Creighton University

Background Adverse childhood experiences (ACEs) are common and can negatively affect the physical, mental, emotional, and developmental health of a child acutely and for a lifetime. Trauma-informed care (TIC) in the pediatric medical home helps counteract these effects by fostering supportive relationships and building skills that promote resilience. As key figures in the medical home, pediatric clinicians must understand adverse childhood experiences (ACEs) and TIC principles to effectively recognize, assess and intervene early in cases of childhood adversity, which ultimately promotes long-term health and well-being. Methods Pediatric clinicians who attended a virtual symposium were surveyed before and after eight one-hour educational sessions on TIC topics. To assess their knowledge of fundamental TIC principles, they were asked about their familiarity with the ACE study, the affiliative response, and the strength-based approach in pediatrics. Participants rated each sessions’ value using a 4-point Likert scale. In the post survey, they also shared how they would apply the knowledge gained clinically and suggestions to improve future education. Results Seventy-five out of the 82 participants (91%) who were pediatric clinicians completed a pre survey and of those pediatric clinicians who completed the pre survey, 47 (63%) also completed the post-education survey. Prior to the educational sessions, 81% of participants were familiar with the ACE Study but only 37.1% were familiar with the affiliate response and only 50.6% with strength-based care approaches to pediatrics. Of those who completed the post survey, 95.7% rated the education as “Useful” or “Very useful.” Statistically significant improvements were detected in scores relating to each of the three fundamental TIC principles: associations between childhood stressors and later life health and well-being (p = < 0.0001), familiarity with the affiliate response (p = < 0.0001), and familiarity with the concept of a strength-based approach to pediatrics (p = < 0.005). After the training sessions, a majority, 34/47 (72%), of participants stated they would apply concepts from the training in clinical care. Conclusions This study was able to demonstrate existing gaps in pediatric clinicians’ knowledge of TIC, the usefulness of pediatric TIC education, and practical steps in providing TIC education for pediatric clinicians and healthcare providers.

Introduction Fundal pressure during the second stage of labor is widely practiced but understudied. Violent fundal pressure can cause maternal and fetal injuries. Many providers believe the maneuver is effective. Administrative efforts to ban fundal pressure are unsuccessful and only drive the procedure to an underground practice. Material and Methods In this single‐center, open‐label, randomized trial, nulliparous women with term singleton cephalic pregnancy under epidural analgesia were assigned to receive gentle manual fundal pressure (GMFP) or routine labor care. The GMFP was designed not to exceed a maximum of 120 mmHg. Women were randomized after 30 min of pushing in the second stage of labor. The primary outcome was the time from randomization to delivery. Secondary outcomes were mode of delivery, episiotomy, perineal laceration, cord blood pH, and other maternal and fetal outcomes. Results Between July 2023 and January 2024, 164 women were randomized to GMFP (n = 82) or to routine care (n = 82). The time from randomization to vaginal delivery did not show statistical significance between the fundal pressure group and the control group (mean [SD], 46.3 [33.3] vs. 55.9 [45.8] min; p = 0.13). Significantly fewer women in the fundal pressure group had operative vaginal deliveries (4 of 82 [4.9%]) than women in the control group (13 of 82 [15.9%]; relative risk [RR] 0.308, 95% confidence interval [CI] 0.105–0.904; p = 0.021). Similarly, mediolateral episiotomy was performed in fewer women in the fundal pressure group (6 of 82 [7.32%]) than in the control group (16 of 82 [19.51%], RR 0.375, 95% CI 0.154–0.910; p = 0.022). Other maternal and fetal outcomes were similar in the two groups. Conclusions GMFP resulted in a nonsignificant reduction in the second stage of labor and a significant reduction in operative vaginal delivery and episiotomy without an increase in adverse outcomes. Fundal pressure during the second stage of labor deserves further investigation.

Objective To investigate the behavioral outcomes of children with clefts and the psychosocial impact and mental health experiences of their caregivers regarding unintended outcomes of genomic sequencing, that is, secondary genetic findings (SFs). Design Convergent parallel mixed methods. Setting The cleft and immunization clinics at the Lagos University Teaching, Hospital, Nigeria. Participants In total, 127 cases and 158 control caregiver child dyads (quantitative) and 22 caregivers of children with clefts (qualitative). Main Outcome Measures Standardized questionnaires were used to assess caregiver-reported mental health, quality of life (QoL), and their children's behavioral difficulties. In 2 focus groups, participants shared their perspectives on genomic testing outcomes, including SFs, mental health, and expectations in the context of clefts. Results Compared to the control group, caregivers of children with clefts reported poorer mental health, lower QoL and more behavioral difficulties in their children. Also, they believed that introducing genomic testing outcomes, including SFs, may exacerbate existing burdens. Following qualitative data analyses, 5 themes emerged—genetics knowledge/awareness, stressors, cognitive appraisals, coping/support strategies, and negative impact/positive gains. Both qualitative and quantitative results showed that caring for children with clefts required significant financial resources placing substantial stress on caregivers. Conclusions These findings highlight the importance of addressing caregivers’ psychosocial needs and the need for proactive measures to prepare for the return of genomic sequencing outcomes to patients and research participants, particularly in resource-limited settings like Africa, where such support may be lacking.

Sepsis is one of the leading causes of death in the United States. We aimed to explore long term demographic and geographical trends of sepsis-related mortality in the United States from 1999 to 2022. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) national database was utilized to analyze differences in mortality associated with sepsis. Age-adjusted mortality rates (AAMR) were calculated, and Joinpoint Regression Program was used to determine trends for mortality. The results demonstrated that 4,177,071 deaths occurred during the study and that mortality increased for most demographic and geographic groups. Sepsis associated mortality did not witness any dramatic change from an AAMR of 77.51 in 1999 to 76.1 in 2019 but saw an increase of 30.22% from 2019 to 2021 which was primarily driven by associated COVID- 19 infections. Demographic and geographical disparities persisted with Men, NH African American and NH American Indians and Alaskan Natives, census region south having worse AAMRs. COVID- 19 contributed to around 1/6 th of sepsis associated deaths in US between 2020 and 2022 and accounted for most of the excess sepsis associated mortality during the pandemic.

Finger millet (Eleusine coracana (L.) Gaertn) is a nutrient-rich cereal crop widely cultivated in many low- and middle-income countries of Asia and Africa. Zinc (Zn) deficiency is the most common problem in worldwide agricultural soils. Zn is one of the important soil micronutrients limiting crop productivity. The objective of this study was to identify quantitative trait loci (QTL) conditioning phenotypic traits, photosynthetic pigment, and Zn content of 100 F2:3 populations of finger millet grown under Zn deficient (ZnD, 0.05 µM) and Zn sufficient (ZnS, 1.0 µM) conditions using 101 simple sequence repeats (SSR) markers by linkage mapping. The ZnD influenced the growth, biomass, photosynthetic pigment, and Zn content in the leaf and root tissues in 100 F2:3 populations of finger millet in this study. A total of 36 QTL were identified under the ZnS condition, and 63 QTL were identified under the ZnD condition. Four SSR markers (UGEP16, UGEP95, UGEP101, and UGEP104) were mostly flanked with several QTL for various traits under ZnS and ZnD conditions. Several abiotic stress-responsive genes were found to be linked with QTL markers identified in this study. This study provides information on the effects of Zn deficiency in finger millet and QTL and candidate genes related to Zn deficiency tolerance. The identified QTL and genes from the present study might help to develop ZnD-tolerant or Zn use-efficient finger millet varieties through marker-assisted breeding. The findings from this study might guide finger millet researchers involved in Zn deficiency-tolerance improvement and genetic analysis.

We describe the construction of a homemade laparoscope that undergraduate and medical students can use to learn abdominal gross anatomy from a different perspective. Students can also explore basic concepts in the laparoscopic procedure. This reliable and low-cost instrument can reduce the learning gap in low-resource universities.

Understanding the relationship between circuit connectivity and function is crucial for uncovering how the brain computes. In mouse primary visual cortex, excitatory neurons with similar response properties are more likely to be synaptically connected1, 2, 3, 4, 5, 6, 7–8; however, broader connectivity rules remain unknown. Here we leverage the millimetre-scale MICrONS dataset to analyse synaptic connectivity and functional properties of neurons across cortical layers and areas. Our results reveal that neurons with similar response properties are preferentially connected within and across layers and areas—including feedback connections—supporting the universality of ‘like-to-like’ connectivity across the visual hierarchy. Using a validated digital twin model, we separated neuronal tuning into feature (what neurons respond to) and spatial (receptive field location) components. We found that only the feature component predicts fine-scale synaptic connections beyond what could be explained by the proximity of axons and dendrites. We also discovered a higher-order rule whereby postsynaptic neuron cohorts downstream of presynaptic cells show greater functional similarity than predicted by a pairwise like-to-like rule. Recurrent neural networks trained on a simple classification task develop connectivity patterns that mirror both pairwise and higher-order rules, with magnitudes similar to those in MICrONS data. Ablation studies in these recurrent neural networks reveal that disrupting like-to-like connections impairs performance more than disrupting random connections. These findings suggest that these connectivity principles may have a functional role in sensory processing and learning, highlighting shared principles between biological and artificial systems.

We are in the era of millimetre-scale electron microscopy volumes collected at nanometre resolution1,2. Dense reconstruction of cellular compartments in these electron microscopy volumes has been enabled by recent advances in machine learning3, 4, 5–6. Automated segmentation methods produce exceptionally accurate reconstructions of cells, but post hoc proofreading is still required to generate large connectomes that are free of merge and split errors. The elaborate 3D meshes of neurons in these volumes contain detailed morphological information at multiple scales, from the diameter, shape and branching patterns of axons and dendrites, down to the fine-scale structure of dendritic spines. However, extracting these features can require substantial effort to piece together existing tools into custom workflows. Here, building on existing open source software for mesh manipulation, we present Neural Decomposition (NEURD), a software package that decomposes meshed neurons into compact and extensively annotated graph representations. With these feature-rich graphs, we automate a variety of tasks such as state-of-the-art automated proofreading of merge errors, cell classification, spine detection, axonal-dendritic proximities and other annotations. These features enable many downstream analyses of neural morphology and connectivity, making these massive and complex datasets more accessible to neuroscience researchers.

Neuroimaging studies have shown age-related alterations in brain structure and function supporting semantic knowledge, although the significance of these is not fully understood. Herein, we report novel temporal, spectral, and spatial information on age-related changes from the largest dynamic functional mapping study of semantic processing. Participants (N = 130, age range 21–87 years, Mage = 51.05, SD = 14.73, 68 females) performed a semantic judgement task during magnetoencephalography (MEG), and significant task-related oscillatory responses were projected into anatomical space using a beamformer. Voxel-wise linear mixed-effects models were performed to assess semantic-related neural oscillations, irrespective of and influenced by age. Mediation analyses were performed to assess if local oscillations mediated the relationship between age and reaction time. Whole-brain analyses revealed stronger left-lateralized alpha/beta oscillations in frontotemporal cortices during semantic trials and stronger right-lateralized alpha/beta responses in temporoparietal regions during length trials (all ps <.001). Older adults showed stronger left temporoparietal alpha and left frontal beta during semantic processing and stronger alpha in the right temporal cortex during the length condition (all ps <.001). Alpha oscillations further mediated the relationship between age and reaction time in a hemisphere- and condition-specific manner, whereby right temporal activity mediated the age-behavior relationship in the length but not semantic condition (Z = 2.01, p =.022), while left temporoparietal activity significantly mediated this relationship in the semantic but not length condition (Z = − 2.41, p =.008). Altogether, our findings demonstrate accentuated oscillations in aging which are hemisphere- and condition-specific and support compensatory processing to aid in maintaining adequate behavioral performance, lending clear support to leading neuroscientific models of aging.

Background There are few reported cases of Dandy–Walker Malformation associated with Noonan syndrome (NS). Case presentation We herein present a case of a late preterm infant with Dandy–Walker malformation (DWM) that underwent a workup for feeding difficulty and was found to have NS. This is one of the few reported cases of DWM with NS having a PTPN11 gene mutation. Conclusion Overlapping clinical features may disguise diagnosis in infants with multiple pathologies.

Jaw cysts are mainly odontogenic in origin, appear radiographically as radiolucent lesions, and are diagnosed based on histopathology. This chapter discusses the diagnostic features of the most common cyst of the jaw bones.

Tumours arising from the cells involved in the development of teeth are called odontogenic tumours. They are classified according to the embryonic differentiation of tissues-ectoderm, mesoderm, and ectoderm.

Introduction This expanded access program (EAP) provided ruxolitinib (oral, selective Janus kinase [JAK]1/JAK2 inhibitor) for emergency treatment of COVID‐19–associated cytokine storm in patients eligible for hospitalization (NCT04355793). Methods Patients received ruxolitinib 5 mg twice daily (preferred regimen when tolerated) or once daily for ≤ 14 days, or until determination of no clinical benefit was made. Outcomes were clinical status, physician‐assessed clinical benefit, and serious adverse event (SAE) incidence. Results Of 312 patients, 45.5% achieved ≥ 1‐point clinical status improvement. Physician‐assessed clinical benefit was reported in 42.6% of evaluable patients. SAEs occurred in 42.9%, with 2.6% experiencing an SAE suspected to be ruxolitinib related. Conclusions Overall, some hospitalized patients with COVID‐19–associated cytokine storm who received ruxolitinib experienced clinical status improvement; ruxolitinib was well tolerated. Trial Registration ClinicalTrials.gov identifier: NCT04355793

Privacy research demonstrates a dichotomy between what individuals describe as their level of concern and the protective behaviors they exhibit. We posit this dichotomy or “privacy paradox” is impacted by a feeling of hopelessness regarding an individual’s ability to protect their personal information. Younger generations have experienced all of life on social networks and much of their private information has been online since before they made individual informed privacy decisions. We evaluate the proposed research model using a survey method targeted primarily at a younger population. This research demonstrates the initial impact of hopelessness on privacy concern and also exhibits the impact of privacy awareness and perceived control. Our findings indicate that a strong antecedent to privacy concern is the feeling there is nothing we can do to protect our privacy. We contribute to the ongoing privacy research stream by incorporating this concept from psychology into a privacy concern model.

We present the Cosmic Piano, a scintillator-based muon detector designed for scientific outreach and education. The Cosmic Piano consists of modules made up of plastic scintillators with embedded wavelength-shifting fibres and avalanche photodiode readout electronics. The detector produces a musical note and a flash of light whenever a muon passes through one of its modules, providing an intuitive and engaging visualization of particle physics phenomena. Its compact design, ease of use, and adaptability make it a versatile tool for outreach activities and public engagement. The Cosmic Piano has been demonstrated successfully at high-profile events such as the Montreux Jazz Festival and the EuroScience Open Forum. This paper details the design, construction, and operation of the Cosmic Piano, emphasizing its applications in making particle physics accessible to a wider audience.

Purpose The purpose of this study was to identify preoperative and demographic risk factors of myopic regression 1 year after corneal refractive surgery. Methods A retrospective study of 2093 patients (2781 eyes) who underwent laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE) and experienced myopic regression of ≥0.5 D 1 year after surgery was conducted. Results The incidence of regression at 1 year was higher in the overall SMILE group (10.1%) and steep keratometry group (9.6%) ( P < 0.05). SMILE eyes with normal (9.0%) and steep corneas (18.2%) had a higher incidence of regression than those of LASIK and PRK eyes ( P < 0.05). The mean magnitude of spherical equivalent (SEQ) regression for all regressed eyes was −0.63 ± 0.15 D. The overall SMILE group had a greater mean magnitude of spherical regression than the overall LASIK and PRK groups (−0.66 D vs. −0.48 D vs. −0.46 D, P < 0.05). There were no differences in cylindrical regression between any analyzed groups ( P > 0.05). Female status and SEQ predicted −0.034 D [(−0.051, −0.017), P < 0.001] and −0.012 D [(−0.018, −0.006), P < 0.001] of regression, respectively. Age and preoperative K m had an odds ratio for regression of 1.033 [(1.017, 1.049), P < 0.001] and 1.109 [(1.006, 1.221), P < 0.001], respectively. Conclusions Risk factors of myopic regression at 1 year included older age, female sex, steep corneas, and higher preoperative SEQ. SMILE had a higher incidence and greater magnitude of regression compared with LASIK and PRK.

In March 2022, Lia Thomas of the University of Pennsylvania became the first openly transgender woman to win an NCAA swimming championship. Using Giddens’ structuration theory as a theoretical lens, this analysis employs Latent Dirichlet Allocation to examine how tweets about Thomas and transgender athletes contain toxic discourses based on established sports structures of fairness and sex separation of sports .