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Towards Interpretable Transfer Learning With Limited Data, Youxiang Zhu

Graduate Doctoral Dissertations

Modern foundation models are typically trained with large-scale data to ensure good performance. However, certain tasks cannot scale with large amounts of data due to cost and practical constraints, resulting in limited performance. To address this, in this dissertation, I introduce model-task alignment, a general methodology for making a foundation model work well with tasks with limited data. The methodology comprises two parts: aligning downstream tasks with foundation models and aligning foundation models with downstream tasks. To study and validate this methodology, I first focus on speech-based dementia detection, a representative task with limited data, and then extend to general …

Evaluation Of Medical Instrument Reliability For The Heath And Maddox Components Of The Accommodative-Vergence System, Jacob Chabuel

Theses

Binocular vision relies on the coordination of near response triad composed in part by the vergence and accommodative systems. Binocular dysfunctions linked to these systems impact the quality of life of those affected by complicating day-to-day tasks and leading to further health concerns. Clinical evaluations that diagnose dysfunctions and tailor therapies rely on subjective methods, creating a need for a reliable, quantitative, measurement tool. This is achieved using a haploscope, a tool that quantitatively measures and observes binocular vision to identify deficiencies within the eye. Modernization of a haploscope system, measurement of the Heath and Maddox components of the visual …

Developing The Evidence And Associated Service Models To Support Older People Living With Frailty To Manage Their Pain And To Reduce Its Impact On Their Lives: A Mixed Method, Co-Design Study (The Poppy Study).: The Poppy Study, Lesley Brown, Deborah Antcliff, Andrew Clegg, Anne Grice, Pat Schofield, Asim Suleman, Amanda Williams, Nikki Harrison, Nicky Kime, Alan Wright, Natalie Lam, Dan Howdon, Davide Tebaldi, Rahena Mossabir, Sarah Hallas, Thomas F Crocker, Anne Forster

School of Nursing and Midwifery

Background: Frailty increases vulnerability to adverse events (falls, illness) resulting in poorer health outcomes in later life. Persistent pain is common and impactful in older adults with frailty. Pain impact is potentially modifiable, and addressing it is important for supporting this population. The Pain in Older People with Frailty study aimed to generate evidence and develop service models to improve pain management for older adults with frailty and inform service provision for this underserved population. Objective(s): Phase 1: Map research evidence and synthesise findings from randomised controlled trials of multi-component pain management programmes and psychological therapies for community-dwelling older adults. …

Developing The Evidence And Associated Service Models To Improve Pain Management In Older People Living With Frailty: A Synopsis Of The Poppy Mixed Method, Co-Design Study: Poppy, Patricia Schofield

School of Nursing and Midwifery

Background: Frailty increases vulnerability to adverse events (falls, illness) resulting in poorer health outcomes in later life. Persistent pain is common and impactful in older adults with frailty. Pain impact is potentially modifiable, and addressing it is important for supporting this population. The Pain in Older People with Frailty study aimed to generate evidence and develop service models to improve pain management for older adults with frailty and inform service provision for this underserved population. Objective(s): Phase 1: Map research evidence and synthesise findings from randomised controlled trials of multi-component pain management programmes and psychological therapies for community-dwelling older adults. …

Investigation Of Environmental Influences On Multiple Sclerosis: A Study For Egypt’S Health, Noha Ezzaldin Alziny Ali

Theses and Dissertations

Background: Multiple sclerosis (MS) is a complex, chronic neuroinflammatory disease influenced by both genetic and environmental factors. While global research has identified potential environmental influences, most evidence comes from Western populations, creating a significant knowledge gap for regions like Egypt, which has witnessed a dramatic rise in MS prevalence over recent decades. This study hypothesized that Egyptian MS patients exhibit a distinct biological signature in their blood, characterized by an imbalance in essential and toxic trace elements (the metallome) and alterations in stress-response biomarkers associated with neuroaxonal injury and cellular stress. Objective: This study aimed to comprehensively profile and compare …

Improving Antihypertensive Medication Adherence Through Education And Follow- Up Phone Calls In A Primary Care Setting, Sarah Peterson

Doctor of Nursing Practice Final Manuscripts

Hypertension affects nearly half of adults and significantly increases the risk of stroke and cardiovascular disease; however, poor medication adherence remains a primary barrier to effective blood pressure management. The purpose of this evidence-based practice (EBP) project was to improve antihypertensive medication adherence among adult patients in a primary care setting. Guided by the Iowa Model of Evidence-Based Practice to Promote Quality Care, the project utilized a pre-test/post-test design at a private practice clinic. The sample included adults with a hypertensive diagnosis and active prescriptions. Medication adherence was defined as the Morisky Medication Adherence Scale (MMAS-8) scores, measured before and …

Closing The Gap: Integrating A Standardized Depression Screening In Primary Care, Cyndy Marie Oreas

Doctor of Nursing Practice Final Manuscripts

Objective: The purpose of this evidence-based practice (EBP) project is to implement the routine use of the Patient Health Questionnaire-9 (PHQ-9) screening instrument in the primary care setting to improve early diagnosis, treatment, and referrals to mental health.

Background: Depression is frequently underdiagnosed in primary care despite its significant impact on health outcomes. Inconsistent screening practices and a lack of standardized workflows contribute to missed opportunities for early identification and intervention. Routine PHQ-9 screening has been shown to improve detection and facilitate timely referral to behavioral health services.

Methods: A standardized PHQ-9 screening was implemented for adult patients aged 18 …

Reducing Preoperative Anxiety In Patients Undergoing Gynecologic-Oncology-Related Surgeries, Iman Sean Lavine-Richardson

Doctor of Nursing Practice Final Manuscripts

Elevated levels of preoperative anxiety are associated with adverse effects in the postoperative period. Evidence demonstrates the effectiveness of incorporating multimedia into preoperative education to alleviate preoperative anxiety. This project aims to decrease preoperative anxiety levels and increase satisfaction and feelings of preparedness in patients scheduled to undergo gynecologic-oncology-related procedures through the implementation of an evidence-based practice (EBP) informational video. The San Diego 8A’s EBP model was utilized to guide this project. Data was collected, anonymously, through online questionnaires which included the Anxiety Specific to Surgery Questionnaire (ASSQ) to assess anxiety levels and Likert-scale questions to assess satisfaction and feelings …

Implementation Of Symptom Management Standing Order Sets In An Ambulatory Palliative Care Clinic, Anna Manfreda

Doctor of Nursing Practice Final Manuscripts

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to …

Enhancing Emergency Preparedness In California High Schools: A Policy Framework For Implementing Nata-Compliant Emergency Action Plans Through Multidisciplinary Task Forces, Jennifer Lu

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, yet it is highly survival with proven measures: a structured emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and access to an automated external defibrillator (AED) within 3 minutes can raise survival rates to 90%. Despite this, high schools show inconsistent compliance, largely due to the lack of fragmented oversight and lack of standardized practices

Purpose of Project: This proposal advocates for multidisciplinary task forces to enforce venue-specific, National Athletic Trainers Association (NATA)-compliant EAPs across California high schools, with the goal of improving emergency response …

Text Message Delivery Of Pre-Procedural Recommendations Prior To Lip Augmentation With Hyaluronic Acid Filler: An Evidence-Based Pilot Project, Jenna De Jonge

Doctor of Nursing Practice Final Manuscripts

Patients seeking lip augmentation procedures commonly experience self-resolving soft-tissue complications such as swelling and bruising. There are many widely accepted pre-procedural recommendations available to help patients minimize the risk of these undesirable outcomes. At a Medical Aesthetics practice in Southern California, lip augmentation patients often arrived to their appointment non-adherent to pre-procedural recommendations that were available on the practice website. Text message delivery systems have been used to improve patient adherence to healthcare instructions across a variety of healthcare settings. To address this gap, I implemented text message delivery of pre-procedural recommendations to lip augmentation patients prior to their appointment. …

Optimizing Lactation Support: Enhancing Patient-Centered Care And Breastfeeding Self Efficacy Through Data-Driven Survey Analysis, Jessica L. Doshay

Doctor of Nursing Practice Final Manuscripts

Objective: The objective of this project was to implement evaluation of an integrated lactation support model within a multi‑site pediatric primary care organization to assess patient experience and breastfeeding confidence associated with a lactation consultation.

Background: Optimizing the patient experience is an indicator of healthcare quality. Improving breastfeeding outcomes remains a national priority. Structured lactation support delivered by International Board-Certified Lactation Consultants (IBCLCs) enhances breastfeeding outcomes, the impact of this is often undocumented in primary care settings.

Methods: This quality improvement project was conducted within the lactation department of a multicenter pediatric clinic in Southern California. Pediatric clinicians who were …

Implementation Of Comprehensive Checklist For Opioid Use Disorder Treatment In Primary Care, Sophia R. Madden

Doctor of Nursing Practice Final Manuscripts

Background: The escalating opioid crisis demands a comprehensive approach to Opioid Use Disorder (OUD) management. Patients often face comorbid mental illnesses, infectious diseases, concurrent substance use, and social determinants of health (SDOH)—all of which increase the risk of treatment attrition. Standardizing care through evidence-based clinical practice guidelines and tools is essential for improving treatment quality and consistency.

Purpose: This project aimed to increase comorbidity screenings and improve resource access for OUD patients at a San Diego Internal Medicine primary care office by implementing a comprehensive care checklist based on the American Society of Addiction Medicine (ASAM) guideline.

Methods: The ASAM …

Empowering Healing And Recovery: Adverse Childhood Experiences Screening In A Cognitive Behavioral Therapy Intensive Outpatient Program, Serena C. Lee

Doctor of Nursing Practice Final Manuscripts

Purpose: This evidence-based practice project implemented Adverse Childhood Experiences (ACEs) screening in an adult Cognitive Behavioral Therapy Intensive Outpatient Program (COG IOP) at San Diego's largest behavioral health hospital to identify ACE exposure, deliver supportive interventions, and enhance clinician competency in trauma-informed care.

Background: ACEs are potentially traumatic experiences occurring before age 18 that are associated with toxic stress and worsening health outcomes. Despite evidence linking ACEs to adverse outcomes and substantial healthcare costs, routine ACE screening is not standardized in behavioral health settings.

Methods: Guided by the San Diego 8A's Evidence-Based Practice model, eligible patients were offered ACEs screening …

Enhancing Tardive Dyskinesia Screening In An Outpatient Psychiatry Training Clinic: A Quality Improvement Initiative, Ariel Davalos

Doctor of Nursing Practice Final Manuscripts

Background: Tardive Dyskinesia (TD) is a debilitating, often irreversible movement disorder caused by prolonged exposure to dopamine receptor-blocking agents, affecting 15-30% of patients on long-term antipsychotic therapy. Despite endorsement of the Abnormal Involuntary Movement Scale (AIMS) as the gold standard for TD screening, the condition remains significantly under-diagnosed. Purpose: This quality improvement project evaluated whether a 45-minute educational intervention could improve PMHNP trainees’ confidence and competence in TD recognition and AIMS administration. Methods: Guided by the Iowa Model of Evidence-Based Practice, the project used a pre-post survey design with a planned one-month follow-up across two clinical training sessions. Ten PMHNP …

Perinatal Mental Health Screening And Care Among Those With Pregnancy Complications, Alison N Goulding, Terri L Fletcher, Emily S Miller

Faculty, Staff and Students Publications

Perinatal mental health conditions are common and, without effective treatment, can contribute to adverse maternal and child outcomes. In the United States, mental health conditions are a leading cause of maternal morbidity and mortality, contributing to over 20% of pregnancy-related deaths. This expert review aims to assess current literature and provide recommendations regarding mental health care in high-risk patients who experience pregnancy complications. Individuals experiencing pregnancy complications are at increased risk for perinatal mental health conditions, including depression, anxiety, and post-traumatic stress disorder, as compared to those with uncomplicated pregnancies. Despite this increased disease burden, there is limited research on …

Rethinking Flow: The Paradox Of Renoprotection Without Increased Renal Blood Flow In Cardiopulmonary Bypass, Shiksha Mohan, Ronald A Shaju, Sharan Misra, Titiksha Sharma, Veeraj K Sirivolu, Abhinav Rajkumar, Anthony Rodas-Camacho, Aizah Zaidi, Dhruv Dhingra, Ilma Khan, Rishav Bhattacharya, Vishal Pancholy, Shivam Banerjee, Shreyo Ghosh, Shiyi Li, Kenneth K Liao, Carl P Walther, Nandan K Mondal

Faculty, Staff and Students Publications

No abstract provided.

Referral Patterns From Primary Care To Referral Care By Icd-10 Codes In Indonesia: Cross-Sectional Analysis Of National Claims Data (2017–2024), Della Dwi Ayu, Syarif Rahman Hasibuan, Putu Erma Pradnyani, Nisrina Widyasanti

Journal of Indonesian Health Policy and Administration

Primary health care (PHC) facilities serve as gatekeepers within Indonesia’s tiered health system. However, PHC referral patterns to hospitals still show substantial variation and remain insufficiently characterized by disease groupings based on the International Classification of Diseases, 10th Revision (ICD-10). This study aimed to identify the most frequently referred diagnoses from PHC to secondary or tertiary care facilities and to determine the participant characteristics associated with referrals. This observational study employed a cross-sectional design using secondary data from the National Health Insurance (Jaminan Kesehatan Nasional – JKN) claims database for the period 2017–2024. The unit of analysis was each …

Factors Associated With The Performance Of Essential Public Health Efforts At Primary Health Centers In Jember Regency, Griselda Ardelia Hibatullah, Nuryadi Nuryadi, Yennike Tri Herawati

Journal of Indonesian Health Policy and Administration

Performance assessment of primary health centers is essential to ensure the quality of healthcare services, including the delivery of essential public health efforts. The performance target for essential public health efforts in Jember Regency is set at ≥82%. This study aimed to analyze factors associated with the performance of essential public health efforts. The study employed an analytical cross-sectional design conducted from April to May 2025, with a sample of 37 out of 50 units selected through simple random sampling. Primary data were collected using questionnaires, while secondary data were obtained from primary health center (Pusat Kesehatan Masyarakat – …

Xanthogranulomatous Osteomyelitis As A Bone Tumor Mimic: A Systematic Review Of Pre-Biopsy Diagnostic Clues And Management Decision Points, Ethan J. Sack, Max Deneroff, Austin Khau, Zubair Mohammed, Chadi Ellaham, Jared Nichols

Student Publications

Xanthogranulomatous osteomyelitis (XO) is a rare inflammatory form of osteomyelitis that can closely resemble a primary bone tumor or metastatic lesion at presentation. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and focused on pre-biopsy diagnostic clues and management decision points in published skeletal XO reports. PubMed, Embase, and Scopus were searched from January 2026 to May 2026, identifying 86 records. Eligible studies included human case reports and case series describing histologically confirmed skeletal XO or xanthogranulomatous inflammation involving bone; non-skeletal xanthogranulomatous disease, duplicate reports, review articles without extractable patient-level …

Pernicious Anemia Presenting As Pseudothrombotic Microangiopathy: A Case Report, Sai Sushrutha M Vemula, Shreeya Adhikari, Shreya Motkur, Alfarooq Alshaikhli, Borys Hrinczenko

School of Medicine Publications

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ dysfunction, with high untreated mortality that can be effectively reduced with timely plasma exchange (PLEX) and immunosuppressive therapy. However, several conditions can produce a clinically similar pseudo-TMA picture, among which severe vitamin B12 deficiency is an underrecognized and potentially treatable mimic that occurs due to ineffective intramedullary erythropoiesis, megaloblastic fragmentation of structurally abnormal erythrocytes, and pancytopenia in the absence of true endothelial injury or ADAMTS13 deficiency. We present a 74-year-old female patient who presented with altered mental status, bradycardia, and severe …

The Effects Of Osha State Plans And State Gdp On Occupational Injuries And Illnesses In The United States, Ahmad Abdel Rahman Mohammad Amoorah

Theses

Workplace safety in the United States is governed by a system in which some states operate under federal OSHA oversight, while others administer their own OSHA-approved safety and health plans. This duality raises questions about whether state-level control leads to variation in safety and health outcomes. Economic conditions have also been shown to influence workplace injury rates, yet the interaction between safety and health regulations and local economies remains underexplored. Understanding these relationships is critical to protecting workers in occupational settings. The effects of OSHA state-plan status and state-level economic activity on occupational injury and illness rates across the United …

Polarimetric Terahertz Imaging For The Measurement Of Birefringence In Plastic, Rachel Cohen

Theses

Birefringence offers a promising way to observe stress concentration in materials such as glass and plastic, and thereby to identify weaknesses. Polarimetric imaging can be used to measure the birefringence of material, so long as the material is transparent to the light being used for the imaging. In this research, 2D Terahertz imaging was investigated as a means of measuring the birefringence of plastics that are opaque to visible light but transparent to THz radiation, for the eventual purpose of analyzing the residual stress present. In order to do so, two separate terahertz cameras were characterized for potential use in …

Ai-Based Simulated Patient Encounters For Clinical Reasoning: A Needs Assessment, Alex Sorrick, David Liebovitz, Sarah Vick, Andrew S. Parsons, Brian W. Locke, Jonathan Herskovitz, Cory Rohlfsen

Graduate Medical Education Research Journal

Background. Artificial Intelligence (AI) offers an opportunity to enhance formative assessment of clinical reasoning skills. Traditionally, these skills have been assessed through workplace-based assessment or simulated patient encounters, both of which are limited by variability in case exposure, faculty resources, scheduling logistics, and cost. AI-based simulated patient encounters provide a scalable solution for convenient, low-stakes practice. At the University of Nebraska Medical Center (UNMC), we piloted an AI-based simulated patient case and conducted a needs assessment to explore current practices and user experiences.

Methods. From June to August 2025, participants trialed an AI-based simulated patient case and received feedback on …

Artificial Intelligence In Healthcare: Ethical Frameworks, Challenges, And Global Approaches To Responsible Implementation: A Perspective, Vikas Vaibhav, Arwinder Singh, Yashpal S, Raviprakash Meshram, Varun Chandran A, Kshitiza Sharma

Graduate Medical Education Research Journal

Major advancements in domains like diagnosis and personalised treatment will be seen because of the rapid growth of artificial intelligence (AI) in healthcare. But this shift additionally presents significant ethical concerns that need to be carefully considered at every stage of AI's research, use, and impact on society in medical settings.

This review summarises the findings of multiple systematic and scoping reviews, as well as studies of specific AI applications published between 2013 and 2025. Additionally, it examines ethical norms from different countries and international organisations objectively. Consistent ethical challenges identified include the "black box" problem (lack of transparency and …

Knowledge And Perception Of Patients Regarding A Postpartum Standardized Hypertensive Disorder Educational Program, Arin Everett, Niranjana Balu, Santiago Ortiz Barragan, Marly Azzi, Sanela Potchileev, Courtney Bisson, Ariel Mueller, Lea Runesha, Sajid Shahul, Sarosh Rana

Graduate Medical Education Research Journal

Background. Hypertensive disorders of pregnancy (HDP) are a major contributor to rising maternal mortality in the United States. The postpartum period represents a critical window to provide education aimed at reducing the risks of complications. This study evaluates the patients’ understanding of HDP and their retention of key education concepts during the first six weeks postpartum after participation in a structured quality improvement program.

Methods. Prospective cohort study of patients diagnosed with HDP were enrolled in the remote blood pressure monitoring program (RPM) and delivered between June 2023 and January 2024. Baseline surveys were administered prior to discharge and repeated …

A Literature Review Of Burnout And Associated Tools In Residency Programs, Foluso Obisanya, Fatima Mncube-Barnes, Kudiratu A. Proctor, Charles A. Mcdaniel, Donna M. Alexander, Tyrece D. Hunter

Graduate Medical Education Research Journal

Background. Burnout poses considerable challenges in workplaces, particularly for resident physicians. This intricate phenomenon stems from a myriad of factors that include, but are not limited to, staff shortages, excessive workloads, specific job responsibilities, work environments, and individual psychological factors. The Accreditation Council for Graduate Medical Education encourages institutions to incorporate wellness as a fundamental component of residency training programs.

Methods. The aim of this review was to investigate burnout among resident physicians via a comprehensive literature review to elucidate this significant issue and identify potential preventative intervention strategies. We analyzed the issue of burnout across various residency specialties, providing …

Recent Progress In Aircraft Structural Health Monitoring: Sensors, Data And Intelligence, Abeer Kadhum Abd, Qasim Abbas Atiyah, Imad Abdulhussein Abdulsahib

Engineering and Technology Journal

Structural Health Monitoring (SHM) systems are essential technologies that contribute to enhancing the safety, reliability, and efficiency of aircraft structures throughout their operational lifespan. With the increasing use of lightweight materials and complex structural designs, coupled with longer maintenance intervals, traditional scheduled inspection methods have become insufficient, leading to a shift towards continuous, sensor-based monitoring systems. This research aims to provide a systematic and comprehensive review of the latest developments in aircraft structural health monitoring, focusing on sensing technologies, data collection methods, and intelligent processing techniques based on artificial intelligence. This study is based on a systematic analysis of the …

Towards Sustainable Agentic Artificial Intelligence In Medical Diagnosis For Autonomous Heart Disease Prediction, Thura J. Mohammed, Dhiaa M. Abed

AUIQ Humanities and Social Sciences

Diagnosis of heart disease is a procedure that requires fast, accurate predictions and conventional fixed machine learning (ML) pipelines may not fully accommodate. Although models, such as Logistic Regression and Naïve Bayes are effective on structured clinical data however they do not have self-assessment or adaptive reasoning mechanisms. In this work, we present an agentic AI framework that turns the classical models into self-evaluating diagnostic agents managed by a performance conscious supervisory component. We trained and tested the system on the UCI Heart disease dataset over three different splits (70:30, 80:20, 85:15) to test its diagnostic stability with respect to …

Civil Liability Arising From Damages Resulting From The Use Of Artificial Intelligence In The Profession Of Robotic Medicine, Hisham Jadallah Mansour Shakaterh, Dr. Ahmed Bin Saleh Bin Nasser Al-Barwani

AUIQ Humanities and Social Sciences

Civil liability for damages arising from the use of artificial intelligence in the practice of robotic medicine is considered a modern topic of significant importance across various countries worldwide, particularly in the United Arab Emirates, which is well known for its progress in all sectors, especially the healthcare sector. The adoption of artificial intelligence in this field aims to employ advanced technologies to enhance the quality of medical services and provide sophisticated healthcare to the community. The importance of this study lies in highlighting the role of artificial intelligence in the practice of robotic medicine, with a focus on the …