Development of a Streamlined Work Flow for Handling Patients’ Genetic Testing Insurance Authorizations

Obtaining genetic testing insurance authorizations for patients is a complex, time-involved process often requiring genetic counselor (GC) and physician involvement. In an effort to mitigate this complexity and meet the increasing number of genetic testing insurance authorization requests, GCs formed a novel partnership with an industrial engineer (IE) and a patient services associate (PSA) to develop a streamlined work flow. Eight genetics clinics and five specialty clinics at the University of Michigan were surveyed to obtain benchmarking data. Tasks needed for genetic testing insurance authorization were outlined and time-saving work flow changes were introduced including 1) creation of an Excel password-protected shared database between GCs and PSAs, used for initiating insurance authorization requests, tracking and follow-up 2) instituting the PSAs sending GCs a pre-clinic email noting each patients’ genetic testing insurance coverage 3) inclusion of test medical necessity documentation in the clinic visit summary note instead of writing a separate insurance letter and 4) PSAs development of a manual with insurance providers and genetic testing laboratories information. These work flow changes made it more efficient to request and track genetic testing insurance authorizations for patients, enhanced GCs and PSAs communication, and reduced tasks done by clinicians.     

An evaluation of auditory feedback for students of dance: Effects of giving and receiving feedback

The purpose of this study was to evaluate auditory feedback for dance students on a competition team in which one peer provided auditory feedback to another peer for a selected dance movement. Some peers switched roles during the study, and increases in their performances were evaluated both as the receiver and deliverer of auditory feedback. All participants demonstrated increases in their respective target behaviors when they received auditory feedback. Several participants also displayed increases in their movements when they provided auditory feedback to their peer partner, although these increases were not as substantial as those who received feedback.     

Set size,assertion form,thematic content and sampling in the selection task

Participants attempted to solve a modified version of Wason's (1966) selection task. Variables were: (1) sizes of the sets referenced by a specified assertion, (2) form of the assertion (conditional or categorical), (3) thematic content of the assertion (letters and numbers or makes and owners of taxicabs), and (4) the need for sampling or not. In Experiment 1, participants were given enough information to determine the truth or falsity of the specified assertion with certainty; in Experiment 2, they had to rely on sampling and could not determine the assertion's truth or falsity with certainty. Performance was better in Experiment 1 than in Experiment 2, but in both cases much better than what is typically obtained with the conventional selection task. The results support the hypothesis that performance of the selection task is sensitive to the sizes of the sets involved, add credence to the conclusion that framing the task in a thematically meaningful way can facilitate performance, and demonstrate that facilitation does not require deontic reasoning or a well-known convention being involved. The relationship between expressed confidence and level of performance is consistent with other studies showing the former to be a good predictor of the latter.     

Is a lower dose of cyproterone acetate as effective at testosterone suppression in transgender women as higher doses?

Objective: The recommended dose of cyproterone acetate (CPA), an anti-androgen that is commonly used in the hormonal treatment of transgender women, is 50–100 mg daily. Our objective was to determine whether CPA at 25 mg daily would suppress total testosterone as effectively as 50 mg daily in transgender women.

Methods: We conducted a retrospective cohort analysis of transgender women attending an endocrinology clinic between April 1, 2009, and June 30, 2015. We used a generalized linear mixed model to compare total testosterone between patients on CPA 25 mg versus CPA 50 mg or higher. In a subgroup of patients for which the CPA dose was decreased from 50 mg to 25 mg, we compared total testosterone levels before and after the decrease.

Results: We divided the sixty-eight patients included in the study into 4 groups: group 1, CPA 25 mg (N =31); group 2, CPA 50 mg or higher (N = 19); group 3, CPA dose lowered from 50 mg to 25 mg (N = 15); group 4, CPA dose increased from 25 mg to 50 mg (N = 3). The mean total testosterone on treatment was 0.9 nmol/L (95% CI 0.7 to 1.1) in group 1 and 1.2 nmol/L (95% CI 0.9–1.5) in group 2 and were not significantly different (p = 0.087). In group 3, there was no significant difference between total testosterone levels before and after decreasing the dose of CPA from 50 mg to 25 mg, p = 0.86. Group 4 was excluded from analysis.

Conclusions: We found that 25 mg of CPA daily was effective at suppressing testosterone levels to within normal female range when used in combination with recommended estrogen therapy in transgender women. Clinicians should consider using a lower dose of CPA in order to minimize potential adverse effects.     

Does fun promote learning? The relationship between fun in the workplace and informal learning

Although research has demonstrated that workplace fun has important benefits, we have an incomplete understanding of the role of fun in the learning domain, especially informal learning. To address this need, the present study examined the influence of fun activities and manager support for fun on informal learning among 206 managers. Fun activities were significantly related to overall informal learning, but manager support for fun was not. Examination of the dimensions of informal learning found that manager support for fun was significantly related to learning from oneself, while fun activities were significantly related to learning from others and learning from non-interpersonal sources. Furthermore, a negative interaction between core-self evaluations and fun activities in predicting learning from oneself was found, suggesting that fun may not be beneficial for all individuals. The key practical implication is that organizations should consider fun as a viable strategy to promote informal learning beyond traditional learning supports. At the same time, organizations should consider the personality of their learners to ensure fun has its intended impact.     

Finding the Right Value: Framing Effects on Domain Experts

By defining the essence of a policy problem, an issue frame shapes how individuals think about a political issue. In this research, we investigate framing effects among domain experts, an understudied yet increasingly important set of individuals in the policymaking process. Because domain experts have extensive and highly structured knowledge on a particular topic, they are likely to actively process issue frames to which they are exposed. Consequently, we hypothesize that frames consistent with experts' values will be particularly influential, whereas frames inconsistent with their values will lead to contrast effects. We test our hypotheses on a unique set of domain experts by examining professional farmers' attitudes toward no‐till agriculture. Using an experimental design, we find evidence that environmental values interact with frames to influence farmers' interest in no‐till, especially when farmers are exposed to a novel frame.     

The Poly-Drug User: Examining Associations between Drugs Used by Adolescents

Based on data from the 2014 Communities that Care Youth Survey, the authors examine the associations between drug use frequencies among 11 drugs. This research represents a step in determining what leads to the use of dangerous drugs like heroin, other opioids, and other not so dangerous substances. Findings indicate the highest association is between marijuana and alcohol use. Most drugs show at least a low to medium association with all other drugs. Findings indicate the difficulty in making gateway assumptions and that poly-drug use determined by peer associations is a better explanation.     

Relationship satisfaction determines the association between Epstein–Barr virus latency and somatic symptoms after the loss of a spouse

The loss of a spouse is associated with a host of negative health outcomes. While bereaved individuals commonly report somatic symptoms, no investigations exist of the association between reactivation of latent Epstein–Barr virus (EBV) and somatic symptoms among this population. Further, how an individual perceives the quality of their lost relationship in retrospect may impact loss outcomes. Among 99 bereaved spouses, elevated EBV antibody titers were associated with somatic symptoms for those who retrospectively reported high or mean levels of relationship satisfaction (RS), but not among those less satisfied. Further, higher RS was associated with greater grief symptoms. This study identifies higher retrospective RS as a possible risk factor for negative physical and mental health outcomes during bereavement.     

The role of rapport in satisfying one’s basic psychological needs

Psychological need satisfaction is essential for daily human functioning and one of its sources is high quality interactions. Rapport is essential to high quality interactions and may be one way that various relationships types can provide the nutriments of healthy functioning. We hypothesized that when people perceive interactions to be higher in rapport, they will experience greater satisfaction of their needs for autonomy, competence, and relatedness. We also explored whether this would be a basic process that would be altered by the relationship between interactants, testing this with multiple operationalizations. We conducted an event-contingent diary study in which participants (n_participants?=?124) responded to items at baseline, each time they experienced an interaction (n_interaction?=?1293), and at two-week follow-up. Supporting hypotheses, rapport in interactions was positively associated with need satisfaction within-persons, between-persons, cross-sectionally, and when examining temporal change. Moreover, rapport tended to predict the satisfaction of one’s needs for competence, autonomy, and relatedness independently. Finally, relationships between interactants did not moderate these associations.