Digital Commons Network^™

Conflicted Assumptions: India's Medical Value Travel Marketing Messages, Irving Stackpole

Visions in Leisure and Business

The chronology of the Indian government’s marketing communications rhetoric about medical services exports (commonly referred to as “medical tourism”) from 1990 to 2024 reveals a clear evolution from basic economic liberalization to global leadership positioning. These marketing messages have progressed through distinct phases, consistently emphasizing cost advantages, quality claims, and international competitiveness. It has also become increasingly sophisticated in its use of branding, digital platforms, and systematic promotional frameworks. The evolution from simple "cost advantage" claims to comprehensive "medical hub of the world" positioning demonstrates an evolving promotional narrative, growing ambition, and overestimation of value and demand. This article reviews …

Collagen Type Ii-Targeting Lentiviral Gene Therapy For Mucopolysaccharidosis Iva, Betul Celik, Sampurna Saikia, Shaukat Khan, Krishna Sai Musini, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Mucopolysaccharidosis (MPS IVA) is caused by pathogenic variations in the GALNS gene, leading to the accumulation of glycosaminoglycans in tissues and causing progressive skeletal lesions. While conventional lentiviral vectors (LVs) provide long-term stable expression, they do not deliver therapeutic levels to bone and cartilage. We hypothesized that engineering the LV envelope with a collagen type II-targeting peptide (WYRGRL) increases the binding affinity of the LVs for bone and cartilage. These modified vectors carrying the CBh and COL2A1 promoters delivered the GALNS gene to MPS IVA newborn mice via intravenous (IV) or intraarticular (IA) administration. The peptide-modified LVs exhibited markedly increased …

Community And Academic Synergy For Cancer Survivorship Care Delivery Enhancement (Project Cascade): A Study Protocol For A Pragmatic, Stepped-Wedge, Cluster-Randomized Trial In Texas Primary Care Community Health Centers, Mary-Louise E Millett, Lauren Q Malthaner, Katharine Mccallister, Derek W Craig, Rebecca Eary, Melissa A Valerio-Shewmaker, L Aubree Shay, Suja S Rajan, Hilary Y Ma, Samiran Ghosh, Benjamin F Crabtree, Simon J Craddock Lee, Bijal A Balasubramanian

Faculty, Staff and Student Publications

Background: In the United States, over 18 million individuals are living with cancer. The majority of these cancer survivors also manage other chronic conditions and receive care from multiple specialists, including oncology, cardiology, and primary care clinicians. However, it remains unclear who holds primarily responsibility for coordinating their care across specialties. Because of its generalist nature, primary care is uniquely suited to deliver whole-person and coordinated care for all conditions for cancer survivors. However, primary care teams experience many challenges delivering high-quality survivorship care. While integrating care for all conditions including cancer is a core principle of high-quality primary care, …

Context Matching Is Not Reasoning When Performing Generalized Clinical Evaluation Of Generative Language Models, Andrew Wen, Qiuhao Lu, Yu-Neng Chuang, Guanchu Wang, Jiayi Yuan, Jiamu Zhang, Liwei Wang, Sunyang Fu, Kurt D Miller, Heling Jia, Steven D Bedrick, William R Hersh, Kirk E Roberts, Xia Hu, Hongfang Liu

Faculty, Staff and Student Publications

Current discussion surrounding the clinical capabilities of generative language models(GLMs) predominantly centers around multiple-choice question-answer(MCQA) benchmarks derived from clinical licensing examinations. While accepted for human examinees, characteristics unique to GLMs bring into question the validity of such benchmarks. Here, we validate five benchmarks using eight GLMs, ablating for parameter size and reasoning capabilities, validating via prompt permutation three key assumptions that underpin the generalizability of MCQA-based assessments: that knowledge is applied, not memorized, that semantic consistency will lead to consistent answers, and that situations with no answers can be recognized. While large models are more resilient to our perturbations compared …

Context Matching Is Not Reasoning When Performing Generalized Clinical Evaluation Of Generative Language Models, Andrew Wen, Qiuhao Lu, Yu-Neng Chuang, Guanchu Wang, Jiayi Yuan, Jiamu Zhang, Liwei Wang, Sunyang Fu, Kurt D Miller, Heling Jia, Steven D Bedrick, William R Hersh, Kirk E Roberts, Xia Hu, Hongfang Liu

Faculty, Staff and Student Publications

Current discussion surrounding the clinical capabilities of generative language models(GLMs) predominantly centers around multiple-choice question-answer(MCQA) benchmarks derived from clinical licensing examinations. While accepted for human examinees, characteristics unique to GLMs bring into question the validity of such benchmarks. Here, we validate five benchmarks using eight GLMs, ablating for parameter size and reasoning capabilities, validating via prompt permutation three key assumptions that underpin the generalizability of MCQA-based assessments: that knowledge is applied, not memorized, that semantic consistency will lead to consistent answers, and that situations with no answers can be recognized. While large models are more resilient to our perturbations compared …

Comparing The Effectiveness Of Eggshell Spectra From Laser-Induced Break-Down Spectroscopy And Near-Infrared Spectroscopy Using Principal Compo-Nent Analysis To Determine The Authenticity Of Organic Eggs, Ahmad Qusthalani, Rara Mitaphonna, Muliadi Ramli, Rajibussalim Rajibussalim, Kurnia Lahna, Nasrullah Zaini, Nasrullah Idris

Makara Journal of Science

This study aimed to explore the potential of modern spectroscopy in the authentication of organic and non-organic chicken eggs using near-infrared spectroscopy (NIRS) and laser-induced breakdown spectroscopy (LIBS) spectra. A total of 175 eggs were analyzed, which were grouped into seven categories based on the source of feed given: 100% organic, 100% non-organic, 75% organic, 75% non-organic, 50% organic, free-range chickens, and eggs obtained from the local traditional market. Each group consisted of 25 eggs. NIRS spectra were recorded in the wavelength range of 350–2500 nm, whereas LIBS spectra were recorded in the range of 200–900 nm. A total of …

A Spatiotemporal Model Of Cxcl10 As A Master Regulator Of Immune Evasion And Metastasis In Osteosarcoma, Benjamin B Gyau, Tsz-Kwong Man

Faculty, Staff and Students Publications

The C-X-C motif chemokine ligand 10 (CXCL10) is implicated in the progression of osteosarcoma (OS), the most aggressive pediatric bone malignancy. However, its role often presents a profound clinical paradox: although high circulating levels are strongly linked to poor prognosis, its canonical function is to recruit anti-tumor immune cells. This review unravels these contrasting roles by proposing a novel spatiotemporal model. We argue that in the early stages, immune-evading OS cells initiate the formation of a pre-metastatic niche (PMN) in the lungs, creating a localized inflammatory environment that becomes the primary source of elevated circulating CXCL10. As the disease progresses, …

Amino Acid Signaling In Skeletal Muscle Is Blunted By Prematurity In A Piglet Model, Antonio C Ramos Dos Santos, Agus Suryawan, Ki Beom Jang, Rosemarie D Parada, Mahmoud A Mohammad, Marta L Fiorotto, Teresa A Davis

Faculty, Staff and Students Publications

Background: Preterm (PT) infants are at increased risk for reduced postnatal lean mass accretion. We established that the feeding-induced stimulation of protein synthesis in skeletal muscle is blunted in piglets born PT compared with those born at term.

Objectives: We evaluated the extent to which key components of the amino acid-sensing pathways that regulate mechanistic target of rapamycin complex 1 (mTORC1) activation contribute to anabolic resistance in skeletal muscle of piglets born PT compared with those born term.

Methods: Piglets delivered by cesarean section 10 d PT (n = 23) or at term (n = 22) were administered total parenteral …

Hate Speech Detection Using Optimized Feature Representation Via Spiral-Grey Wolf Optimizer-Based Machine Learning Approaches, Noor S. Farhan, Matheel E. Abdulmunim, Hasanen S. Abdullah

Journal of Soft Computing and Computer Applications

Hate speech detection is crucial as social media diversifies. This research present a lightweight, scalable system using traditional machine learning methods along with a new approach called Spiral-Grey Wolf Optimizer (S-GWO).

S-GWO effectively selects key features that consider both meaning and content from the Term Frequency Inverse Document Frequency (TF-IDF) space, leading to high-quality representation without excessive computing power.

The propoused system was tested on Arabic and another English datasets using six machine learning methods: SVM, RF, LR, KNN, NB, and SGD. It achieved 92% accuracy and F1 score on the Arabic dataset, while reaching 100% accuracy on the English …

The Tax Adviser, Volume 8, Number 6, June 1977, American Institute Of Certified Public Accountants

Tax Adviser

No abstract provided.

Viewpoint: Managing The Erisa Requalification Crunch, Alvin D. Lurie

Tax Adviser

No abstract provided.

Roan Stallion, Tamar And Other Poems: Centennial Edition, By Robinson Jeffers, Brett Colasacco

Jeffers Studies

No abstract provided.

A Maker Of Poems: Robinson Jeffers' "To His Father", William E. Cain

Jeffers Studies

No abstract provided.

Wild Anthropocene Literature And Multispecies Justice In Deep Time, By Louise Economides, George Hart

Jeffers Studies

No abstract provided.

Voices Of The Headland: Robinson Jeffers And The Bird Of Prey, By Alan Malnar, Eric San George

Jeffers Studies

No abstract provided.

Sex Differences In The Association Of Vascular Risk And Apoe Genotype With Cognitive Decline And Dementia: Evidence From A U.S. Longitudinal Study, Longjian Liu, Jintong Hou, Saishi Cui, Xiaopeng Zhao, Zuolu Liu, J. Craig Longenecker, Nathalie S May, Jin Jun Luo, Rose Ann Dimaria-Ghalili, Howard J. Eisen

Division of Cardiology Faculty Papers

BACKGROUND: Sex differences in the association between vascular factors and cognitive outcomes remain unclear. We aimed to investigate the associations of blood pressure metrics (hypertension, systolic blood pressure [SBP), pulse pressure, ankle and brachial pressures, and ankle to brachial pressure index [ABI]) with the risk of cognitive decline and dementia.

METHODS: We conducted a population-based longitudinal analysis using data from the Atherosclerosis Risk in Communities (ARIC) study (begun in 1987-1989) in the United States. We analyzed a total of 12,268 participants aged 45-64 years who had validated exposure measurements, cognitive function tests (first administrated 1990-1992), and followed up for incidence …

Tumor Biology And Access To Care And Metastatic Breast Cancer Outcomes, Matthew R. Dunn, Sarah C. Van Alsten, Marc A. Emerson, Katherine Reeder-Hayes, Terry Hyslop, Melissa A. Troester

Kimmel Cancer Center Faculty Papers

PURPOSE: To understand how access to care influences metastatic breast cancer burden (MBC) while accounting for molecular tumor characteristics, and identify interventions to reduce metastatic disease burden.

METHODS: The Carolina Breast Cancer Study is a population-based cohort with invasive breast cancer (diagnosed 2008-2013). Both de novo metastasis (stage IV at diagnosis) and distant recurrence were evaluated (12 years of follow-up. Tumor data were from medical records, pathology reports, and RNA expression data. Social variables and access to care were from participant surveys. Generalized linear models were used to estimate associations of biological and access characteristics with MBC; Cox models were …

Managing The Uncertainty Of "Precision" While Navigating Goals Of Care: A Framework For Collaborative Interpretation Of Complex Genomic Testing Results In Critically-Ill Neonates, Donnamaria E. Cortezzo, Katharine Press Callahan, Bimal P. Chaudhari, Elliott M. Weiss, Monica Hsiung Wojcik, Krishna Acharya, Amy B. Schlegel, Kevin M. Sullivan, Jessica T. Fry

Department of Pediatrics Faculty Papers

Each year, many neonates are born with genetic diagnoses that carry a range of prognoses. As the types and availability of genetic testing have expanded, neonatal intensive care units (NICUs) have served as "launching points" for their clinical application. Broad genetic testing has both improved diagnostic precision and expanded uncertainty. Genetic information may be explicitly uncertain, as in the case of a variant of unknown significance (VUS). But it is also frequently uncertain whether/how the information relates to a patient's phenotype or what it may mean for a child's future. Even without ambiguity in the diagnosis or prognosis, the significance …

Teach-Back Techniques In Telehealth: A Review And Insights For Future Directions, Faith A. Albertson, Waka Alnakhi, Shanikque Barksdale, Shannon Stark Taylor, Shaniece Criss, Daniela B. Friedman Ph.D., Karen A. Kemper, Lorie Donelle Phd, Rn, Fcan, Wanda Thompson, Phyllis Macgilvray, Nabil Natafgi

Publications

Background and objectives: The rapid expansion of telehealth during the COVID-19 pandemic has created new challenges in patient-provider communication due to the absence of in-person interactions and visual cues. Teach-back, a method where patients repeat information to confirm understanding, is a promising tool for improving communication in virtual care. This review evaluates the effectiveness of teach-back techniques in telehealth settings.

Methods: A search of four databases (CINAHL, EMBASE, PsycINFO, PubMed) was conducted, yielding 10 studies that met the inclusion criteria. The article inclusion/exclusion criteria consisted of the following: (1) telehealth services topic; (2) direction provision related to teach-back; and (3) …

Read Well, Read Right: Developing Thai Reading Skills Of Third-Grade Students Through Phonics-Based Instruction Combined With Reading Skill Exercises, Wirachai Longkaeo, Sitah Thayati

Journal of Education Studies

This pre-experimental research aimed to 1) examine the effects of phonics-based instruction combined with reading skill exercises on Thai reading skills of third-grade students, and 2) investigate the learning process and factors contributing to the success of this instructional approach. A one-group pretest-posttest was employed. The target group consisted of 15 third-grade students from a private school in Chiang Mai Province, selected through purposive sampling based on their Thai reading assessment scores, identifying students with beginning-level reading foundations. The intervention lasted 10 hours. Research instruments included 1) a Thai reading skill test, and 2) observation and student reflection form. Quantitative …

Development Of A Learning Activity Package With Integrated Reading Strategies To Promote Reading Literacy Among Lower Secondary School Students, Tasanee Satthaphong, Thassanant Unnanantn

Journal of Education Studies

The objectives of this study were to: 1) develop learning activity packages incorporating integrated reading strategies among lower secondary school students, with a targeted efficiency of 80/80, and 2) examine differences in students’ reading literacy performance before and after the implementation of the learning activity packages. The sample comprised 30 grade 9 students, through multi-stage random sampling, who were enrolled in the first semester of the 2024 academic year at a public secondary school in Bangkok. The intervention was conducted over a period of eight weeks, encompassing a total of 16 instructional periods. The research instruments consisted of 1) four …

Digital Resistance Against The Lasting Manipulation Of Capitalism: Ai, Luddite Rebellion, And The Haunted Future Of Cyberpunk, James Sweeting

School of Art, Design and Architecture

This paper examines the complex relationship between artificial intelligence, labour, and resistance amidst contemporary capitalism. Big Tech presents AI as revolutionary innovation, yet this narrative obscures its function in maintaining growth and preventing alternative economic forms from emerging. Through the lens of "enshittification," we observe a strategic shift toward AI deployment despite its beta state of development, threatening workers' livelihoods. This tension echoes historical patterns of technological implementation and resistance, exemplified by the Luddite movement whose meaning elites have successfully corrupted over time. The Luddites, organised under the mythical figurehead Ned Ludd (a Robin Hood-esque figure), recognised technological change as …

Detection Of The Linac Jaw Face Angle Misalignment Using High Energy Electron Beam Symmetry, Song Gao, Andres Cibrian, Jared Ohrt, Peter Balter

Faculty, Staff and Student Publications

Purpose: To demonstrate the usage of a high energy electron beam symmetry measured at different collimator angles to detect jaws face angle misalignments on Varian TrueBeam linear accelerators (linac) during acceptance and commissioning processes.

Methods: During the linac acceptance, all beams were steered to a symmetric shape with the gantry and collimator at 0°. We noted that the symmetries of higher energies electrons (e.g., 16 MeV, 20 MeV) changed over 2% when measured with the collimator at 90° and/or 270° for two linacs commissioned within 5-months of each other. Misaligned applicators were ruled out as the cause of this issue. …

The Impact Of Targeting Traf2 And Nck-Interacting Protein Kinase On Antitumor Effect And Tumor Immune Environment In C-Myc-High Sclc, Azusa Tanimoto, Kavya Ramkumar, C Allison Stewart, Bingnan Zhang, Kyle Concannon, Robert J Cardnell, Li Shen, Qi Wang, Jing Wang, Carl M Gay, Lauren Averett Byers

Faculty, Staff and Student Publications

Introduction: Wnt/β-catenin signaling pathway activation contributes to tumorigenesis and chemo-resistance in SCLC, yet clinical attempts to target this pathway have been unsuccessful. TRAF2 and NCK-interacting protein kinase (TNIK), an essential nuclear activator of Wnt/β-catenin target genes, has not yet been validated as a viable therapeutic target in SCLC. Here, we validated that TNIK inhibition is a promising approach for personalized anticancer therapy in SCLC.

Methods: We correlated the IC50 values of a TNIK inhibitor, NCB-0846, with proteomic profiling (reverse phase protein array) data across 28 SCLC cell lines. Cytokine array analysis was performed to quantify changes in 105 cytokines after …

Visualizing The Effect Of Process Pause On Virus Entrapment During Constant Flux Virus Filtration, Wenbo Xu, Xianghong Qian, Hironobu Shirataki, Daniel Straus, Sumith Ranil Wickramasinghe

Biomedical Engineering Faculty Publications and Presentations

Virus filtration is an essential unit operation used to validate clearance of adventitious virus during the manufacture of biopharmaceutical products such as monoclonal antibodies. Obtaining at least a 10,000-fold reduction in virus particles in the permeate is challenging as monoclonal antibodies are about half the size of the virus particles. Minute virus of mice, FDA-recommended model adventitious virus, was labeled with a fluorescent dye. Laser scanning confocal microscopy was used to determine the location of virus entrapment within the virus filtration membrane. Three different hollow fiber membranes made of regenerated cellulose and polyvinylidene fluoride were tested. Feed streams consisted of …

Structural Behavior Of Reinforced Concrete Columns Under Eccentric Loads Strengthened By Steel Jackets Filled With Normal And High-Strength Concrete, Mahmoud Ahmed M. Amin, Mahmoud Mostafa El Hawary, Ahmed Shaheen, Ibrahim M. Mashhour

HBRC Journal

Reinforced concrete (RC) columns are essential structural components in buildings and infrastructure, providing vertical load support and stability. However, these columns can be degraded over time due to various factors, such as environmental exposure, seismic events, and increased loading demands. As a result, the need for effective and reliable column-strengthening techniques arises to ensure the safety, durability, and longevity of structures. The main objective of this study is to investigate how fully strengthening damaged columns affects load-bearing capacity and overall structural performance. Moreover, this study tested thirteen reinforced concrete columns during the experimental program. The original dimensions of these columns …

Systemic Sclerosis-Associated Interstitial Lung Disease: Improved Understanding And Advances In Management, Amit Syal, Chris T. Derk

Student Papers, Posters & Projects

Interstitial lung disease (ILD), a common manifestation of systemic sclerosis (SSc), has the highest organ-specific morbidity and mortality, particularly in patients with diffuse cutaneous SSc (dcSSc). Recent advances in diagnostics-including artificial intelligence (AI)-enhanced high-resolution computed tomography (HRCT) and biomarkers such as Krebs van den Lungen (KL)-6-have enabled earlier detection and monitoring of disease progression. Therapeutically, the approval of antifibrotics like nintedanib (NINT) and immunomodulators such as tocilizumab (Toci) has significantly expanded treatment options. Updated international guidelines from the American College of Rheumatology (ACR), American College of Chest Physicians (CHEST), American Thoracic Society (ATS), and European league against Rheumatism (EULAR) now …

Effects Of Video Game Type On Cognitive Performance And Brain Functional Connectivity: A Longitudinal Eeg Study, Jingqing Lu, Ruifang Cui, Lijun Jiang, Chenyu Mu, Weiyi Ma, Diankun Gong, Dezhong Yao

General Human Environmental Sciences Faculty Publications and Presentations

Background: Previous research has shown that video gaming experience is associated with changes in cognitive and perceptual functions as well as neural structure and function. However, how the different types of video games differentially influence cognitive function and neuroplasticity remains unclear. Methods: In this 30-week longitudinal study, participants were randomly assigned to an action video game group or a strategy card game group. Behavioral assessments and resting-state electroencephalography (EEG) recordings were administered at six time points to evaluate changes in attention, working memory, executive function, and their neural correlates. Results: Both groups showed significant improvements in multiple cognitive tasks, but …

Supersaturation Effect And Its Characterization In Gas-Rich Intervals Of Deep Coal Seams, Zhou Lihong, Li Yong, Ding Rong, Li Yun, Li Yongzhou, Kong Jintao

Coal Geology & Exploration

Objective and Method High free gas content serves as a key factor controlling the enrichment and high productivity of deep coalbed methane (CBM). However, its direct determination is challenging, making the accurate identification of free gas-rich coal seam intervals a core scientific issue for efficient exploration and recovery of CBM. This study investigated the Daning-Jixian block (also referred to as the Daji Block) within the Ordos Basin. Based on analyses and tests of the gas content, coal macrolithotype, physical properties, and log responses of cores collected from representative wells through pressure-retained coring, this study systematically assessed the vertical heterogeneity of …

Braingenebot: A Gpt-Engineered, User-Driven Genetic Data Exploration With Polygenic Risk Scores Ranking In Alzheimer’S Disease, Guan Ou, Zhongming Zhao

Faculty, Staff and Student Publications

Background

Polygenic risk scores (PGSs) aggregate the effects of multiple genetic variants to attribute to disease susceptibility, and have been applied to numerous complex diseases including Alzheimer's disease (AD). However, as omics and phenotypic data grow exponentially, reconciling findings across studies with differing ancestral backgrounds, study designs, and statistical methodologies remains a pressing issue. Efficiently extracting biologically relevant insights from this expanding body of data is equally challenging, especially for diseases driven by complex interactions among genetic, environmental, and lifestyle factors.

Method

To address these challenges, we introduce BrainGeneBot, an AI‐driven chatbot framework that automates genetic data analysis and bridges …