Exposing omitted moderators: Explaining why effect sizes differ in the social sciences.

Policymakers increasingly rely on behavioral science in response to global challenges, such as climate change or global health crises. But applications of behavioral science face an important problem: Interventions often exert substantially different effects across contexts and individuals. We examine this heterogeneity for different paradigms that underlie many behavioral interventions. We study the paradigms in a series of five preregistered studies across one in-person and 10 online panels, with over 11,000 respondents in total. We find substantial heterogeneity across settings and paradigms, apply techniques for modeling the heterogeneity, and introduce a framework that measures typically omitted moderators. The framework's factors (Fluid Intelligence, Attentiveness, Crystallized Intelligence, and Experience) affect the effectiveness of many text-based interventions, producing different observed effect sizes and explaining variations across samples. Moderators are associated with effect sizes through two paths, with the intensity of the manipulation and with the effect of the manipulation directly. Our results motivate observing these moderators and provide a theoretical and empirical framework for understanding and predicting varying effect sizes in the social sciences.

Dark defaults: How choice architecture steers political campaign donations.

In the months before the 2020 U.S. election, several political campaign websites added prechecked boxes (defaults), automatically making all donations into recurring weekly contributions unless donors unchecked them. Since these changes occurred at different times for different campaigns, we use a staggered difference-in-differences design to measure the causal effects of defaults on donors' behavior. We estimate that defaults increased campaign donations by over $43 million while increasing requested refunds by almost $3 million. The weekly default only impacted weekly recurring donations, and not other donations, suggesting that donors may not have intended to make weekly donations. The longer defaults were displayed, the more money campaigns raised through weekly donations. Donors did not compensate by changing the amount they donated. We found that the default had a larger impact on smaller donors and on donors who had no prior experience with defaults, causing them to start more chains and donate a larger proportion of their money through weekly recurring donations.

When nudges have societal-level impact.

Individual-level research in behavioral science can have massive impact and create system-level changes, as several recent mandates and other policy actions have shown. Although not every nudge creates long-term behavior change, defaults and other forms of choice architecture can not only change individual behavior but also reduce inequities and lead to changes in public policy and norms.

Prescriber and employee utilization of a health sciences center campus outpatient pharmacy: A qualitative analysis.

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.

Framing to reduce present bias in infrastructure design intentions.

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.

Creation and implementation of a pharmacy-led meds-to-beds program at a large teaching hospital.

BACKGROUND: "Meds-to-beds" 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. There are sufficient data on the benefits of meds-to-beds programs, but there is a lack of literature on describing the development and implementation process. OBJECTIVES: The objective of this article is to describe the planning process, implementation, and barriers encountered during the organization of a pharmacy-led meds-to-beds program operating within 2 large teaching hospitals. PRACTICE DESCRIPTION: The University of Oklahoma Health Sciences Center campus has 7 colleges, multiple primary care and specialty clinics, and 2 hospitals. In addition, there are 3 on-campus outpatient pharmacies operated by the University of Oklahoma College of Pharmacy (OUCOP). PRACTICE INNOVATION: The college implemented a meds-to-beds program primarily serving 2 on-campus hospitals, The Oklahoma Children's Hospital and University of Oklahoma College of Pharmacy 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. In addition, after the initiation of the meds-to-beds program, the daily prescription count more than doubled. The program averages 40 deliveries per day and 3 prescriptions per delivery and continues to grow, providing evidence of a successful meds-to-beds 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.

Shot of a lifetime: How pharmacists stay ahead of the season.

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.

High-Throughput Simultaneous mRNA Profiling Using nCounter Technology Demonstrates That Extracellular Vesicles Contain Different mRNA Transcripts Than Their Parental Prostate Cancer Cells.

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.

Sensitivity and Specificity of Gastric Ultrasonography in Determination of Gastric Contents.

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.

Challenges and Lessons Amid the COVID-19 Pandemic at One College of Pharmacy.

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.

Student agreement regarding adequacy of didactic content and practical experiences of vaccination clinic business operations.

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.

Evidence for hippocampal dependence of value-based decisions.

Consistent decisions are intuitively desirable and theoretically important for utility maximization. Neuroeconomics has established the neurobiological substrate of value representation, but brain regions that provide input to this network is less explored. The constructed-preference tradition within behavioral decision research gives a critical role to associative cognitive processes, suggesting a hippocampal role in making consistent decisions. We compared the performance of 31 patients with mediotemporal lobe (MTL) epilepsy and hippocampal lesions, 30 patients with extratemporal lobe epilepsy, and 30 healthy controls on two tasks: binary choices between candy bars based on their preferences and a number-comparison control task where the larger number is chosen. MTL patients made more inconsistent choices than the other two groups for the value-based choice but not the number-comparison task. These inconsistencies correlated with the volume of compromised hippocampal tissue. These results add to increasing evidence on a critical involvement of the MTL in preference construction and value-based choices.

Search predicts and changes patience in intertemporal choice.

Intertemporal choice impacts many important outcomes, such as decisions about health, education, wealth, and the environment. However, the psychological processes underlying decisions involving outcomes at different points in time remain unclear, limiting opportunities to intervene and improve people's patience. This research examines information-search strategies used during intertemporal choice and their impact on decisions. In experiment 1, we demonstrate that search strategies vary substantially across individuals. We subsequently identify two distinct search strategies across individuals. Comparative searchers, who compare features across options, discount future options less and are more susceptible to acceleration versus delay framing than integrative searchers, who integrate the features of an option. Experiment 2 manipulates search using an unobtrusive method to establish a causal relationship between strategy and choice, randomly assigning participants to conditions promoting either comparative or integrative search. Again, comparative search promotes greater patience than integrative search. Additionally, when participants adopt a comparative search strategy, they also exhibit greater effects of acceleration versus delay framing. Although most participants reported that the manipulation did not change their behavior, promoting comparative search decreased discounting of future rewards substantially and speeded patient choices. These findings highlight the central role that heterogeneity in psychological processes plays in shaping intertemporal choice. Importantly, these results indicate that theories that ignore variability in search strategies may be inadvertently aggregating over different subpopulations that use very different processes. The findings also inform interventions in choice architecture to increase patience and improve consumer welfare.

Student and faculty perceptions about mandatory influenza vaccinations on a health sciences campus.

OBJECTIVE: To examine the perceptions among faculty and health professional students regarding mandatory vaccination policies on a health sciences campus. PARTICIPANTS: A total of 296 faculty and 244 students completed surveys during Fall 2015. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Animal origin of 13th-century uterine vellum revealed using noninvasive peptide fingerprinting.

Tissue-thin parchment made it possible to produce the first pocket Bibles: Thousands were made in the 13th century. The source of this parchment, often called "uterine vellum," has been a long-standing controversy in codicology. Use of the Latin term abortivum in many sources has led some scholars to suggest that the skin of fetal calves or sheep was used. Others have argued that it would not be possible to sustain herds if so many pocket Bibles were produced from fetal skins, arguing instead for unexpected alternatives, such as rabbit. Here, we report a simple and objective technique using standard conservation treatments to identify the animal origin of parchment. The noninvasive method is a variant on zooarchaeology by mass spectrometry (ZooMS) peptide mass fingerprinting but extracts protein from the parchment surface by using an electrostatic charge generated by gentle rubbing of a PVC eraser on the membrane surface. Using this method, we analyzed 72 pocket Bibles originating in France, England, and Italy and 293 additional parchment samples that bracket this period. We found no evidence for the use of unexpected animals; however, we did identify the use of more than one mammal species in a single manuscript, consistent with the local availability of hides. These results suggest that ultrafine vellum does not necessarily derive from the use of abortive or newborn animals with ultrathin hides, but could equally well reflect a production process that allowed the skins of maturing animals of several species to be rendered into vellum of equal quality and fineness.

Sound credit scores and financial decisions despite cognitive aging.

Age-related deterioration in cognitive ability may compromise the ability of older adults to make major financial decisions. We explore whether knowledge and expertise accumulated from past decisions can offset cognitive decline to maintain decision quality over the life span. Using a unique dataset that combines measures of cognitive ability (fluid intelligence) and of general and domain-specific knowledge (crystallized intelligence), credit report data, and other measures of decision quality, we show that domain-specific knowledge and expertise provide an alternative route for sound financial decisions. That is, cognitive aging does not spell doom for financial decision-making in domains where the decision maker has developed expertise. These results have important implications for public policy and for the design of effective interventions and decision aids.

Connecting cognition and consumer choice.

We describe what can be gained from connecting cognition and consumer choice by discussing two contexts ripe for interaction between the two fields. The first-context effects on choice-has already been addressed by cognitive science yielding insights about cognitive process but there is promise for more interaction. The second is learning and representation in choice where relevant theories in cognitive science could be informed by consumer choice, and in return, could pose and answer new questions. We conclude by discussing how these two fields of research stand to benefit from more interaction, citing examples of how interfaces of cognitive science with other fields have been illuminating for theories of cognition.

Influenza vaccination by pharmacists in a health sciences center: A 3-year experience.

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.

Can consumers make affordable care affordable? The value of choice architecture.

Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a "smart" default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year.

Complementary cognitive capabilities, economic decision making, and aging.

Fluid intelligence decreases with age, yet evidence about age declines in decision-making quality is mixed: Depending on the study, older adults make worse, equally good, or even better decisions than younger adults. We propose a potential explanation for this puzzle, namely that age differences in decision performance result from the interplay between two sets of cognitive capabilities that impact decision making, one in which older adults fare worse (i.e., fluid intelligence) and one in which they fare better (i.e., crystallized intelligence). Specifically, we hypothesized that older adults' higher levels of crystallized intelligence can provide an alternate pathway to good decisions when the fluid intelligence pathway declines. The performance of older adults relative to younger adults therefore depends on the relative importance of each type of intelligence for the decision at hand. We tested this complementary capabilities hypothesis in a broad sample of younger and older adults, collecting a battery of standard cognitive measures and measures of economically important decision-making "traits"--including temporal discounting, loss aversion, financial literacy, and debt literacy. We found that older participants performed as well as or better than younger participants on these four decision-making measures. Structural equation modeling verified our hypothesis: Older participants' greater crystallized intelligence offset their lower levels of fluid intelligence for temporal discounting, financial literacy, and debt literacy, but not for loss aversion. These results have important implications for public policy and for the design of effective decision environments for older adults.