What supports hospital pharmacist prescribing in Scotland? A mixed methods, exploratory sequential study.

While approximately half of all qualified hospital pharmacist independent prescribers (PIPs) in Scotland are active prescribers, there are major differences in prescribing activity across geographical areas. This study aimed to explore, through focus groups, interviews and a questionnaire, hospital PIPs' perceptions of factors associated with prescribing activity and to investigate the infrastructure required to better support active prescribing by PIPs. Findings reinforced the perceived positive impact of supportive pharmacy leadership within the organisation, recognition that prescribing is integral to the clinical pharmacist role and a work environment conducive to prescribing

Development of a paediatric triage tool to aid clinical prioritisation and delivery of pharmaceutical care

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Urinary Paraben Concentrations and Ovarian Aging among Women from a Fertility Center

Background: Parabens are preservatives commonly used in personal care products, pharmaceuticals, and foods. There is documented widespread human exposure to parabens, and some experimental data suggest that they act as estrogenic endocrine disruptors. As far as we are aware, no epidemiologic studies have assessed female reproductive health effects in relation to paraben exposure. Objective: We examined the association of urinary paraben concentrations with markers of ovarian reserve in a prospective cohort study of women seeking fertility treatment at Massachusetts General Hospital, Boston, Massachusetts. Methods: Measures of ovarian reserve were day-3 follicle-stimulating hormone (FSH), antral follicle count (AFC), and ovarian volume. Paraben concentrations [methylparaben (MP), propylparaben (PP), and butylparaben (BP)] were measured in spot urine samples collected prior to the assessment of outcome measures. We used linear and Poisson regression models to estimate associations of urinary paraben concentrations (in tertiles) with ovarian reserve measures. Results: Of the women enrolled in 2004–2010, 192 had at least one ovarian reserve outcome measured (mean age ± SD, 36.1 ± 4.5 years; range, 21.0–46.7 years). MP and PP were detected in > 99% of urine samples and BP in > 75%. We found a suggestive trend of lower AFC with increasing urinary PP tertiles [mean percent change (95% CI) for tertiles 2 and 3 compared with tertile 1, respectively, were –5.0% (–23.7, 18.4) and –16.3% (–30.8, 1.3); trend p-value (ptrend) = 0.07] as well as higher day-3 FSH with higher urinary PP tertiles [mean change (95% CI) for tertiles 2 and 3 compared with tertile 1 were 1.16 IU/L (–0.26, 2.57) and 1.02 IU/L (–0.40, 2.43); ptrend = 0.16]. We found no consistent evidence of associations between urinary MP or BP and day-3 FSH or AFC, or between urinary MP, PP, or BP and ovarian volume. Conclusions: PP may be associated with diminished ovarian reserve. However, our results require confirmation in further studies. Citation: Smith KW, Souter I, Dimitriadis I, Ehrlich S, Williams PL, Calafat AM, Hauser R. 2013. Urinary paraben concentrations and ovarian aging among women from a fertility center. Environ Health Perspect 121:1299–1305; http://dx.doi.org/10.1289/ehp.120535

Using Interpretable Machine Learning to Predict Maternal and Fetal Outcomes

Most pregnancies and births result in a good outcome, but complications are not uncommon and when they do occur, they can be associated with serious implications for mothers and babies. Predictive modeling has the potential to improve outcomes through better understanding of risk factors, heightened surveillance, and more timely and appropriate interventions, thereby helping obstetricians deliver better care. For three types of complications we identify and study the most important risk factors using Explainable Boosting Machine (EBM), a glass box model, in order to gain intelligibility: (i) Severe Maternal Morbidity (SMM), (ii) shoulder dystocia, and (iii) preterm preeclampsia. While using the interpretability of EBM's to reveal surprising insights into the features contributing to risk, our experiments show EBMs match the accuracy of other black-box ML methods such as deep neural nets and random forests.Comment: DSHealth at SIGKDD 2022, 5 pages, 3 figure

Among-individual and within-individual variation in seasonal migration covaries with subsequent reproductive success in a partially migratory bird

Acknowledgements: We thank Raymond Duncan (Grampian Ringing Group), whose insatiable enthusiasm for ringing was inspirational. We thank everyone who contributed to fieldwork, especially Mike Harris and David Hunter; Roger Pradel for generous advice on CMR mixture models; and UK Natural Environment Research Council for funding (NE/R000859/1, NE/P009719/1). Data accessibility Data are available from the Dryad Digital Repository: https://doi.org/10.5061/dryad.pvmcvdnhv [46]. Electronic supplementary material is available online at https://doi.org/10.6084/m9.figshare.c.5054649.Peer reviewedPostprin

The 2015-2017 excavations at Chalcolithic site of Chlorakas-Palloures on Cyprus

From 2015 to 2017 the first three excavation seasons took place at Chlorakas-Palloures, a Chalcolithic site in western Cyprus. Here we present the site stratigraphy, and the structures and burials, excavated at the site. We also introduce the ground stone, figurines and chipped stone found during these first seasons. We also introduce the ground stone, figurines, and chipped stone found during these first seasons. We discuss the raw materials used, the formal and informal tool types, and the context in which these objects were found, as well as how they fit into the broader knowledge of the period. Finally we present the faunal evidence. The aim is to provide colleagues with a first assessment of our results rather than a final report. Not all our assemblages have been fully processed, and inevitably our interpretations of the site and its assemblages will change in future seasons, as we excavate additional trenches and analyse further assemblages. Nonetheless we feel that our data are providing a siginificant addition to our knowledge of Chalcolithic Cyprus that should therefore be published in this interim report.Archaeology of the Near East and the Mediterranea

Present Day Kinematics of the Eastern California Shear Zone from a Geodetically Constrained Block Model

We use Global Positioning System (GPS) data from 1993–2000 to determine horizontal velocities of 65 stations in eastern California and western Nevada between 35° and 37° N. We relate the geodetic velocities to fault slip rates using a block model that enforces path integral constraints over geologic and geodetic time scales and that includes the effects of elastic strain accumulation on faults locked to a depth of 15 km. The velocity of the Sierra Nevada block with respect to Nevada is 11.1±0.3 mm/yr, with slip partitioned across the Death Valley, (2.8±0.5 mm/yr), Panamint Valley (2.5±0.8 mm/yr), and Airport Lake/Owens Valley (5.3±0.7/4.6±0.5 mm/yr) faults. The western Mojave block rotates at 2.1±0.8°/My clockwise, with 3.7±0.7 mm/yr of left lateral motion across the western Garlock Fault. We infer 11±2 mm/yr of right lateral motion across the Mojave region of the Eastern California Shear Zone

Fatal flaws in the UK asylum decision-making system: an analysis of Home Office refusal letters

The process of deciding who is in need of international protection is well established most western liberal democracies, and has been subject to critical scrutiny for decades. And yet asylum seekers remain vulnerable to serious and ongoing flaws in that system. In this paper, based on research conducted in Afghanistan 2012–2018, Schuster explores a number of shortcomings in the asylum decision-making process, specifically with regard to the rejection of claims from Afghans. The analysis of Reasons for Refusal Letters, allows Schuster to examine the use of key tools in that process (previous cases and country of origin reports). Schuster argues that the current adversarial approach, which seeks to prove an applicant is not credible or does not need protection, undermines the legitimacy of the asylum and risks refusing protection to those in need and or condemning others to years of damaging appeals before they are granted asylum. She concludes by arguing for a shift to a more investigative approach, one that seeks to identify those in need of protection, rather than to keep numbers low