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The growing acknowledgement of the phenomenon of individuals terminating their pregnancies by obtaining medications necessary for an abortion—what we refer to as “self- sourced and managed medication abortion” (SSMA)— has shed a light on the current contradictions in the world of abortion provision. In this paper, we offer a brief historical overview of the relationship of abortion provision and mainstream medicine, pointing to the various factors that have led to the marginalization of abortion care. We then turn to interviews with 40 physicians who provide abortions about their perspectives on SSMA, and we explore how this group responds to the contradictions presented by SSMA. In doing so, we interrogate the changing meaning of "physician authority" among this subset of physicians. We suggest that these interviewees represent an emergent sensibility among this generation of abortion physicians, a sensibility very tied to a commitment to social justice.

To assess adolescent awareness of the safety of self-removal of intrauterine contraception (IUC) and explore associations with sociodemographic characteristics, IUC knowledge, and personal experience using an IUC.We recruited women aged 15 to 20 years from 21 U.S. states and Washington, D.C. Participants completed an online survey assessing their communication with peers about contraception and knowledge and use of IUCs.Few (11%, 95% CI 9%-13%) adolescents knew that IUC self-removal is safe, whether or not they had personally used an IUC (14% vs 8%, p = 0.01). Knowledge that IUCs do not protect users from sexually transmitted infections (99% vs 91%, p0.001) and that IUCs can be removed early (99% vs 88%, p0.001) was higher among adolescents who had used an IUC than those who had not. Knowledge that IUC use does not adversely affect fertility after IUC removal (86% vs 63%, p0.001) and that IUCs are more effective than birth control pills (82% vs 50%, p0.001) also differed by personal experience with an IUC. Awareness of the safety of IUC self-removal was not associated with overall knowledge of IUCs. However, adolescents who knew that IUCs are more effective than birth control pills were more likely to be aware of the safety of IUC self-removal (OR = 1.85, 95% CI 1.12-3.05).Adolescent women in the U.S. possess incomplete knowledge of many important aspects of IUC use, and awareness of the safety of IUC self-removal is particularly low, even among those who have used an IUC.Efforts to increase adolescent knowledge of IUC should include information about the safety of IUC self-removal in order to safeguard adolescents' reproductive autonomy.

This essay is an ethnographic account of a volunteer, anonymous hotline of physicians and advanced practice providers who offer medical advice and guidance to those who are taking medications on their own to end their pregnancies. Attending to the phenomenology of caring on the Hotline reveals a new form of medical expertise at play, which we call “care with nothing in the way.” By operating outside the State’s scrutiny of abortion provision, the Hotline offers its volunteers a way to practice abortion care that aligns with their professional and political commitments and that distances them from the direct harm they see caused by the political, financial, and bureaucratic constraints of their clinical work. By delineating the structure of this new regime of care, these providers call into question the notion of the “good doctor.” They radically re-frame widely shared assumptions about the tenets of the ideal patient–doctor relationship and engender a new form of intimacy–one based, ironically, out of anonymity and not the familiarity that is often idealized in the caregiving relationship. We suggest the implications of “care with nothing in the way” are urgent, not only in the context of increasing hostility to abortion rights, but also for a culture of medicine plagued by physician burnout.

Sensitive motor outcome measures are needed to efficiently evaluate novel therapies for neurodegenerative diseases. Devices that can passively collect movement data in the home setting can provide continuous and ecologically valid measures of motor function. We tested the hypothesis that movement patterns extracted from continuous wrist accelerometer data capture motor impairment and disease progression in ataxia-telangiectasia. One week of continuous wrist accelerometer data were collected from 31 individuals with ataxia-telangiectasia and 27 controls aged 2-20 years old. Longitudinal wrist sensor data were collected in 14 ataxia-telangiectasia participants and 13 controls. A novel algorithm was developed to extract wrist submovements from the velocity time series. Wrist sensor features were compared with caregiver-reported motor function on the Caregiver Priorities and Child Health Index of Life with Disabilities survey and ataxia severity on the neurologist-performed Brief Ataxia Rating Scale. Submovements became smaller, slower, and less variable in ataxia-telangiectasia compared to controls. High-frequency oscillations in submovements were increased, and more variable and low-frequency oscillations were decreased and less variable in ataxia-telangiectasia. Wrist movement features correlated strongly with ataxia severity and caregiver-reported function, demonstrated high reliability, and showed significant progression over a 1-year interval. These results show that passive wrist sensor data produces interpretable and reliable measures that are sensitive to disease change, supporting their potential as ecologically valid motor biomarkers. The ability to obtain these measures from a low-cost sensor that is ubiquitous in smartwatches could help facilitate neurological care and participation in research regardless of geography and socioeconomic status.

This paper reflects on the significance of ABET’s “maverick evaluators” and what it says about the limits of accreditation as a mode of governance in US engineering education. The US system of engineering education operates as a highly complex system, where the diversity of the system is an asset to robust knowledge production and the production of a varied workforce. ABET Inc., the principal accreditation agency for engineering degree programs in the US, attempts to uphold a set of professional standards for engineering education using a voluntary, peer-based system of evaluation. Key to their approach is a volunteer army of trained program evaluators (PEVs) assigned by the engineering professional societies, who serve as the frontline workers responsible for auditing the content, learning outcomes, and continuous improvement processes utilized by every engineering degree program accredited by ABET. We take a look specifically at those who become labeled “maverick evaluators” in order to better understand how this system functions, and to understand its limitations as a form of governance in maintaining educational quality and appropriate professional standards within engineering education. ABET was established in 1932 as the Engineers’ Council for Professional Development (ECPD). The Cold War consensus around the engineering sciences led to a more quantitative system of accreditation first implemented in 1956. However, the decline of the Cold War and rising concerns about national competitiveness prompted ABET to shift to a more neoliberal model of accountability built around outcomes assessment and modeled after total quality management / continuous process improvement (TQM/CPI) processes that nominally gave PEVs greater discretion in evaluating engineering degree programs. However, conflicts over how the PEVs exercised judgment points to conservative aspects in the structure of the ABET organization, and within the engineering profession at large. This paper and the phenomena we describe here is one part of a broader, interview-based study of higher education governance and engineering educational reform within the United States. We have conducted over 300 interviews at more than 40 different academic institutions and professional organizations, where ABET and institutional responses to the reforms associated with “EC 2000,” which brought outcomes assessment to engineering education, are extensively discussed. The phenomenon of so-called “maverick evaluators” reveal the divergent professional interests that remain embedded within ABET and the engineering profession at large. Those associated with Civil and Environmental Engineering, and to a lesser extent Mechanical Engineering continue to push for higher standards of accreditation grounded in a stronger vision for their professions. While the phenomenon is complex and more subtle than we can summarize in an abstract, “maverick evaluators” emerged as a label for PEVs who interpreted their role, including determinations about whether certain content “appropriate to the field of study,” utilizing professional standards that lay outside of the consensus position held by the majority of the member of the Engineering Accreditation Commission. This, conjoined with the engineers’ epistemic aversion to uncertainty and concerns about the legal liability of their decisions, resulted in a more narrow interpretation of key accreditation criteria. The organization then designed and used a “due-process” reviews process to discipline identified shortcomings in order to limit divergent interpretations. The net result is that the bureaucratic process ABET built to obtain uniformity in accreditation outcomes, simultaneously blunts the organization’s capacity to support varied interpretations of professional standards at the program level. The apparatus has also contributed to ABET’s reputation as an organization focused on minimum standards, as opposed to one that functions as an effective driver for further change in engineering education.

ObjectiveTo describe the implementation and results of a proactive patient outreach project to offer self-administered, depot medroxyprogesterone (DMPA) subcutaneous (SC) to interested patients at a California safety-net clinic following expanded state Medicaid coverage.Study designWe contacted non-pregnant patients at an urban, safety-net hospital-based primary care clinic who had been prescribed DMPA intramuscular (IM) in the past year to gauge interest in self-administered DMPA-SC. Interested patients received a prescription for DMPA-SC and a telehealth appointment with a clinic provider to learn self-injection. We recorded patient interest in DMPA-SC, completed appointments, and completed first injections. We conducted initial outreach in May, 2020 and recorded appointment attendance and completed injections through August, 2020.ResultsOf 90 eligible patients (age 17-54), we successfully contacted and discussed DMPA-SC with 70 (78%). Twenty-six (37%) patients expressed interest in DMPA-SC and scheduled telehealth appointments to learn to self-administer the medication. Fifteen (58%) of those interested (21% of the total) successfully self-injected DMPA-SC. Of the 44 (63%) patients not interested in DMPA-SC, the three most common reasons were fear of self-injection (n = 23 [52%]), wanting to stop DMPA (n = 11 [25%]), and satisfaction with DMPA-IM (n = 6 [14%]).ConclusionThere is interest in and successful initiation of self-administered DMPA-SC among patients at an urban safety net hospital-based primary care clinic who have used DMPA-IM in the last year.ImplicationsOur data provide evidence for the interest and successful first injection rate after offering self-administered DMPA-SC to patients on DMPA-IM. Expanding coverage of self-administered DMPA-SC could increase patient-centeredness and accessibility of contraception as well as reduce patient anxiety around COVID-19 transmission without losing contraceptive access.

This study uses distribution-to-distribution statistical tests to determine the level of similarity between the CSET offering institutions and the entire population of higher education institutions in the United States, as listed in the Carnegie data. These results show that the institutional context in which U.S. CSET education occurs is sufficiently different from higher education in the U.S. as a whole that CSET education research needs to continue as a stand-alone discipline. In particular, the large number of classifications in which the sample and population data are significantly different indicates that CSET education is a special case from higher education as a whole and thus needs its own studies.

This Special Session will engage engineering and computing education professionals in role play and an interactive discussion to explore their assumptions about their colleagues’ response to change initiatives and how to react to those responses. Acting skill is not necessary for role playing; everyone can participate. It builds on the successful work done in developing the Change Champions resources and collaborative inquiry results of engineering education research CAREER network project. Every member of the FIE community, regardless of their institution or job title, is a potential change agent for improving CSET education and needs opportunities to continue building their skill sets. As a special session, we can offer a portion of the needed change management training in an interactive, hands-on manner within the safe environment of FIE. In addition, the nature of this special session allows participants to try a variety of interactions to determine their comfort level with different pathways.

Author(s): Karlin, Jennifer; Sarnaik, Shashi; Holt, Kelsey; Dehlendorf, Christine; Joffe, Carole; Steinauer, Jody | Abstract: ObjectiveTo explore US provider perspectives about self-sourced medication abortion and how their attitudes and clinic practices changed in the context of the COVID-19 pandemic.Study designWe conducted a multi-method study of survey and interview data. We performed 40 baseline interviews and surveys in spring 2019 and 36 follow-up surveys and ten interviews one year later. We compared pre- and post-Likert scale responses of provider views on the importance of different aspects of standard medication abortion assessment and evaluation (e.g., related to ultrasounds and blood-typing). We performed content analysis of the follow-up interviews using deductive-inductive analysis.ResultsSurvey results revealed that clinics substantially changed their medication abortion protocols in response to COVID-19, with more than half increasing their gestational age limits and introducing telemedicine for follow-up of a medication abortion. Interview analysis suggested that physicians were more supportive of self-sourced medication abortion in response to changing clinic protocols that decreased in-clinic assessment and evaluation for medication abortion, and as a result of physicians' altered assessments of risk in the context of COVID-19. Having evidence already in place that supported these practice changes made the implementation of new protocols more efficient, while working in a state with restrictive abortion policies thwarted the flexibility of clinics to adapt to changes in standards of care.ConclusionThis exploratory study reveals that the COVID-19 pandemic has altered clinical assessment of risk and has shifted practice towards a less medicalized model. Further work to facilitate person-centered abortion information and care can build on initial modifications in response to the pandemic.ImplicationsCOVID-19 has shifted clinician perception of risk and has catalyzed a change in clinical protocols for medication abortion. However, state laws and policies that regulate medication abortion limit physician ability to respond to changes in risk assessment.

This research category full paper explores National Science Foundation (NSF) Faculty Early Career Development (CAREER) Program awardees from the Division of Engineering Education and Centers. The NSF CAREER Award distinguishes researchers as promising future leaders who are advancing the frontier of engineering education research (EER). Additionally, the multidisciplinary rise of EER has resulted in a diverse community of researchers from many backgrounds and academic departments. Given the recognition associated with the CAREER award, it is crucial that all early career faculty members possess the knowledge and support to create high quality CAREER applications. In this study, we investigated the educational backgrounds, institutional affiliation, and public abstracts of CAREER awardees to document prevailing patterns in recognition through CAREER awards. This knowledge informs future work to provide additional support for early career faculty planning on applying to the program.