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Program Evaluation of the Behavioral Interventions Monitoring Assessment System-2 for High School Students in Rural Nebraska
No full textBehavioral and mental health issues among adolescents in rural areas often go unrecognized due to limited access to screening and intervention. This study evaluated the efficacy of the BIMAS- 2 tool in identifying at-risk high school students in a rural Nebraska high school. Methods: A retrospective cohort program evaluation was conducted over two years with 263 students in grades 9-12. The BIMAS-2 assessment was administered electronically each semester, followed by in-person mental health interviews. Descriptive statistics and Pearson chi-square tests assessed the tool’s sensitivity, specificity, and predictive value. Results: The BIMAS-2 demonstrated high sensitivity (100%) and specificity (96.15%), with a positive predictive value of 42.22% and a negative predictive value of 100%. Few students had repeated positive screenings, reinforcing the tool’s reliability. Findings support BIMAS-2 as a sustainable model for early mental health identification in rural schools. Continued funding and stigma reduction initiatives are crucial to ensuring equitable access to mental health resources. Conclusions: The BIMAS-2 effectively identifies at-risk students, offering an effective approach to addressing adolescent mental health needs in rural communities. This study sets a foundation for improving mental health care screening, offering a model that can be implemented in other rural school districts to better address the mental health challenges faced by adolescents.
Keywords: Mental Health, BIMAS-2, Rural, Adolescents, School screenin
An Innovative Approach to Operating Room Simulation with Dental Hygiene Student Preparedness and Awareness: An iEXCEL Interprofessional Pilot Project
Full text linkIntroduction/Purpose: This study examines the preparedness, awareness, and empathy of senior dental hygiene students during an operating room simulation at UNMC’s iEXCEL. A lack of confidence and limited hands-on learning opportunities in the operating room rotation contribute to anxiety, restricting students’ ability to develop essential clinical competencies. To address this issue, a convergent mixed methods approach was used to evaluate the impact of simulation-based learning of a dental surgical case on students\u27 readiness for real-world scenarios while fostering empathy for special needs patients requiring treatment under general anesthesia.
Methods: A total of 23 second-year dental hygiene students participated in pre- and post-simulation assessments via REDCap. Quantitative data were gathered using Likert scale questions (1=strongly disagree to 4=strongly agree), while qualitative insights were obtained through open-ended responses. The simulation consisted of a pre-brief, four rotation stations, and a group debrief.
Results: Data analysis included a paired t-test to compare pre- and post-Likert responses, as well as Fischer’s exact test to identify associations between thematic elements and survey findings. A p-value of \u3c 0.05 was considered statistically significant. Results revealed a significant increase in student preparedness post-simulation (p=0.0164). Thematic analysis confirmed that “prior knowledge/past experiences” demonstrated strong associations with improved empathy (p=0.0238) and reduced anxiety (p=0.0215). These findings suggest that structured simulations can effectively enhance students\u27 clinical competencies while mitigating stress related to operating room experiences.
Conclusion: This study underscores the importance of integrating simulation-based learning into dental hygiene curricula to optimize student readiness for real-world practice. By fostering preparedness, awareness, and empathy, such simulations can play a crucial role in shaping competent and confident professionals. Future plans include expanding the simulation to include dental students and refining survey questions based on pilot insights
Disrupted Rhythms: The Impact of Altered Neural Oscillations and Sleep Patterns on Cognitive Impairment and Amyloid Accumulation in Alzheimer’s Disease
Full text linkThere has been a significant shift in the demographics of the United States towards an older populace, which has been accompanied by an increase in the prevalence of age-related neurodegenerative disorders, including Alzheimer’s disease (AD). A major component of AD-related cognitive impairment is attention deficits. While alterations of neurophysiological activity are well-documented in other domains, those which underlie the observed attentional deficits are less understood. Moreover, sleep disruptions are a common comorbidity of AD and sleep has been proven to be a modifiable risk factor in the development of AD. Sleep disruptions may contribute to the development and more rapid progression of cognitive decline in AD, including attention deficits, but these factors are understudied, and the key neurophysiological features of these comorbidities remain unknown. The studies reported herein aim to fill this knowledge gap by integrating cutting-edge multimodal brain mapping methods, with neuropsychological testing and subjective and objective sleep measures to quantify spontaneous neural activity during the resting-state and the neural dynamics underlying visual attention. Our primary goals were to determine how these neural indices were related to sleep disturbances and amyloid-beta protein deposition in the context of AD. Overall, we observed aberrant multi-spectral cortical oscillations in individuals on the AD spectrum. These aberrations were related to cognitive deficits, subjective and objective sleep measurements, and regional pathological protein deposition. Specifically in Chapter 1, we show that sleep is tightly related to spontaneous neural activity in patients on the AD spectrum and associated with cognitive function and regional amyloid accumulation. In Chapter 2, we demonstrate that neural oscillations important for visual attention are modulated by AD and that attention-related oscillations differentially predict neuropsychological outcomes in patients on the AD spectrum compared to cognitively-normal older adults. Finally, in Chapter 3 we examine the relationship between objective sleep metrics and neural oscillations during an attention task, as well as how sleep hygiene together with neural activity relates to cognitive outcomes. Altogether, our results show that AD strongly modulates neural oscillatory activity and support a mechanistic role for sleep disturbances in the widely reported neurophysiological aberrations seen in patients on the AD spectrum. Our primary findings help further the field’s understanding of the complex interactions between sleep quality, AD-related pathologies, and cognitive function, and suggest that sleep should be a major focus of future research, as it could be a potentially pivotal modifiable risk factor in AD
Feasibility, Acceptability, and Satisfaction of REDCap as a Tool for Interprofessional Education
Full text linkInterprofessional education (IPE) is an important component of health science training. Ensuring all students have access to necessary information prior to, during, and following simulation-enhanced IPE (Sim-IPE) activities is imperative to ensure a beneficial learning environment and student engagement. Ensuring access to necessary materials can be difficult due to differences in educational resources between institutions. This manuscript will assess the feasibility, acceptability, and satisfaction of using Research Electronic Data Capture (REDCap) as an educational tool for a Sim-IPE activity. After a pilot Sim-IPE activity, data from student evaluations was reviewed. Updates were made including use of REDCap as a universally accessible web-application. In addition to data collection, REDCap served multiple purposes, including as a pre-activity learning module and assignment submission portal. Students and faculty were provided direct links to specific portions of REDCap project throughout the activity. Data collected during the following two years was reviewed. From the pilot in 2021 (n=76) to the activity in 2022 (n=220), a significant increase in mean score for students’ overall assessment of the Sim-IPE activity was found (9.8% increase from 2021;
Exposure of Tracheostomy Education Well-Received During Pre-Clinical Head and Neck Physical Exam Course
Full text linkObjective: Previous tracheostomy education programs have focused on many healthcare personnel populations including non-surgical residents and senior level medical students. However, the impact of tracheostomy educations programs on pre-clinical medical students has not been investigated. This pilot QI study aims to demonstrate that a concise hands-on tracheostomy education course can provide pre-clinical medical students adequate instruction and improve confidence in providing care for tracheostomy patients.
Methods: This pilot quality improvement study included academic otolaryngologists across multiple subspecialties providing concise hands-on tracheostomy education as part of a mandatory head and neck physical examination course for all medical students. A mannequin with a tracheostomy was assigned to each small group and clinical situations were simulated. Time was allowed for questions and further independent practice. Students were asked to complete an anonymous questionnaire prior to and following the course which included a knowledge assessment and inquiry on the confidence level of each scenario based on a rating of 1 (not confident) to 4 (very confident). Seventy-nine pre-clinical medical students completed both surveys. A two-sample paired t-test was utilized to compare changes in confidence and knowledge.
Results: Of the 79 students who completed both surveys, 10% had previously participated in tracheostomy training. Scores for the confidence assessment increased by an average of 110% (p\u3c0.005), with a pre-course average of 1.2 and a post-course average of 2.5. Significant improvements in the knowledge assessment were also seen with an average of 80% correct following the course compared to the 50% prior to the course (p\u3c0.005). Most of the students either wouldn’t change anything or wanted more detail or resources (89%), with few individuals noting the assessment was too long (5%).
Conclusion: Pre-clinical medical students benefit from a tracheostomy education component included in their head and neck physical exam course. Feedback supported the course being well-received, well-timed, and appropriately concise
Enhancing Care Through Occupational Therapy: Implementing Services at the UNMC SHARING Clinic
Full text linkThe Kaiser Family Foundation reports 121,800 uninsured persons in Nebraska in 2023, with 26% of residents below 200% of the Federal Poverty Level. The Student Health Alliance Reaching Indigent Needy Groups (SHARING) clinic is a pro bono clinic run by student volunteers at UNMC. The SHARING Clinic provides primary health care to uninsured and underserved individuals in the Omaha, NE area. As of January 2025, occupational therapy students and faculty have joined medical, physician associate, pharmacy, laboratory, nursing, psychiatry, physical therapy, and medical nutrition as care partners for the community. The purpose of our poster is to highlight how we integrated occupational therapy services into the SHARING Clinic. This poster emphasizes specific elements such as the creation of patient education materials, team-based care, occupational therapy in primary care, and advocacy for the occupational therapy profession in this setting. We will also share our plan to measure program effectiveness by using key performance indicators
Variable Selection with False Discovery Rate Control in High-Dimensional Data
No full textThe increasing availability of high-dimensional (HD) observational data offers great opportunities for scientific discovery through feature selection. However, HD biomedical data also present significant statistical challenges, as signals are often rare and weak, and the relationship between predictors and outcomes is frequently unknown. We are interested in developing a knockoff-based framework to identify features that are truly associated with biomedical outcomes from HD data, while effectively ensuring the quality of selection by controlling the false discovery rate (FDR). This framework allows for the integration of machine learning methods, such as penalized regression and random forests. In particular, we demonstrate that our methods address the following challenges: (1) handling measurement errors and missingness in HD metabolomics data; (2) selecting reproducible features by integrating information from multiple electronic health record (EHR) sources with heterogeneity and privacy concerns; and (3) conducting mediator selection in high-dimensional causal models involving nonlinearities and interactions. We validate the FDR control and improved power of our methods through extensive simulation studies. Finally, we apply the proposed framework to the Women’s Health Initiative data, the National COVID Cohort Collaborative (N3C), and Alzheimer’s research datasets. These applications provide new insights into FDR control in HD feature selection and lead to novel scientific findings in nutritional epidemiology, infectious disease research, and neuroscience
Scientist Perspectives: A Correlation Analysis of Translational Science Competencies Compared with Principles of Engagement and Knowledge Integration
No full textThe competencies identified in the development of the “Fundamental Characteristics of the Translational Scientist” may not consider and fully integrate the concepts of knowledge integration and engagement, key components of the translational science spectrum. This gap may be widening and deepening the “valley of death” and exacerbating ongoing challenges in the field of translational science. This dissertation explored the association of knowledge integration, stakeholder engagement, and community engagement principles compared with translational science competencies.
Utilizing content review and a non-experimental, correlation study design, data were collected through a quantitative survey from adult research subjects all self-identified as a research investigator (n=93) at a Clinical and Translational Science Award (CTSA) associated, high-research activity institution (e.g., R1).
Key findings from the content review suggest a gap between competencies and principles of knowledge integration and engagement. In addition, key findings indicate a statistically significant, positive correlation between the two variables of importance and perceived skill of the research investigator among the competencies associated with the fundamental characteristics of a translational scientist, rs(93) = .298, p \u3c .003. All competencies were perceived to be important by research investigators; however, the importance of the competency versus the perceived skill of the research investigator allows us to have a deeper understanding of the implications of this research.
These results have practical implications for research institutions seeking to further enhance research/community partnerships, support for research investigators and to better identify training programs that focus on key components of the translational science spectrum. Further research should be completed to refine the research methods, expand the sample, and explore community needs versus research organizational needs and the systems by which they operate. Review of translational research training programs and other community engagement efforts at CTSAs and translational research hubs should be reviewed to assess the coverage of competencies versus principles. Finally, additional research should focus on whether skills can be further refined to be more relevant to the individual stages and to provide a better pathway for community engagement across all areas of the translational spectrum from basic to clinical to public health stages
Beyond the Bruise: Understanding Injury Risk Factors Among Livestock Workers in Cattle Feedyards and Animal Handling Farms and Ranches
No full textCattle feeding and livestock production are central to U.S. agriculture and represent some of the most hazardous occupational environments. Workers in feedyards and on cattle farms and ranches face elevated risks of injury due to physically demanding labor, frequent animal handling, and exposure to environmental and ergonomic hazards. Many feedyard workers are Hispanic/Latino immigrants who may experience additional barriers related to language, healthcare access, and job security. Similarly, injury risks among cattle producers are compounded by seasonal workload fluctuations, limited rest opportunities, and psychosocial stressors. Beyond individual impacts, agricultural injuries also pose a substantial economic burden. Recent estimates indicate that the average cost of a nonfatal farm injury exceeds 11.3 billion annually. Despite these risks and costs, limited research has examined how multilevel factors, including individual characteristics, organizational conditions, and broader contextual influences, contribute to injury among livestock workers. This dissertation addresses that gap through three studies focused on cattle feedyard workers and cattle operators in the U.S. Central States.
Study 1 used Partial Least Squares Structural Equation Modeling (PLS-SEM) to examine how job demands, perceived organizational support (POS), related contextual factors and health conditions, influence work-related injury outcomes among 170 Hispanic/Latino cattle feedyard workers in Nebraska, Kansas, and Colorado. Higher job demands, animal handling, and high blood pressure were associated with increased injury risk, while older age and greater POS were protective. Several significant interaction terms suggest that the effects of individual predictors are shaped by the context in which they occur.
Study 2 applied multivariable logistic regression within a Social Ecological Model (SEM) framework to identify individual, interpersonal, and organizational predictors of injury among 180 Hispanic/Latino feedyard workers. Higher education, frequent work fatigue, and self-rated good or very good health were significantly associated with past-year injury.
Study 3 analyzed data from 4,523 farmers and ranchers with cattle operations across seven Midwestern states using Generalized Estimating Equations. Seasonal patterns showed a peak in spring injuries, primarily due to livestock-related events in the farmyard. Male sex, high stress, exhaustion, and awkward postures were independently associated with past year injury.
Together, these studies indicate that livestock injuries arise from identifiable and often modifiable patterns across personal, social, and structural levels. Findings support comprehensive prevention strategies that address work demands, fatigue, organizational culture, and seasonal risks in high-intensity livestock operations
A Novel Approach for Understanding the Role of Bone Remodeling in Early Structural Knee Osteoarthritis
No full textKnee osteoarthritis (KOA) is a leading cause of disability in the U.S., yet few effective treatments exist due to limited understanding of the mechanisms underlying its initiation and early structural progression. KOA is a degenerative disease affecting the synovium, cartilage, and underlying subchondral bone. While subchondral and trabecular bone thickening are well documented in late-stage KOA, their roles in early structural disease development remain unclear. Some studies suggest that bone changes may precede cartilage loss, highlighting the importance of understanding early bone remodeling to identify intervention targets that could slow or prevent disease progression.
Current KOA diagnosis relies on physical exams and patient-reported symptoms, with radiographs commonly used to assess structural progression. However, radiography is limited in its ability to detect early structural changes and cannot visualize many joint tissues affected by KOA, such as cartilage and synovium.
The primary focus of this dissertation was to assess subchondral bone features in early structural KOA. This study evaluated subchondral bone density in high-risk individuals (prior knee injury and/or obesity), with and without early radiographic KOA using two imaging tools: dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT). Both are low-radiation, quick imaging techniques that provide reliable quantitative bone assessments. pQCT offers additional insights by separately assessing cortical and trabecular compartments.
No significant bone density differences were found between early and no KOA groups, suggesting that bone changes in the earliest stages may be minimal or highly variable. While our findings do not support a specific bone density biomarker for early structural KOA, they highlight the need for longitudinal studies incorporating imaging of soft tissue features. Subtle bone changes may still play a role in early disease and could be linked to soft tissue alterations in the synovium or cartilage that emerge over time.
This research emphasizes the need for accessible, validated imaging biomarkers to detect early structural KOA. Early detection would enable timely, targeted interventions to preserve joint health, reduce symptoms, and prevent long-term disability from this debilitating condition