Rebuttal Comments To The Us Trade Representative On The Operation Of The Usmca Agreement, Barry Appleton

Other Publications

These rebuttal comments incorporate insights from US Trade Representative Jamieson Greer's public remarks on December 10, 2025 to the Atlantic Council,2 that sheds additional light on the administration’s approach to the USMCA, its overall US trade strategy, and the nature of this review. This better understanding of the USTR’s approach permits a more informed rebuttal commentary. My core submission remains the same as in my oral statement: law, not leverage, builds North American prosperity.

Concurrent Tb And Hiv Therapies Control Tb Reactivation During Co-Infection But Not Chronic Immune Activation, Riti Sharan, Yi Zou, Bindu Singh, Vinay Shivanna, Edward J Dick, Shannan Hall-Ursone, Xi Luo, Guanlin Guo, Shabaana A Khader, Xavier Alvarez, Jyothi Rengarajan, Zhao Lai, Smriti Mehra, Hulin Wu, Deepak Kaushal

Faculty, Staff and Student Publications

Most HIV-negative individuals exposed to Mycobacterium tuberculosis (Mtb) control infection as latent TB infection (LTBI), but HIV co-infection greatly increases progression to tuberculosis (TB), the leading cause of death in people living with HIV (PLHIV). Although combination antiretroviral therapy (cART) reduces LTBI reactivation, immune control of Mtb is not fully restored, as shown by persistent TB incidence in PLHIV on cART. In macaques, skewed pulmonary effector memory CD4⁺ T-cell (TEM) responses and new TB lesions persist despite cART. We hypothesize that concurrent anti-TB therapy with cART would improve bacterial control and immune restoration compared to cART alone. Using …

Growth Of Porang (Amorphopallus Muelleri) Seedlings As Influenced By Seed Maturity And The Presence Of Sarcotesta, Indri Fariroh, Restiani Sih Harsanti, Aminatun Nisa, Didik Pudji Restanto, Rizky Anugerah Putra

Jurnal Kultivasi

Porang seed maturity based its position on spadix position significantly impacts germination. The presence of the seed coat (sarcotesta) also influenced germination and initial seedling growth. This study aimed to explore the effect of seed maturity and the presence of sarcotesta to the seedling growth. The experiment was conducted from January to June 2023. A two factor Randomized Complete Block Design was employed, examining three maturity levels based on spadix position (physiological maturity seed from the tip spadix (red colour), half physiological maturity seed from the middle spadix (orange colour), and immature seed from the base spadix (green colour)), and …

Enhancing Flu Vaccination Rates Through Improved Electronic Health Record User Workflow Training, Grace Sayre

Master's Projects and Capstones

A quality improvement project was implemented at an urban community health clinic primarily serving low-income, underinsured, and Latinx individuals. The site had a history of poorly organized flu vaccine rollout and low vaccination rates among the patient population. Seasonal influenza infects millions of people across the US each year, resulting in hundreds of thousands of deaths (Garza et al., 2023), and vaccination is the best prevention. Electronic health record training has been shown to reduce user burnout and improve efficiency (Gordon et al., 2022). The QI project aims to increase medical assistant satisfaction with the flu vaccine rollout by 15%, …

Charting The Course: Improving Psychotropic Medication Documentation Through Staff Education To Promote Patient Safety And Cms Compliance, Anne J. Bertram Rn

Master's Projects and Capstones

The University of San Francisco master’s level nursing program culminates with a clinical nurse leader (CNL) quality improvement project. The objective of this project is to reinforce the program’s didactic CNL classes by allowing students the opportunity to design, implement, and analyze a quality improvement project in a microsystem. SETTING: Skilled nursing facilities often prescribe psychotropic medications to help manage residents’ behavioral and psychological symptoms. Due to the possibility of side effects and increased sedation, there are concerns for patient safety and quality of life. Inadequate management of these patients and symptoms compromises patient safety and breaches state and federal …

Improving Chemotherapy Patients' Confidence And Preparedness Through Dual-Format Teaching, Jasmine Esther Aminpour, Harshpreet Kaur, Ana Ruvalcaba, Sarah Muwanas

Master's Projects and Capstones

Section I: Abstract

Objective

Chemotherapy initiation is widely recognized as a period of heightened anxiety and cognitive overload for oncology patients, often limiting their ability to retain essential information during traditional one-time, nurse-led education sessions (Gucuyener & Karabacak, 2025; Howell et al., 2020). This quality improvement (QI) project sought to address gaps in comprehension, preparedness, and digital engagement within an outpatient oncology infusion microsystem by integrating evidence-based digital chemotherapy education with structured follow-up support.

Aim

The project aimed to determine whether a nurse-guided walkthrough of a digital chemotherapy education platform, paired with standardized follow-up calls, would improve patient comprehension, confidence …

Enhancing Patient Safety In A Skilled Nursing Facility With A Post-Fall Huddle Protocol: A Quality Improvement Initiative, Evelin Yajaira Dominguez Dominguez

Master's Projects and Capstones

Objective To implement a post-fall huddle guide at a San Francisco Bay Area skilled nursing facility to address the 75 resident falls that occurred over an eight-month period. The literature emphasized the positive impact of huddles on staff communication, awareness, and collaboration which ultimately created a safe environment. Aim By November 4, 2025, the overall fall rates among patients in a San Francisco Bay Area SNF will decrease by 25%, from 4.8 falls per 1,000 patient days to 3.6 falls per 1,000 patient days. Methods Pre-implementation and post-implementation surveys were completed by LVNs and CNAs to assess knowledge of post-fall …

From Incomplete To Impactful—Finalizing Unfinished Nursing Projects In Nart And Polypharmacy For Lasting Improvement, Paula Thanh Nhat Pham, Armine Lianna Chamichyan, Anastasia Yerofeyeva, Stelene Alexis Tragus

Master's Projects and Capstones

This quality improvement project addressed the problem of incomplete or unsustained clinical initiatives at a long-term care facility by introducing Kotter’s Change Model, an evidence-based framework designed to support and sustain lasting improvements in clinical practice. Within the context of a religious-based residential community for older adults with complex chronic needs, the objective was to strengthen the facility’s capacity to implement and sustain change more effectively. By using two previously unfinished initiatives, the NaRT triage tool and Polypharmacy management process, the project applied Kotter’s model to evaluate how structured change strategies can improve staff engagement, leadership alignment, and long-term project …

Beyond Compliance: How Targeted Education Improves Psychotropic Medication Documentation And Patient Safety In Skilled Nursing Facilities, Dyani Williams

Master's Projects and Capstones

Psychotropic medications are routinely prescribed in skilled nursing facilities to manage behavioral and psychological symptoms, but inadequate documentation poses risk to patient safety and leads to regulatory noncompliance. Objective: This project aimed to improve nursing staff knowledge and confidence in documenting psychotropic medication use in order to safeguard patient safety and follow Center for Medicare and Medicaid Services (CMS) guidelines. Aim: A targeted education session and standardized flowsheets were developed to enhance documentation adherence and staff confidence in psychotropic medication administration. Methods: To assess knowledge, comfort, and adherence to documentation standards a pre- and post-intervention survey were administered to nursing …

A Visual Nudge Toward Safer Skin: Reducing Hospital-Acquired Pressure Injuries (Hapi) At The Bedside, Iris Quach

Master's Projects and Capstones

Objective: With the increasing prevalence of hospital-acquired pressure injuries (HAPIs) among trauma patients at Highland Hospital, a quality improvement initiative was developed as a call to action. The overarching goal of this project was to design and implement a Quality Assurance and Performance Improvement (QAPI) intervention that was both feasible and cost-effective to address existing gaps and disparities during hospitalization at Highland Hospital, part of Alameda Health System in the Bay Area. Aim: The project aimed to evaluate whether a bedside visual cueing system could strengthen nursing compliance with pressure-injury prevention protocols and improve the consistency of communication among interdisciplinary …

Antibacterial Analysis Of Human Amniotic Membrane Against Streptococcus Mutants, Streptococcus Sobrinus, And Enterococcus Faecalis, Mohamad Ezany Yusoff, Ruhil Hayati Hamdan, Haslina Taib, Tan Li Peng, Maizan Mohamed, Rumaizi Shaari, Mohamad Arif Awang Nawi

Journal of Dentistry Indonesia

Objectives: The human amniotic membrane (HAM) is a promising scaffold for oral applications due to its antimicrobial properties, which help protect against bacterial degradation. However, evidence of its activity against oral bacteria remains limited. Thus, this study aimed to evaluate the antibacterial activity of the HAM against selected Gram-positive oral bacteria, namely, Streptococcus mutans (S. mutans), Streptococcus sobrinus (S. sobrinus), and Enterococcus faecalis (E. faecalis). Methods: HAM in 1 cm²-pieces was inoculated with bacterial suspensions and incubated at 37 °C in 5% carbon dioxide (CO₂) for 48 hours to evaluate …

Association Between Gonial Angle And Mandibular Residual Ridge Resorption In Implant-Overdenture Patients, Pl Ranganayakidevi S Palaniappan, Norsiah Yunus, Norliza Ibrahim, Siti Fauzza Ahmad, Anitha Krishnan

Journal of Dentistry Indonesia

Objectives: The gonial angle could be one of the contributing factors for the continuous bone resorption in edentulous persons. This study aimed to examine the association between the gonial angle and RRR in edentulous patients receiving mandibular implant-supported overdenture (ISOD) and to compare different gonial angle measuring techniques. Methods: Twenty-three individuals with opposing mandibular ISOD and maxillary full dentures were recruited. The proportional area index was used to calculate the posterior RRR. Orthopantomographs (OPGs) pre- and four years post-implant insertion were compared. Comparison of the gonial angle measurements was made on 5 patients using four measurement methods: (i) Two different …

Factors Influencing The Re-Emergence Of Vaccine-Preventable Diseases Using The Social Ecological Model: A Scoping Review, Glenda Dorina Rodriguez Lenarduzzi

Master's Projects and Capstones

Abstract

Background.

Several factors contribute to the resurgence of vaccine-preventable diseases, affecting coverage rates and vaccine uptake during recent outbreaks. The pandemic has underscored how crucial it is to comprehend vaccine literacy, as this understanding influences people's perspectives and behaviors toward vaccination, particularly in their approaches to problem-solving and decision-making.

Objective.

The present study conducts a scoping review of research on the impact of vaccine literacy and vaccine uptake on the re-emergence of vaccine-preventable diseases in the United States, framed by the social ecological model (SEM).

Design.

PubMed and Google Scholar were utilized as online databases to identify papers published …

Shattering The Silence: The Path To Maternal Equity In Texas, Karah Renfroe

The Scholar: St. Mary's Law Review on Race and Social Justice

The Black maternal mortality crisis reflects the persistence of institutionalized racism embedded in the U.S. healthcare system. In Texas, Black women account for just 11% of births yet represent 31% of maternal deaths—a mortality rate more than twice that of their white counterparts. This staggering disparity has persisted, even as statewide initiatives have improved maternal outcomes for non-Black women. This Comment situates the current crisis within a broader historical continuum: from the coerced medical experimentation on enslaved Black women by figures such as J. Marion Sims, through the codified racism of the Jim Crow era, to present-day inequities ingrained in …

Texas Black Maternal Mortality Crisis: A Spotlight On The Texas Legislature’S Alternatives To Abortion Program, Camille Tealer-Misage

The Scholar: St. Mary's Law Review on Race and Social Justice

Texas leads the nation in maternal mortality and morbidity which intersects with high uninsured rates, abortion bans, and legislative policies promoting medical misinformation. Texas’ legislatively codified Alternatives to Abortion Program allocates tens of millions of dollars per year to crisis pregnancy centers and non-profits with the goal of deterring women from seeking abortions. These clinics do not have to hire medical professionals or obtain licensing for the pregnancy-related services provided to clients. Crisis pregnancy centers do not have to provide accurate medical information or social services to the thousands of people who seek care in a state with increasingly limited …

The Evil Historical Twin: How The Requirement Of A Historical Analogy Could Result In Further Discrimination In The Law, Bryanna Mall

The Scholar: St. Mary's Law Review on Race and Social Justice

In 2024, the Supreme Court decided the case of United States v. Rahimi. The Court, unpersuaded by Rahimi’s objection regarding federal law which prohibited an individual subject to a domestic violence restraining order from possessing a firearm, decided the restriction was constitutional. While the holding of this case represents a win for survivors of domestic violence, the legal reasoning plants itself of flimsy concepts of history. The Court utilized a historical analysis test and looked to precedent rooted in social customs, legislation, and court holdings. The first major issue of this test is the dueling interpretation between a historical …

Pavements And The Urban Heat Island Effect: A Network Analysis Of Research Trends And Knowledge Structure, Fouzieh Rouzmehr, Saman Jamshidi

Architecture Faculty Research

The urban heat island (UHI) effect is one of the most pressing challenges associated with rapid urbanization. It arises primarily from the replacement of natural vegetation with impervious surfaces, alterations in surface energy balance, and heat emissions from human activity. Mitigating these drivers has become a global priority, particularly in fast-growing cities. Pavements play a central role in UHI intensification due to their large surface coverage, low albedo, and capacity to retain heat. This study adopts a bibliometric approach to systematically map the knowledge structure and research trends in pavement-related UHI studies. A dataset of 834 publications from Web of …

Food, Fitness, And Filipino Culture: Evaluating And Reimagining Chronic Disease Interventions For Filipino Americans Through The Pen-3 Framework, Juliana Mastro

Master's Projects and Capstones

Filipino Americans experience high rates of chronic diseases such as diabetes and hypertension. This paper reviews nutrition and exercise interventions targeting this population through the strengths-based PEN-3 cultural framework, focusing on cultural identity, relationships and expectations, and cultural values. It identifies effective strategies that engage these cultural components, and highlights gaps such as limited research on Filipino-American health outcomes. Recommendations include family-centered approaches, culturally relevant activities like tinikling dance, and community-driven online healthy recipe archives to promote positive health behaviors. These culturally informed strategies aim to improve self-efficacy, support lasting health behavior change and reduce chronic disease prevalence nationwide.

Enhancing Documentation Accuracy And Nurse Handoffs Through Virtual Reality In A Pediatric Perianesthesia Unit, Alicia G. Fregoso

Master's Projects and Capstones

Setting: The pediatric perianesthesia unit (pre-operative and post-anesthesia care unit). Problem: Gaps in perianesthesia documentation contribute to poor handoff communication, leading to adverse events and increased hospital costs. Additionally, inconsistent documentation reduces clarity and consistency during handoffs. Context: Staff in the microsystem reported low confidence scores with required OP-Time documentation, inconsistent workflows, and I-PASS handoff expectations. These factors contribute to incomplete charting and a lack of standardization across providers. Interventions: A two-part educational intervention was conducted, consisting of eight sessions. The first component is a Virtual Reality (VR) simulation that demonstrates an accurate perianesthesia I-PASS handoff. The second component is …

Improving Doula Visibility And Integration In The Labor & Delivery Unit Through The Implementation Of Creative Standardized Visual Strategies, Ninna Alessandra Arcena Acebedo

Master's Projects and Capstones

Objective: The 22-bed, Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post- implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for four weeks, …

Increasing Nursing Staff Confidence And Documentation Compliance For Psychotropic Medication Use, Ei Chit Paing

Master's Projects and Capstones

Objective: Psychotropic medications place a high risk for side effects such as confusion, dizziness, falls, and death in older adults above age 65 (Seifert et al., 2024). Educational training on appropriate psychotropic drug use to nursing staff is linked to a decrease in penalties (Jung et al., 2021), side effects, and an increase in staff knowledge in caring for patients with behavioral and psychological symptoms (Pinazo-Clapés et al, 2020). Aim: Facility A in Northern California is currently non-compliant with the Centers for Medicare and Medicaid Services (CMS) guidelines for appropriate psychotropic use due to limited staff understanding of regulations and …

Anexelekto (Axl)/Mer Inhibitor Tamnorzatinib In Patients With Relapsed/Refractory Acute Myeloid Leukaemia: Results From A Phase I (Monotherapy) And Phase Ii (Combination With Venetoclax) Clinical Study, Margaret T Kasner, Nigel Courtenay-Luck, Courtney Dinardo, Sean M Post, Praneeth Baratam, George N Magrath, Takaaki Nakamura, Akifumi Fujii, Sergio Prados, Naoki Honda, Mary Mcbride, Paula Edwards-Holmes, Robert Stuart

Faculty, Staff and Student Publications

Introduction: Relapsed/refractory (R/R) acute myeloid leukaemia (AML) is a life-threatening haematological malignancy without effective treatments. Anexelekto (Axl) and Mer receptor tyrosine kinases have emerged as important therapeutic targets in AML for their crucial role in survival of AML cells. Tamnorzatinib (ONO-7475) is a potent and highly selective inhibitor of Axl/Mer. We report first-in-human study of tamnorzatinib (NCT03176277) in patients with R/R AML.

Methods: Tamnorzatinib was administered as monotherapy (n = 20) to determine an appropriate biological dose of tamnorzatinib and then in combination (n = 22) with venetoclax to evaluate safety and clinical efficacy.

Results: Tamnorzatinib was safe …

Agpat2 Acts At The Crossroads Of Lipid Biosynthesis And Drp1-Mediated Er Morphogenesis, Yoshihiro Adachi, Mauricio Torres, Allen H Hunter, Woo Jung Cho, Meixia Pan, Xianlin Han, Guangwei Du, Ling Qi, Miho Iijima, Hiromi Sesaki

Faculty, Staff and Student Publications

The morphology of the endoplasmic reticulum (ER), characterized by central sheets and peripheral tubules, is controlled by membrane-shaping proteins. However, the role of lipids in ER morphogenesis remains elusive, despite the ER being the major site for lipid synthesis. Here, by examining the role of eighteen phosphatidic acid (PA)-generating enzymes in ER morphology, we identify lysophosphatidic acid acyltransferase 2 (AGPAT2) as a critical factor in mouse and human cells. AGPAT2 produces PA in the glycerophospholipid/triacylglycerol biosynthesis pathway, and its mutations cause congenital generalized lipodystrophy. We find that AGPAT2-generated PA drives ER tubulation through gene knockout, 3D structural analysis by FIB-SEM, …

Stromal Fibroblastic Mutant Trp53 Promotes Mammary Tumor Development Via Enhanced Secretion Of Paracrine Factors, Bin Liu, Shunbin Xiong, Abie Williams-Villalobo, Gilda Chau, Yuan Qi, Hehua Chen, Carenza Johnson, Dhruv Chachad, Joy Mcdaniel, Xiaoping Su, Adel K El-Naggar, Guillermina Lozano, Yun Zhang

Faculty, Staff and Student Publications

Mutations in the tumor suppressor gene TP53 have been identified in breast cancer-associated fibroblasts and are associated with poor patient prognosis. However, the functional impact of fibroblastic mutant p53 on breast cancer development remains unclear. To investigate this, we compared female mice harboring HER2-driven mammary tumors with a fibroblast-specific Trp53 mutation (NP) to those with wild-type fibroblastic Trp53 (N). NP mice exhibited significantly shorter median tumor-free survival than N mice. RNA sequencing of NP and N tumors and mammary glands revealed numerous differentially expressed genes (DEGs) between tumors and the corresponding glands in both genotypes. Notably, the NP tumors showed …

Measurable Imaging-Based Changes In Enhancement Of Intrahepatic Cholangiocarcinoma After Radiotherapy Reflect Physical Mechanisms Of Response, Brian De, Prashant Dogra, Mohamed Zaid, Dalia Elganainy, Kevin Sun, Ahmed M Amer, Charles Wang, Michael K Rooney, Enoch Chang, Hyunseon C Kang, Zhihui Wang, Priya Bhosale, Bruno C Odisio, Timothy E Newhook, Ching-Wei D Tzeng, Hop S Tran Cao, Yun S Chun, Jean-Nicholas Vauthey, Sunyoung S Lee, Ahmed Kaseb, Kanwal Raghav, Milind Javle, Bruce D Minsky, Sonal S Noticewala, Emma B Holliday, Grace L Smith, Albert C Koong, Prajnan Das, Vittorio Cristini, Ethan B Ludmir, Eugene J Koay

Faculty, Staff and Student Publications

Escalated doses of radiotherapy associate with improved local control and overall survival (OS) in intrahepatic cholangiocarcinoma (iCCA), but personalization remains limited because conventional size-based CT criteria correlate poorly with outcomes. We hypothesized that quantitative enhancement measurements would better predict clinical outcomes and guide individualized RT optimization. In a retrospective cohort of 154 patients, we analyzed pre- and post-RT CT scans using quantitative European Association for Study of Liver (qEASL) to derive viable tumor volumes, comparing enhancement-based metrics with size-based RECIST and linking them to outcomes via survival and mathematical modeling. Change in enhancement volume was strongly associated with OS after …

Nurses’ Voices In Prevention: Evaluating Enhanced Bedside Signage To Reduce Hospital-Acquired Pressure Injuries, Jorge Pinzon Figueroa

Master's Projects and Capstones

Abstract

Objective: Hospital-acquired pressure injuries remain a patient safety concern despite standard practice of nurses’ prevention protocols (National Pressure Injury Advisory Panel, 2022). Barriers include: inconsistent two-hour repositioning, documentation burden, inadequate staffing, lack of visual cues of patient risk level, and inconsistent compliance with the overall comprehensive prevention bundle (Agency for Healthcare Research and Quality, 2023).

Aim: HAPIs occur within two adult medical-surgical and telemetry units at a tertiary hospital. In response, staff were surveyed on potential interventions, resulting in the production of a visual cuing system.

Methods: Pre- and post-surveys were conducted on the two medical-surgical units to assess …

Improving Dka Protocol Adherence In The Emergency Department, Anjolaoluwa Lawani

Master's Projects and Capstones

Problem There was inconsistency in implementation of the DKA protocol by nurses in the emergency department at the Hospital A. Only 58% of the nurses reported feeling comfortable following the DK protocol, and 84% of the nurses described the DKA order set as confusing. Context Hospital A is a large magnet-recognition hospital system in the Bay Area. The emergency department at Hospital A averages about 12 DKA patients per quarter. Intervention Education sessions were held during pre-shift cuddles across day and night shifts to clarify the DKA protocol and answer any questions or nurses may have. Measures Baseline surveys and …

Is Public Website Design An Administrative Burden? The Case Of Snap, Guangli Zhang, Stephen Roll, Mathieu Despard

Center for Social Development Research

How do websites for public-benefit programs affect access to benefits?

This brief examines the state websites for the Supplemental Nutrition Assistance Program (SNAP), investigating whether there is a relationship between site design and experience of administrative burdens in SNAP. The authors examine page design using Google’s Lighthouse service and draw upon data from the Workforce Economic Inclusion and Mobility Survey of a nationally representative sample of 2,511 low-wage U.S. workers to examine administrative burdens in SNAP. Data from the U.S. Department of Agriculture are used to investigate the relationship between SNAP page design and SNAP quality-control measures. The finding suggest …

Effects Of Communication Boards On Improving Communication In Assisted Living Care Facilities, Koleen Beatrice Arribas

Master's Projects and Capstones

Problem: A Residential Care facility utilizes paper charting causing limited access to vital information such as code status, allergies, and/or diet for those caring for the resident.

Context: Exceptional charting only when a resident’s condition changes may not provide enough vital information for the caregiver to administer medication or provide proper support during an emergency, such as the resident’s DNR status.

Interventions: A communication board was placed in a secure space near the nurses’ station with key resident information. Nurses would huddle at the board at before the change of shift and make updates as necessary.

Measures: Staff input in …

Improving Pressure Injury Prevention With Educational Programs For Caregivers And Nurses, Michella B. Kahanding

Master's Projects and Capstones

Problem: Pressure injuries are preventable with adequate interventions and knowledge by healthcare staff; however, skilled nursing facilities struggle with pressure ulcer prevention (PUP). Patient suffering and associated costs with treating these injuries are considerable.

Context: Staff education in knowledge regarding PUP is lacking, and annual PUP education is ineffective in reducing the number of pressure injuries in these facilities.

Interventions: Staff education on prevention strategies includes education, pre- and post-knowledge assessments, return demonstration and product use will be implemented

Measures: Results from the baseline knowledge of appropriate PUP in caregivers, pre- and post-test for knowledge retention, teach back techniques to …