University of Nebraska at Omaha

The global workforce crisis significantly impacts how evidence-based treatment is provided to youth with developmental disabilities and co-occurring mental health conditions. Addressing the workforce crisis requires re-examining the long-standing methods of selecting individuals for employment based on academic degrees. This project offers an innovative workforce development option that provides specialized training to staff with advanced education degrees and staff with less education. The participants in this study were employed in a rural area of the USA within the mental health, child welfare, and correctional industries. All participants worked with youth experiencing intellectual disabilities and mental illness. Results indicated that participants improved their knowledge of the population, demonstrated a better understanding of EBPs, and were willing to employ evidence-based approaches regardless of their education or age. Although overall attitudes toward EBPs decreased, diverging attitudes increased, suggesting a need to accommodate treatment strategies when EBP models are unavailable for special populations. Initial knowledge gaps demonstrated by those with a master's degree and those with less education disappeared after the training. This finding supports the application of innovative task-shifting options in mental health, such as diverting more sophisticated care tasks to nonprofessionally trained persons, which can reduce workforce pressure and unmet demand for care. This study demonstrates cost-effective and time-efficient methods of training staff regardless of education by relying less on specific EBP models and more on adaptation.

When theorizing, it is sometimes colloquially said “I reckon…” This essay attempts to reckon with theorizing by proposing a heuristic for systematically gauging rigorous and/or meaningful theoretical research with the analysis of eight factors: novelty, challenge, relevance, power, fecundity, usefulness, deliberateness, and clarity. These factors offer a manual for theorists writing theoretical research, and a loose set of considerations to begin discussions of what it is that makes invigorating theory.

Prospective memory (PM) - memory for future intentions - has a core term called focality which describes how closely a PM task relates to an ongoing task. When a close relationship exists between an ongoing and PM task, the task is classified as focal (loose relationships are classified as nonfocal). Competing PM theories differ primarily in explanations for how focality changes participants' approaches. Researchers classify PM intentions as focal or nonfocal in two ways: (1) task appropriateness, congruency (TAP) or incongruency (TIP) of processing to complete both tasks, and (2) cue specificity, specific or general task cues. Independently manipulating this ambiguity in defining "focality" was our current focus. Participants were randomly assigned to a control group, a focal PM condition, or one of three nonfocal conditions. Their ongoing task involved a semantic judgment (Experiment 1) or an orthographic judgment (Experiment 2). Cue specificity impacted PM accuracy consistently, favouring specific cues. Task-appropriateness impacted PM accuracy in Experiment 1, but not in Experiment 2 which showed protective effects for specific, whole-word PM cues - emphasizing the role that deeper processing has on PM success. These studies highlight the ambiguity in the operational definition of focality and provide the groundwork for continued refinement of the definition.

Creating sustained, transformative change within and across organizations is challenging, particularly when those undertaking change act as individuals. COMmunities of Practice (CoPs) are organically created collaborations among like-minded participants, working toward a common set of goals (Lave & Wenger, 1991; Wenger-Trayner & Wenger-Trayner, 2014). CoPs offer an avenue for members to connect individuals across various boundaries. In this paper, we investigate the ways in which regional CoP leaders experience value participating in their community, using the Communities for Mathematics Inquiry in Teaching (COMMIT) Network as our unit of study. The COMMIT Network is a grant funded project aimed at engaging mathematics faculty at institutions of higher education in regional CoPs around teaching with inquiry. In this study we examine the experiences of CoP leaders nested within this network setting. We interviewed 19 leaders from eight United States regions to understand their perceptions of individual and collective value participating in the regional CoP and COMMIT Network structures. We framed our study on Wenger et al. (2011). Promoting and assessing value creation in communities and networks: A conceptual framework. Open University of the Netherlands.) Value Framework. Our findings show that leaders found Immediate Value as individuals participating in a collaborative, supportive CoP environment and they found Realized Value in terms of the impact their CoP could make on instructional practices, both in their region and the network. An unexpected finding examines how future opportunities for value creation may influence long-term sustainability and transformation of college mathematics instruction. We provide implications for the ways that regional CoPs, along with CoP networks, can provide value for members through such communities.

Background The human skin contains a diverse microbiome that provides protective functions against environmental pathogens. Studies have demonstrated that bacteriophages modulate bacterial community composition and facilitate the transfer of host-specific genes, potentially influencing host cellular functions. However, little is known about the human skin virome and its role in human health. Especially, how viral-host relationships influence skin microbiome structure and function is poorly understood. Results Population dynamics and genetic diversity of bacteriophage communities in viral metagenomic data collected from three anatomical skin locations from 60 subjects at five different time points revealed that cutaneous bacteriophage populations are mainly composed of tailed Caudovirales phages that carry auxiliary genes to help improve metabolic remodeling to increase bacterial host fitness through antimicrobial resistance. Sequence variation in the MRSA associated antimicrobial resistance gene, erm(C) was evaluated using targeted sequencing to further confirm the presence of antimicrobial resistance genes in the human virome and to demonstrate how functionality of such genes may influence persistence and in turn stabilization of bacterial host and their functions. Conclusions This large temporal study of human skin associated viruses indicates that the human skin virome is associated with auxiliary metabolic genes and antimicrobial resistance genes to help increase bacterial host fitness.

Erratum to article [1]: J. Brummer and V. Naibo, Weighted fractional Leibniz-type rules for bilinear multiplier operators, Potential Anal. 51(1), 71–99 (1).

Background and objectives: There is a paucity of multicenter data on rates of high flow nasal cannula (HFNC) usage in bronchiolitis in the United States, largely because of the absence of standardized coding, with HFNC often subsumed into the larger category of noninvasive mechanical ventilation. Methods: We examined HFNC utilization in patients with bronchiolitis from a sample of hospitals participating in a national bronchiolitis quality improvement collaborative. Medical records of patients aged <2 years admitted November 2019 to March 2020 were reviewed and hospital-specific bronchiolitis policies were collected. Exclusion criteria were prematurity <32 weeks, any use of mechanical ventilation, and presence of comorbidities. HFNC utilization (including initiation, initiation location, and treatment duration), and hospital length of stay (LOS) were calculated. HFNC utilization was analyzed by individual hospital HFNC policy characteristics. Results: Sixty-one hospitals contributed data on 8296 patients; HFNC was used in 52% (n = 4286) of admissions, with the most common initiation site being the emergency department (ED) (75%, n = 3226). Hospitals that limited HFNC use to PICUs had reduced odds of initiating HFNC (odds ratio, 0.3; 95% confidence interval [CI], 0.3 to 0.4). Hospitals with an ED protocol to delay HFNC initiation had shorter HFNC treatment duration (-12 hours; 95% CI, -15.6 to -8.8) and shorter LOS (-14.9 hours; 95% CI, -18.2 to -11.6). Conclusions: HFNC was initiated in >50% of patients admitted with bronchiolitis in this hospital cohort, most commonly in the ED. In general, hospitals with policies to limit HFNC use demonstrated decreased odds of HFNC initiation, shorter HFNC duration, and reduced LOS compared with the study population.

Posttraumatic stress disorder (PTSD) significantly impacts many veterans. Although PTSD has been linked to alterations in the fear brain network, the disorder likely involves alterations in both the fear and anxiety networks. Fear involves responses to imminent, predictable threat and is driven by the amygdala, whereas anxiety involves responses to potential, unpredictable threat and engages the bed nucleus of the stria terminalis (BNST). The BNST has been implicated in PTSD, but the role of the BNST in combat veterans with PTSD has yet to be examined. Identifying alterations in BNST responses to unpredictable threat could provide important new targets for treatment. The current study examined whether veterans with PTSD have altered BNST or amygdala responses (function and connectivity) to unpredictable and predictable threat. The fMRI task involved viewing predictable threat cues followed by threat images, predictable neutral cues followed by neutral images, and unpredictable threat cues followed by either a threat or neutral image. Participants included 32 combat-exposed veterans with PTSD and 13 combat-exposed controls without PTSD. Across all conditions, veterans with PTSD had heightened BNST activation and displayed stronger BNST and amygdala connectivity with multiple fear and anxiety regions (hypothalamus, hippocampus, insula, ventromedial prefrontal cortex) relative to controls. In contrast, combat controls showed a pattern of stronger connectivity during neutral conditions (e.g., BNST-vmPFC), which may suggest a neural signature of resilience to developing PTSD, ηp 2 = .087-.527, ps < .001. These findings have implications for understanding fear and anxiety networks that may contribute to the development and maintenance of PTSD.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics/gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1=not important, 4=essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p=0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

More organizations use AI in the hiring process than ever before, yet the perceived ethicality of such processes seems to be mixed. With such variation in our views of AI in hiring, we need to understand how these perceptions impact the organizations that use it. In two studies, we investigate how ethical perceptions of using AI in hiring are related to perceptions of organizational attractiveness and innovativeness. Our findings indicate that ethical perceptions of using AI in hiring are positively related to perceptions of organizational attractiveness, both directly and indirectly via perceptions of organizational innovativeness, with variations depending on the type of hiring method used. For instance, we find that individuals who consider it ethical for organizations to use AI in ways often considered to be intrusive to privacy, such as analyzing social media content for traits and characteristics, view such organizations as both more innovative and attractive. Our findings trigger a timely discussion about the critical role of ethical perceptions of AI in hiring on organizational attractiveness and innovativeness.

Traditional methods do not capture the multidimensional domains and dynamic nature of infant behavioral patterns. We aim to compare full-day, in-home leg movement data between infants with typical development (TD) and infants at risk of developmental disabilities (AR) using barcod-ing and nonlinear analysis. Eleven infants with TD (2-10 months) and nine infants AR (adjusted age: 2-14 months) wore a sensor on each ankle for 7 days. We calculated the standard deviation for linear variability and sample entropy (SampEn) of leg acceleration and angular velocity for nonlinear variability. Movements were also categorized into 16 barcoding states, and we calculated the SampEn and proportions of the barcoding. All variables were compared between the two groups using independent-samples t-test or Mann-Whitney U test. The AR group had larger linear variability compared to the TD group. SampEn was lower

Coping with surprise and uncertainty resulting from the emergence of undesired and unexpected novelty or the sudden reorganization of systems at multiple spatiotemporal scales requires both a scientific process that can incorporate diverse expertise and viewpoints, and a scientific framework that can account for the structure and dynamics of interacting social-ecological systems (SES) and the inherent uncertainty of what might emerge in the future. We argue that combining a convergence scientific process with a panarchy framework provides a pathway for improving our understanding of, and response to, emergence. Emergent phenomena are often unexpected (e.g., pandemics, regime shifts) and can be highly disruptive, so can pose a significant challenge to the development of sustainable and resilient SES. Convergence science is a new approach promoted by the U.S. National Science Foundation for tackling complex problems confronting humanity through the integration of multiple perspectives, expertise, methods, tools, and analytical approaches. Panarchy theory is a framework useful for studying emergence, because it characterizes complex systems of people and nature as dynamically organized and structured within and across scales of space and time. It accounts for the fundamental tenets of complex systems and explicitly grapples with emergence, including the emergence of novelty, and the emergent property of social-ecological resilience. We provide an overview of panarchy, convergence science, and emergence. We discuss the significant data and methodological challenges of using panarchy in a convergence approach to address emergent phenomena, as well as state-of-the-art methods for overcoming them. We present two examples that would benefit from such an approach: climate change and its impacts on social-ecological systems, and the relationships between infectious disease and social-ecological systems.

CRISPR-based technology has become widely used as an antiviral strategy, including as a broad-spectrum human coronavirus (HCoV) therapeutic. In this work, we have designed a CRISPR-CasRx effector system with guide RNAs (gRNAs) that are cross-reactive among several HCoV species. We tested the efficacy of this pan-coronavirus effector system by evaluating the reduction in viral viability associated with different CRISPR targets in HCoV-OC43, HCoV-229E, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We determined that several CRISPR targets significantly reduce viral titer, despite the presence of single nucleotide polymorphisms in the gRNA when compared with a non-targeting, negative control gRNA. CRISPR targets reduced viral titer between 85% and >99% in HCoV-OC43, between 78% and >99% in HCoV-229E, and between 70% and 94% in SARS-CoV-2 when compared with an untreated virus control. These data establish a proof-of-concept for a pan-coronavirus CRISPR effector system that is capable of reducing viable virus in both Risk Group 2 and Risk Group 3 HCoV pathogens.

Over the past decades, government agencies have been under increasing institutional pressures to improve performance while engaging the public in decision-making processes. This study aims to explore how agency managers perceive institutional pressures and how these pressures shape their network behaviors for interagency collaboration. Specifically, this research focuses on structural holes, which refer to network positions that connect otherwise-disconnected agencies. Drawing on the literature of public management, citizen participation, and social networks, this research develops a theoretical model of an agency’s network position and proposes hypotheses. This research tested two hypotheses using network and survey data collected from agency managers in the Seoul Metropolitan Government in 2009. The results of the study showed that agencies under greater performance pressure tended to locate themselves in interagency networks with structural holes, while agencies facing greater citizen participation demands tended to embed themselves in interagency networks with fewer structural holes. This implies that performance pressure drives city agencies to seek competitive structural positions in interagency networks, while citizen participation demands lead agencies to locate in dense interagency networks.

Caring for a child diagnosed with Autism Spectrum Disorder (ASD) can be challenging for parents. Many of parent’s challenges are related to the spectrum of symptoms associated with the condition. Because one of the most pivotal changes made in the DSM–5 relates to ASD concerns the symptoms’ impact on social communication aspects of functioning we sought to assess symptoms of autism in relation to parents’ mental health. Specifically, this investigation assessed the association between diagnoses of autism spectrum disorders and the mental health profile of parents. In our study, we used two measures for assessment of autism. The first was DSM5 diagnosis of autism and the second was The Krug Aspeger Disorder Index (KADI). A sample of 184 parents was used to evaluate the above association. Of the sample collected, 154 parents indicated that their child met the diagnostic criteria for Asperger Syndrome. The main findings in this study suggested that a DSM 5 diagnosis of autism was associated with an elevated level of depression of the parents. A higher chance of a diagnosis of Asperger Syndrome was associated with higher levels of suicidal ideation among parents. Finally, parents who indicated that their child would have a high to very high chance of being diagnosed with Asperger Syndrome received a higher score on the anxiety and depression measures compare with parents of a child who would have an extremely low chance of being diagnosed. The implication for practice, assessment, and research are presented.

Extensive reviews of functional analysis literature were conducted 10 (Beavers et al., 2013) and 20 (Hanley et al., 2003) years ago; we expanded this review to capture the vast and innovative functional analysis research that has occurred over the past decade. Our review produced 1,333 functional analysis outcomes from 326 studies on the functional analysis of problem behavior between June 2012 and May 2022. Some characteristics of functional analysis studies were similar across the current and previous two reviews (e.g., child participants, developmental disability diagnosis, use of line graphs depicting session means, differentiated response outcomes). Other characteristics deviated from the previous two reviews (e.g., increase in autistic representation, outpatient settings, use of supplementary assessments, the inclusion of tangible conditions, and multiple function outcomes; decrease in session durations). We update previously reported participant and methodological characteristics, summarize outcomes, comment on recent trends, and propose future directions in the functional analysis literature.

Background No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat bloodstream infections (BSIs), and practices may vary depending on clinician specialty and experience. Objective To assess practice patterns regarding oral antibiotic use for treatment of bacteremia in infectious diseases clinicians (IDCs, including physicians and pharmacists and trainees in these groups) and non–infectious diseases clinicians (NIDCs). Design Open-access survey. Participants Clinicians caring for hospitalized patients receiving antibiotics. Methods An open-access, web-based survey was distributed to clinicians at a Midwestern academic medical center using e-mail and to clinicians outside the medical center using social media. Respondents answered questions regarding confidence prescribing OAT for BSI in different scenarios. We used χ2 analysis for categorical data evaluated association between responses and demographic groups. Results Of 282 survey responses, 82.6% of respondents were physicians, 17.4% pharmacists, and IDCs represented 69.2% of all respondents. IDCs were more likely to select routine use of OAT for BSI due to gram-negative anaerobes (84.6% vs 59.8%; P < .0001), Klebsiella spp (84.5% vs 69.0%; P < .009), Proteus spp (83.6% vs 71.3%; P < .027), and other Enterobacterales (79.5% vs 60.9%; P < .004). Our survey results revealed significant differences in selected treatment of Staphylococcus aureus syndromes. Fewer IDCs than NIDCs selected OAT to complete treatment for methicillin-resistant S. aureus (MRSA) BSI due to gluteal abscess (11.9% vs 25.6%; P = .012) and methicillin-susceptible S. aureus (MSSA) BSI due to septic arthritis (13.9% vs 20.9%; P = .219). Conclusions Practice variation and discordance with evidence for the use of OAT for BSIs exists among IDCs versus NIDCs, highlighting opportunities for education in both clinician groups.

Background Yellow fever (YF) vaccination is often mandatory for travelers to YF-endemic areas. The areas with risk of YF partially overlap with those of dengue, for which there is currently no recommended vaccine available for dengue-naïve individuals. This phase 3 study assessed the immunogenicity and safety of concomitant and sequential administration of YF (YF-17D) and tetravalent dengue (TAK-003) vaccines in healthy adults aged 18-60 years living in areas of the US non-endemic for either virus.Methods Participants were randomized 1:1:1 to receive the following vaccinations at Months 0, 3, and 6, respectively: YF-17D+placebo, TAK-003, and TAK-003 (Group 1); TAK-003+placebo, TAK-003, and YF-17D (Group 2); or YF-17D+TAK-003, TAK-003, and placebo (Group 3). The primary objective was to demonstrate non-inferiority (upper bound of 95% confidence interval [UB95%CI] of difference