Drexel University

This research study examined a novel cellulose fiber extracted from the central part of the banana plant. The physical, chemical, and thermal properties, crystallography, and surface morphology analysis were studied to investigate their suitability in textiles and bio-based composite material applications. The physical analysis revealed the mean tensile strength as 81 ± 18.4 MPa, with a 0.643 ± 0.12 GPa tensile modulus and a linear density of 0.14 tex for the obtained fiber. The findings also demonstrate that these fibers possess unique properties such as lower density (1.10 g/cc) and, most particularly, high crimp (4–6 cp/mm). The existence of different basic components was confirmed by Fourier transform infrared spectroscopy analysis. The chemical analysis estimated the cellulose, hemicellulose, and lignin percentages to be 65.92%, 17%, and 10%, respectively. The moisture regain of the fibers was 9.22%. Similar to cotton fibers, these fibers dissolved completely in a 60% H2SO4 solution. Thermogravimetric analysis establishes the thermal stability of the fiber up to 270 °C, making it viable for use in composite manufacturing. The crystallinity index of the fiber was 62.71% determined by X-ray diffraction. Scanning electron microscopy reveals the presence of natural convolution commonly found in cotton fiber. The study concludes that banana floral stem fibers could provide a sustainable alternative in various industrial applications, e.g., eco-friendly automotive interiors, sustainable insulation materials, and turning agricultural waste into valuable resources. Graphical abstract

The autism social motivation hypothesis suggests that diminished reward value of social stimuli contributes to deficits in social motivation. Research indicates that autistic individuals show decreased neural responding to both social and non-social reward, suggesting domain-general reward system differences. However, autism is heterogenous with extensive co-occurring psychopathology, and the autism phenotype may not be the best way to understand its relationship with neural reward response. Autism has been associated with normative and pathological personality domains that may better represent the heterogeneity and comorbidity of autism. The present study examined associations between autism traits, pathological personality, and the neural response to multiple reward types. The sample included 18-33-year-old undergraduates who completed monetary, social, and restricted interests reward tasks while we recorded electroencephalography to measure the reward positivity (RewP), an event-related potential indicator of reward sensitivity. Participants completed self-report measures of autism traits and the pathological personality traits negative emotionality, detachment, and anankastia. Autism traits were not directly related to the RewP but were positively associated with pathological personality dimensions. Across all reward tasks, negative emotionality was related to a larger RewP while detachment and anankastia were related to a smaller RewP. All three pathological personality dimensions mediated the relationship between autism traits and the RewP. The present study suggests that autism and neural reward response is at least partially mediated by comorbid psychopathology. Moreover, the results are inconsistent with the social motivation hypothesis and instead suggest that autism is linked to domain-general neural response to rewards.

Eosinophilic cholangitis (EC) is a rare condition characterized by eosinophilic infiltration of the bile ducts, often mimicking diseases like primary sclerosing cholangitis or cholangiocarcinoma. We report the case of a 32-year-old man with severe epigastric pain and elevated liver function tests. Initial imaging revealed common bile duct dilation and multiple strictures, initially suggestive of primary sclerosing cholangitis. Multiple endoscopic retrograde cholangiopancreatographies with brushings showed benign cytology but revealed polysomy on fluorescence in situ hybridization. A biopsy confirmed EC. High-dose corticosteroids led to significant clinical improvement. This case underscores the importance of considering EC in the differential diagnosis of biliary diseases, as timely diagnosis and treatment can lead to excellent outcomes.

Background MRI has emerged as an important tool for prostate cancer early detection. Despite its utility, insurance coverage for prebiopsy MRI is variable, with previous studies suggesting dramatic underutilization. Methods MarketScan Commercial and Medicare Claims Database was used to identify men who underwent a prostate MRI within 9 months preceding their prostate biopsy from January 2012 to December 2021. Exclusion criteria included a prior prostate cancer (PCa) diagnosis and previous PCa treatment. We examined national trends in MRI utilization according to insurance and prior biopsy status and used multivariable logistic regression to identify predictors of its use. As a supplemental analysis, we explored the probability of treatment with radiation or radical prostatectomy according to prebiopsy MRI status. Results We identified 252,962 prostate biopsy claims between 2012 and 2021. Prebiopsy MRI use increased from 1.5% of total biopsies to 30.3% in 2021. Among patients who had a prior biopsy, the proportion rose from 2.7% to 59.0%. On multivariable analysis, having undergone a previous biopsy (odds ratio [OR]: 6.04, 95% confidence interval [95% CI]: 5.24 to 6.96; P < .001) and residing in an urban area (OR: 1.95, 95%CI: 1.67-2.28; P < .001) were both independent predictors of having an MRI before biopsy. No differences in the use of prebiopsy MRI were observed between Medicare and commercial insurance holders (OR: 1.07, 95%CI: 0.99-1.15; P = .112). Among patients who had undergone a prior biopsy, the probability of undergoing a subsequent radical prostatectomy was higher for patients who had an MRI before their biopsy (15.9%, 95%CI: 15.0%-16.8%) as compared with patients who did not have a prebiopsy MRI (10.4%, 95%CI: 9.8%-10.9%). Conclusions The use of prebiopsy MRI for prostate cancer diagnosis has increased over the past decade, particularly in patients who had undergone a prior negative biopsy. Having undergone an MRI was associated with an increase in the odds of treatment, particularly in those with a prior biopsy, suggesting an increase in the detection of higher-grade cancers associated with MRI use at a population level.

The Tailored Activity Program (TAP), an intervention for people living with dementia (PLWD) and their caregivers, has been shown to reduce behavioral symptoms for PLWD and caregiver burden. While TAP is proven as an evidence-based practice (EBP), it has yet to be implemented at scale. The Department of Veterans Affairs (VA) has prioritized the Age-Friendly Health System (AFHS) initiative, providing an opportunity to test implementation of TAP in a complex healthcare system. We conducted semi-structured pre-implementation interviews with leaders and clinicians at 6 VA Medical Centers (VAMCs) to engage key implementation partners and understand their unique implementation contexts. We utilized team-based rapid qualitative analysis to identify themes related to implementation determinants. We interviewed 65 unique informants in 58 interviews (5 VAMC leaders, 36 department leaders, and 17 frontline clinical staff). Informants identified 4 key factors critical to consider prior to implementing TAP: (1) alignment with organizational priorities; (2) perceived value and fit with existing clinical workflows; (3) competition with existing organizational and clinical priorities; and (4) considerations about the effect of caregiver burden on participation. We identified key factors to consider for successful implementation of a multicomponent intervention for PLWD and their caregivers within a complex healthcare system. As the AFHS initiative expands, there is a growing need for EBPs focused on the care of PLWD and their caregivers. These factors can guide clinicians, leaders, and implementation scientists in planning for implementation and sustainment of EBPs to bolster AFHS initiatives. Trial Registration Registered 05 May 2021, at ISRCTN #60,657,985. Reporting Guidelines The COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used to ensure proper standards for reporting qualitative studies (see attached).

Effective communication is crucial in reducing health disparities. However, linguistic differences, such as African American Vernacular English (AAVE), can lead to communication gaps between patients and physicians, negatively affecting care and outcomes. This study examines whether large language models (LLMs), specifically GPT-4 and Llama 3.3, can replicate AAVE in simulated clinical dialogues to improve cultural sensitivity. We tested four prompt types—BaseP, DemoP, LingP, and CompP—using United States Medical Licensing Examination (USMLE) case simulations. Statistical analyses on the models’ outputs showed a significant difference among prompt types for both GPT-4 (F(2,70) = 6.218, p = 0.003) and Llama 3.3 (F(2,70) = 12.124, p < 0.001), indicating that including demographic information and/or explicit AAVE cues influences each model’s output. Combining demographic and linguistic cues (CompP) yielded the highest mean AAVE feature counts (e.g., 9.83 for GPT-4 vs. 16.06 for Llama 3.3), although neither model fully captured the diversity of AAVE. Moreover, simply mentioning African American demographics triggers extra informal forms, suggesting built-in stereotypes or biases in both models. Overall, these findings highlight the promise of LLMs for culturally sensitive healthcare communication, while underscoring the need for continued refinement to address stereotypes and more accurately represent diverse linguistic styles.

Aims This study assessed the antibacterial, anti-biofilm, and immunomodulatory activity of Lactobacillus acidophilus (strain Scav) postbiotic (LaP) in a mouse model of Pseudomonas aeruginosa wound infection and evaluated the bioactive components of the LaP. Methods and Results LaP was tested for P. aeruginosa clearance and immunomodulatory activity during wound infection. We show that LaP applied 1 hour after infection reduced tissue bacterial burden within 24 hours, and this reduction persisted for 5 days. Ciprofloxacin given once at the exact same time did not reduce bacteria load as compared to vehicle controls. LaP reduced plasma IL-6 and MCP-1 levels after 5 days. Wound tissue IL-6 and MCP-1 levels were increased in infected vehicle mice at 5 days, but tissues from LaP treated mice were similar to sham controls. LaP increased tissue IL-10 (anti-inflammatory cytokine) levels. Ciprofloxacin decreased plasma and tissue IL-6 compared to vehicle controls but did not affect MCP-1 or IL-10 levels. To elucidate antibacterial and anti-biofilm metabolite(s) in LaP, fractionation followed by P. aeruginosa antagonistic activity assays were performed. This was followed by liquid chromatography coupled to mass spectrometry (LCMS) analysis. Our analyses identified a low molecular weight, polar molecule which had both antibacterial and anti-biofilm activity. Conclusions L. acidophilus secretes an antibacterial and anti-biofilm metabolite that reduced pathogen burden, resolved systemic inflammation in a P. aeruginosa wound infection model.

Emotion regulation deficits are a hallmark of adolescent depression, and sleep greatly impacts emotion regulation. Initial data indicate acute mood benefits of slow‐wave sleep deprivation (SWSD) in depressed adults, but it is unclear whether this may occur through improvement in emotion regulation. In addition, this has not been tested experimentally in adolescent depression. In this pilot study, we tested the effect of SWSD on emotion regulation in adolescents with elevated depressive symptoms. Fifteen adolescents (mean age [SD] = 17.47 [1.55] years, 12 female) completed three consecutive nights of polysomnographic sleep recording: Baseline, SWSD, and Recovery. Auditory stimulation (sounds of varying pitch, duration, and volume) suppressed slow‐wave sleep (SWS) during SWSD. After Baseline and SWSD nights, the Emotional Go/No‐Go task was administered the next day as a behavioural assessment of cognitive control, emotion discrimination, and emotion regulation outcomes. False Discovery Rate was used to account for multiple comparison correction. We found that, at Baseline, longer SWS duration was associated with poorer emotion discrimination (β = −0.44, p = 0.012, Q = 0.036). There was no association between other sleep stages and emotion regulation. While Emotional Go/No‐Go outcomes did not significantly differ between Baseline and SWSD nights, greater attenuation in SWS significantly correlated with improvement in cognitive control (β = 0.61, p = 0.021, Q = 0.038), emotion discrimination (β = −0.44, p = 0.025, Q = 0.038), and emotion regulation (β = 0.62, p = 0.049, Q = 0.049) between nights. Findings from this pilot study tie elevated SWS to impaired emotion regulation in adolescents with depressive symptoms and suggest that targeted deprivation of SWS may improve emotion regulation in depressed adolescents with elevated SWS.

Li-Fraumeni Syndrome (LFS) is a rare hereditary cancer syndrome characterized by an increased risk of early-onset and multiple tumors across various organ systems, predominantly linked to germline TP53 mutations. While commonly associated neoplasms include sarcomas, breast cancer, and adrenocortical carcinoma, the occurrence of high-grade gliomas (HGG), including glioblastoma multiforme (GBM), in LFS patients is less documented and typically presents at a younger age relative to sporadic cases. A systematic review following PRISMA guidelines was conducted, focusing on clinical studies and case reports that explore the association between HGG and LFS. A comprehensive PubMed search was used to capture relevant studies. The inclusion criteria focused on patients with a confirmed diagnosis of LFS and histopathologically verified HGG. A total of 248 articles were initially identified, with 8 studies meeting the final inclusion criteria after independent review and consensus. Overall, 8 studied reported on patients with either WHO grade 3 or 4 gliomas in the setting of LFS. In total these studies represent 12 patients, with 8 (66%) WHO grade 4, and 4 (33%) WHO grade 3. 9 (75%) patients underwent maximal safe resection, 5 (42%) underwent concurrent TMZ and EBRT. 9 (75%) patients underwent external beam radiation therapy (EBRT), 1 (8%) underwent intensity modulated radiation therapy (IMRT), and 1 (8%) underwent adjuvant treatment with tumor treating fields (TTF) therapy. Overall chemotherapy utilization was 75% with 9 patients receiving some form of chemotherapy. The median time to recurrence following initial treatment was 7 months (IQR: 2.00–7.00). Time to progression was variable, ranging from 5.1 months to 7 years. 64% of patients succumbed to their disease with a median OS of 17 months across studies. LFS associated HGGs are a genetically heterogenous entity. Detailed study of outcomes reported in the literature with respect to these genetics will develop further insight into therapeutic response and prognostication.

Background Although many studies have examined outcomes after glioma surgery, few have explored the factors driving variation in the cost-effectiveness of surgical care. In this study, we integrate granular time-driven activity-based costing (TDABC) methodology with quality-adjusted life years (QALYs) to measure the true “value” (outcomes achieved per dollar spent) of glioma surgery. Methods 176 glioma surgeries performed at a single institution were reviewed. Process maps were designed to identify all resources utilized in the intraoperative episode. Costing software was developed to automate the extraction of this data from the electronic medical record (EMR). QALYs were calculated based on progression-free survival (PFS) and 6-month postoperative Karnofsky Performance Status (KPS) scores. The Operative Value Index (OVI) was defined as the QALYs achieved per $1,000 spent intraoperatively. Multivariable regression models were performed to examine factors driving variability in both costs and OVI. Results The median total cost of surgery was$6,987, most of which was driven by the cost of supplies ($3,804, 53$1,635, 23%). The median QALY was 0.96, PFS was 403 days (1.1 years), and the OVI was 0.14. Multivariable regression analysis revealed that awake surgery was associated with $2,540 of additional cost compared to surgery under general anesthesia, while World Health Organization Grade III (p < 0.001) and Grade IV (p < 0.001) gliomas were associated with significantly lower OVI. Conclusions This study establishes a scalable, EMR-based framework for evaluating surgical value by integrating cost with outcomes. We show that awake surgery is associated with significantly higher total cost, and that increasing glioma disease severity is associated with worse outcomes achieved per dollar spent.

The Homeostasis Concept Inventory (HCI) is a validated instrument for measuring students' knowledge of homeostasis. It is comprised of 20 multiple-choice questions covering key components of the previously validated Homeostasis Conceptual Framework (HCF). In this paper we present the first multi-institutional study of the impact of physiology instruction on students' HCI performance. Five cohorts of physiology or anatomy & physiology (A&P) students at four academic institutions took the HCI both at the start of their academic term (pre-test) and at the end of their term (post-test). Statistically significant but relatively modest improvements in overall scores were seen from pre-test to post-test. Among the 20 questions, eight questions had incorrect choices identified as “attractive distractors” on the pre-test, meaning that they were chosen at higher-than-random frequencies. From pre-test to post-test, there were only modest declines in selections of incorrect answers generally and of attractive distractors in particular. Three attractive distractors that all target one specific misconception -- that homeostatic mechanisms are active only when a regulated variable is not at its setpoint -- remained persistently attractive except for students of one instructor who directly addressed that misconception in lecture. These data are sobering in that they show a limited impact of instruction on HCI performance. However, these data also include encouraging evidence that instructional targeting of a specific misconception may help students overcome that misconception.

Background Glypican-4 (GPC4) is a cell-surface heparan sulfate proteoglycan that can be released into circulation under various clinical conditions. Elevated levels of circulating GPC4 have recently been associated with reduced kidney function and an increased risk of all-cause mortality across different patient populations. The potential of circulating GPC4 for assessing disease status or prognosis in patients with end-stage kidney disease has not yet been explored and was addressed in the present study. Methods The study included 187 patients starting chronic dialysis treatment. In addition, 108 control subjects with normal or mildly reduced kidney function, matched for sex and age, were included in the study. The median follow-up time of incident dialysis patients was 3.8 years. Blood samples were collected immediately before initiation of dialysis. Serum GPC4 levels were determined using an enzyme-linked immunosorbent assay. Results Serum GPC4 levels were approximately 10-fold higher in incident dialysis patients compared to controls demonstrating excellent classification ability to distinguish between the two groups. Furthermore, circulating GPC4 was significantly positively correlated with creatinine and phosphate and significantly negatively correlated with estimated glomerular filtration rate, hemoglobin, erythrocytes, calcium, and cholinesterase in incident dialysis patients. There was no significant association between GPC4 levels and all-cause mortality in patients starting dialysis. Conclusions GPC4 levels were markedly elevated in patients initiating dialysis and were linked with several pathophysiological characteristics commonly observed in end-stage kidney disease. However, our findings did not indicate that elevated serum GPC4 levels serve as a significant predictor of all-cause mortality in this patient population.

Endothelial dysfunction, defined as a reduction in the bioavailability of nitric oxide (NO), is a risk factor for the occurrence and progression of various vascular diseases. This study investigates the effect of endothelial dysfunction on age-related changes in aortic extracellular matrix (ECM) microstructure and the relationship between microstructural adaptation and the mechanical response. Here, we used groups of NOS3 knockout (KO), NOS3 heterozygotes (Het), and wild type (WT) B6 mice (controls) to study changes in hemodynamic parameters, collagen fiber organization, and both active and passive aortic mechanics using biaxial pressure myography over a time course from 1.5 to 12 months. Our results show that homeostatic levels of passive circumferential stress and stretch were preserved in KO mice by remodeling adventitial collagen fibers towards a more predominantly circumferential direction with age, rather than by increased fibrosis, in response to hypertension induced by endothelial dysfunction. However, passive aortic stiffness in KO mice was significantly increased owing to geometrical changes, including significant increases in wall thickness and decreases in inner diameter, as well as by ECM microstructural reorganization, during this maladaptive vascular remodeling. Furthermore, long-term NO deficiency significantly increased smooth muscle cell (SMC) contractility initially, but this effect was attenuated with age. These findings improve our understanding of microstructural and mechanical changes during the maladaptive vascular remodeling process, demonstrating a role for adventitial collagen fiber re-orientation in the response to hypertension.

While the development of metaverse platforms of the blockchain and metaverse technologies of Artificial Intelligence (AI), the Internet of Things (IoT), Extended Reality (XR), and Digital Twins has been ongoing for decades, the COVID-19 pandemic accelerated their adoption as critical enablers of organisational transformation during this upheaval and its aftermath. In this chapter, we conceptually extend our understanding of the role of metaverse platforms in organisational transformation. As a starting point, we review previous management models of organisational transformation and posit that complex adaptive systems theory best explains the importance of metaverse platforms in allowing for continuous internal and external responses to opportunities and threats. We suggest that the key role of the metaverse platform is to facilitate four critical adaptive responses: reorienting leadership, reshaping organisational culture, redefining work design, and reimaging workforce talent. We pose research questions for each of these adaptive responses and conclude with a framework to inform future research efforts.

Human immunodeficiency virus type 1 (HIV-1) is a retrovirus that infects multiple immune cell types and integrates into host cell DNA termed provirus. Under antiretroviral control, provirus in cells is able to evade targeting by both host immune surveillance and antiretroviral drug regimens. Additionally, the provirus remains integrated for the life of the cell, and clonal expansion establishes a persistent reservoir. As host cells become quiescent following the acute stage of infection, the provirus also enters a latent state characterized by low levels of transcription and virion production. Proviral latency may last years or even decades, but stimuli such as immune activation, accumulation of viral proteins, and certain medications can trigger reactivation of proviral gene expression. Left untreated, this can lead to virema, development of pathogenic out comes, and even death as the immune system becomes weakened and dysregulated. Over the last few decades, the role of chromatin in both HIV-1 latency and reactivation has been characterized in-depth, and a number of host factors have been identified as key players in modifying the local (2D) chromatin environment of the provirus. Here, the impact of the 2D chromatin environment and its related factors are reviewed. Enzymes that catalyze the addition or removal of covalent groups from histone proteins, such as histone deacetylase complexes (HDACs) and methyltransferases (HMTs) are of particular interest, as they both alter the affinity of histones for proviral DNA and function to recruit other proteins that contribute to chromatin remodeling and gene expression from the provirus. More recently, advances in next-generation sequencing and imaging technology has enabled the study of how the higher-order (3D) chromatin environment relates to proviral latency, including the impacts of integration site and cell type. All together, these multi-dimensional factors regulate latency by influencing the degree of accessibility to the proviral DNA by transcription machinery. Finally, additional implications for therapeutics and functional studies are proposed and discussed.

Background Nonpharmacological pain interventions are effective but underutilized in people living with dementia (PLWD). Leveraging an implementation lens (i.e., the Readiness Assessment for Pragmatic Trials [RAPT] model) to scope the literature may reveal research gaps contributing to this underutilization. The purpose of this scoping review is to summarize the literature, map the studies to the RAPT model, and identify research gaps. Methods Following Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Review and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ ScR) guidelines, two reviewers screened, collated, extracted, and mapped data from eligible studies to the 9 RAPT domains (implementation, evidence, risk, feasibility, measurement, cost, acceptability, alignment, and impact). We used descriptive statistics to summarize the studies and the extent to which interventions were mapped to RAPT domains. Results Of 81 studies covering 24 interventions, 64% were in long‐term care facilities (LTCFs), 66% reported unspecified pain, and 32% reported unspecified dementia. Of the interventions, the Tailored Activities Program had literature informing the most domains (6 domains), followed by exercise, pain education, and stepwise approaches (5 domains each). Most studies were mapped to the evidence domain (33 studies), few studies to feasibility (7 studies), acceptability (5 studies), and implementation (10 studies) domains, one study to cost, and no studies to risk or impact. Conclusion Despite the variety of nonpharmacological pain interventions studied, there is a notable lack of literature that aligns with the RAPT model. Furthermore, there is limited consideration of the specific pain and dementia conditions, as well as the diverse environments where PLWD reside and receive care. These gaps underscore the need for robust and holistic research to ensure pain interventions are effectively tailored and implemented for PLWD. Starting with acceptability and feasibility studies can establish a foundation for building robust evidence, ensuring practical and well‐received interventions before larger‐scale clinical trials.