Sharing Reliable COVID-19 Information and Countering Misinformation: In-Depth Interviews With Information Advocates.

BACKGROUND: The rampant spread of misinformation about COVID-19 has been linked to a lower uptake of preventive behaviors such as vaccination. Some individuals, however, have been able to resist believing in COVID-19 misinformation. Further, some have acted as information advocates, spreading accurate information and combating misinformation about the pandemic. OBJECTIVE: This work explores highly knowledgeable information advocates' perspectives, behaviors, and information-related practices. METHODS: To identify participants for this study, we used outcomes of survey research of a national sample of 1498 adults to find individuals who scored a perfect or near-perfect score on COVID-19 knowledge questions and who also self-reported actively sharing or responding to news information within the past week. Among this subsample, we selected a diverse sample of 25 individuals to participate in a 1-time, phone-based, semistructured interview. Interviews were recorded and transcribed, and the team conducted an inductive thematic analysis. RESULTS: Participants reported trusting in science, data-driven sources, public health, medical experts, and organizations. They had mixed levels of trust in various social media sites to find reliable health information, noting distrust in particular sites such as Facebook (Meta Platforms) and more trust in specific accounts on Twitter (X Corp) and Reddit (Advance Publications). They reported relying on multiple sources of information to find facts instead of depending on their intuition and emotions to inform their perspectives about COVID-19. Participants determined the credibility of information by cross-referencing it, identifying information sources and their potential biases, clarifying information they were unclear about with health care providers, and using fact-checking sites to verify information. Most participants reported ignoring misinformation. Others, however, responded to misinformation by flagging, reporting, and responding to it on social media sites. Some described feeling more comfortable responding to misinformation in person than online. Participants' responses to misinformation posted on the internet depended on various factors, including their relationship to the individual posting the misinformation, their level of outrage in response to it, and how dangerous they perceived it could be if others acted on such information. CONCLUSIONS: This research illustrates how well-informed US adults assess the credibility of COVID-19 information, how they share it, and how they respond to misinformation. It illustrates web-based and offline information practices and describes how the role of interpersonal relationships contributes to their preferences for acting on such information. Implications of our findings could help inform future training in health information literacy, interpersonal information advocacy, and organizational information advocacy. It is critical to continue working to share reliable health information and debunk misinformation, particularly since this information informs health behaviors.

Influences on male college students' patient-provider communications and uptake behaviors related to the human papillomavirus vaccine.

OBJECTIVE: We assessed the psychosocial influences on college males' human papillomavirus (HPV) vaccine patient-provider communication and their uptake of one or more HPV vaccine doses. METHODS: We conducted a cross-sectional survey with college males attending one large southwestern university. We used logistic regressions to explore the relationships between psychosocial and demographic variables on patient-provider communication and HPV vaccine uptake. RESULTS: Patient-provider communication had the most significant influence on HPV vaccine uptake. However, most college males reported never discussing the HPV vaccine with their healthcare providers. HPV vaccine awareness, perceived subjective norms to vaccinate, and behavioral control to talk to healthcare providers about the vaccine significantly influenced college males' patient-provider communication and vaccine uptake. CONCLUSION: HPV vaccine awareness, perceived behavioral control to communicate about the vaccine, and subjective norms to vaccinate are all addressable factors that influence HPV vaccine communication and uptake. Future intervention work should specifically target these factors for college men.

The feasibility and acceptability of a pilot randomized controlled trial testing pharmacy-based HPV vaccine completion.

OBJECTIVE: Immunizing pharmacists can administer vaccines; however, they are less likely to administer adolescent vaccines such as vaccines that protect against human papillomavirus (HPV). Although past research has recommended incorporating pharmacists to increase adolescent vaccination, few intervention studies have tested healthcare delivery models that incorporate pharmacists to aid in vaccine series completion. This research explored the feasibility and acceptability of an intervention in which pharmacists administered booster doses of the HPV vaccine series. METHODS: Between April 2019 and February 2020, the research team recruited participants for a pilot randomized controlled trial hosted in one federally qualified health center (FQHC) clinic. Researchers asked intervention group participants to complete the HPV vaccine series with their community pharmacists and control group participants to complete the series at their FQHC. We conducted a pre- and post-intervention surveys and in-depth interviews with both intervention and control group participants. RESULTS: A total of 33 parents of children who received the first dose of the HPV vaccine enrolled in the study of whom 8 intervention and 11 control group participants completed post-intervention data collection. Although there were no statistically significant changes in vaccine completion and in psychometric variables, we did find that pharmacist-delivered HPV vaccination was acceptable, due, primarily, to convenience. Barriers to receiving pharmacist-administered vaccines included pharmacies' lack of stocking the vaccine and insurance-related barriers to care. CONCLUSION: Although a promising and acceptable healthcare delivery approach, there are still barriers for caregivers to have their children vaccinated against HPV at their community pharmacies.

Rural Caregivers' Willingness for Community Pharmacists to Administer the HPV Vaccine to Their Age-Eligible Children.

Human papillomavirus (HPV) vaccination uptake varies by geographic regions with rural, often medically underserved areas, lagging behind more urban regions in terms of vaccine initiation and completion. In these regions, pharmacies may serve as an additional location for HPV vaccine administration. Little is known about rural caregivers' willingness to have their HPV vaccine age-eligible children obtain this vaccine from their local pharmacist. First and second authors conducted 26 in-depth interviews with caregivers of HPV vaccine age-eligible children living in rural regions of a southwestern state to explore their perceptions of the HPV vaccine and their willingness for pharmacist-administered HPV vaccination. They analyzed interview data using an inductive qualitative content analyses approach. The majority of caregivers were unaware that pharmacists could offer adolescent vaccines. However, most were willing to allow their children to receive the vaccine from this non-traditional source. Comments related to obtaining vaccinations from pharmacists related mostly to concerns about proper training and their certification to vaccinate against HPV. Caregivers believed that having a pharmacist administer the HPV vaccine would not affect their relationship with their primary care provider. Caregivers preferred print health education resources and were interested in also receiving health information via social media to learn more about the HPV vaccine and pharmacists' role in HPV vaccine administration. Pharmacies may serve as an additional site to increase HPV vaccine initiation and completion. Rural regions need additional health information about the HPV vaccine and pharmacists' abilities to administer this cancer prevention resource.

Contrasting cumulative risk and multiple individual risk models of the relationship between Adverse Childhood Experiences (ACEs) and adult health outcomes.

BACKGROUND: A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of self-reported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other. Also, while a cumulative numeric 'ACE Score' is normative, there are differences in the way it is calculated and used in statistical models. We investigated differences in model fit and performance between the cumulative ACE Score and a 'multiple individual risk' (MIR) model that enters individual ACE events together into prediction models. We also investigated differences that arise from the use of different strategies for coding and calculating the ACE Score. METHODS: We merged the 2011-2012 BRFSS data (N = 56,640) and analyzed 3 outcomes. We compared descriptive model fit metrics and used Vuong's test for model selection to arrive at best fit models using the cumulative ACE Score (as both a continuous or categorical variable) and the MIR model, and then statistically compared the best fit models to each other. RESULTS: The multiple individual risk model was a better fit than the categorical ACE Score for the 'lifetime history of depression' outcome. For the outcomes of obesity and cardiac disease, the cumulative risk and multiple individual risks models were of comparable fit, but yield different and complementary inferences. CONCLUSIONS: Additional information-rich inferences about ACE-health relationships can be obtained from including a multiple individual risk modeling strategy. Results suggest that investigators working with large srACEs data sources could empirically derive the number of items, as well as the exposure coding strategy, that are a best fit for the outcome under study. A multiple individual risk model could also be considered in addition to the cumulative risk model, potentially in place of estimation of unadjusted ACE-outcome relationships.

Screening for anal cancer precursors among patients living with HIV in the absence of national guidelines: practitioners' perspectives.

PURPOSE: Immunocompromised populations including people living with HIV (PLWH) suffer disproportionate burden from anal cancer, a rare cancer caused by persistent infection of the anal canal with oncogenic strains of human papillomavirus. In the US, there are no nationally adopted screening guidelines for anal cancer. In the absence of such guidelines, this study explores healthcare practitioners' screening practices for early signs of anal cancer among PLWH. METHODS: Between November 2017 and June 2018, the research team completed 25 interviews among a diverse sample of healthcare practitioners who provide care for PLWH. RESULTS: Providers expressed frustration that screening and treatment guidelines for anal cancer were scant, and they varied in their screening practices. The majority of providers screened PLWH for anal dysplasia via the anal Pap smear; few providers were trained and had the medical equipment to conduct high-resolution anoscopy-guided biopsies, a more sensitive and specific screening method. Others screened through digital ano-rectal examinations (DARE) and both visually and with a DARE. Participants discussed how providers may be over-treating their patients who have high-grade anal intraepithelial neoplasia (AIN) and the role of biomarkers to determine whether the lesion is carcinogenic. CONCLUSIONS: Practitioners who provide care for PLWH are proactive in screening to help prevent and control anal cancer, a rare and slow-growing disease. Continuing to regularly surveil high-risk populations, particularly PLWH previously diagnosed with high-grade lesions, is critical to prevent and control anal cancer.

Changing the Culture of Academic Medicine: Critical Mass or Critical Actors?

PURPOSE: By 2006, women constituted 34% of academic medical faculty, reaching a critical mass. Theoretically, with critical mass, culture and policy supportive of gender equity should be evident. We explore whether having a critical mass of women transforms institutional culture and organizational change. METHODS: Career development program participants were interviewed to elucidate their experiences in academic health centers (AHCs). Focus group discussions were held with institutional leaders to explore their perceptions about contemporary challenges related to gender and leadership. Content analysis of both data sources revealed points of convergence. Findings were interpreted using the theory of critical mass. RESULTS: Two nested domains emerged: the individual domain included the rewards and personal satisfaction of meaningful work, personal agency, tensions between cultural expectations of family and academic roles, and women's efforts to work for gender equity. The institutional domain depicted the sociocultural environment of AHCs that shaped women's experience, both personally and professionally, lack of institutional strategies to engage women in organizational initiatives, and the influence of one leader on women's ascent to leadership. CONCLUSIONS: The predominant evidence from this research demonstrates that the institutional barriers and sociocultural environment continue to be formidable obstacles confronting women, stalling the transformational effects expected from achieving a critical mass of women faculty. We conclude that the promise of critical mass as a turning point for women should be abandoned in favor of "critical actor" leaders, both women and men, who individually and collectively have the commitment and power to create gender-equitable cultures in AHCs.

Disclosing neuroimaging incidental findings: a qualitative thematic analysis of health literacy challenges.

BACKGROUND: Returning neuroimaging incidental findings (IF) may create a challenge to research participants' health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders involved in disclosing IF. METHODS: We surveyed participants who had received a radiology report from a research study and conducted focus groups with participants, parents of child participants, Institutional Review Board (IRB) members, investigators and physicians. Qualitative thematic analyses were conducted using standard group-coding procedures and descriptive summaries of health literacy scores and radiology report outcomes are examined. RESULTS: Although participants reported high health literacy skills (m = 87.3 on a scale of 1-100), 67 % did not seek medical care when recommended to do so; and many participants in the focus groups disclosed they could not understand the findings described in their report. Despite their lack of understanding, participants desire to have information about their radiology results, and the investigators feel ethically inclined to return findings. CONCLUSIONS: The language in clinically useful radiology reports can create a challenge for participants' health literacy skills and has the potential to negatively impact the healthcare system and investigators conducting imaging research. Radiology reports need accompanying resources that explain findings in lay language, which can help reduce the challenge caused by the need to communicate incidental findings.

Narratives of Participants in National Career Development Programs for Women in Academic Medicine: Identifying the Opportunities for Strategic Investment.

BACKGROUND: Academic medicine has initiated changes in policy, practice, and programs over the past several decades to address persistent gender disparity and other issues pertinent to its sociocultural context. Three career development programs were implemented to prepare women faculty to succeed in academic medicine: two sponsored by the Association of American Medical Colleges, which began a professional development program for early career women faculty in 1988. By 1995, it had evolved into two programs one for early career women and another for mid-career women. By 2012, more than 4000 women faculty from medical schools across the U.S and Canada had participated in these intensive 3-day programs. The third national program, the Hedwig van Ameringen Executive Leadership in Academic Medicine(®) (ELAM) program for women, was developed in 1995 at the Drexel University College of Medicine. METHODS: Narratives from telephone interviews representing reflections on 78 career development seminars between 1988 and 2010 describe the dynamic relationships between individual, institutional, and sociocultural influences on participants' career advancement. RESULTS: The narratives illuminate the pathway from participating in a career development program to self-defined success in academic medicine in revealing a host of influences that promoted and/or hindered program attendance and participants' ability to benefit after the program in both individual and institutional systems. The context for understanding the importance of these career development programs to women's advancement is nestled in the sociocultural environment, which includes both the gender-related influences and the current status of institutional practices that support women faculty. CONCLUSIONS: The findings contribute to the growing evidence that career development programs, concurrent with strategic, intentional support of institutional leaders, are necessary to achieve gender equity and diversity inclusion.

Evolution of universal review and disclosure of MRI reports to research participants.

BACKGROUND: Although incidental findings (IF) are commonly encountered in neuroimaging research, there is no consensus regarding what to do with them. Whether researchers are obligated to review scans for IF, or if such findings should be disclosed to research participants at all, is controversial. Objective data are required to inform reasonable research policy; unfortunately, such data are lacking in the published literature. This manuscript summarizes the development of a radiology review and disclosure system in place at a neuroimaging research institute and its impact on key stakeholders. METHODS: The evolution of a universal radiology review system is described, from inception to its current status. Financial information is reviewed, and stakeholder impact is characterized through surveys and interviews. RESULTS: Consistent with prior reports, 34% of research participants had an incidental finding identified, of which 2.5% required urgent medical attention. A total of 87% of research participants wanted their magnetic resonance imaging (MRI) results regardless of clinical significance and 91% considered getting an MRI report a benefit of study participation. A total of 63% of participants who were encouraged to see a doctor about their incidental finding actually followed up with a physician. Reasons provided for not following-up included already knowing the finding existed (14%), not being able to afford seeing a physician (29%), or being reassured after speaking with the institute's Medical Director (43%). Of those participants who followed the recommendation to see a physician, nine (38%) required further diagnostic testing. No participants, including those who pursued further testing, regretted receiving their MRI report, although two participants expressed concern about the excessive personal cost. The current cost of the radiology review system is about $23 per scan. CONCLUSIONS: It is possible to provide universal radiology review of research scans through a system that is cost-effective, minimizes investigator burden, and does not overwhelm local healthcare resources.

Viewing Focus Groups Through a Critical Incident Lens.

Scholars often do not describe in detail the complex process of conducting focus groups, including what happens when they take unexpected turns. A critical incident lens provides a framework for better analyzing and understanding what actually happens during focus group sessions. Using a critical incident approach, we examine our experiences of carrying out focus groups about the human papillomavirus (HPV) vaccine with vaccine-eligible adolescent girls and parents/caregivers of vaccine-eligible adolescent girls in New Mexico. The critical incident lens allowed us to productively explore the context and interactional dynamics of our focus groups and ultimately pushed us to talk through the challenges of conducting and analyzing them. We hope this serves as a call to qualitative researchers to be attentive to the critical incidents in your own research to enrich your analysis and contribute to a broader discussion of the realities of focus group conduct.

'Ethical responsibility' or 'a whole can of worms': differences in opinion on incidental finding review and disclosure in neuroimaging research from focus group discussions with participants, parents, IRB members, investigators, physicians and community members.

PURPOSE: To identify the specific needs, preferences and expectations of the stakeholders impacted by returning neuroimaging incidental findings to research participants. METHODS: Six key stakeholder groups were identified to participate in focus group discussions at our active neuroimaging research facility: Participants, Parents of child participants, Investigators, Institutional Review Board (IRB) Members, Physicians and Community Members. A total of 151 subjects attended these discussions. Transcripts were analysed using principles of Grounded Theory and group consensus coding. RESULTS: A series of similar and divergent themes were identified across our subject groups. Similarities included beliefs that it is ethical for researchers to disclose incidental findings as it grants certain health and emotional benefits to participants. All stakeholders also recognised the potential psychological and financial risks to disclosure. Divergent perspectives elucidated consistent differences between our 'Participant' subjects (Participants, Parents, Community Members) and our 'Professional' subjects (IRB Members, Investigators and Physicians). Key differences included (1) what results should be reported, (2) participants' autonomous right to research information and (3) the perception of the risk-benefit ratio in managing results. CONCLUSIONS: Understanding the perceived impact on all stakeholders involved in the process of disclosing incidental findings is necessary to determine appropriate research management policy. Our data further demonstrate the challenge of this task as different stakeholders evaluate the balance between risk and benefit related to their unique positions in this process. These findings offer some of the first qualitative insight into the expectations of the diverse stakeholders affected by incidental finding disclosure.

Along the way to developing a theory of the program: a re-examination of the conceptual framework as an organizing strategy.

PURPOSE: Conceptual frameworks (CF) have historically been used to develop program theory. We re-examine the literature about the role of CF in this context, specifically how they can be used to create descriptive and prescriptive theories, as building blocks for a program theory. Using a case example of colorectal cancer screening intervention development, we describe the process of developing our initial CF, the methods used to explore the constructs in the framework and revise the framework for intervention development. METHODS: We present seven steps that guided the development of our CF: (1) assemble the "right" research team, (2) incorporate existing literature into the emerging CF, (3) construct the conceptual framework, (4) diagram the framework, (5) operationalize the framework: develop the research design and measures, (6) conduct the research, and (7) revise the framework. RESULTS: A revised conceptual framework depicted more complicated inter-relationships of the different predisposing, enabling, reinforcing, and system-based factors. The updated framework led us to generate program theory and serves as the basis for designing future intervention studies and outcome evaluations. CONCLUSIONS: A CF can build a foundation for program theory. We provide a set of concrete steps and lessons learned to assist practitioners in developing a CF.

Perceptions of skill development of participants in three national career development programs for women faculty in academic medicine.

PURPOSE: The Association of American Medical Colleges (AAMC) and Drexel University College of Medicine have designed and implemented national career development programs (CDPs) to help women faculty acquire and strengthen skills needed for success in academic medicine. The authors hypothesized that skills women acquired in CDPs would vary by career stage and program attended. METHOD: In 2011, the authors surveyed a national cohort of 2,779 women listed in the AAMC Faculty Roster who also attended one of three CDPs (Early- and Mid-Career Women in Medicine Seminars, and/or Executive Leadership in Academic Medicine) between 1988 and 2010 to examine their characteristics and CDP experiences. Participants indicated from a list of 16 skills whether each skill was newly acquired, improved, or not improved as a result of their program participation. RESULTS: Of 2,537 eligible CDP women, 942 clicked on the link in an invitation e-mail, and 879 (93%) completed the survey. Respondents were representative of women faculty in academic medicine. Participants rated the CDPs highly. Almost all reported gaining and/or improving skills from the CDP. Four skills predominated across all three programs: interpersonal skills, leadership, negotiation, and networking. The skills that attendees endorsed differed by respondents' career stages, more so than by program attended. CONCLUSIONS: Women participants perceived varying skills gained or improved from their attendance at the CDPs. Determining ways in which CDPs can support women's advancement in academic medicine requires a deeper understanding of what participants seek from CDPs and how they use program content to advance their careers.

Identifying barriers to healthcare to reduce health disparity in Zuni Indians using focus group conducted by community health workers.

The Zuni Pueblo is home to an economically disadvantaged population, which faces a public health challenge from the interrelated epidemics of obesity, diabetes and kidney disease. Efforts to decrease the impact of these epidemics have been complicated by historical, economic and cultural barriers, which may limit healthcare utilization. The NIH supported Zuni Health Initiative (ZHI) conducted a study to identify barriers to healthcare in the Zuni Pueblo. Community health representatives (CHRs) led 14 one-hour focus group sessions at which a total of 112 people participated posed unique questions that took into account the Zuni culture to elicit information on perceived barriers to healthcare. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program. We identified nine themes emerged regarding the barriers experienced in receiving healthcare and adhering to medical advice. These included distance; transportation; embarrassment; relating to healthcare professionals; navigating the medical system; awareness of available resources; waiting times; adhering to medication; and incentives in health promotion. In conclusion the implementation of culturally appropriate community-based health promotion programs and preventive screening techniques will improve access to healthcare and diminish health disparities.

Different models of HPV vaccine decision-making among adolescent girls, parents, and health-care clinicians in New Mexico.

OBJECTIVE: Human papillomavirus (HPV) vaccination rates in the United States have been lower than anticipated since the vaccine became widely available globally in 2006. Of particular concern are data that suggest disparities in vaccine receipt among US ethnic minority and health disparity populations such as Hispanics, who are disproportionately affected by cervical cancer. Given these trends, it is important to examine actual vaccination decision-making processes among clinicians, parents, and adolescents to identify strategies to enhance uptake. DESIGN: We conducted a mixed-method study examining HPV vaccine decision-making, utilizing both structured questionnaires of primarily Hispanic mothers and daughters (aged 12-18) and semi-structured interviews with mothers, daughters, and health-care clinicians to more deeply investigate decision-making dynamics. Quantitative analysis was used for descriptive purposes, while qualitative analysis featured an iterative process to examine factors related to decision-making surrounding the HPV vaccine. The study was conducted in two primary care clinics serving predominantly Hispanic patients in an urban New Mexico setting through Research Involving Outpatient Setting Network (RIOS Net), a primary care practice-based research network. RESULTS: We administered 22 questionnaires and conducted 30 interviews. We identified three aspects of vaccine delivery that were similar across clinics: availability/supply of the vaccine, favorable clinician attitudes toward the vaccine, and clinicians' competing demands. We also identified three decision-making stages (pre-encounter, encounter, and post-encounter), though we found distinct differences in decision-making processes at the two sites. We describe the differences between an encounter-based and a process-based model of decision-making, and the ways in which explanatory factors might influence the decision-making process. CONCLUSION: Our findings suggest that factors other than race and ethnicity, such as education, socioeconomic status, and health-care access, play an important role in HPV vaccination decisions. Further research to elucidate the specific informational needs and communication strategies associated with these factors will be needed to enhance vaccine uptake.

Sponsorship: a path to the academic medicine C-suite for women faculty?

Despite increases in the percentages of women medical school graduates and faculty over the past decade, women physicians and scientists remain underrepresented in academic medicine's highest-level executive positions, known as the "C-suite." The challenges of today and the future require novel approaches and solutions that depend on having diverse leaders. Such diversity has been widely shown to be critical to creating initiatives and solving complex problems such as those facing academic medicine and science. However, neither formal mentoring programs focused on individual career development nor executive coaching programs focused on individual job performance have led to substantial increases in the proportion of women in academic medicine's top leadership positions.Faced with a similar dilemma, the corporate world has initiated sponsorship programs designed to accelerate the careers of women as leaders. Sponsors differ from mentors and coaches in one key area: They have the position and power to advocate publicly for the advancement of nascent talent, including women, in the organization. Although academic medicine differs from the corporate world, the strong sponsorship programs that have advanced women into corporations' upper levels of leadership can serve as models for sponsorship programs to launch new leaders in academic medicine.

Negative affect predicts adults' ratings of the current, but not childhood, impact of adverse childhood events.

Adverse childhood events (ACE's) have been empirically related to a wide range of negative health and mental health outcomes. However, not all individuals who experience ACE's follow a trajectory of poor outcomes, and not all individuals perceive the impact of ACE's as necessarily negative. The purpose of this study was to investigate positive and negative affect as predictors of adults' ratings of both the childhood and adult impact of their childhood adversity. Self-report data on ACE experiences, including number, severity, and 'impact' were collected from 158 community members recruited on the basis of having adverse childhood experiences. Results indicated that, regardless of event severity and number of different types of adverse events experienced, high levels of negative affect were the strongest predictor of whether the adult impact of the adverse childhood events was rated as negative. All individuals rated the childhood impact of events the same. Implications are discussed.

Clinical and translational scientist career success: metrics for evaluation.

Despite the increased emphasis on formal training in clinical and translational research and the growth in the number and scope of training programs over the past decade, the impact of training on research productivity and career success has yet to be fully evaluated at the institutional level. In this article, the Education Evaluation Working Group of the Clinical and Translational Science Award Consortium introduces selected metrics and methods associated with the assessment of key factors that affect research career success. The goals in providing this information are to encourage more consistent data collection across training sites, to foster more rigorous and systematic exploration of factors associated with career success, and to help address previously identified difficulties in program evaluation.

Children's safety on American Indian farms: information and recommendations.

It is estimated that 1.2 million youth younger than age 20 live on farms; American Indian children constitute an important but understudied subset of this at-risk group. Despite documented risks of injuries and death among children who live and work on farms and a descending trend in the overall reported fatalities among youth who live and/or work on farms, very little is known about the agriculture-related injury and fatality experience of American Indian youth. Limited data indicate that drowning, motor vehicles, and poisonings are leading causes of unintentional mortality and morbidity for this group, although the attribution to agricultural exposure is not evident. The scant available data indicate a need to look more closely at agricultural work, bystander exposures, and other farm events that put American Indian youth at risk of illness, injury, or death compared to factors more fully reported for majority youth in the agriculture population, in order to guide intervention and prevention programs that are appropriate and acceptable to this vulnerable population.