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Recently, defaults have become celebrated as a low-cost and easy-to-implement nudge for promoting positive outcomes, both at an individual and societal level. In the present research, we conducted a large-scale field experiment (N = 32,508) in an educational context to test the effectiveness of a default intervention in promoting participation in a potentially beneficial achievement test. We found that a default manipulation increased the rate at which high school students registered to take the test but failed to produce a significant change in students’ actual rate of test-taking. These results join past literature documenting robust effects of default framings on initial choice but marked variability in the extent to which those choices ultimately translate to real-world outcomes. We suggest that this variability is attributable to differences in choice-to-outcome pathways – the extent to which the initial choice is causally determinative of the outcome.

Background “Meds-to-bed” programs are a quality improvement intervention that is gaining wider implementation throughout the United States. The University of Oklahoma hospital system did not have this program and sought to implement one. While there is sufficient data on the benefits of meds-to-bed programs, there is a lack of literature on describing the development and implementation process. Objectives The objective of this paper is to describe the planning process, implementation, and barriers encountered during the organization of a pharmacy-led meds-to-bed program operating within two large teaching hospitals. Practice Description The University of Oklahoma Health Sciences Center campus has seven colleges, multiple primary care and specialty clinics, and two hospitals. Additionally, there are three on-campus outpatient pharmacies operated by the University of Oklahoma College of Pharmacy. Practice Innovation The University of Oklahoma College of Pharmacy implemented a meds-to-beds program primarily serving two on-campus hospitals, The Oklahoma Children’s Hospital and OU Medical Center. The program operated out of The Children’s Pharmacy, an outpatient pharmacy located within the Children’s Hospital. Evaluation Methods A Plan-Do-Study-Act model was used which allowed for adaptation in response to barriers encountered throughout the process. Frequent meetings among stakeholders were held to continuously evaluate progress (e.g. awareness and utilization of the program and prescription counts) and make necessary changes. Results Implementation of the program required changes in workflow both within the pharmacy and within the registration and discharge processes of medical teams. Additionally, following the initiation of the meds-to-beds program, the daily prescription count more than doubled. The program averages 40 deliveries per day with three prescriptions per delivery and continues to grow providing evidence of a successful meds-to-bed implementation. Conclusion The Plan-Do-Study-Act model allowed for many adjustments to be made throughout the process, including the conversion from an opt-in to an opt-out model to increase program utilization.

Researchers and practitioners in marketing, economics, and public policy often use preference elicitation tasks to forecast real-world behaviors. These tasks typically ask a series of similarly structured questions. The authors posit that every time a respondent answers an additional elicitation question, two things happen: (1) they provide information about some parameter(s) of interest, such as their time preference or the partworth for a product attribute, and (2) the respondent increasingly “adapts” to the task—that is, using task-specific decision processes specialized for this task that may or may not apply to other tasks. Importantly, adaptation comes at the cost of potential mismatch between the task-specific decision process and real-world processes that generate the target behaviors, such that asking more questions can reduce external validity. The authors used mouse and eye tracking to trace decision processes in time preference measurement and conjoint choice tasks. Respondents increasingly relied on task-specific decision processes as more questions were asked, leading to reduced external validity for both related tasks and real-world behaviors. Importantly, the external validity of measured preferences peaked after as few as seven questions in both types of tasks. When measuring preferences, less can be more.

Purpose The college of pharmacy has operated pharmacies on campus for over 26 years. Employees and patients are users of the pharmacies; however, utilization across the campus has been limited. This paper describes a process, as well as results, that was used to gather input from employees on a large university health sciences center campus on pharmacy needs and related behaviors on campus pharmacy utilization. Methods Two focus groups of staff and 4 focus groups of prescribers were conducted over 1 month. Participants were selected through purposive sampling via email within an academic health sciences center campus over a 1-month period. The sessions were moderated by one investigator using a preconstructed discussion guide and lasted 1 hour. Two additional investigators observed sessions for nonverbal communication; all sessions were audio recorded for subsequent transcription. An open-coding process was performed on verbatim transcripts using NVivo12. The investigator team then developed, refined, and grouped themes during subsequent group discussions. Results A total of 44 participants took part in 6 focus groups. Participants included prescribers (physicians, nurses, physician assistants) and staff (nonprescribers). Two major themes identified were (1) factors related to on-campus pharmacies and (2) qualities valued in a pharmacy. There was an equal split (8% for each group) on awareness of the on-campus pharmacies. Almost 11% of participants commented on the accessibility of a pharmacy being a quality valued in a pharmacy. Conclusion Focus groups provided insights for the administration team regarding additional value-added services that would be helpful for the campus community, as well as various approaches to increase utilization of the on-campus pharmacies. Focus group methodology is an effective approach to engage employees of a large university campus to garner new ideas to enhance existing policies or services, as well as to gather thoughts on preliminary strategic plans before implementation.

This manuscript is the short, preliminary summary of a large preregistered online study investigating the effect sizes of five established effects across eight online panels revealed significant heterogeneity of effect sizes. Some effect sizes were negatively correlated across panels, challenging a unidimensional evaluation of online panels. This result was replicated in a preregistered follow-up study. We show that panels differ on confounder variables that explain the heterogeneity and negative correlation of effect sizes across panels. This offers opportunities for a deeper understanding of the effects we study in consumer research. Panel choice, we argue, should be an integral part of the experimental design in consumer research.

We examine a Query Theory account of risky choice framing effects — when risky choices are framed as a gain, people are generally risky averse but, when an equivalent choice is framed as a loss, people are risk seeking. Consistent with Query Theory, frames affected the structure of participants’ arguments: gain frame participants listed arguments favoring the certain option earlier and more often than loss frame participants. These argumentative shifts mediated framing effects; manipulating participants initial arguments attenuated them. While emotions, as measured by PANAS, were related to frames but not related to choices, an exploratory text analysis of the affective valence of arguments was related to both. Compared to loss-frame participants, gain-frame participants expressed more positive sentiment towards the certain option than the risky option. Thisrelative-sentiment indexpredicted choices by itself but not when included with structure of arguments. Further, manipulated initial arguments did not significantly affect participant’s relative sentiment. Prior to changing choices, risky choice frames alter both the structure and emotional valence of participants’ internal arguments.

Community input matters in long-term decisions related to climate change, including the development of public infrastructure. In order to assess the effect of different ways of informing the public about infrastructure projects, a sample of people in the United States (n = 630) was provided with a case study concerning the redevelopment of the San Diego Airport. Participants received the same written information about the projected future condition of the airport. In addition, participants received images either portraying current conditions or portraying conditions in 2100 based on NOAA (National Oceanic and Atmospheric Administration) sea-level rise data. Participants were asked to choose 7 out of 21 design options to implement in the redevelopment project. The framework used for the design options stemmed from the Envision rating system. We analyzed the participants’ selection of the credits using generalized linear mixed models. Those that received the images portraying the future were significantly more likely to select design options that would reduce the risk of climate change and flooding. Images portraying sea-level rise had different effects depending on participant demographics. Such images increased the selection of design elements related to the climate and risk for participants identifying as female or as Democrat. For participants identifying as male or as Republican, the same images increased their selection of design elements to enhance community public space. The results demonstrate the positive effects of portraying the future in terms of encouraging focus on long-term sustainable design decisions for infrastructure systems. Published version

Making good health insurance decisions is important for health outcomes and longevity, but consumers’ errors are well documented. The authors examine whether targeted choice architecture interventions can reduce these mistakes. The article examines the interaction of two choice architecture tools on improved consumer insurance decisions in online health care exchanges: (1) ordering the options from best to worst based on a high-quality user model and (2) partitioning the total set of options. Although ordering and partitioning do not always improve choices separately, the authors use one field study and three experiments to identify the conditions that allow the combination to greatly improve health insurance decisions. Findings indicate that when options are ordered such that the best options appear at the beginning of the presented list, partitioning nudges consumers to focus on the best options. However, if the best options are not at the top of the list, partitioning discourages search and can impair consumers’ discovery of the best options. Process data show that these effects are achieved by focusing consumers’ limited attention on higher-quality options. These results suggest that wise choice architecture interventions need to consider the joint effect of choice architecture tools as well as the quality of the firm's user model.

How can firms encourage consumers to adopt smartphone apps? The authors show that several inexpensive choice architecture techniques can make users more likely to enable important app features and complete app onboarding. In six preregistered experiments (n = 5,968) and a field experiment (n = 594,997), choice architecture interventions manipulating choice sequence, color, and wording of app adoption decisions dramatically increased app adoption. Across experiments, integrating multiple feature decisions into a single choice increased adoption. This integration effect emerges because it decreases decision noise and reduces the prominence of individual features, consistent with support theory. Changing colors to match habitual patterns commonly found in current digital interfaces appears to increase adoption by accelerating consumers’ decisions. Finally, wording options as if enabling the app is the default response (even without changing the actual default) also increases adoption. These “defaultless defaults” may be particularly relevant in heavily regulated consumer domains, such as finance or health care. The effects generalized across different types of apps and were robust across subsamples varying in demographics, attitudes toward the apps, and political affiliation. These results suggest simple tools that marketing managers and app developers can use to increase app adoption.

Infrastructure professionals (N = 261) were randomly assigned to either a future or present-framed project description and asked to recommend design attributes for an infrastructure project. The future-framed condition led professionals to propose a significantly longer infrastructure design life, useful life to the community, and acceptable return on financial investment. The findings suggest a straightforward and inexpensive way to lessen present bias in various design contexts National Science Foundation [1744246] Published version This material is based upon work supported by the National Science Foundation under Grant No. 1744246. We are grateful for feedback and support from Anthony Kane, Lindsey Geiger, Allen Townsend, and Anne Janisch.

Extracellular vesicles (EVs) are nano-sized lipid bilayer encapsulated particles with a molecular cargo that appears to play important roles within the human body, such as in cell-to-cell communication. Unraveling the composition of EV cargos remains one of the most fundamental steps toward understanding the role of EVs in intercellular communication and the discovery of new biomarkers. One of the unmet needs in this field is the lack of a robust, sensitive, and multiplexed method for EV mRNA profiling. We established a new protocol using the NanoString low RNA input nCounter assay by which the targeted mRNA transcripts in EVs can be efficiently and specifically amplified and then assayed for 770 mRNAs in one reaction. Prostate cancer cells with epithelial (PC3-Epi) or mesenchymal (PC3-EMT) phenotypes and their progeny EVs were analyzed by the same panel. Among these mRNAs, 157 were detected in PC3-Epi EVs and 564 were detected in PC3-EMT EVs. NOTCH1 was the most significantly abundant mRNA transcripts in PC3-EMT EVs compared to PC3-Epi EVs. Our results demonstrated that when cells undergo epithelial-to-mesenchymal transition (EMT), a more active loading of cancer progression-related mRNA transcripts may occur. The mRNA cargos of EVs derived from mesenchymal prostate cancer cells may contribute to the pro-EMT function. We found that mRNA transcripts are different in progeny EVs compared to parental cells. EV cargos are not completely reflective of their cell origin, and the underlying mechanism of cargo sorting is complicated and needs to be further elucidated.

Perioperative pulmonary aspiration (PPA) is a major cause of morbidity and mortality. During anesthesia, airway reflexes become depressed, placing patients at risk of PPA. Gastric ultrasonography (GUS) can be used to qualitatively differentiate between solids, liquids, and empty gastric contents. The purpose of this study was to determine the sensitivity and specificity of GUS in identifying gastric contents after participants were randomly assigned to consume 1 donut, drink 360 mL of water, or remain fasted (n=60 each group). Ultrasonography was performed by a blinded scanner, and qualitative findings were recorded by 2 sonography examiners and the primary scanner. Findings from the water group included a sensitivity of 95% to 100% and specificity of 87.5% to 90% for identification of liquids. Interrater reliability results yielded an intraclass correlation coefficient (ICC)=.781 for the solid group; ICC=.950 for the fluid group; and ICC=.761 for the fasted group. Statistically significant differences were found for the effect that body mass index classifications had on sensitivity and specificity of GUS for predicting gastric content. Results of this study demonstrated that GUS is highly sensitive, specific, and reliable with low false-positive and false-negative rates in the identification of fluid gastric content.

Background With the advent of precision oncology, liquid biopsies are quickly gaining acceptance in the clinical setting. However, in some cases, the amount of DNA isolated is insufficient for Next-Generation Sequencing (NGS) analysis. The nCounter platform could be an alternative, but it has never been explored for detection of clinically relevant alterations in fluids. Methods Circulating-free DNA (cfDNA) was purified from blood, cerebrospinal fluid, and ascites of patients with cancer and analyzed with the nCounter 3 D Single Nucleotide Variant (SNV) Solid Tumor Panel, which allows for detection of 97 driver mutations in 24 genes. Results Validation experiments revealed that the nCounter SNV panel could detect mutations at allelic fractions of 0.02–2% in samples with ≥5 pg mutant DNA/µL. In a retrospective analysis of 70 cfDNAs from patients with cancer, the panel successfully detected EGFR, KRAS, BRAF, PIK3CA, and NRAS mutations when compared with previous genotyping in the same liquid biopsies and paired tumor tissues [Cohen kappa of 0.96 (CI = 0.92–1.00) and 0.90 (CI = 0.74–1.00), respectively]. In a prospective study including 91 liquid biopsies from patients with different malignancies, 90 yielded valid results with the SNV panel and mutations in EGFR, KRAS, BRAF, PIK3CA, TP53, NFE2L2, CTNNB1, ALK, FBXW7, and PTEN were found. Finally, serial liquid biopsies from a patient with NSCLC revealed that the semiquantitative results of the mutation analysis by the SNV panel correlated with the evolution of the disease. Conclusions The nCounter platform requires less DNA than NGS and can be employed for routine mutation testing in liquid biopsies of patients with cancer.

Objectives The profession of pharmacy has long advocated for the advancement of practice through increased clinical responsibility. Provision of immunization related services has been one service pharmacists have been able to provide to add to their existing responsibilities. A universal influenza vaccination has been under investigation and is nearing success. While other clinical services should be considered, now more than ever, development of the universal vaccine should provide a pause for the profession and consideration of not only the impact on student learning opportunities but also pharmacy revenue. Summary The development of the universal influenza vaccination poses a potential challenge to existing service-related revenue models for community pharmacies. There are many other opportunities pharmacists can capitalize on including, but not limited to, travel and other vaccinations, point-of-care testing, and transitions-of-care. In addition, through initiatives such as “Flip the Pharmacy” and Community Pharmacy Enhanced Service Network, pharmacists are in a great position to be innovative with clinical services while continuing to provide learners with training opportunities. Conclusion Many opportunities exist for pharmacists to expand services that lean into their clinical training and add other vaccination opportunities. These opportunities can augment revenue streams and still provide learners with training.

The rapid decline of indigenous languages represents one of the most troubling topics within applied linguistics. Teachers’ implementation of indigenous language planning through their pedagogical practices is a significant but under-researched issue. This ethnographic study examines a Maya language program (i.e., professional development) for 1,600 teachers in the Yucatan’s Intercultural Bilingual Education (EIB) system, and K-12 schools in Maya-speaking communities where they worked. Using longitudinal data (2010-2016), analysis centered on the creation and promulgation of the Norms of Writing for the Maya Language (2014) and related language policy. Findings illustrate: 1) the importance of increasing the quantity of Maya-speaking teachers, and 2) a clash between widespread orthographic variation in Maya and teachers’ standard language-culture. The new standard has not been implemented in EIB, which still does not in practice require Maya proficiency of teachers. This research discusses possible benefits and risks of a standard Maya for EIB.

The administrative response to the coronavirus identified in 2019 (COVID-19) pandemic for a variety of units housed in the University of Oklahoma College of Pharmacy is described. Continuity of operations, essential vs nonessential personnel, distance learning, online testing procedures for the Doctor of Pharmacy degree program, and the impact on development are discussed.

Background and purpose To report student perceived adequacy regarding didactic content and practical experiences of vaccination clinic business operations. Educational activity and setting Didactic content, a case study, and practical experiences regarding vaccination clinic business operations were implemented in related lectures of a Pharmacy Business and Entrepreneurship (PBE) elective and the college of pharmacy sponsored vaccination clinics. An online survey was used to evaluate student perceived adequacy of didactic content and practical experiences of vaccination clinic business operations. Findings Mean scaled agreement was compared between students in the PBE elective versus those not in the elective. Student confidence in performing business operations was also assessed. Students in the PBE had higher mean confidence than non-elective students regarding staff management (3.23 vs. 2.73, p = 0.04). Summary Success of the interventions may be attributed to students in the PBE elective that reported a higher mean perceived adequacy of content and practical experiences and confidence in performing nearly all business operations. Still, further evaluation of interventions is being considered to assess effectiveness of learning.

Objective Elicit student preferences for didactic content and practical experiences of vaccination clinic business operations. Design Pharmacy students who worked at least one shift in a campus-wide vaccination clinic managed by the College of Pharmacy during the fall 2012 and fall 2013 semesters were invited to participate in an online survey. Students were sent a link to the survey immediately after working in the vaccination clinic and were given two weeks to electronically complete the survey. Assessment In all, 83 out of 110 students (75.5%) responded to the online survey. A majority of students indicated that didactic content and practical experiences of business operations related to vaccination clinics were needed. The two business operations for which the largest proportions of students agreed they would like to have included were didactic content of billing information (62.5%), and practical experience of managing clinic staff (78.5%). Conclusion Students indicated preference for both didactic content and practical experiences related to vaccination clinic business operations. Didactic content about operations will be implemented in an entrepreneurship elective in the College of Pharmacy, and related practical experiences will be made available to students who work in the vaccine clinic. Course coordinators will assess student learning following implementation of the integrated didactic and experiential instructional model.

The Schoenberg Database of Manuscripts can be used not only to track the provenance of individual manuscripts, but also to uncover larger patterns in multiple provenance strings of manuscripts. For example, does an individual auction sale or bookseller’s catalogue have any discernable influence on the acquisitions made by a collector or institution? Or is the publication of a collection or exhibition catalogue preceded or followed by any discernable pattern of acquisition activity? This paper explores patterns of acquisition, exhibition and sale associated with the collections of William Bragge (1823-1884) of Sheffield and Dr. T. Shadford Walker (1834-1885) of Liverpool. Bragge was the largest single exhibitor in the Burlington Fine Arts Club exhibition in 1874. The sale of his library less than two years later at Sotheby’s in June 1876 was only identified as the property of “a gentleman of consummate taste and judgment,” but full reports in The Times revealed his identity to those not already in the know. Not surprisingly the London antiquarian booksellers, Bernard Quaritch, were a major buyer at the sale; its Catalogue 31 published in the fall of 1876 after the sale contains numerous items acquired there. Quaritch was also apparently bidding on behalf of the British Museum and of Dr. Walker of Liverpool. In October of the same year Walker was a major contributor to the Liverpool Fine Arts Club exhibition of illuminated manuscripts and every one of the 18 manuscripts exhibited by Walker had been purchased at the Bragge sale earlier that year.

Objectives To provide guidance for safe and appropriate vitamin and mineral supplementation regimens for patients who use vitamins marketed for ocular use concurrently with general-purpose multivitamin (MVI) supplementation. Data sources Primary and tertiary evidence was compiled from secondary literature reference databases. Study selection Dosage exposure with the use of supplements marketed for the prevention of ocular disease, including those recommended by the Age-Related Eye Disease Studies (AREDS), when used in combination with conventional MVI/nutrient products was determined. An analysis of the data was performed to suggest appropriate supplement recommendations. Data extraction Combined dosages for single and duplicate ingredients found in ocular supplements and select MVI/nutrient supplements were compared with U.S. Food and Drug Administration--recommended daily value intake levels and the National Academy of Medicine recommendations on vitamin and nutrient tolerable upper intake levels (TUILs). Results With the exception of copper, all studied product components that conformed to AREDS guidelines for vitamin and nutrient levels far exceeded U.S. Food and Drug Administration--recommended daily value intake level limits. Furthermore, vitamin A and zinc exceeded the National Academies of Medicine TUIL when a multivitamin product was combined with an ocular-specific vitamin or nutrient that conformed with AREDS-recommended dosage levels. Several products marketed specifically for ocular use failed to provide AREDS-recommended vitamin or nutrient levels even when combined with MVI products. Conclusion With the exception of vitamin A and zinc, the addition of typical multivitamin preparations to AREDS-recommended vitamin and nutrient regimens do not result in vitamin and mineral dosages that exceed TUIL as outlined by the National Academy of Medicine. However, combined AREDS and MVI regimens can create a substantial vitamin or mineral burden that is not appropriate for all older adult populations, particularly those with comorbidities, contributing to susceptibility of component toxicity.

To examine the perceptions among faculty and health professional students regarding mandatory vaccination policies on a health sciences campus.A total of 296 faculty and 244 students completed surveys during Fall 2015.The online survey administered to individuals who received the influenza vaccine during the fall 2015 influenza vaccination clinic season included five items evaluating perceptions of employer mandatory vaccination requirements.Chi-square analysis indicated that although faculty and students agree mandatory vaccinations in a health care environment are appropriate, faculty are more likely than students to get vaccinated in the absence of a mandate. Additionally, a small fraction of faculty would consider employment elsewhere when facing this mandate.Overall, faculty and students had favorable perceptions about mandatory influenza vaccine policies. Since students were less likely to be vaccinated in the absence of a mandate, education of students should be improved to support the importance of vaccinations in a health care environment.

Objective To assess the design and implementation of influenza vaccination clinics across campus, assess participant satisfaction with the pharmacist-led clinics, and educate and increase visibility of the role of pharmacists as vaccinators. Setting University of Oklahoma Health Sciences Center (OUHSC), a comprehensive health sciences center. Practice innovation The College of Pharmacy on the OUHSC campus developed and implemented a vaccination program to increase influenza vaccination of OUHSC employees. Main outcome measures Number of employees receiving influenza vaccination, employee satisfaction with the pharmacist-led clinics, and employee awareness of the pharmacist's role in vaccination. Results Reported OUHSC employee influenza vaccination rates increased from approximately 35% before implementation of the pharmacy-based program to 54% in 2012 after implementation. The increase was attributed to maintaining no out-of-pocket costs for employees, offering various clinic locations, and using media resources to educate employees about influenza infection and vaccination. Employees reported high satisfaction with the influenza vaccination clinics and with receiving vaccinations from pharmacists and student pharmacists. In the first 2 years of the program, the percentage of surveyed employees "very familiar" with the pharmacist's role in vaccinations increased from 23% to 66%. Conclusion A college of pharmacy on a large health sciences center developed and successfully implemented an influenza vaccination program, providing an accessible and convenient route for influenza prevention to employees, as well as enhanced the visibility of pharmacists as vaccination providers.