Decline Is Not Inevitable: Changes in Science Identity during the Progression through a U.S. Middle School among Boys and Girls.

In the United States, science capital is important for navigating many aspects of life. Yet during middle school, science interest declines more for girls than boys. It is unclear, however, whether science identity also declines during the middle school years and if there are differences by gender. The authors advance prior research by modeling changes in science identity and associations with changes in identity-relevant characteristics using growth curve analyses on four waves of data from 760 middle school youth. For girls and boys, science identity changes over time; about 40 percent of the variance is within-person change, with the remainder explained by aggregate between-person differences. The associations of all identity-relevant characteristics with science identity are not significantly different for girls and boys, yet declines in average values of identity-relevant characteristics are larger for girls than boys.

Influence of prior authorization requirements on provider clinical decision-making.

OBJECTIVES: Prior authorization (PA) aims to promote the safe and effective use of medications and to control costs. However, PA-related administrative tasks can contribute to burden on health care providers. This study examines how such tasks affect treatment decisions. STUDY DESIGN: Cross-sectional, online survey. METHODS: We conducted an online survey of US medical providers in 2020 based on a convenience sample of 100,000 providers. Multivariate path analysis was used to examine associations among provider practice characteristics, step therapy and other health plan requirements, perceived burdens of PA, communication issues with insurers, and prescribing behaviors (prescribing a different medication than planned, avoiding prescribing of newer medications even if evidence-based guideline recommendations are met, and modifying a diagnosis). Weighted analyses were conducted to assess nonresponse bias. RESULTS: A total of 1173 respondents (1.2% response rate) provided 1147 usable surveys. Step therapy requirements had the largest effect on clinical decision-making. Other significant effects on clinical decision-making included perceived PA likelihood, communication issues, and health plan requirements (eg, clinical documentation). Weighted analyses showed that the study conclusions were unlikely to have been biased by nonresponse. CONCLUSIONS: Respondents report that they may alter clinical decisions to avoid PA requirements and related burdens, even in cases in which use of the PA medication was clinically appropriate. Processes that reduce the administrative burden of PA through improved communication and transparency as well as standardized documentation may help ensure that PA more seamlessly achieves its goals of safe and effective use of medications.

Accuracy of COVID-19 relevant knowledge among youth: Number of information sources matters.

Can comics effectively convey scientific knowledge about COVID-19 to youth? What types and how many sources of information did youth have about COVID-19 during the pandemic? How are sources of information associated with accurate COVID-19 knowledge? To answer these questions, we surveyed youth in grades 5-9 in a Midwestern United States school district in the winter of 2020-2021. The online survey used measures of COVID-19 knowledge and sources, with an embedded experiment on COVID-19 relevant comics. Guided by an integrated science capital and just-in-time health and science information acquisition model, we also measured level of science capital, science identity, and utility of science for health and society. The school district protocol required parental consent for participation; 264 of ~15,000 youth participated. Youth were randomly assigned one of four comic conditions before receiving an online survey. Results indicate that, similar to knowledge gains in comic studies on other science topics, reading the comics was associated with 7 to 29% higher accuracy about COVID-19. We found that youth reported getting information about COVID-19 from between 0-6 sources including media, family, friends, school, and experts. The bivariate positive association of news versus other sources with accuracy of knowledge did not persist in the full model, yet the positive association of a higher number of sources and accuracy did persist in the multivariate models. The degree of valuing the utility of science for their health moderated the number of sources to accuracy association. Those with less value on science for health had a stronger positive association of number of sources and accuracy in COVID-19 knowledge. We conclude that during a pandemic, even with health and science information ubiquitous in the news media, increasing youth access to a variety of accurate sources of information about science and health can increase youth knowledge.

Perceptions of prior authorization by use of electronic prior authorization software: A survey of providers in the United States.

BACKGROUND: Given provider, patient, and health plan administrative burden, there is consensus that the medication prior authorization (PA) process needs to be streamlined and standardized. This includes broader adoption of electronic PA (ePA) solutions, including real-time clinical benefit determination. Insight into provider experiences with ePA will help health plans and pharmacy benefit managers (PBMs) prioritize efforts and investments in PA process improvement. OBJECTIVE: To identify provider experiences with PA by their use of ePA technology in a national sample of providers from the United States. METHODS: An online, nationwide survey was sent to licensed providers in 2020. The survey obtained information on provider experiences with PA, including PA workload, time to the communication of a PA decision, and other PA-related interactions with plans/PBMs. Provider characteristics and survey responses by provider use of ePA were compared using analysis of variance tests for items based on ordinal scales and a chi-square test statistic for nominal variables. Multivariable regression analyses identified associations between ePA use and PA experience variables, controlling for provider characteristics. RESULTS: Of 1,147 providers submitting usable surveys, 58% reported personally using ePA for at least some of their PA submissions, 88% submit at least 1 PA in a typical week, and most (82%) spend up to 5 hours a week on PA submissions. A majority (58.5%) reported that manual PA is often required. Those using ePA submitted a higher volume of PAs (P < 0.001) and spent more time on PA submissions (P = 0.003) than providers not using ePA software, but the duration of time from start to finish for a PA submission did not differ (P = 0.211). Providers who use ePA reported more difficulty identifying step therapy requirements (P = 0.005) and more frequently needing to submit additional documentation (P = 0.022). PA-related communication failures did not differ. Those using ePA reported a shorter time to PA decision (P = 0.004) than those not using ePA. Univariate descriptive findings were supported by multivariable analyses. CONCLUSIONS: This large, nationwide survey identified that a provider's use of ePA was not associated with less provider time or fewer challenges in preparing and submitting PA requests. However, the use of ePA was associated with a reported shorter PA decision time. Efforts to standardize PA requirements, support of real-time benefits check functionality, and better integration of ePA processes into provider workflows may help reduce PA burden and treatment delays. DISCLOSURES: Funding provided by the National Institutes of Health (NIMH #1R41MH124600-01).

Discovery Orientation, Cognitive Schemas, and Disparities in Science Identity in Early Adolescence.

Why are some youth more likely to think of themselves as a science kind of person than others? In this paper, we use a cognitive social-theoretical framework to assess disparities in science identity among middle school-age youth in the United States. We investigate how discovery orientation is associated with science interest, perceived ability, importance, and reflected appraisal, and how they are related to whether youth see themselves, and perceive that others see them, as a science kind of person. We surveyed 441 students in an ethnically diverse, low-income middle school. Gender and race/ethnicity are associated with science identity but not with discovery orientation. Structural equation model results show that the positive association between discovery orientation and science identity is mediated by science interest, importance, and reflected appraisal. These findings advance understanding of how science attitudes and recognition may contribute to the underrepresentation of girls and/or minorities in science.

Informal Science Experiences among Urban and Rural Youth: Exploring Differences at the Intersections of Socioeconomic Status, Gender and Ethnicity.

The current study explores patterns of informal science experiences among youth in urban and rural middle schools by gender and socioeconomic status. Data come from surveys in two Midwestern middle schools, one in a mid-sized city, and the other in a rural-remote town. We asked about participation in informal science activities (e.g. visiting zoos or museums, or watching shows about science) and if youth had participated in science-focused clubs in the last 12 months (e.g. after-school science clubs, 4-H, scouts). Rural youth reported lower rates of participation in after-school science clubs and a greater desire to participate in after-school science programming than urban youth. Latino/a youth tend to have fewer informal science experiences than non-Latino/a youth, particularly in urban areas. There were few differences in informal science experiences between boys and girls, but in urban areas, girls report more science experiences than boys. Reported science experiences are overall higher in urban areas, yet youth with fewer resources (i.e. books in the home) have fewer informal science experiences overall. This study sheds new light on how socioeconomic status, gender, ethnicity, and geography interact with one another to shape youth science exposure and interest.

The potential scientist's dilemma: How the Masculinization of Science Shapes Friendships and Science Job Preferences.

In the United States, girls and boys have similar science achievement, yet fewer girls aspire to science careers than boys. This paradox emerges in middle school, when peers begin to play a stronger role in shaping adolescent identities. We use complete network data from a single middle school and theories of gender, identity, and social distance to explore how friendship patterns might influence this gender and science paradox. Three patterns highlight the social dimensions of gendered science persistence: (1) boys and girls do not differ in self-perceived science potential and science career aspirations; (2) consistent with gender-based norms, both middle school boys and girls report that the majority of their female friends are not science kinds of people; and (3) youth with gender-inconsistent science aspirations are more likely to be friends with each other than youth with gender normative science aspirations. Together, this evidence suggests that friendship dynamics contribute to gendered patterns in science career aspirations.

Science Possible Selves and the Desire to be a Scientist: Mindsets, Gender Bias, and Confidence during Early Adolescence.

In the United States, gender gaps in science interest widen during the middle school years. Recent research on adults shows that gender gaps in some academic fields are associated with mindsets about ability and gender-science biases. In a sample of 529 students in a U.S. middle school, we assess how explicit boy-science bias, science confidence, science possible self (belief in being able to become a scientist), and desire to be a scientist vary by gender. Guided by theories and prior research, we use a series of multivariate logistic regression models to examine the relationships between mindsets about ability and these variables. We control for self-reported science grades, social capital, and race/ethnic minority status. Results show that seeing academic ability as innate ("fixed mindsets") is associated with boy-science bias, and that younger girls have less boy-science bias than older girls. Fixed mindsets and boy-science bias are both negatively associated with a science possible self; science confidence is positively associated with a science possible self. In the final model, high science confident and having a science possible self are positively associated with a desire to be a scientist. Facilitating growth mindsets and countering boy-science bias in middle school may be fruitful interventions for widening participation in science careers.

The loss of self: The effect of miscarriage, stillbirth, and child death on maternal self-esteem.

A child's death augments how grieving parents view the world, the family, and the self. Using a representative sample of women ages 25-45 who have ever given birth, we assessed whether miscarriage, stillbirth, and child death impact self-esteem and whether this loss is moderated by maternal identity. We found that stillbirth and child death, but not miscarriage, negatively impacted self-esteem. For those who experienced a loss, the impact on self-esteem was moderated by maternal identity. Women who experienced a stillbirth were the only group who had significantly lower self-esteem after controlling for background characteristics and maternal identity variables.

Viruses, Vaccines and the Public.

Current research in virology is changing public conceptions about vaccines and infectious disease. The University of Nebraska State Museum collaborated with research virologists, science writers, artists and learning researchers to create public outreach materials about viruses and infectious disease. The project, funded by the National Institute of Health's SEPA program, developed comics, a book with Carl Zimmer, and other materials and programs. The project launched three kinds of learning research: 1) a survey of Nebraska adults on their opinions about vaccines and infectious disease; 2) a study comparing the mental models of viruses, vaccines and infection from virologists, teachers, and students; and 3) a controlled study 873 high school students randomly assigned to read either a comic or a text-based essay with the same virus information.

Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals.

BACKGROUND: To increase error reporting, a better understanding of physicians' and nurses' perspectives regarding medical error reporting in hospitals, barriers to reporting, and possible ways to increase reporting is necessary. METHODS: Nine focus groups--four with 49 staff nurses, two with 10 nurse managers, and three with 30 physicians--from 20 academic and community hospitals were conducted in May-June 2002 in the St. Louis metropolitan area. Qualitative analysis of focus group transcripts characterized participants' perspectives. RESULTS: Although participants knew they should report errors associated with serious adverse events, there was much uncertainty about reporting less serious errors or near misses. Nurses were more knowledgeable than physicians about how to report errors. All groups mentioned barriers to reporting, such as fear of reprisals and lack of confidentiality, time, and feedback after an error is reported. Some physicians doubted the benefit of reporting errors, but, generally, both physicians and nurses agreed that reporting was intended to change practice and policy to promote patient safety. CONCLUSIONS: A culture characterized by anonymous reporting, freedom from repercussions, and feedback about error reports should promote error reporting.

Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic.

BACKGROUND: Pharmacists' responsibilities in caring for patients with diabetes mellitus are expanding. However, few data are available to support pharmacists optimizing therapy and improving outcomes in these patients. OBJECTIVE: To determine the effect of a clinical pharmacist-directed diabetes management clinic on glycemic control and cardiovascular and renal parameters in patients with type 2 diabetes. METHODS: A nonrandomized, prospective study was conducted in 70 Veterans Affairs patients. Patients met with the pharmacist every 6-8 weeks for approximately 30 minutes for education, medication counseling, monitoring, and management. The primary endpoint was the impact of 9-12 months of participation in the clinic on glycosylated hemoglobin (HbA1C). Secondarily, we evaluated body weight, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, and level of microalbuminuria. All comparisons were made using a paired t-test at a significance level of p < or = 0.05. RESULTS: HbA1C significantly decreased from 10.3% +/- 2.2% at baseline to 6.9% +/- 1.1% (mean +/- SD) during the 9- to 12-month evaluation period (p < 0.001). The secondary endpoints including systolic (p < 0.001) and diastolic (p < 0.001) blood pressure, total cholesterol (p < 0.001), LDL-C (p < 0.001), triglycerides (p = 0.006), and level of microalbuminuria (p < 0.001) also were reduced at 9-12 months. CONCLUSIONS: This study demonstrated that a clinical pharmacist can effectively care for patients with diabetes referred by their primary care provider because of poor glycemic control.

Safety and efficacy of alteplase for restoring function in occluded central venous catheters: results of the cardiovascular thrombolytic to open occluded lines trial.

PURPOSE: To evaluate the safety and efficacy of alteplase (TPA) for restoring function to occluded central venous catheters (CVCs). PATIENTS AND METHODS: The study design was a phase III, open-label, single-arm multicenter trial. Subjects with occluded, nondialysis CVCs were enrolled. All subjects received a 2-mg dose of TPA within the dysfunctional catheter lumen that was allowed to dwell for 30 to 120 minutes. Functionality was tested at 30 and 120 minutes. If the CVC remained obstructed at 120 minutes, a second 2-mg TPA dose was allowed to dwell for 30 to 120 minutes. The primary safety end point was the rate of intracranial hemorrhage (ICH) within 5 days of treatment, and serious adverse events were recorded up to 30 days. RESULTS: Nine hundred ninety-five patients received treatment (female, 562; male, 433; mean age, 50.7 years; range, 2 to 91 years). CVCs treated were as follows: single (26%), double (39%), or triple (6%) lumen catheters or ports (29%). The primary end point was 0% ICH within 5 days. There were no cases of death, major bleeding episodes, or embolic events attributable to treatment. Flow was successfully restored in 52% and 78% of CVCs at 30 and 120 minutes after one dose, and 84% and 87% at 30 and 120 minutes after a second dose, respectively. Restoration of flow was 86%, 93%, 90%, and 79%, for single, double, and triple lumen catheters and ports, respectively. Estimated 30-day catheter patency was 74%. CONCLUSION: A regimen of up to two 2-mg doses of TPA is safe and effective for the restoration of flow to occluded central venous catheters.