Increasing use of immunization information systems for routine vaccinations in independent community pharmacies: A randomized controlled trial.

BACKGROUND: Only 60% of adults nationwide and just 36.8% of adults in Alabama have immunization data recorded in an Immunization Information System (IIS). The objective of this study, which took place before the coronavirus disease 2019 (COVID-19) pandemic, was to evaluate the impact of an IIS training program on pharmacists' IIS enrollment, participation, awareness, knowledge, intention, and attitudes. METHODS: A randomized controlled trial was conducted in 2019 among Alabama pharmacists (N = 41) practicing in independently owned pharmacies and providing vaccination services but whose pharmacy was not enrolled in Alabama's IIS (Immunization Patient Registry with Integrated Technology [ImmPRINT]). Intervention pharmacists were offered a 2-hour IIS training program, including an online continuing pharmacy education article, demonstration videos, implementation guide, and informational flyer. Control pharmacies received the informational flyer only. Pharmacy-level outcomes, including enrollment and participation, were obtained from ImmPRINT administrative records. Pharmacist-level outcomes, including awareness, knowledge, intention, and attitudes, were self-reported using baseline, 1-month, and 3-month surveys. Two-way mixed analysis of variance, chi-square, and independent t tests were used to analyze differences in outcomes between and within groups. RESULTS: Enrollment in ImmPRINT was significantly greater among intervention pharmacists' pharmacies (P = 0.035). In particular, 59.1% of intervention pharmacies compared with 26.3% of control pharmacies were enrolled in ImmPRINT at 3 months. No statistically significant differences were found between groups in terms of participation in ImmPRINT. Intervention pharmacists' awareness of IIS was significantly greater than control pharmacists (P = 0.028) at 1 month (postintervention). Furthermore, the IIS training program significantly improved intervention pharmacists' knowledge (P = 0.030) and attitudes (P = 0.016) toward IIS over 3 months compared with the control group. CONCLUSIONS: This pharmacist-centered training program focused on practical strategies to integrate IIS into pharmacy workflow. Results show that pharmacists' enrollment, awareness, knowledge, and attitudes significantly improved as a result of this training. As pharmacists become more involved in immunization efforts, particularly in response to COVID-19, awareness of and participation in responsible immunization documentation are critical.

Getting Everyone to the Fair: Supporting Teachers in Broadening Participation in Science and Engineering Fairs.

Science and Engineering (S&E) fairs are a valuable educational activity and are believed to increase students' engagement and learning in science and engineering. However, due to differences in resources, many schools do not implement fairs to achieve these benefits for their students. This study reports the findings of a program intended to increase the participation of students from low-achieving and under-resourced schools in a regional fair program that feeds into the international fair competition. We found that the number of schools and projects participating in our regional fair increased dramatically since the start of the program. Teachers had mostly positive expectations for the project and expressed buy-in for the effort the project would take. They recruited a diverse pool of students to participate in the school fairs. Quasi-experimental methods allowed us to explore the impact of completing S&E fairs on student gains on science self-efficacy, interest and value perceptions. Controlling for pre-existing differences in these attitudes, we found that students not completing projects showed declines in their science attitudes during the year. Students who completed projects maintained similar attitudes, while those whose projects advanced to the regional fair had substantial gains on all three variables. It is unknown whether this gain can be attributed to the experience of engaging with a quality project, from being the kind of student who completes a quality project, or some other factor. Future research with greater experimental control could address these questions.

Pharmacist-led motivational interviewing for diabetes medication adherence in a worksite wellness program.

OBJECTIVE: The primary objective was to evaluate the impact of a pharmacist-delivered motivational interviewing (MI) intervention for diabetes medication adherence; the secondary objectives were to assess the changes in clinical outcomes and health-related quality of life (HRQoL). METHODS: A quasi-experimental intervention study was conducted with baseline, postintervention, and follow-up data collections. The study duration was 6 months. Pharmacists trained in MI delivered 3 face-to-face encounters using MI-based semistructured conversation tools to address barriers or challenges to medication adherence. A diabetes worksite wellness program (WWP) at a 350-bed regional hospital in the southeastern United States was the setting, and the study participants were WWP employees or dependents (with type 1 diabetes or type 2 diabetes). The primary outcome was a change in self-reported diabetes medication adherence; the secondary outcomes included the changes in clinical indicators (glycated hemoglobin [HbA1c], blood pressure, and depressive symptoms), and HRQoL. The measures included the Medometer, Summary of Diabetes Self-Care Activities-Medication Subscale (SDSCA-MS), Audit of Diabetes-Dependent QoL (ADDQoL-19), and the Short Form-12 (SF-12) health survey. RESULTS: Fifty-three WWP participants enrolled, and 36 completed the full intervention protocol. Medication adherence (through the Medometer) demonstrated statistically significant improvement after the intervention (P = 0.010); the SDSCA-MS score improved, but was not statistically significant. The change in diastolic blood pressure was statistically significant (P = 0.034), but the changes in HbA1c, systolic blood pressure, presence of depressive symptoms, and ADDQoL-19 were not statistically significant. The SF-12 physical component summary (PCS) and mental component summary (MCS) scores were statistically significant: PCS, P = 0.003, and MCS, P = 0.025. CONCLUSION: The findings from this pilot study support the effectiveness of a pharmacist-delivered, semistructured MI-based intervention for medication adherence in persons with diabetes in a hospital-based WWP. Pharmacists can support patients' behavior change using MI communication skills to explore salient barriers to medication adherence and to facilitate goal setting to overcome these in encounters aimed at shared clinical and behavioral decision-making.

Exploring the Influence of Item Characteristics in a Spatial Reasoning Task.

Well-designed spatial assessments can incorporate multiple sources of complexity that reflect important aspects of spatial reasoning. When these aspects are systematically included in spatial reasoning items, researchers can use psychometric models to examine the impact of each aspect on item difficulty. These methods can then help the researchers to understand the nature and development of spatial reasoning and can also inform the development of new items to better reflect the construct. This study investigated sources of item difficulty for object assembly (OA), a format for the assessment of spatial reasoning, by specifying nine item characteristics that were predicted to contribute to item difficulty. We used data from two focal samples including high-ability students in grades 3 to 7 and undergraduate students who responded to 15 newly developed OA items. Results from the linear logistic test model (LLTM) indicated that eight of the nine identified item characteristics significantly contributed to item difficulty. This suggests that an LLTM approach is useful in examining the contributions of various aspects of spatial reasoning to item difficulty and informing item development for spatial reasoning assessments.

Determinants to immunization information system implementation in independent community pharmacies.

BACKGROUND: Immunization information systems (IISs) facilitate consolidated vaccination data within each state. Many have limited pharmacy participation, especially Alabama. As pharmacists increasingly engage in delivery of vaccines recommended across the life span, it is critical to understand the barriers to IIS implementation, particularly in rural community pharmacies where access to primary care may be limited. OBJECTIVE: The purpose of this study was to identify barriers and facilitators to IIS implementation in rural, independent community pharmacies in Alabama. METHODS: Qualitative interviews with rural, independent community pharmacy personnel and IIS experts in both states with high IIS participation and Alabama (state with low IIS participation) were conducted. States with high participation were identified as those with ≥75% of adults recorded in their respective state IIS. Less than 25% of Alabama adults were recorded in the state IIS at the time of this study. Deductive coding using CFIR constructs was conducted with a second coder to ensure inter-rater reliability. CFIR Rating Rules were applied to the coded data to allow for identification of constructs that have the greatest impact on implementation. RESULTS: A total of twenty-five participants (16 pharmacy personnel; 9 IIS experts) were interviewed. During interviews, 32 of 39 CFIR constructs were mentioned and 11 constructs with a strong influence (+2 or -2) were identified. These included, "adaptability", "complexity", "compatibility", "available resources", "access to knowledge and information", "needs and resources of those served by the organization", "peer pressure", "external policy and initiatives", "knowledge and beliefs about the innovation", "engaging key stakeholders", and "engaging innovation participants". CONCLUSIONS: This qualitative study explored perceived barriers and facilitators to IIS implementation in the rural, independent community pharmacy setting from the perspectives of pharmacy personnel and IIS experts. Factors identified can be used to inform the development of resources and implementation strategies to improve IIS uptake and participation.

Spatially gifted, academically inconvenienced: Spatially talented students experience less academic engagement and more behavioural issues than other talented students.

BACKGROUND: Spatially talented students have a capacity for success that is too often overlooked by educational services. Because these students may lack appropriate challenge, theorists suggest these students experience greater academic struggles than other gifted students, including behavioural problems and lack of academic engagement. AIMS: The goal of this research was to explore empirical evidence for the claim that spatially talented students would experience more academic struggles than other gifted students. We sought to understand the size of the 'spatially talented' population and their patterns of behavioural and academic struggles in high school. We also looked at long-term outcomes, including degree completion. SAMPLES: This article explores characteristics of spatial talent in three US nationally representative data sets: Project Talent (1960), High School and Beyond (1980), and the National Longitudinal Study of Youth (1997). Combined, these data provide a 60-year longitudinal study of student outcomes. METHODS: This study utilized factor analysis, analysis of variance (ANOVA), and regression methods to explore the research questions for each data set. RESULTS AND CONCLUSIONS: From our analyses, we estimate that 4-6% (at least 2 million) of the 56.6 million students in the US K-12 system are spatially talented students that are not identified by common gifted and talented screening processes. These students had greater academic challenges, including reading difficulties, poor study habits, and behavioural troubles. We also found that spatially talented students were less likely to complete college degrees compared to other talented students. Our findings support the need for greater services to these talented students.

Assessing barriers and increasing use of immunization information systems in independent community pharmacies: Study protocol for a randomized controlled trial.

BACKGROUND: As the number of providers administering vaccines increases, including pharmacists, there is a concern of fragmented immunization records in state and regional immunization information systems (IIS). In order for IIS to have complete records, it is critical that each provider administering vaccines, including pharmacists, participate and update the IIS each time a vaccine is administered to a patient. In Alabama, provider participation in the state IIS is not mandatory; as a result, less than 25% of adults over the age of 19 have immunization data recorded. IIS participation among independent pharmacies is of particular concern as approximately 40% of Alabama pharmacies are independently owned, but only 27% of these are enrolled in the IIS. OBJECTIVE: The objective of this report is to describe a study protocol to assess the impact of an IIS training program among community pharmacies' IIS enrollment and actual participation rates. METHODS: The research design is a randomized controlled trial. Study participants are Alabama pharmacists who work in independently owned pharmacies that currently provide at least one type of non-seasonal vaccine and are not currently enrolled in the Alabama IIS. Multiple outcomes including awareness, knowledge, attitudes, intention, IIS enrollment, and IIS participation will be compared between intervention and control groups across three time points (baseline, one-month, and three-months). Individual and organizational factors will be measured to identify any possible associations with outcomes. IMPLICATIONS: The expected outcome is to create an effective training program that is scalable and ready for dissemination. If successful, this training program can be replicated and used to significantly impact the completeness and accuracy of IIS across the U.S., providing the potential for IIS to be used consistently in assessing immunization status and recommending additional vaccines in the pharmacy setting, thereby improving vaccination coverage and making the provision of immunizations safe and efficient.

Consistencies in sex differences on the Cognitive Abilities Test across countries, grades, test forms, and cohorts.

BACKGROUND: Strand, Deary, and Smith (2006) reported an analysis of sex differences on the Cognitive Abilities Test (CAT) for over 320,000 UK students 11-12 years old. Although mean differences were small, males were overrepresented at the upper and lower extremes of the score distributions on the quantitative and non-verbal batteries and at the lower extreme of the verbal battery. AIMS: We investigate whether these results were unique to the UK or whether they would be seen in other countries, at other grades, cohorts, or forms of the test. SAMPLE: The sample consisted of three nationally representative cohorts of US students in grades 3 through 11 (total N=318,599) for the 1984, 1992, and 2000 standardizations of the US version of the CAT. METHODS: We replicated and extended the Strand et al. (2006) results by comparing the proportions of males and females at each score level across countries (UK vs. US), grades (3-11), and cohorts/test forms (Forms 4, 5, and 6 standardized in 1984, 1992, and 2000, respectively). RESULTS: The results showed an astonishing consistency in sex differences across countries, grades, cohorts, and test forms. CONCLUSIONS: Implications for the current debate about sex differences in quantitative reasoning abilities are discussed.

Local Pressure Application Effects on Neurological and Circulatory Function.

BACKGROUND: Pain and discomfort reported during sitting is a significant problem for aviators during prolonged missions. Previous work has determined that areas of local pressure exist during prolonged sitting in UH-60 seat systems; however, no work has examined the effects of this local pressure on measures of neurological and circulatory function. METHODS: A total of 30 healthy subjects completed the study in which focal pressure was applied in three conditions (no pressure, pressure to the ischial tuberosity, and pressure to the posterior thigh). We applied pressure using a purpose-built pressure application system allowing subjects to sit in a position mimicking the sitting position in a UH-60 Black Hawk helicopter and measurements were taken before, during, and after pressure application. We measured neurological function with the soleus Hoffmann reflex and sural nerve conduction velocity, and circulatory function with dynamic infrared thermography. RESULTS: We found a decrease in soleus Hoffmann reflex by 0.87 V and 0.52 V during pressure application at the posterior thigh and ischial tuberosity, respectively. No changes in nerve conduction velocity were found among the conditions during or after pressure application. Limb temperature increased 0.42-0.44°C during pressure application, but began to return to baseline once pressure was removed. DISCUSSION: This study examined the development of neurological and circulatory alterations due to local pressure application in an aviation specific functional position. These results may be used in the development of future interventions to mitigate the negative effects of localized pressure in military aviators.Games KE, Lakin JM, Quindry JC, Weimar WH, Sefton JM. Local pressure application effects on neurological and circulatory function. Aerosp Med Hum Perform. 2018; 89(8):693-699.

Local Pressure Application Effects on Discomfort, Temperature, and Limb Oxygenation.

INTRODUCTION: Despite significant investment into the development and improvement of military helicopter seat systems, military aviators continue to report seat system related pain and discomfort during prolonged missions. METHODS: Using a factorial repeated measures design, 15 healthy subjects completed the study, in which focal pressure was applied to two locations on the sitting surfaces of the body (ischial tuberosity and middle of the posterior thigh). Pressure was applied using a purpose-built pressure application system allowing subjects to sit in a position mimicking the sitting position in the UH-60 Black Hawk helicopter. The researchers measured pain using the Category Partitioning Scale and McGill Pain Questionnaire and vascular function using dynamic infrared thermography in the lower leg and pulse oximetry at the great toe. Data were collected before and during a 10-min application of focal pressure applied to either the ischial tuberosity or middle of the posterior thigh and at two different pressure magnitudes (36 or 44 kPa). RESULTS: We found that during a 10-min pressure application, superficial skin temperature increased by 0.61°C, suggesting a decreased venous return during pressure application. We found that lower extremity blood oxygenation remained unchanged during pressure application. Subjects' reported pain increased during pressure application and was greater with 44 kPa of application compared to 36 kPa. DISCUSSION: These results support the hypothesis that locally high pressure creates symptoms of discomfort and paresthesia. Research examining the effects of local pressure application on physiological and neurological function is needed. Games KE, Lakin JM, Quindry JC, Weimar WH, Sefton JM. Local pressure application effects on discomfort, temperature, and limb oxygenation. Aerosp Med Hum Perform. 2016; 87(8):697-703.

Prolonged restricted sitting effects in UH-60 helicopters.

INTRODUCTION: Advances in flight technologies and the demand for long-range flight have increased mission lengths for U.S. Army Black Hawk UH-60 crewmembers. Prolonged mission times have increased reports of pilot discomfort and symptoms of paresthesia thought to be due to UH-60 seat design and areas of locally high pressure. Discomfort created by the seat-system decreases situational awareness, putting aviators and support crew at risk of injury. Therefore, the purpose of this study was to examine the effects of prolonged restricted sitting in a UH-60 on discomfort, sensory function, and vascular measures in the lower extremities. METHODS: There were 15 healthy men (age = 23.4 ± 3.1 yr) meeting physical flight status requirements who sat in an unpadded, UH-60 pilot's seat for 4 h while completing a common cognitive task. During the session, subjective discomfort, sensory function, and vascular function were measured. RESULTS: Across 4 h of restricted sitting, subjective discomfort increased using the Category Partitioning Scale (30.27 point increase) and McGill Pain Questionnaire (8.53 point increase); lower extremity sensory function was diminished along the S1 dermatome; and skin temperature decreased on both the lateral (2.85°C decrease) and anterior (2.78°C decrease) aspects of the ankle. DISCUSSION: The results suggest that prolonged sitting in a UH-60 seat increases discomfort, potentially through a peripheral nervous or vascular system mechanism. Further research is needed to understand the etiology and onset of pain and paresthesia during prolonged sitting in UH-60 pilot seats. Games KE, Lakin JM, Quindry JC, Weimar WH, Sefton JM. Prolonged restricted sitting effects in UH-60 helicopters.