Medicine and Health Sciences Commons^™

Ai-Supported Analysis Of Jury Deliberation Impact Factors, Jennifer Siciliani Phd

Generative AI Teaching Activities

Students conduct a controlled, two-run generative AI jury simulation to examine how a single socio-legal variable affects simulated jury deliberation. They compare and manually code the AI-generated outcomes against peer-reviewed human jury research to evaluate the model’s accuracy, limitations, and potential biases.

Implementation Of Asynchronous Mentor Education Modules To Improve Mentoring Competency, Elvira Sayfutdinova

Doctor of Nursing Practice (DNP) Student Projects

Background & Significance: Structured mentorship supports new CRNAs as they transition to practice, fostering confidence, job satisfaction, and professional growth. The WashU Medicine Department of Anesthesiology (WUDA) launched a CRNA Mentorship Program in 2022, but it lacked standardized mentor education, leading to inconsistent mentor preparation and variable mentoring practices.

Review of Literature Findings: Structured mentor education improves mentoring competency across healthcare settings, yet the literature specific to CRNAs remains limited. Asynchronous, self-paced formats reduce barriers to participation for busy clinicians, but no prior study has evaluated a fully asynchronous, prerecorded mentor-education format for CRNAs.

Methods: This pre-/post quality improvement (QI) …

Palliative Care Consults In The Intensive Care Unit, Kyra Zimmer

Doctor of Nursing Practice (DNP) Student Projects

Background & Significance: Intensive care unit (ICU) patients often face serious illness or terminal diagnoses requiring invasive monitoring and life-sustaining treatments. Palliative care (PC) supports patients and their families by focusing on improving quality of life, goals of care, and symptom management. It is estimated that 14-20% of ICU patients in the United States could benefit from palliative care consults (PCCs) with potential savings of $6 billion per year. Nurses caring for these patients face unique ethical challenges and may develop secondary post-traumatic stress, emotional strain, burnout, and compassion fatigue.

Review of Literature: The review of literature supported a structured …

Implementation Of A Learning Module To Reduce Advanced Practice Provider Preceptor Burden, Michelle Bloom

Doctor of Nursing Practice (DNP) Student Projects

The transition of advanced practice providers (APPs) from student to provider, or from an experienced provider to a new organization or location, has been identified as a high-stress period with potential turnover for new-hire APPs. APP preceptors play a key role in this transition. Limited time to teach during the clinical day and a limited knowledge base among new hires were two of many factors associated with increased preceptor burden. A brief online educational module that provided pre-clinical, organization-specific education was proposed to improve new-hire APPs’ knowledge base and reduce preceptor burden, among APP preceptors working in a 36-bed surgical/burn/trauma …

Discovering Repurposable Drugs For Alzheimer's Disease And Related Dementias: Target Trial Emulation Using Decentralised Real-World Data, Qiong Wu, Lu Li, Yuqing Lei, Ting Zhou, Huilin Tang, Bingyu Zhang, Yiwen Lu, Maxwell Salvatore, Dazheng Zhang, Jiayi Tong, Tingyin Wang, Siqi Chen, Haoyang Li, Zhenxing Xu, Yu Huang, Yu Hu, Na Hong, Yujia Zhou, Fongci Lin, Kyra O'Brien, Yong Chen, Ruowang Li, Hua Xu, Fei Wang, Jiang Bian, David Wolk, Yong Chen

College of Population Health Faculty Papers

BACKGROUND: Alzheimer's disease and related dementias (ADRD) affect nearly 6.9 million Americans, with the number expected to triple by 2050, while disease-modifying therapies remain unavailable. Drug repurposing, which identifies new indications for already approved medications, offers a more efficient and cost-effective pathway to accelerate development of effective therapies for ADRD. The aim of this study is to identify potential drug repurposing signals by systematically screening routinely prescribed drugs for associations with progression from mild cognitive impairment (MCI) to ADRD.

METHODS: We conducted a multi-site target trial emulation using electronic health record (EHR) data from four decentralised databases: INSIGHT Clinical Research …

Universal Screening For Measles Immunity During Pregnancy: A Cost-Effectiveness Analysis, Anuradha Devabhaktuni, Sarah Boudova, Elias Kassir, Sohum Shah, Neil S. Silverman, Christina S. Han

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Measles is a highly contagious illness capable of causing significant morbidity and mortality, including adverse pregnancy outcomes. Routine screening for measles immunity is not currently recommended during pregnancy. Given the increasing frequency of measles outbreaks nationally and globally, awareness of measles immunity status can influence management of pregnant individuals who incur measles exposures and offer an opportunity for postpartum or preconception vaccination.

OBJECTIVE: We sought to evaluate the cost-effectiveness of universal screening for measles immunity during pregnancy in the United States.

STUDY DESIGN: A decision-analytic model was constructed to evaluate the cost-effectiveness of universal screening for measles immunity during …

Complementary Vertebrate Wac Models Exhibit Phenotypes Relevant To Desanto-Shinawi Syndrome, Kang-Han Lee, Marwan Shinawi, Et Al.

2020-Current year OA Pubs

Monogenic syndromes are associated with neurodevelopmental changes that result in cognitive impairments and neurobehavioral phenotypes, including autism and seizures. Limited studies and resources are available to make meaningful headway into the underlying molecular mechanisms that result in these symptoms. One such example is DeSanto-Shinawi Syndrome (DESSH), a rare disorder caused by pathogenic variants in the

Benchmarking Institutional Support For Point-Of-Care Testing Programs: Scale, Staffing, And Operational Challenges, Min Yu, Nam K Tran, Julie L V Shaw, Nicholas E Larkey, Nicole V Tolan, Andrew Szczembara, Leslie J Donato, Robert D Maynard, Adil I Khan

2020-Current year OA Pubs

BACKGROUND: Point-of-care testing (POCT) has expanded rapidly across healthcare systems, increasing both program scale and operational complexity. However, quantitative benchmarking data describing how POCT programs are structured and supported across institutions remain limited.

METHODS: We conducted a cross-sectional survey to characterize POCT program support, including program scope, staffing, operational practices, governance, and challenges. The survey was distributed electronically through professional networks, and 93 institutional responses were analyzed. Descriptive analyses were performed, and derived metrics, including sites per point-of-care testing coordinator (POCC), were used to evaluate the relationship between program scale and staffing.

RESULTS: POCT programs demonstrated substantial variability in scale, …

Current State And Needs Of Clinical Laboratories In Selected Countries In Africa, Merih Tesfazghi, Anne E Tebo, Roa Harb, Anthony O Okorodudu, Lee Schroeder, Jeannette Guarner, Christine Bales, Jack Ladenson, Allison Targowski, Kerry Cosby, Olajumoke Oladipo

2020-Current year OA Pubs

The Africa Working Group, under the auspices of the Global Laboratory Quality Initiative of the Association for Diagnostics & Laboratory Medicine (ADLM), conducted several educational workshops in Africa to promote laboratory quality in the region. The challenges faced in maintaining quality in clinical laboratories in low-resource countries may differ from region to region and country to country. To better understand current gaps and inform our engagement with partners in Africa, a needs assessment survey was distributed to 1427 ADLM members in Africa and further disseminated through local partners, resulting in 121 responses from participants across 8 countries in the region. …

Assessment Of Timp1, Transgelin-2, And Procalcitonin As Protein Biomarkers For Diagnosis And Prognosis Of Bloodstream Infection In A Critically Ill Cohort, Sajal Tiwary, Caroline A O'Neil, Sydney Lawless, Olivia Arter, Meghan Brown, Brittany Roemmich, Carleigh Samuels, Jennie H Kwon, Christopher W Farnsworth

2020-Current year OA Pubs

BACKGROUND: Bloodstream infections (BSI) are a significant contributor to morbidity and mortality among hospitalized patients. Rapid diagnosis of BSI is critical for timely and appropriate clinical management, but current diagnostic strategies have a prolonged turnaround time or only identify select pathogens with minimal prognostic information.

METHODS: We examined serial serologic samples from 77 intensive care unit (ICU) patients at time points before, during, and after diagnosis of presumptive BSI to identify host-derived protein biomarkers associated with specific organisms and with clinical outcomes in BSI. ICU patients with and without BSI were included. Two candidate biomarkers, tissue metalloproteinase 1 (TIMP-1) and …

Pulmonary Adenocarcinoma Arising From Somatic-Type Malignant Transformation Of A Nonseminomatous Germ Cell Tumor: A Case Report, Abdel Martinez Borrego, Brandon Cantazaro, Fatimah Bello, Christine Vega, Natacha Vargas, Payal Bhakta, Renzo Arauco

School of Medicine Publications

Somatic-type malignant transformation (STM) is a rare but aggressive complication of nonseminomatous germ cell tumors (NSGCTs), most commonly arising from the teratomatous component and frequently occurring in metastatic sites. We report the case of a man in his 20s with a history of mixed NSGCT (50% yolk sac tumor, 40% teratoma, and 10% embryonal carcinoma) treated with left orchiectomy and chemotherapy in 2023, who initially responded to treatment but was subsequently lost to follow-up. He presented with one week of progressive dyspnea and pleuritic left-sided chest pain. Serum alpha-fetoprotein was markedly elevated at 2,966.7 ng/mL. Computed tomography demonstrated a progressive …

Single-Session Robot-Assisted Removal Of A Retained Ureteral Stent With Complex Proximal And Distal Encrustation: A Case Report, Maximo Alvarez, Cole Freedman, Emma Romero, Paul Kim, Alexis Garza, Harras Zaid

School of Medicine Publications

Retained encrusted ureteral stents represent a complex urologic problem, particularly in patients with limited healthcare access. We present a 28-year-old undocumented female with a 10-month retained ureteral stent who developed massive right-sided encrustation, including a 3 cm proximal renal stone near the renal pelvis and a 5-6 cm bladder stone, classified as FECal Grade IV-V. A single-session combined approach consisting of robot-assisted cystolithotomy, intraoperative ureteroscopy with stent exchange, and robot-assisted pyelolithotomy was performed successfully. Intraoperative ureteroscopy between operative phases confirmed ureteral clearance and enabled immediate stent placement without repositioning delay. This case supports the use of combined robotic approaches for …

No Evidence For Modulation Of The Readiness Potential By Respiratory Phase During Natural Breathing, Lucas Jeay-Bizot, Raniyah Chisti, Uri Maoz, Aaron Schurger

Psychology Faculty Articles and Research

Respiratory processes are increasingly implicated in shaping neural activity and behavior. Recent studies have reported a coupling between respiratory phase and the cortical readiness potential (RP), suggesting that breathing may modulate the neural processes preceding voluntary action. Here, using electroencephalography recordings in humans, we re-examine this claim using the original dataset and a new independent dataset, as well as in simulated data with no coupling. We show that the reported association arises from a confound: both RP amplitude and respiratory phase are coupled to movement onset. The original analysis does not control for this dependency, leading to a spurious effect …

September 2026, Swosu Rural Health Center

RURAL ROCKS

Introducing Hilltop Health: Connecting Campus, Community & Care

This fall marks an exciting new chapter for SWOSU Hilltop Health as services and partnerships continue to grow within the Jerry & Margaret Hodge College of Pharmacy and Rural Health Center. Designed to create a more connected approach to health and wellness, Hilltop Health brings together healthcare access, prevention, education, and community resources while creating new opportunities for collaboration across SWOSU and western Oklahoma.

Unique Pharmaceutical Laboratories (A Div. of J. B. Chemicals & Pharmaceuticals Ltd.) Issues Voluntary Nationwide Recall of Cetirizine Hydrochloride Tablets USP 5 mg Due to Potential Cross Contamination …

Cyanobacteria-Derived Near-Infrared Autofluorescent Exosomes Enabling Synergistic Brain Lesion Imaging And Neuroprotection, Jingmei Pan, Yayun Wang, Yikun Feng, Jiaoyang Wang, Qiongya Huang, Lei Yan, Xiaobo Zhou, Huili Sun, Huaiyu Wang, Qu Wei

Faculty, Staff and Student Publications

Precision diagnosis and treatment of central nervous system (CNS) diseases are hindered by limited probe penetration, toxicity risks, and low imaging signal-to-noise ratio (SNR). The blood-brain barrier (BBB) further restricts drug delivery, especially in stroke therapy. This study proposes and validates a natural exosome (sExos) from cyanobacteria, featuring intrinsic near-infrared-I (NIR-I) autofluorescence, with strong imaging and neuroprotective functions. As a theranostic nanoplatform, sExos enable integrated diagnosis and treatment of stroke and other brain disorders. Enriched with the fluorescent phycobiliprotein ApcE, sExos support label-free, high-SNR brain imaging in the NIR-I window. In vivo, sExos cross the BBB and accumulate in …

Endocarditis Caused By Candida (Candidozyma) Auris, Farah Ebrahim, Mzee Ngunga, Abdulaziz Abeid, Hilda Nasibwa, Newnex Mongare, Rodney Adam

Internal Medicine, East Africa

Candida (Candidozyma) auris has emerged as a hospital-acquired pathogen and was first reported in East Asia in 2009. Infective endocarditis due to C. auris has been rarely reported, while other Candida species account for < 2% of infective endocarditis (IE) cases. Herein we report three cases of endocarditis caused by C. auris , including a native aortic valve, a native tricuspid valve, and a prosthetic valve. Each of these cases had been in healthcare settings months to years earlier that were the likely sources of their infec- tions. These cases suggest the possibility for indolent but life-threatening infections from C. auris . ©2026 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Strategies To Improve Outcomes Of Obstetric Emergencies In Sub-Saharan Africa: A Scoping Review, Serah Wachira, Ruth Wagathu, Beth Waweru, Rose Maina, Abednego Ongeso, Constance Sibongile Shumba, Benard Mutwiri, Diana Mbattude, Cliff Aliga, Lucy Kisaka, Peter Gatiti

School of Nursing & Midwifery, East Africa

Background: Obstetric emergencies remain a leading cause of maternal morbidity and mortality in sub-Saharan Africa (SSA) despite increased access to facility-based deliveries and emergency obstetric care. Improving outcomes requires not only life-saving clinical interventions but also effective health system strategies. This review mapped published evidence on strategies used to improve outcomes of obstetric emergencies in SSA.

Objective: This scoping review aimed to identify strategies reported in the literature to improve outcomes of obstetric emergencies in SSA.

Methods: The review was reported in accordance with PRISMA-ScR. A comprehensive electronic search of PubMed, CINAHL, SCOPUS, and CORE identified studies published between January …

Bridging The Dermatology Divide: A Literature Review Of Artificial Intelligence–Enabled Point-Of-Care Tools For Skin Cancer Detection In Primary Care, Jared Hensley, Smaran Marupudi, Maria Villegas

School of Medicine Publications

The United States faces a critical dermatology workforce shortage, with more than 60% of counties lacking specialist access. Primary care providers (PCPs) are often tasked with managing suspicious skin lesions but demonstrate lower diagnostic accuracy than dermatologists. Artificial intelligence (AI) tools offer potential solutions, and meta-analytic evidence demonstrates that AI assistance improves PCP sensitivity by 13 percentage points and specificity by 11 percentage points. Yet only 1 Food and Drug Administration–authorized device (January 2024) is cleared for nondermatologist use in the United States. This device achieves 96% sensitivity but only 21% specificity, meaning most positive results are false alarms. A …

Relationships Between Psychosocial Aspects Of Stuttering And Self-Disclosure Of Stuttering In A Japanese Sample, Daichi Iimura, Saburo Takahashi, Mizuki Aoki, Kentaro Yoshizawa, Kota Yanai, Shoko Miyamoto, Michael P. Boyle

Department of Communication Sciences and Disorders Faculty Scholarship and Creative Works

Purpose We aimed to psychometrically evaluate a Japanese version of the Disclosure of Stuttering Scale, from Boyle et al. (2018), and identify the psychosocial factors associated with level of stuttering self-disclosure among adults who stutter.

Methods: Adults who stutter were recruited via stuttering self-help groups in Japan and the authors’ contacts. Participants completed their demographics, the Disclosure of Stuttering Scale and other psychological scales assessing affective, cognitive, and social aspects of stuttering via an online survey. We analyzed 180 participants after those with unreliable or duplicate responses were excluded. The scale’s reliability and validity were confirmed, and multiple linear regression …

Closing Gaps In Urban Trauma Systems: Outcomes Of An Inner-City Community Emergency Department Multidisciplinary Trauma Protocol, Kory S. London, Alan Cherney, Sulabh Neupane, H. Alex Tomlinson, Joseph Cervone, Elaine Qian, Casey Fishman, Jennifer Davis, Sean Mcgann, Varsha Goswami, George Koenig, Frederick Randolph

Department of Emergency Medicine Faculty Papers

BACKGROUND: Non-trauma center (NTC) emergency departments (EDs) play regular but underappreciated roles in the management of severely injured patients, yet many lack formal protocols to guide care. We describe the implementation and outcomes of a structured trauma evaluation and transfer protocol at an urban NTC emergency department.

METHODS: A multidisciplinary trauma protocol was implemented on April 1, 2023, at an urban NTC, supported by a Level I trauma center, 2.5 miles apart. The study period ran from January 1, 2019, to June 30, 2025. Using pre-post study design, 62 patients treated prior to implementation were compared with 49 post-intervention patients. …

Targeting Grasp-Related Cortical Areas For Intracortical Brain-Machine Interfaces, Tyler R Johnson, Crispin Foli, Emily C Conlan, Katherine A Koenig, Mark J Lowe, William D Memberg, Robert F Kirsch, Eric Z Herring, Stanley F Bazarek, Emily L Graczyk, Dawn M Taylor, A Bolu Ajiboye, Jennifer A Sweet

Faculty, Staff and Student Publications

This study aimed to improve intracortical microelectrode array implantation sites for grasp-related motor decoding by integrating anatomical, functional, and vascular imaging with preoperative 3D modeling. A participant with C5 tetraplegia underwent anatomical MRI, diffusion-weighted imaging, and task-based fMRI to identify grasp-related cortical regions while avoiding vasculature and speech-critical areas. Quicktome software was used to refine target selection by integrating structural connectivity and functional activation data. A 3D-printed skull and cortical model enabled preoperative planning, including craniotomy and electrode positioning simulations. Electrode placement was validated postoperatively using neural data collected from the implanted arrays during attempted movements of the arm and …

Reply, Jacqueline L. Chen, Amanda J. Lu, Rohan Verma, Li Wang, Douglas D. Koch, Allison J. Chen

Department of Medicine Faculty Papers

No abstract provided.

Best Practices For Supporting Occupational Therapy Students With Disabilities During Clinical Education: Results From A Three-Round Delphi Study, Courtney Gohean, Katie Mclaughlin, Aster Harrison

Department of Occupational Therapy Faculty Papers

INTRODUCTION: Disabled occupational therapy students face systemic barriers in clinical education. Although legal mandates require reasonable accommodations, implementation is often inconsistent, and few standardized guidelines exist for fieldwork education. This study is aimed at establishing best practices for supporting occupational therapy and occupational therapy assistant students with disabilities during fieldwork.

MATERIALS AND METHODS: A three-round Delphi study was conducted with a panel of 30 experts, including disabled occupational therapy students, disabled occupational therapy practitioners, academic fieldwork coordinators (AFWCs), fieldwork educators (FWEs), disability services staff, and researchers. In Round 1, participants answered open-ended questions about challenges, accommodations, and environmental supports. Responses …

Patient-Specific Computational Fluid Dynamics Modeling Of Airway Collapse In Infants With Robin Sequence., Gautam Jalori, Michael Barbour, Michael Bindschadler, Kelly Evans, John P. Dahl, Alberto Aliseda

Manuscripts, Articles, Book Chapters and Other Papers

Robin Sequence (RS) is a congenital condition in which patients experience dynamic, periodic obstruction or collapse of the upper airway due to an underdeveloped jaw and a posteriorly displaced tongue. Current clinical techniques for evaluating airway obstruction do not provide quantifiable data and fail to account for the dynamic nature of obstruction or collapse. There is no standardized criterion to characterize obstruction or collapse severity. This study presents the first method that extracts airway motion from 4-dimensional computed tomography and performs a patient-specific, moving-mesh computational fluid dynamics (CFD) analysis of RS patients with complete airway collapse or obstruction. To quantify …

Posaconazole Target Attainment In Critically Ill Children: A 15-Year Single-Center Retrospective Analysis., Kathryn Pavia, Addison M. Pritchett Ms, Jennifer Goldman

Manuscripts, Articles, Book Chapters and Other Papers

Posaconazole is a triazole antifungal agent used for prophylaxis and treatment of invasive fungal diseases. Posaconazole has high inter-individual variability in dose-exposure relationship and benefits from therapeutic drug monitoring (TDM). Adult studies report particularly high rates of subtherapeutic exposure among intensive care unit (ICU) patients related to changes in physiology during critical illness. The rates of subtherapeutic posaconazole exposure among critically ill children in ICU's are unknown. This single-center retrospective analysis at a large freestanding children's hospital used TDM results from 2010 to 2025 obtained while patients were undergoing care in a pediatric ICU. Therapeutic targets were ≥ 1.0 mg/L …

Maternal Violent Injury And Child Exposure To Violence-A Call For Trauma-Informed And Structural Responses., Gunjan Tiyyagura, M Katherine Henry, Kimberly Randell

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Characteristics Of Individuals With Cerebral Palsy Across The Us., Bhooma R. Aravamuthan, Amy F. Bailes, Micah Baird, Kristie Bjornson, Ira Bowen, Angeline Bowman, Elizabeth R. Boyer, Rose N. Gelineau-Morel, Laurie Glader, Paul H. Gross, Stacey Hall, Edward A. Hurvitz, Michael Kruer, Thomas Larrew, Neena I. Marupudi, Patrick G. Mcphee, Stephen A. Nichols, Garey Noritz, Joyce Oleszek, Justin Ramsey, Jeffrey S. Raskin, Heather Riordan, Brandon G. Rocque, Manish N. Shah, Benjamin J. Shore, M Wade Shrader, David Spence, Charles B. Stevenson, Richard Stevenson, Sruthi P. Thomas, Joyce P. Trost, Stephen R. Wisniewski, Cerebral Palsy Research Network

Manuscripts, Articles, Book Chapters and Other Papers

This cross-sectional study examines how demographics and characteristics of individuals with cerebral palsy across the US associate with Gross Motor Function Classification System level and genetic etiology.

Vomica And Respiratory Distress: A Complicated Lung Hydatid Cyst In A Child., Riccardo Guanà, Antonella Peduto, Maria Grazia Sacco Casamassima, Marco Denina, Marco Petraz, Cristina Giuliano, Giuseppe Farruggio, Lucia Gerbaudo, Fabrizio Gennari

Manuscripts, Articles, Book Chapters and Other Papers

Hydatid cyst, caused by Echinococcus infection, is the most common parasitic lung infection in children. Giant cysts are generally the result of a late diagnosis and are associated with a high risk of spontaneous rupture and life-threatening complications, including anaphylactic shock. We present the complex management of a large, complicated hydatid cyst of the lung in an 11-year-old boy in a nonendemic area. This case highlighted the specific work-up and surgical treatment of lung cysts as well as the differential diagnosis to consider when treating pulmonary masses or pneumonia.

Opioid Dispensing Volume And Per-Patient Intensity In Sickle Cell Disease, Kevin Y Xu, Brandon K Attell, Joanna L Buss, Tashalee R Brown, Charles R Jonassaint, Richard A Grucza, Allison A King, Max Jordan Nguemeni Tiako

2020-Current year OA Pubs

IMPORTANCE: Opioids remain central to management of acute and chronic pain in sickle cell disease (SCD). Opioid dispensing declined over the 2010s amid opioid stewardship efforts, but patterns since 2020 are less clear. Analyses aggregating opioids into morphine milligram equivalents (MME) may obscure agent-specific patterns.

OBJECTIVE: To characterize opioid dispensing volume and per-recipient frequency, duration, and dose among individuals with SCD.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of commercially insured and Medicaid-enrolled patients with SCD using the Merative MarketScan databases across 3 periods from January 2011 to February 2016, March 2016 to December 2020, and January 2021 to …

Parent-Child Neural Dynamics During A Stressful Task: Probing Associations With Temperament And Anxiety, Joscelin Rocha-Hidalgo, Harmony Nguyen, Dakota Reis, Denny Schaedig, Kahlil I Thompson, Susan B Perlman, Koraly E Pérez-Edgar

2020-Current year OA Pubs

Dynamic social interactions between parents and children can contribute to anxiety risk, amplifying shared genetic risk. Research has focused on observed behaviors to explain intergenerational transmission. Neural synchrony may contribute as a biological conduit for behavioral transmission of risk. We examined 109 parent-child dyads (