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Comparison of Hand-Wrist and CVMS Methods for Craniofacial Growth Spurt Assessment
No full textObjective: Hand-wrist (HW) radiographs are considered the most accurate method for assessing pubertal growth spurts in orthodontics but have declined in use due to added radiation exposure and the expertise required. Cervical vertebral maturation staging (CVMS) is now commonly used, given the routine availability of lateral cephalograms. However, the validity of CVMS remains uncertain. A recent study reported only 66% inter-observer reliability across time periods (Ingersoll, 2024). This follow-up study aims to evaluate CVMS as a predictor of growth to guide clinical decision-making. Methods: With protocol approval (MU HR-4695), this retrospective study followed a design modeled after a prior study to reduce bias. Two trained observers assessed 129 HW radiographs from the Burlington Growth sample. These radiographs were matched to lateral cephalograms used in the earlier CVMS study. All images were randomly sorted, renamed, and anonymized. Observers used the Bjork system (Hashim et al., 2018) to classify HW radiographs into pre-, peak-, or post-pubertal growth phases. These classifications were compared with the original CVMS-based classifications to evaluate validity. Results: Statistical analysis showed high inter- and intra-observer reliability (p \u3c 0.0001). However, the percent agreement between HW and CVMS classifications was relatively low. Conclusion: While observer consistency was high, agreement between HW and CVMS methods was limited. Clinicians should exercise caution when relying solely on CVMS and consider supplementing assessments with HW radiographs or additional indicators like secondary sexual characteristics
The Effects of Internalizing Symptoms and Attentional Difficulties on Adolescent Outcomes of the PEERS Intervention
No full textThe Program for the Education and Enrichment of Relational Skills (PEERS) is effective at improving the social skills of autistic youth. However, few studies have examined the suitability of PEERS for youth with comorbid mental health concerns. Research suggests that autistic youth are highly likely to have co-occurring disorders such as internalizing and attentional disorders, which are linked with poorer social skills in autistic youth. The current study explores the effects of internalizing symptoms and attentional difficulties on outcomes of the PEERS intervention by examining the relationship between these symptoms and 3 composite outcome variables (i.e., social awareness, social interaction, social communication) before and following the intervention. 61 autistic youth ages 12–17 who completed the PEERS program were included in the analysis. Composite outcome variables were calculated using z-score transformations. Paired-samples t-tests examined changes between the pre- and post-intervention timepoints for the three composite variables. All showed an increase from pre- to post-treatment, with moderate to large effect sizes, indicating significant improvement in social skills following the intervention. Hierarchical regression was used to examine whether internalizing symptoms or attentional difficulties predicted participants’ social awareness, interaction, and communication at pre- and post-treatment. Findings from these analyses indicated that gains from pre- to post-treatment in the social interaction domain were potentially hindered by internalizing symptoms but not attentional difficulties. Social awareness was potentially reduced at pre-treatment with higher attentional difficulties, although this effect did not persist following intervention. Social communication did not appear to be affected by either internalizing symptoms or attentional difficulties at either time point. In sum, findings indicate that PEERS is generally suitable for adolescents experiencing comorbid internalizing symptoms and attentional difficulties, as elevated levels of symptoms did not consistently limit gains made from pre- to post-intervention. As such, the present study contributes to a broader understanding of the efficacy of the PEERS intervention. Future work will examine the efficacy of the PEERS program with youth who have confirmed diagnoses of internalizing and attentional disorders
Evaluating the Effectiveness of LLM-Generated Phishing Campaigns
No full textThis paper investigates the effectiveness and security implications of Large Language Models (LLMs) in phishing campaigns. Existing research has explored using LLMs and AI for enterprise security tools and automating phishing email processes. However, few studies evaluated the effectiveness of fine-tuned LLMs in generating phishing email content and measuring real-world user interaction. This research used LLMs to produce the body content of phishing emails with phishing links manually inserted post-generation. The researcher performed three core experiments: (1) evaluating the success rate of jailbreaking three commercial LLMs to generate phishing content, (2) analyzing ChatGPT-4o mini’s phishing emails based on institution-specific context and a historical phishing email, and (3) comparing user email interaction metrics between real-world traditional and LLM-generated phishing campaigns. The results revealed that LLM-generated emails are just as effective or better, under certain conditions, at compromising users by avoiding common phishing indicators such as poor grammar, urgency, and formatting inconsistencies. Fine-tuned phishing emails demonstrated that credibility through writing style transfer, contextual relevance, authority, and timing significantly influence recipient behavior. These findings emphasize the growing threat of AI-assisted phishing and highlight the need for enhanced detection methods, user awareness, and responsible LLM deployment
Integrated Mental Health Care in Specialty Clinics for Children with a Diagnosis of Asthma or Diabetes: A Mixed Methods Study
No full textIntroduction
Using patient-reported outcome measures (PROM) in a shared-space mental health-integrated specialty clinic, we explored the feasibility, acceptance, and experience of youth with asthma and diabetes, their families, and the healthcare team. Method
Using mixed methods, we examined feasibility, acceptability, and experience of PROM inclusion in caring for youth with asthma (n = 7) and diabetes (n = 11), their families (n = 18), and healthcare providers (n= 13). Completion and receipt of PROM (feasibility), postvisit surveys (acceptance), and structured interviews (experience) between June 2019 and February 2020. Results
Targeted PROM met feasibility goals (80%) and exceeded youth and family acceptance (70%). Time and low confidence using PROM affected healthcare team acceptance (64%). Families’ experiences included increased learning, trust, and partnership with the clinic team. Providers appreciated partnerships, resources, and mental health support for families. Discussion
Integrating PROM into clinical services promoted engagement, partnership, and individualized, strength-based care among youth, their parent/guardian (family), and their healthcare team
Simultaneous Emergent Phenomena: Leadership and Team Synchrony
No full textEmergent phenomena exhibit interesting dynamics when considered individually. The present article examines two emergent processes that could be occurring simultaneously in an intense team interaction: the emergence of leaders and the emergence of autonomic synchrony within teams making dynamic decisions. In the framework of panarchy theory and related studies on complex systems, autonomic synchrony would be a fast dynamic that is shaped or controlled by leadership emergence, which is a slower dynamic. The present study outlines three distinct statistical distributions—the swallowtail catastrophe model for phase shifts, inverse power laws that indicate fractal processes, and lognormal distributions—that are known to characterize emergent processes of different types. The objective was to determine the extent to which the two emergent processes reflected the same dynamics. Research participants were 136 undergraduates who were organized into teams of three to five members playing the computer-game Counter-Strike while wearing GSR sensors to measure autonomic arousal levels in a steady stream. After approximately two hours of interaction, team members rated each other on leadership behaviors. Autonomic synchrony was analyzed as a driver-empath process that produced individual driver scores (the total influence of one person on the rest of the group) and empath scores (the total influence of the group on one person). Results showed that leadership emergence displayed the swallowtail configuration that was consistent with prior studies. Autonomic synchrony started as a simpler process and unfolded into a swallowtail catastrophe toward the end of the experimental session. Lognormal distributions were second-best representations of all variables. Inverse power laws were least descriptive of any of the research variables. The implications of the temporal dynamics of the co-emerging processes for training and team development are discussed
From AI Chatbot to Brand Support: An Exploration of Perceived Empathy and Ethics in Shaping Trust and Word of Mouth
No full textRecent technological advancements have significantly enhanced AI chatbots’ ability to engage in meaningful conversations and empathic interactions, creating new opportunities for human-AI interaction while also introducing ethical considerations. This study surveyed 789 U.S. users of AI chatbots to examine how their perceptions of empathy and ethics in these chatbots influence trust in the company. The results show that perceived empathy and ethics are strongly linked to users’ trust in the company, which, in turn, affects their intention to continue using the chatbots and their likelihood of providing positive word of mouth. This study highlights the importance of empathy and ethics in AI chatbot usage from the end user’s perspective, with both theoretical and practical implications discussed
ASSESSING THE RELATIONSHIP OF CULTURAL VALUES, AND NEIGHBORHOOD FACTORS IN PRENATAL DEPRESSION AMONGST MEXICAN WOMEN
Full text linkMaternal depression during the perinatal period is a debilitating illness which negatively influences maternal health, child development and family functioning. The rate of maternal depression in Mexican-American mothers is substantially higher than non-Hispanic white populations. Some work has linked maternal depression in the US Mexican population to cultural factors and neighborhood dynamics, but these factors are only beginning to be addressed in perinatal mental health. This study investigates the independent and interactive roles of cultural values and neighborhood factors in predicting perinatal maternal depressive symptoms in women of Mexican descent. The study recruited pregnant women (N= 261) of Mexican descent in Southern California. Depressive symptoms were measured at early, mid and late pregnancy (15-17, 25-27 and 33-35 weeks’ gestation; respectively), using the Center for Epidemiologic Studies Depression Scale (CES-D). Cultural values (familismo and respeto) were assessed in early pregnancy using the Mexican American Cultural Values Scales (MACVS). Neighborhood factors, including systemic neighborhood factors (Area Deprivation Index—ADI), perceived neighborhood quality (Neighborhood Quality Evaluation Scale—NQES), and social cohesion (Neighborhood Environment Questionnaire—NEQ), were evaluated at mid-pregnancy. Linear mixed-effects models analyzed the effect of cultural values and neighborhood factors on depressive symptom trajectories over pregnancy, and moderation analyses tested the interaction effects of cultural values and neighborhood factors on depressive symptoms during mid-pregnancy. The findings showed that higher adherence to the cultural value of respeto was significantly associated with a decrease in depressive symptoms across pregnancy. While familismo alone did not have a significant main effect on depressive symptoms, it moderated the relationship between perceived sense of safety and depressive symptoms during mid-pregnancy, such that lower perceived safety significantly predicted higher depressive symptoms at mean and high levels of familismo. Furthermore, individual perceptions of lower sense of safety and lower social cohesion were associated with increased depressive symptoms over pregnancy, but the systemic measure of neighborhood disadvantage (ADI) did not significantly predict the trajectory of depressive symptoms. The study highlights the importance of cultural values and individual perceptions of the neighborhood environment in understanding perinatal depression among women of Mexican descent
Cardiac and Coronary Hemodynamics: Using an Integrated Ex-vivo Beating Heart Experiments and Computational Modeling
Full text linkCardiovascular function arises from the complex interactions among the heart, the arterial system, and the coronary circulation. Questions such as how variations in left ventricular (LV) loading conditions affect LV and aortic functions through LV–aorta interactions; and how coronary artery diseases, such as stenosis, impact cardiac function and myocardial perfusion including left and right coronary perfusion via LV–coronary interactions, remain understudied. To answer these questions, this thesis focuses on two core objectives: (1) investigate the effects of LV loading conditions on LV and aortic functions through LV–aortic interactions by performing ex-vivo beating rat heart experiments, and (2) elucidate the impact of coronary artery stenosis on coronary perfusion in the left and right coronary arteries (LCA and RCA) by developing a Distributive Model and a one-dimensional Navier-Stokes Model. Understanding LV–aorta interaction is essential for revealing how alterations in preload and afterload affect cardiac output and hemodynamic efficiency. To investigate these interactions, we conducted ex-vivo beating heart experiments that allowed independent modulation of preload and afterload to quantify their effects on LV and aortic functions. In the ex-vivo beating heart experiments, LV and aortic functions including LV pressure and volume waveforms, aortic pressure waveforms, aortic flow rate, were measured by independently varying LV preload and afterload. Our results demonstrated that increased afterload led to reduced aortic flow and elevated LV developed pressure (DP), whereas increased preload enhanced aortic flow and was accompanied by a rise in DP. These findings indicate that aortic pressure predominantly governs aortic flow under varying afterload conditions, whereas LV DP plays a dominant role in regulating aortic flow under different preload conditions. In parallel, a Distributive Model and a one-dimensional Navier-Stokes Model were developed to investigate cardiac–coronary interactions, focusing on how coronary artery stenosis impacts myocardial perfusion, in both LCA and RCA. Specifically, a one-dimensional Distributive Model and Navier–Stokes Model, incorporating anatomical LCA and RCA networks, vessel compliance, and fractional flow reserve (FFR), were developed to simulate coronary functions and regional perfusion under varying degrees of stenosis in a closed-loop of systemic circulation. The model predicts that as stenosis severity increased, coronary flow decreased significantly in both the LCA and RCA, demonstrating the nonlinear nature of hemodynamic impairment. Notably, coronary flow reduction in the RCA is more pronounced than that in the LCA, indicating a vessel-specific susceptibility to stenotic effects. These results highlight two key findings: (1) stenosis severity exerts a nonlinear impact on coronary pressure and flow, and (2) the RCA exhibits greater perfusion loss compared to the LCA under equivalent levels of stenotic conditions. Together, the ex-vivo beating heart experiments not only demonstrate mechanistic insights into how ventricular loading and aortic properties collectively shape cardiovascular function but also provide valuable information for computational modeling (e.g., measured hemodynamics serve as boundary conditions and reconstructed contractility-flow relationship) and rigorous model validation. The developed computational modeling can predict detailed hemodynamics in coronary vessels and elucidates how ventricular loading and coronary artery stenosis influence myocardial perfusion and overall cardiovascular performance, which is difficult to measure in experiments, overcoming the limitations in pure experimental studies. These findings have important implications for advancing the diagnosis, monitoring, and management of cardiovascular diseases such as heart failure, aortic stenosis, and coronary artery disease. The developed integrated experimental and computational tools can be applied to understand the underlying mechanisms of a wide range of cardiovascular diseases in future