A Symbiosis of Access: Proliferating STEM PhD Training in the U.S. from 1920-2010.

Over the course of the 20th century, unprecedented growth in scientific discovery was fueled by broad growth in the number of university-based scientists. During this period the American undergraduate enrollment rate and number of universities with STEM graduate programs each doubled three times and the annual volume of new PhDs doubled six times. This generated the research capacity that allowed the United States to surpass early European-dominated science production and lead for the rest of the century. Here, we focus on origins in the organizational environment and institutional dynamics instead of conventional economic factors. We argue that three trends of such dynamics in the development of American higher education not often considered together-mass undergraduate education, decentralized founding of universities, and flexible mission charters for PhD training-form a process characterized by a term coined here: access symbiosis. Then using a 90-year data series on STEM PhD production and institutional development, we demonstrate the historical progression of these mutually beneficial trends. This access symbiosis in the U.S., and perhaps versions of it in other nations, is likely one critical component of the integration of higher education development with the growing global capacity for scientific discovery. These results are discussed in terms of the contributions of American universities to the Century of Science, recent international trends, and its future viability.

Explaining the Education-Health Gradient in Preventing STIs in Andean Peru: Cognitive Executive Functioning, Awareness and Health Knowledge.

CONTEXT: Little is known about the pathways mediating the relationship between education and health. It is widely assumed that formal schooling leads to awareness of health risks (e.g., STIs) and, in turn, to adoption of preventive behavior (e.g., condom use); however, evidence supporting this mechanism has been limited. METHODS: Survey data were collected in 2010 from a sample of 247 adults aged 30-62 living in an isolated Andean district of Peru; these individuals had widely varying exposure to schooling, and their community had recently experienced elevated risks of STIs. Structural equation modeling was used to estimate the degree to which schooling is associated with cognitive resources, STI awareness and sexual health knowledge, and how these jointly are associated with ever-use of condoms. RESULTS: Thirty-two percent of respondents reported ever-use of condoms. One additional year of schooling was associated with a 2.7-percentage-point increase in the probability of condom use, after adjustment for covariates. The pathway between education and condom use was mediated by cognitive executive functioning (CEF) skills (0.26 standard deviations), STI awareness (0.09) and sexual health knowledge (0.10); CEF skills were associated with condom use both directly and indirectly, through STI awareness and sexual health knowledge, and accounted for two-thirds of the education-condom use gradient. CONCLUSIONS: The relationship between education and STI prevention may be more complex than is often assumed and is mediated by CEF skills, STI awareness and sexual health knowledge. Studies should examine whether STI prevention interventions are more effective if they enhance cognitive skills used to translate information into protective behaviors.

RESUMEN Contexto: Se sabe poco acerca de las vías que median la relación entre el nivel educativo y la salud. Generalmente se supone que la escolaridad formal conduce a la conciencia de los riesgos para la salud (por ejemplo, las ITS) y, a su vez, a la adopción de un comportamiento preventivo (por ejemplo, el uso del condón); sin embargo, la evidencia que apoya este mecanismo ha sido limitada. Métodos: Los datos de la encuesta se obtuvieron en 2010 de una muestra de 247 adultos de 30 a 62 años que vivían en un distrito andino aislado de Perú; estas personas tenían una exposición muy variable a la escolaridad y su comunidad había experimentado recientemente riesgos elevados de ITS. Se usó el modelo de ecuaciones estructurales para estimar el grado en que la escolaridad se asociaba con los recursos cognitivos, la conciencia de las ITS y el conocimiento de la salud sexual y cómo estos se asocian conjuntamente con el haber usado alguna vez condones. Resultados: El treinta y dos por ciento de los encuestados informaron que alguna vez usaron condones. Un año adicional de escolaridad se asoció con un aumento de 2.7 puntos porcentuales en la probabilidad de uso del condón, después del ajuste por covariables. La vía entre el nivel educativo y el uso del condón estuvo mediada por las habilidades de funcionamiento cognitivo ejecutivo (FCE) (0.26 desviaciones estándar), conciencia de las ITS (0.09) y conocimiento de salud sexual (0.10); Las habilidades de FCE se asociaron con el uso del condón tanto directa como indirectamente, a través de la conciencia de las ITS y los conocimientos sobre salud sexual y representaron dos tercios del gradiente educativo del uso del condón. Conclusiones: La relación entre el nivel educativo y la prevención de las ITS podría ser más compleja de lo que a menudo se supone y está mediada por las habilidades de FCE, la conciencia de las ITS y el conocimiento de la salud sexual. Los estudios deben examinar si las intervenciones de prevención de ITS son más efectivas si mejoran las habilidades cognitivas utilizadas para traducir la información en comportamientos protectores.

RÉSUMÉ Contexte: Les voies de médiation de la relation entre l'éducation et la santé ne sont guère documentées. Il est généralement présumé que la scolarité mène à la conscience des risques de santé (par ex., les IST), qui conduit à son tour à l'adoption d'un comportement préventif (par ex., l'utilisation du préservatif). Les données qui appuient ce mécanisme sont cependant limitées. Méthodes: Des données d'enquête ont été collectées en 2010 auprès d'un échantillon de 247 adultes de 30 à 62 ans vivant dans un district andin isolé du Pérou. Ces personnes présentaient une exposition fort variable à la scolarité et leur communauté était depuis peu confrontée à un risque élevé d'IST. La modélisation par équation structurelle a permis d'estimer le degré d'association entre, d'une part, la scolarité et, d'autre part, les ressources cognitives, la conscience des IST et la connaissance en matière de santé sexuelle, ainsi que de déterminer l'association globale de ces éléments avec le fait d'avoir déjà utilisé le préservatif. Résultats: Trente-deux pour cent des répondants ont déclaré avoir utilisé le préservatif. Chaque année supplémentaire de scolarité s'est avérée associée à une augmentation de 2,7 points de pourcentage de la probabilité d'usage du préservatif, sous correction des covariables. Le lien entre l'éducation et l'utilisation du préservatif était induit par les compétences de fonctionnement exécutif cognitif (FEC) (écarts types de 0,26), la conscience des IST (0,09) et la connaissance en matière de santé sexuelle (0,10). Les compétences FEC étaient associées à l'utilisation du préservatif de façon directe et indirecte, du fait de la conscience des IST et de la connaissance en matière de santé sexuelle; elles représentaient deux tiers du gradient éducation-utilisation du préservatif. Conclusions: La relation entre l'éducation et la prévention des IST peut être plus complexe qu'on ne le pense souvent. Elle est induite par les compétences FEC, la conscience des IST et la connaissance en matière de santé sexuelle. Il serait utile d'examiner si les interventions de prévention des IST sont plus efficaces quand elles améliorent les compétences cognitives qui traduisent l'information en comportements de protection.

The Population Education Transition Curve: Education Gradients Across Population Exposure to New Health Risks.

The salutary effect of formal education on health-risk behaviors and mortality is extensively documented: ceteris paribus, greater educational attainment leads to healthier lives and longevity. Even though the epidemiological evidence has strongly indicated formal education as a leading "social vaccine," there is intermittent reporting of counter-education gradients for health-risk behavior and associated outcomes for certain populations during specific periods. How can education have both beneficial and harmful effects on health, and under which contexts do particular effects emerge? It is useful to conceptualize the influence of education as a process sensitive to the nature, timing of entry, and uniqueness of a new pleasurable and desirable lifestyle and/or product (such as smoking) with initially unclear health risks for populations. Developed herein is a hypothesis that the education gradient comprises multiple potent pathways (material, psychological, cognitive) by which health-risk behaviors are influenced, and that there can be circumstances under which pathways act in opposite directions or are differentially suppressed and enhanced. We propose the population education transition (PET) curve as a unifying functional form to predict shifting education gradients across the onset and course of a population's exposure to new health risks and their associated consequences. Then, we estimate PET curves for cases with prior epidemiological evidence of heterogeneous education gradients with health-risk behaviors related to mass-produced cigarettes in China and the United States; saturated fats, sugar, and processed food diets in Latin America; and HIV infection in sub-Saharan Africa. Each offers speculation on interactions between environmental factors during population exposure and education pathways to health-risk behaviors that could be responsible for the temporal dynamics of PET curves. Past epidemiological studies reporting either negative or positive education gradients may not represent contradictory findings as much as come from analyses unintentionally limited to just one part of the PET process. Last, the PET curve formulation offers richer nuances about educational pathways, macro-historical population dynamics, and the fundamental cause of disease paradigm.

The Role of Objective Numeracy and Fluid Intelligence in Sex-Related Protective Behaviors.

A wealth of studies has indicated that greater cognitive ability is related to healthier behaviors and outcomes throughout the lifespan. In the present paper, we focus on objective numeracy (ability with numbers) and present findings from a study conducted in the Peruvian Highlands that examines the relations among formal education, numeracy, other more general cognitive skills, and a sex-related protective behavior (condom use). Our results show a potential unique protective effect of numeracy on this healthprotective behavior even after accounting for measures of fluid intelligence and potential confounding factors. These results add to a growing literature highlighting the robust protective effect on health behaviors of greater cognitive skills that are enhanced through schooling. Challenges for future research will be identifying the causal mechanisms that underlie these effects and translating this knowledge into effective interventions for improving health.

Non-linear education gradient across the nutrition transition: mothers' overweight and the population education transition.

OBJECTIVE: Previous studies found that developed and developing countries present opposite education-overweight gradients but have not considered the dynamics at different levels of national development. An inverted U-shaped curve is hypothesized to best describe the education-overweight association. It is also hypothesized that as the nutrition transition unfolds within nations the shape of education-overweight curve changes. DESIGN: Multilevel logistic regression was used to estimate the moderating effect of the nutrition transition at the population level on the education-overweight gradient. At the individual level, a non-linear estimate of the education association was used to assess the optimal functional form of the association across the nutrition transition. SETTING: Twenty-two administrations of the Demographic and Health Survey, collected at different time points across the nutrition transition in nine Latin American/Caribbean countries. SUBJECTS: Mothers of reproductive age (15-49 years) in each administration (n 143 258). RESULTS: In the pooled sample, a non-linear education gradient on mothers' overweight was found; each additional year of schooling increases the probability of being overweight up to the end of primary schooling, after which each additional year of schooling decreases the probability of overweight. Also, as access to diets high in animal fats and sweeteners increases over time, the curve's critical point moves to lower education levels, the detrimental positive effect of education diminishes, and both occur as the overall risk of overweight increases with greater access to harmful diets. CONCLUSIONS: Both hypotheses were supported. As the nutrition transition progresses, the education-overweight curve shifts steadily to a negative linear association with a higher average risk of overweight; and education, at increasingly lower levels, acts as a 'social vaccine' against increasing risk of overweight. These empirical patterns fit the general 'population education transition' curve hypothesis about how education's influences on health risks are contextualized across population transitions.

A meta-analysis of education effects on chronic disease: the causal dynamics of the Population Education Transition Curve.

As the Epidemiological Transition progresses worldwide, chronic diseases account for the majority of deaths in developed countries and a rising proportion in developing countries indicating a new global pattern of mortality and health challenges into the future. Attainment of formal education is widely reported to have a negative gradient with risk factors and onset of chronic disease, yet there has not been a formal assessment of this research. A random-effects meta-analysis finds that across 414 published effects more education significantly reduces the likelihood of chronic disease, except for neoplastic diseases with substantial genetic causes. Some studies, however, report null effects and other research on infectious disease report positive education gradients. Instead of assuming these contradictory results are spurious, it is suggested that they are part of a predictable systemic interaction between multiple mediating effects of education and the Epidemiological Transition stage of the population; and thus represent one case of the Population Education Transition Curve modeling changes in the association between education and health as dependent on population context.

An envisioned bridge: schooling as a neurocognitive developmental institution.

The potential contribution of social science research to close the gap of knowledge between cognitive neuroscience and educational research has been underappreciated. Despite their virtual absence in the interdisciplinary dialog of neuroscience, sociology of education and related study of the cultural impact of formal education have generated research relevant to an understanding of how the social environment, such as widespread schooling, co-evolves with, and enhances neurocognitive development. Two clusters of isolated research literatures are synthesized that taken together anticipates a dynamic integration of neuroscience and education. The first cluster is on the social construction of cognition through formal education in contemporary society, including the effects of schooling on neurological and cognitive development; the demographic expansion of exposure to the developmental influence of schooling; and education's cultural impact on the meaning of the learning experience and reinforcement of cognition as the key human capability across ever more key institutions in postindustrial society. The second cluster turns the issue around by examining current investigations from neuroscience that support neurological hypotheses about the causes behind the schooling effect on neurocognitive development. We propose that further integration of these literatures will provide a more ecologically valid context in which to investigate the evolving functional architecture of the contemporary brain.

Understanding the association between maternal education and use of health services in Ghana: exploring the role of health knowledge.

This paper examines the role of health knowledge in the association between mothers' education and use of maternal and child health services in Ghana. The study uses data from a nationally representative sample of female respondents to the 2008 Ghana Demographic and Health Survey. Ordered probit regression models evaluate whether women's health knowledge helps to explain use of three specific maternal and child health services: antenatal care, giving birth with the supervision of a trained professional and complete child vaccination. The analyses reveal that mothers' years of formal education are strongly associated with health knowledge; health knowledge helps explain the association between maternal education and use of health services; and, net of a set of stringent demographic and socioeconomic controls, mothers' health knowledge is a key factor associated with use of health services.

The education effect on population health: a reassessment.

Demographic research frequently reports consistent and significant associations between formal educational attainment and a range of health risks such as smoking, drug abuse, and accidents, as well as the contraction of many diseases, and health outcomes such as mortality­almost all indicating the same conclusion: better-educated individuals are healthier and live longer. Despite the substantial reporting of a robust education effect, there is inadequate appreciation of its independent influence and role as a causal agent. To address the effect of education on health in general, three contributions are provided: 1) a macro-level summary of the dimensions of the worldwide educational revolution and a reassessment of its causal role in the health of individuals and in the demographic health transition are carried out; 2) a meta-analysis of methodologically sophisticated studies of the effect of educational attainment on all-cause mortality is conducted to establish the independence and robustness of the education effect on health; and 3) a schooling-cognition hypothesis about the influence of education as a powerful determinant of health is developed in light of new multidisciplinary cognitive research.

Facts, attitudes, and health reasoning about HIV and AIDS: explaining the education effect on condom use among adults in sub-Saharan Africa.

In contrast to earlier in the HIV/AIDS pandemic, net of other demographic factors, formal education acts as a preventative factor in sub-Saharan Africa. Despite this trend, there has been almost no research on the causal mechanisms behind the widely reported education effect. Consistent with the education effect, structural equation modeling of the influence of education attainment on condom use with Demographic Health Survey data from nine sub-Saharan Africa nations collected between 2003 and 2005 finds that net of control variables, there is a robust, positive influence of education on condom use among sexually risky adults. Information-transfer and attitude change, the two most commonly assumed educational influences on the use of condoms, are tested, and although education attainment increases acquisition of basic facts and the inculcation of positive attitudes about HIV/AIDS, these factors have only weak influence on condom use. Given this, a new hypothesis about education's enhancement of health reasoning is developed from neuro-developmental and decision-making research. Modeling finds that education robustly influences health reasoning ability and this factor mediates a significant proportion of the education effect on condom use. The results raise concern about the enormous effort by NGOs in the region to use mainly fact- and attitude-based educational programs to reduce future HIV infections. Future research on the causal mechanisms behind the association between education and HIV/AIDS prevention should focus how on schooling enhances the cognitive skills needed for health reasoning.

Explaining the effect of education on health: a field study in Ghana.

Higher education (or more years of formal schooling) is widely associated with better health, but the underlying causes of this association are unclear. In this study, we tested our schooling-decision-making model, which posits that formal education fosters intellectual ability, which in turn provides individuals with enduring competencies to support better health-related behaviors. Using data from a field study on formal education in 181 adults in rural Ghana, we examined health-protective behaviors related to HIV/AIDS infection, a critical health issue in Ghana. As expected, individuals with more education practiced more protective health behaviors. Our structural equation modeling analysis showed that cognitive abilities, numeracy, and decision-making abilities increased with exposure to schooling, and that these enhanced abilities (and not HIV/AIDS knowledge) mediated the effects of education on health-protective behavior. Research and policy implications for HIV prevention efforts in sub-Saharan Africa are discussed.

Assessing teamwork attitudes in healthcare: development of the TeamSTEPPS teamwork attitudes questionnaire.

INTRODUCTION: The report, To Err is Human, indicated that a large number of deaths are caused by medical error. A central tenet of this report was that patient safety was not only a function of sophisticated healthcare technology and treatments, but also the degree to which healthcare professionals could perform effectively as teams. Research suggests that teamwork comprises four core skills: Leadership, Situation Monitoring, Mutual Support and Communication. In healthcare, team training programmes, such as TeamSTEPPS®, are designed to improve participant knowledge of, attitudes towards, and skills in these core areas. If such training programmes are effective, changes in knowledge, attitudes and skills should be observed. The purpose of this study was to develop and validate the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ), a measure designed to assess attitudes towards the core components of teamwork in healthcare. METHOD: A pilot test version of the survey was developed and administered to 495 respondents from various healthcare organisations. RESULTS: Classical item statistics were used to select the final T-TAQ items. Based on this analysis, 30 of the original 110 items were selected for inclusion in the final instrument. Scale reliabilities exceed 0.7, and scales were found to be moderately correlated. DISCUSSION: The T-TAQ provides a useful, reliable and valid tool for assessing individual attitudes related to the role of teamwork in the delivery of healthcare. Issues related to its use and interpretation are discussed.

Development and validation of Aviation Causal Contributors for Error Reporting Systems (ACCERS).

OBJECTIVE: This investigation sought to develop a reliable and valid classification system for identifying and classifying the underlying causes of pilot errors reported under the Aviation Safety Action Program (ASAP). BACKGROUND: ASAP is a voluntary safety program that air carriers may establish to study pilot and crew performance on the line. In ASAP programs, similar to the Aviation Safety Reporting System, pilots self-report incidents by filing a short text description of the event. The identification of contributors to errors is critical if organizations are to improve human performance, yet it is difficult for analysts to extract this information from text narratives. A taxonomy was needed that could be used by pilots to classify the causes of errors. METHOD: After completing a thorough literature review, pilot interviews and a card-sorting task were conducted in Studies 1 and 2 to develop the initial structure of the Aviation Causal Contributors for Event Reporting Systems (ACCERS) taxonomy. The reliability and utility of ACCERS was then tested in studies 3a and 3b by having pilots independently classify the primary and secondary causes of ASAP reports. RESULTS: The results provided initial evidence for the internal and external validity of ACCERS. Pilots were found to demonstrate adequate levels of agreement with respect to their category classifications. CONCLUSIONS: ACCERS appears to be a useful system for studying human error captured under pilot ASAP reports. Future work should focus on how ACCERS is organized and whether it can be used or modified to classify human error in ASAP programs for other aviation-related job categories such as dispatchers. APPLICATION: Potential applications of this research include systems in which individuals self-report errors and that attempt to extract and classify the causes of those events.

Teamwork as an essential component of high-reliability organizations.

Organizations are increasingly becoming dynamic and unstable. This evolution has given rise to greater reliance on teams and increased complexity in terms of team composition, skills required, and degree of risk involved. High-reliability organizations (HROs) are those that exist in such hazardous environments where the consequences of errors are high, but the occurrence of error is extremely low. In this article, we argue that teamwork is an essential component of achieving high reliability particularly in health care organizations. We describe the fundamental characteristics of teams, review strategies in team training, demonstrate the criticality of teamwork in HROs and finally, identify specific challenges the health care community must address to improve teamwork and enhance reliability.

The role of teamwork in the professional education of physicians: current status and assessment recommendations.

BACKGROUND: The Institute of Medicine (IOM) has recommended that organizations establish interdisciplinary team training programs that incorporate proven methods for team management. Teamwork can be assessed during physician medical education, board certification, licensure, and continuing practice. Team members must possess specific knowledge, skills, and attitudes (KSAs), such as the ability to exchange information, which enable individual team members to coordinate. ASSESSING PHYSICIAN TEAMWORK: KSAs might be elicited and assessed across a physician's career, starting in medical school and continuing through licensure and board certification. Professional bodies should be responsible for the development of specific team knowledge and skill competencies and for promoting specific team attitude competencies. Tools are available to assess medical student, resident, and physician competence in these critical team KSAs. CHALLENGES AND COMPLEXITIES IN TEAM PERFORMANCE MEASUREMENT: For teamwork skills to be assessed and have credibility, team performance measures must be grounded in team theory, account for individual and team-level performance, capture team process and outcomes, adhere to standards for reliability and validity, and address real or perceived barriers to measurement.