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

[Abstract unavailable

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

A comparative evaluation of modern English corpus grammatical annotation schemes

Many English Corpus Linguistics projects reported in ICAME Journal and elsewhere involve grammatical analysis or tagging of English texts (eg Atwell 1983, Leech et al 1983, Booth 1985, Owen 1987, Souter 1989a, O’Donoghue 1991, Belmore 1991, Kytö and Voutilainen 1995, Aarts 1996, Qiao and Huang 1998). Each new project has to review existing tagging schemes, and decide which to adopt and/or adapt. The AMALGAM project can help in this decision, by providing descriptions and analyses of a range of tagging schemes, and an internet-based service for researchers to try out the range of tagging schemes on their own data. The project AMALGAM (Automatic Mapping Among Lexico-Grammatical Annotation Models) explored a range of Part-of-Speech tagsets and phrase structure parsing schemes used in modern English corpus-based research. The PoS-tagging schemes include: Brown (Greene and Rubin 1981), LOB (Atwell 1982, Johansson et al 1986), Parts (man 1986), SEC (Taylor and Knowles 1988), POW (Souter 1989b), UPenn (Santorini 1990), LLC (Eeg-Olofsson 1991), ICE (Greenbaum 1993), and BNC (Garside 1996). The parsing schemes include some which have been used for hand annotation of corpora or manual post-editing of automatic parsers, and others which are unedited output of a parsing program. Project deliverables include: – a detailed description of each PoS-tagging scheme, at a comparable level of detail. This includes a list of PoS-tags with descriptions and example uses from the source Corpus. The description of the use of PoS-tags is also illustrated in a multi-tagged corpus: a set of sample texts PoS-tagged in parallel with each PoS-tagset (and proofread by experts), for comparative studies – an analysis of the different lexical tokenization rules used in the source Corpora, to arrive at a ‘Corpus-neutral’ tokenization scheme (and consequent adjustments to the PoS-tagsets in our study to accept modified tokenization) – an implementation of each PoS-tagset in conjunction with our standardised tokenizer, as a family of PoS-taggers, one for each PoS-tagset – a method for ‘PoS-tagset conversion’, taking a text tagged according to one PoS-tagset and outputting the text annotated with another PoS-tagset – a sample of texts parsed according to a range a parsing schemes: a Multi-Treebank resource for comparative studies – an Internet service allowing researchers worldwide free access to the above resources, including a simple email-based method for PoS-tagging any English text with any or all PoS-tagset(s)

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

Outcomes of preimplantation genetic diagnosis in neurofibromatosis type 1

Objective To examine the effect of patient and facility level factors on the success of preimplantation genetic diagnosis (PGD) in patients with neurofibromatosis 1 (NF1). Design Retrospective review. Setting Large PGD reference laboratory. Patient(s) All patients with NF1 referred from June 2004 to May 2013. Intervention(s) None. Main Outcome Measure(s) Embryos' NF1 mutation status and live birth rates. Result(s) Seventy-seven couples underwent 156 PGD cycles during the study period. The average maternal age at the time of embryo biopsy was 33.2 years. The majority of embryos had a day 3 single blastomere biopsy without aneuploidy screening. A diagnosis was obtained for 80% of biopsied embryos; 20% of biopsies were nondiagnostic due to technical failures. Diagnosis was more often obtained for embryos of parents with familial disease and for embryos biopsied at centers that referred multiple NF1 cases. Among diagnosed embryos, 483/1,060 (46%) were unaffected by the parental NF1 mutation. Twenty-two (14%) of the 156 cycles had a confirmed live birth; if the observed success rate is applied to cycles with unknown outcomes, 33/156 (21%) cycles are expected to have resulted in live birth. In multivariate logistic regression, having a live birth was significantly associated with having more unaffected embryos available for transfer (odds ratio 1.33 per additional embryo, 95% confidence interval 1.02–1.72). Conclusion(s) Advances in biopsy and diagnostic techniques which increase the number of unaffected embryos identified may improve live birth rates for patients with NF1. Clinicians should counsel patients about their fertility and reproductive options early, with the use of disease-specific data, to set appropriate expectations for the PGD process

Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: A protocol for a randomised double-blind placebo-controlled trial

<p>Abstract</p> <p>Background</p> <p>Major shoulder surgery often results in severe post-operative pain and a variety of interventions have been developed in an attempt to address this. The continuous slow infusion of a local anaesthetic directly into the operative site has recently gained popularity but it is expensive and as yet there is little conclusive evidence that it provides additional benefits over other methods of post-operative pain management.</p> <p>Methods/Design</p> <p>This will be a randomised, placebo-controlled trial involving 158 participants. Following diagnostic arthroscopy, all participants will undergo arthroscopic subacromial decompression with or without rotator cuff repair, all operations performed by a single surgeon. Participants, the surgeon, nurses caring for the patients and outcome assessors will be blinded to treatment allocation. All participants will receive a pre-incision bolus injection of 20 mls of ropivacaine 1% into the shoulder and an intra-operative intravenous bolus of parecoxib 40 mg. Using concealed allocation participants will be randomly assigned to active treatment (local anaesthetic ropivacaine 0.75%) or placebo (normal saline) administered continuously into the subacromial space by an elastomeric pump at 5 mls per hour post-operatively. Patient controlled opioid analgesia and oral analgesics will be available for breakthrough pain. Outcome assessment will be at 15, 30 and 60 minutes, 2, 4, 8, 12, 18 and 24 hours, and 2 or 4 months for decompression or decompression plus repair respectively.</p> <p>The primary end point will be average pain at rest over the first 12-hour post-operative period on a verbal analogue pain score. Secondary end points will be average pain at rest over the second 12-hour post-operative period, maximal pain at rest over the first and second 12-hour periods, amount of rescue medication used, length of inpatient stay and incidence of post-operative adhesive capsulitis.</p> <p>Discussion</p> <p>The results of this trial will contribute to evidence-based recommendations for the effectiveness of pain management modalities following arthroscopic rotator cuff surgery. If the local anaesthetic pain-buster provides no additional benefits over placebo then valuable resources can be put to better use in other ways.</p> <p>Trial registration</p> <p>Australian Clinical Trials Register Number ACTR12606000195550</p

Integration and Reintegration: Comparing pathways to citizenship through asylum and criminal justice

The development of scholarship related to particular categories of people who are subject to different forms of social control often results in subfields that become or remain isolated from each other. As an example, theory and research relating to the reintegration of ex-offenders and the integration of asylum seekers have developed almost completely independently. However, both processes involve people who are marginalized and stigmatized through legal and social processes, and policies and practices in the two fields share somewhat similar concepts and goals. This article therefore seeks to identify insights through a critical comparison of these two areas of research, theory and practice, with the intention of enriching our understanding of both. This comparison highlights that the frameworks reviewed here enable us to move beyond a narrow focus on service user’s behaviours, needs or risks, and into an examination of questions of identity, belonging and justice

Severe male infertility after failed ICSI treatment-a phenomenological study of men's experiences

<p>Abstract</p> <p>Background</p> <p>Male-factor infertility underlies approximately 30% of infertility in couples seeking treatment; of which 10% is due to azoospermia. The development of assisted reproductive technology (ART), enabling the use of epididymal or testicular sperm for fertilization of the partner's oocytes, has made biological fatherhood possible for men with obstructive azoospermia. There is limited knowledge of men's experience of their own infertility. The aim of this study was to describe men's experiences of obstructive azoospermia infertility.</p> <p>Methods</p> <p>Eight men with obstructive azoospermia, who had terminated Swedish public health system ART treatment two years previously without subsequent childbirth, were interviewed using a descriptive phenomenological method.</p> <p>Results</p> <p>The essence of the phenomenon is expressed with a metaphor: climbing a mountain step by step with the aim of reaching the top, i.e. having a child and thus a family with a child. Four constituents are included (1) inadequacy followed by a feeling of redress (2) marginalisation, (3) chivalry (4) extension of life and starting a family as driving forces.</p> <p>Conclusions</p> <p>Knowledge of men's experiences of their own infertility is important as a supporting measure to increase the quality of care of infertile couples. By adopting this facet of gender perspective in fertility treatment guidelines, care can hopefully be optimized.</p