University of Nebraska at Omaha

The purpose of the present interpretative phenomenological analysis (IPA) study was to understand how military service members and veterans (MSMVs) make sense of their reintegration experiences following deployment. IPA provides the ability to gain a deeper understanding of a shared experience, or phenomenon, such as reintegration following deployment. Data collection involved semi‐structured interviews via Zoom. Participants included seven men and three women who met eligibility criteria. The present study provides important insights into how MSMVs make sense of their reintegration experiences following deployment through exploration of transitional challenges, transitional support aspects, and growth through deployment experiences, as well as the urgent need for comprehensive community‐based, growth‐focused initiatives to support their reintegration following deployment.

This paper explores the role of employee disclosures of future business outlook in predicting a firm’s cessation as a going concern. Using a large sample from 2012 to 2021, we find that employee outlook provides explanatory power in predicting firm bankruptcy. The predictive ability of employee outlook is incremental to financial ratios, market-based variables, and other stakeholders’ disclosures. Our path analysis shows that employee outlook is a mediating variable that is influenced by financial and market-based variables and in turn, impacts firm bankruptcy. We also find stronger predictive ability of employee outlook when reviews are given by current employees, when reviews aggregate the opinions from a larger group of employees and from more diverse employees, and when reviews are provided by non-unionized employees. Furthermore, we find that the current employee outlook predicts firm bankruptcy in the subsequent two and three years.

Background Sex inequality in randomized controlled trials (RCTs) related to cardiovascular disease has been observed. This study examined the proportion of women enrolled in atrial fibrillation (AF) ablation RCTs and the potential risks of underrepresentation of women. Methods and Results We systematically searched PubMed and Embase for AF ablation RCTs published from 2015 to 2022. Participant characteristics were compared among trials with higher and lower proportions of women. Of 147 AF ablation RCTs (30,055 participants), only 10 trials had enrolled women ≥50% of the total participants. Additionally, 42 trials (28.57%) excluded pregnant/breastfeeding women; 6 (4.1%) excluded reproductive‐age women without reliable birth control. The proportion of women in AF RCTs ranged from 9% to 71% (median 31.5%), whereas the median proportion of men was 67.7%. The rate of women included in the trials was stable from 2015 to 2022 ( P =0.49). Study characteristics, including funding source, showed no correlation with the rate of inclusion of women. RCTs with a higher proportion of female participants enrolled older patients with AF, had a higher prevalence of hypertension but less persistent AF, and smaller left atrium size ( P <0.05 for all). Biological sex was evaluated as a risk factor or in a subgroup analysis in 28 RCTs; 10.7% of these trials observed the implication of sex on their results. Conclusion Women were underrepresented in contemporary AF ablation RCTs. Additionally, women enrolled in AF RCTs were likely to have more comorbidities but less advanced AF, limiting the applicability of the results to women with AF.

Background Dementia care management programs, including the Care Ecosystem, have been shown to improve patient and caregiver outcomes, reduce unnecessary healthcare expenditures, and are the focus of Medicare’s new GUIDE payment model. Until now, prior research has focused on evaluating the effectiveness of participating for a short (eg, 12‐month) time frame. The purpose of this study was to evaluate the effects of the Care Ecosystem when delivered for up to 5 years or end of life. Methods Of the 804 PLWD‐caregiver dyads enrolled in the previously reported single‐blind 12‐month RCT of the Care Ecosystem (NCT02213458), 456 reported high baseline caregiver burden and were included in this extension trial (NCT04287738). Telephone‐based dementia care management was delivered by a trained care team navigator, with a team of dementia specialists. Primary outcome: PLWD quality of life (QoL‐AD); Secondary: caregiver depression (PHQ‐9), self‐efficacy (Care Ecosystem Self‐Efficacy scale), and burden (Zarit‐12), and PLWD ED and hospital use. The cumulative treatment effect was the sum of the average treatment effect on each outcome at each timepoint, weighted by the number of active participants over time. Linear mixed effects models were used to estimate the treatment effect at the annual timepoints. Caregivers’ perspectives on the value of longer care were derived via semi‐structured interviews after 5 years of participation. Results In this prespecified analysis including 297 dyads randomized to Care Ecosystem participation and 159 dyads to usual care, the cumulative 5‐year treatment effect on quality of life, caregiver depression and self‐efficacy were significant; there was a trend for caregiver burden. These treatment effects were most robust during the first 2‐3 years of the study (Figure). The cumulative treatment effects on ED and hospital use were not significant. Most caregivers who participated for the 5 full years indicated that the emotional and practical support was helpful for the duration, but many derived the greatest benefit during the first few years when they were newer to being a caregiver. Conclusion The benefits of dementia care management on PLWD quality of life and caregiver well‐being are sustained for five years, with the greatest effects in the first 2‐3 years.

Objective Posterior cervical spine surgery can result in significant discomfort in the post-operative period. Post-operative pain management presents a challenge, particularly in the elderly population which is more sensitive to adverse effects from analgesia. We aimed to compare outcomes after peri-operative posterior cervical muscle plane blocks versus patients who received general anesthesia only. Methods MEDLINE, EMBASE, and the Cochrane Library were searched for articles concerning the use of blocks in posterior cervical spinal surgery from January 1, 1974, to December 11, 2023. Data from studies meeting inclusion criteria were analyzed. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. Results The results of the pooled analysis showed that in patients undergoing elective posterior cervical spine surgery, a peri-operative posterior cervical muscle plane block resulted in a statistically significant decrease in numerical pain rating scores at 2 hours post-operatively, 12 hours post-operatively, adverse events, and post-operative nausea/vomiting. A pre-operative posterior cervical block resulted in a decrease in the duration of surgery, and numerical pain rating scores at 24 hours post-operatively though not to a level of statistical significance. Discussion These meta-analyses suggest that peri-operative posterior cervical muscle plane blocks are safe and result in improved post-operative analgesic efficacy when compared to controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of peri-operative posterior cervical blocks for elective posterior cervical spine surgery.

Neuroenhancements have the potential to dramatically increase our intelligence, memory, motivation, and attention, to name a few ways such technology can benefit us. But can neuroenhancements increase our moral status as well? I argue in the affirmative. A higher moral status than personhood is both possible and likely given advancements in neuroenhancements. Some have argued that personhood is the highest moral status possible, so the notion of a post-person is conceptually confused. I respond by presenting an inductive argument with the conclusion that a higher moral status than personhood is both possible and likely, given the potential of neuroenhancements. While making my argument I confront the inexpressibility problem, the claim that we cannot give an account of what a higher moral status than personhood would be like. I conclude the paper with an answer to the inexpressibility challenge, by suggesting an account of a higher moral status than personhood.

Purpose: Breast cancer (BC) brain metastasis (BrM) remains a significant clinical problem. Mucins have been implicated in metastasis; however, if they are also involved in BCBrM remains unknown. We queried BrM patient databases and found Mucin 5AC (MUC5AC) to be upregulated and therefore sought to define the role of MUC5AC in BCBrM. Experimental design: In-silico dataset analysis, RNA-sequence profiling on patients and cell lines, analysis of patients’ serum samples, and in-vitro/vivo knockdown experiments were performed to determine the function of MUC5AC in BCBrM. Coimmunoprecipitation unravels the interactions that can be therapeutically targeted. Results: Global in-silico transcriptomic analysis showed that MUC5AC is significantly higher in BCBrM patients. Archived BCBrM tissue analysis further revealed significantly higher expression of MUC5AC in all BC subtypes, and high MUC5AC expression predicted poor survival in HER2+ BCBrM. We validated these observations in BCBrM cell lines and tissue samples. Interestingly, elevated levels of MUC5AC were detected in the sera of BCBrM patients. MUC5AC silencing in BCBrM cells reduced migration, adhesion, and reduced BrM in experimental intracardiac injection mouse model. We found high expression of cMET and CD44v6 in BCBrM, which increased MUC5AC expression via HGF signaling. MUC5AC interacts with cMET and CD44v6, suggesting that MUC5AC promotes BCBrM via the cMET/CD44v6 axis. This axis can be targeted with c-MET inhibitor Bozitinib (PLB1001) to inhibit BCBrM. Conclusions: Our study establishes that the MUC5AC/cMET/CD44v6 axis is critical for BCBrM, and blocking this axis will be a novel therapeutic approach for BCBrM.

Background Anterior cruciate ligament (ACL) stress techniques—including single-leg stress radiographs, Telos, and KT-1000 arthrometer—are highly accessible and can provide additional diagnostic information to assess ACL and ACL graft integrity. The degree of anterior tibial translation (ATT) may be useful in guiding treatment when a diagnosis on magnetic resonance imaging is not conclusive or for judging if additional treatments, such as anterolateral complex augmentation, may be necessary. Purpose/Hypothesis The purpose of this study was to evaluate the effect of increasing posterior tibial slope (PTS) on baseline tibial position (BTP) and side-to-side differences (SSD) in ATT. A secondary purpose was to perform a subgroup analysis of SSD in ATT for patients with a PTS of ≥12° versus <12°, as well as for acute (<6 weeks from injury) versus chronic (≥6 weeks from injury or ACL graft tear) ACL tears. It was hypothesized that the BTP in normal intact knees would increase linearly with the PTS and there would be an increased SSD in ATT when comparing ACL-injured and ACL-intact knees. Study Design Case-control study; Level of evidence, 3. Methods Bilateral ACL stress radiographs were assessed from patients with primary ACL and ACL graft tears between March 2023 and March 2024. Bilateral stress views were obtained by single-leg full-length lateral weightbearing radiograph in 20° of knee flexion. The BTP and ATT were measured using a perpendicular line drawn between the posterior position of the lateral femoral condyle and the lateral tibial plateau. PTS measurements were assessed by the anatomic tibial axis. Statistical analysis using linear regression— r > 0.6 was considered strong, r between 0.4 and 0.6 moderate, and r < 0.4 weak—and t tests were used to compare the PTS with BTP and SSD in ATT. Results A total of 72 patients were analyzed using ACL stress radiographs. The results found a significant positive correlation between increased PTS and increased BTP for the ACL-intact knees ( P < .001; r = 0.476). A significant increase was found in the SSD in ATT of 1.73 mm with a positive correlation between increased PTS and increased SSD in ATT of ACL-deficient knees ( P < .001; r = 0.397). A subgroup analysis reported significant increases in SSD in ATT for both ACL-injured knees with a PTS ≥12° ( P = .008) and for chronic ACL tears ( P < .001) and no significant differences in SSD in ATT for ACL-injured knees with a PTS of <12° ( P = .650) and for acute ACL tears ( P = .745). Conclusion This study found a significant positive correlation between PTS and the BTP in ACL-intact knees and for the SSD in ATT between ACL-injured and ACL-intact knees. Moreover, the SSD in ATT was significantly increased for ACL-injured knees with a PTS of ≥12° and for chronic ACL tears. No significant difference in SSD in ATT was found for ACL-injured knees with a PTS of <12° and for acute ACL tears.

Many people in the United States express anti-LGBT attitudes and oppose LGBT rights. These views are perpetuated when others, including allies, tolerate expressions of anti-LGBT bias. In this study, we adapted and validated a measure of tolerance of homonegativity and transnega-tivity (TOHT), and assessed its associations with evaluations of LGBT people, straight people, support for LGBT rights, and system-justifying ideologies among heterosexual , straight, binary-gendered/non-trans (i.e., cisgender) women and men who identified as liberal, moderate, or conservative (N = 295). Participants completed measures of TOHT, evaluations of LGBT people, support for LGBT rights, authoritarianism, religiosity, and contact with LGBT people. Analyses by gender and political ideology indicated that all groups tolerated anti-LGBT bias to some degree. Among conservatives, women (vs. men) endorsed TOHT more and exhibited less support for LGBT rights; the opposite was true of liberals. As expected, higher TOHT scores were associated with cooler evaluations of LGBT people This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Plurisexual parents (who are attracted to more than one gender) represent a unique group of parents, yet there are no current studies that examine associations between relationship structures and sexual well-being, parenting self-efficacy, resilience, and positive plurisexual identity-related outcomes. This is the purpose of the current study in addition to understanding how branches (or differences) in relationship configurations preferences (e.g., CNM) versus current lived experiences (e.g., monogamous) are associated with sexual well-being, parenting self-efficacy, resilience and positive plurisexual identity-related outcomes. The current mixed methods study included 548 plurisexual parents, of which 85 reported branches between their preferred relationship configuration and their current relationship structure. Results indicated unique differences between plurisexual parents engaged in CNM relationships (higher levels of positive plurisexual identity-related intimacy) and monogamous relationships (higher levels of positive plurisexual identity-related authenticity and parenting self-efficacy). Branches in preferred and current relationship structures predicted lower levels of sexual satisfaction, relationship satisfaction and positive plurisexual identity-related intimacy. Qualitative analyses of comparisons between ideal and current sexual lives among 85 participants with branches in preferred and current relationship structures indicated that participants experience typical sexual difficulties that parents have reported in previous research, some participants were happy with their current sexual life, others wished for more sex and sexploration with their current partner and some participants were not satisfied with their current relationship structure. Findings have implications for future research and clinical practice with plurisexual parents.

Shoes or insoles embedded with carbon fiber materials to increase longitudinal stiffness have been shown to enhance running and walking performance in elite runners, and younger adults, respectively. It is unclear, however, if such stiffness modifications can translate to enhanced mobility in older adults who typically walk with greater metabolic cost of transport compared to younger adults. Here, we sought to test whether adding footwear stiffness via carbon fiber insoles could improve walking outcomes (eg, distance traveled and metabolic cost of transport) in older adults during the 6-minute walk test. 20 older adults (10 M/10 F; 75.95 [6.01] y) performed 6-minute walk tests in 3 different shoe/insole stiffnesses (low, medium, and high) and their own footwear (4 total conditions). We also evaluated participants’ toe flexor strength and passive foot compliance to identify subject-specific factors that influence performance from added shoe/insole stiffnesses. We found no significant group differences in distance traveled or net metabolic cost of transport ( P ≥ .171). However, weaker toe flexors were associated with greater improvement in distance traveled between the medium and low stiffness conditions ( P = .033, r = −.478), indicating that individual foot characteristics may help identify potential candidates for interventions involving footwear stiffness modifications.

Many undergraduate chemistry students hold alternate conceptions related to resonance—an important and fundamental topic of organic chemistry. To help address these alternate conceptions, an organic chemistry instructor could administer the resonance concept inventory (RCI), which is a multiple-choice assessment that was designed to identify resonance-related alternate conceptions held by organic chemistry students. In this study, two iterations of the RCI were administered to undergraduate organic chemistry students: the RCI-Pilot ( N = 484) and the RCI-Final ( N = 595). Evidence was collected to support the quality of the RCI items, the validity of the data obtained with the RCI based on internal structure, and the reliability of the data obtained with the RCI. Classical test theory (CTT) was utilized to determine the quality of the items. To gather validity evidence, the Rasch model was used and a differential item functioning (DIF) analysis was conducted. Reliability estimates were made using McDonald's Omega. Since validity and reliability evidence was gathered for the assessment scores, the data obtained in this study supports the use of the 14-item RCI for detecting student alternate conceptions with resonance.

This work focuses on using advanced techniques for Structural Health Monitoring (SHM) for bridges with Traffic (SHM-Traffic). We propose an approach using Deep Reinforcement Learning (DRL)-based control for Unmanned Aerial Vehicle (UAV). Our approach conducts a concrete bridge deck survey while traffic is ongoing and detects cracks. The UAV performs the crack detection, and the location of cracks is initially unknown. We use two edge detection techniques. First, we use canny edge detection for crack detection. We also use a Convolutional Neural Network (CNN) for crack detection and compare it with canny edge detection. Transfer learning is applied using CNN with pre-trained weights obtained from a crack image dataset. This enables the model to adapt and improve its performance in identifying and localizing cracks. Proximal Policy Optimization (PPO) is applied for UAV control and bridge surveys. The experimentation across various scenarios is performed to evaluate the performance of the proposed methodology. Key metrics such as task completion time and reward convergence are observed to gauge the effectiveness of the approach. We observe that the Canny edge detector offers up to 40% lower task completion time, while the CNN excels in up to 12% better damage detection and 1.8 times better rewards.

Long-latency reflexes (LLRs) are critical precursors to intricate postural coordination of muscular adaptations that sustain equilibrium following abrupt disturbances. Both disturbances and adaptive responses reflect excursions of postural control from quiescent Gaussian stability under a narrow bell curve, excursions beyond Gaussianity unfolding at many timescales. LLRs slow with age, accentuating the risk of falls and undermining dexterity, particularly in settings with concurrent additional tasks. We investigated whether the wobble board could cultivate the engagement of LLRs selectively in healthy young participants executing a suprapostural Trail Making Task (TMT). A concurrent additional-task demand constituted visual precision predominantly along the anteroposterior (AP) axis and mechanical instability mainly along the mediolateral (ML) axis. We scrutinized planar center-of-pressure (CoP) trajectories to quantify postural non-Gaussianity across various temporal scales. Wobble board increased engagement of LLRs and decreased engagement of compensatory postural adjustments (CPAs), indicated by the peak in non-Gaussianity of CoP planar displacements over LLR-specific timescales (50–100 ms) and non-Gaussianity of CoP planar displacements progressively diminishing over CPA-specific timescales ($>100$ ms). Engagement with TMT did not show any noticeable influence on non-Gaussian postural sway patterns. Despite aligning the unstable axis of the wobble board with participants’ ML axis, thus rendering posture more unstable along the ML axis, the wobble board increased engagement of LLRs significantly more along the AP axis and reduced engagement of CPAs significantly more along the ML axis. These findings offer initial mechanistic insights into how wobble boards may bolster balance and potentially reduce the occurrence of falls by catalyzing the engagement of LLRs selectively.

People with cystic fibrosis (PwCF), families, and clinicians, partner to co-produce care, navigate access barriers, address mental health and social factors, follow specific infection prevention and control practices, and share decision-making regarding treatments and daily care. Standard patient satisfaction and experience of care surveys are not tailored to return relevant, actionable data for specific populations. To improve the care experience, the U.S. CF Foundation committed to fielding a national survey in 2015. In 2020, the onset of the COVID-19 pandemic prompted revisions to capture virtual care experiences, a mode of care delivery not previously offered to PwCF. Leveraging this opportunity, the CF Foundation also reorganized how stakeholders are engaged in survey design, implementation, and improving the care experience. These changes resulted in a focused survey instrument as well as equitable and transparent data reports available to all stakeholders.

Dicamba-resistant soybeans are being developed to provide an additional herbicide mechanism-of-action for postemergence weed control in soybean. Numerous broadleaf species, including horseweed, have evolved resistance to glyphosate. It is anticipated that dicamba will be used by farmers as a primary tool to manage these weeds. Studying and understanding variability in horseweed response to dicamba will aid in developing appropriate risk management strategies to extend the utility of the dicamba-resistance technology. Horseweed plants from ten Nebraska populations were treated with one of nine doses of dicamba in greenhouse experiments. At 28 days after treatment (DAT) visual injury estimations were made and plants were harvested to determine dry weight. There was a three-fold difference in the I90 (90% visual injury estimate) between the least (638 g ha-1) and most (205 g ha-1) susceptible populations. Two plants from five populations were observed for an additional three months. No plants treated at doses above 280 g ha-1 survived to set seeds. These results suggest that maintaining use doses of 560 g ha-1 or greater may fully control horseweed populations from Nebraska and minimize the risk of plants surviving to set seed, in addition to practicing other proven herbicide-resistance management strategies.