (88%). Multivariable logistic regression analyses showed that pharmacists in practice 11-30 years were found to be at significantly decreased odds of support for oral, transdermal, and vaginal dosage forms compared to those in practice 10 years or less. With regard to the student survey, PY3 students were found to be at higher odds of support for provision of the oral and vaginal dosage forms. Additionally, students who anticipate practicing in a hospital inpatient setting were at higher odds of support for provision of the injectable dosage form. A protocol for provision of nonprescription emergency contraception was approved by the Kentucky Board of Pharmacy and training program development remains underway. This work provides the framework for pharmacists to provide nonprescription emergency contraception via protocol. Additionally, data collected regarding pharmacist and student pharmacist opinions provide the foundation for discussion regarding pharmacist provision of hormonal contraception in Kentucky

Code improvement and model validation for Asco-II Nuclear Power Plant model using a coupled 3D neutron kinetics/thermal-hydraulic code

This paper provides a Best Estimate validation calculation with a coupled thermal–hydraulic and 3D neutron kinetic model for Ascó-II Nuclear Power Plant. Common NRC codes have been used for its purpose. TRACE is the code used for the thermal–hydraulic system calculations; PARCS is the code used for the 3D neutron kinetics calculations. Cross section calculations were performed with the HELIOS lattice physics code, finally GenPMAXS was used to convert the cross section into the PARCS format. A simplified three dimensional 3D neutronics model of the Ascó II NPP is used as a core kinetics model. A 3D cylindrical thermal–hydraulic vessel plus 1D representation of the remainder of the full plant model is used as the thermal–hydraulic model. The transient selected to ensure the model validation is an actual 50% Loss of Load. This transient is characterized by space–time effects and was used to validate different thermal–hydraulic system models for the GET university group in the past. The scenario is also good to ensure the validation of a coupled 3D neutron kinetics code since it provides a transient situation between two stable regions at 100% and 50%. From the current code versions used, some source code modifications have been carried out in order to ensure the correct feedback between thermal–hydraulic and neutron kinetics code. In that sense, a dynamic control rod movement between TRACE and PARCS has been implemented. This is a complete control rod position feedback during transient scenarios. After all the work was performed, the important TH and NK time trend parameters were compared to the plant data and the comparison was reasonable with some discrepancy, thus the developed system models and the code modifications are robust enough to be used for future safety analysis. New coupled code capability has been tested and found as a required capability, when validating 3D NK–TH coupled calculations.Peer ReviewedPostprint (published version

Layering in the Ising model

We consider the three-dimensional Ising model in a half-space with a boundary field (no bulk field). We compute the low-temperature expansion of layering transition lines

Oxygen impurities in NiAl: Relaxation effects

We have used a full-potential linear muffin-tin orbital method to calculate the effects of oxygen impurities on the electronic structure of NiAl. Using the supercell method with a 16-atom supercell we have investigated the cases where an oxygen atom is substitutionally placed at either a nickel or an aluminum site. Full relaxation of the atoms within the supercell was allowed. We found that oxygen prefers to occupy a nickel site over an aluminum site with a site selection energy of 138 mRy (21,370 K). An oxygen atom placed at an aluminum site is found to cause a substantial relaxation of its nickel neighbors away from it. In contrast, this steric repulsion is hardly present when the oxygen atom occupies the nickel site and is surrounded by aluminum neighbors. We comment on the possible relation of this effect to the pesting degradation phenomenon (essentially spontaneous disintegration in air) in nickel aluminides.Comment: To appear in Phys. Rev. B (Aug. 15, 2001

Case Studies on the Application of Fuzzy Linear Programming in Decision-Making

This study demonstrated the effectiveness of fuzzy method in decision-making and recommends the integration of fuzzy methods in decision-making in production, transportation, power production and distribution and utility maintenance in Nigeria companies

Atomic structure of Mg-based metallic glasses from molecular dynamics and neutron diffraction

We use a combination of classical molecular dynamics simulation and neutron diffraction to identify the atomic structure of five different Mg–Zn–Ca bulk metallic glasses, covering a range of compositions with substantially different behaviour when implanted in vitro. There is very good agreement between the structures obtained from computer simulation and those found experimentally. Bond lengths and the total correlation function do not change significantly with composition. The zinc and calcium bonding shows differences between composition: the distribution of Zn–Ca bond lengths becomes narrower with increasing Zn content, and the preference for Zn and Ca to avoid bonding to themselves or each other becomes less strong, and, for Zn–Ca, transforms into a positive preference to bond to each other. This transition occurs at about the same Zn content at which the behaviour on implantation changes, hinting at a possible structural connection. A very broad distribution of Voronoi polyhedra are also found, and this distribution broadens with increasing Zn content. The efficient cluster packing model, which is often used to describe the structure of bulk metallic glasses, was found not to describe these systems well

Influence of Peer Relationship on Self-Consciousness and Social Adaptation of School-Aged Children

This study aimed to assess the influence of peer relationships on the self-consciousness and social adaptation of school-aged children in the Enugu North Local Government Area of Enugu State. A descriptive cross-sectional survey design was used, with a population of 60,780 (29,968 males and 30,812 females). A multi-stage sampling method was employed to select 602 school-aged children from 58 schools in the Local Government Area, forming the sample for the study. For data collection, the study used questionnaires. Data were analyzed with descriptive statistics and inferential statistics. The findings revealed that more than half of the respondents (62.6%) showed moderate social adaptation, particularly when they were with their families (mean score of 4.53±2.31). The majority (76.6%) had low peer relationships, while 80.6% had high self-consciousness. The mean scores for peer relationships, self-consciousness, and social adaptation differed between male and female respondents. Females had higher peer relationships and social adaptation. The mean score for peer relationships was higher among students in private schools compared to those in public schools. A moderate positive relationship was found between peer relationships and social adaptation at a significance level of p\u3c0.05. It is recommended that governmental and non-governmental organizations organize programs to facilitate peer relationships and social adaptation among school-aged children. Furthermore, teachers and parents should be educated to provide support to children in these areas