Digital Commons Network^™

Retrieval Augmented Framework For Deepfake Audio Detection, Avinash Saxena

Master's Theses

The widespread use of AI-based audio deepfakes threatens severely to undermine media integrity and public trust. Speech synthesis techniques have improved dramatically in voice conversion (VC) and text-to-speech (TTS) in recent years, making forgeries sound highly realistic, and concerns are raised about possible malevolent uses. Existing state-of-the-art techniques for identifying fake speech have proven to be effective in some cases but are still limited in application and robustness when faced with novel attacking strategies, different acoustic conditions, or alternative linguistic domains. To address some of these limitations, the current research presents a novel deepfake audio detection system based on personalized …

The Intersection Of Near-Death Experiences (Ndes) And Traumatic Brain Injury (Tbi): Neurobiological, Phenomenological, And Creative Implications, Diego Iacono, Gloria C Feltis

Department of Neurology Faculty Papers

Traumatic brain injury (TBI) and near-death experiences (NDEs) represent profound disruptions in brain function, often associated with dramatic changes in consciousness, self-perception, and behavior. While these events are typically studied for their pathological consequences, a growing body of evidence suggests they may also trigger unexpected cognitive and creative enhancements in a subset of individuals. We explore the intersection between TBI, NDEs, and the emergence of heightened artistic expression, integrating findings from neuroanatomy, neuropathology, genetics, and phenomenology. We examine how alterations in key brain networks - such as the default mode network, frontoparietal circuits, and limbic regions - may underpin shifts …

Development Of A Digestion Procedure Using Fe2+ Ions For Electrochemical Detection Of Mno2 Particles In Drinking Water, Kayla Elliott, Sarah Jane Payne, Zhe She

Journal of Electrochemistry

Developing methods for detection contaminants in drinking water is essential to ensuring that safe and acceptable quality drinking water is delivered to consumers. While manganese (Mn) was previously known only as a mere aesthetic issue, recent epidemiological data has shown to have negative neurological effects on humans, especially on children, prompting new health-based guidelines by Health Canada and the World Health Organization. In drinking water, Mn exists predominantly as Mn(II) and Mn(IV), and is regulated based on total Mn levels. Interestingly, measurement of Mn particulate using electroanalytical methods has not yet been reported in the literature. Herein, a digestion procedure …

Gender Differences In Healthy Eating Index As Informed By The Awareness Of Diagnosis Of Metabolic Dysfunction-Associated Steatotic Liver Disease, Wei Ting Lin, Madeline Novack, Suthat Liangpunsakul, Chiung Kuei Huang, Hui Yi Lin, Po Hung Chen, Tung Sung Tseng, Peng Sheng Ting

School of Public Health Faculty Publications

Background/Objectives: Dietary quality is a driver of metabolic dysfunction-associated steatotic liver disease (MASLD). Men and women often have different levels of adherence to medical advice, but the effect of gender on adherence to dietary advice as a function of awareness of MASLD is understudied. We aim to investigate the differences in diet quality between men and women who are aware of their diagnosis of MASLD compared to their undiagnosed counterparts. Methods: We utilized the National Health and Nutrition Examination Survey 2017–2020 to identify a nationally representative sample of subjects with MASLD, 127 of whom reported a diagnosis of MASLD (diagnosed …

Low Magnetic Fields Stimulate Cardiac Mitochondrial Bioenergetics With A Bell-Shaped Response: Possibly Via A Radical Pair Mechanism, Gisela Beutner, Huoy-Jen Yuh, Ilan Goldenberg, Douglas C. Wallace, George A. Porter, Arthur J. Moss, Shey-Shing Sheu

Center for Translational Medicine Faculty Papers

Low magnetic fields (LMFs) of less than 1 × 10 3 Tesla (T) affect numerous biological processes, including plant growth and bird migration. At a cellular level, LMFs influence intracellular Ca2+ concentrations and generation of mitochondrial reactive oxygen species (mROS). However, the mechanisms that account for these effects are controversial. Here, by applying a static LMF, ranging from ~2.7 × 10 4 to ~1.9 × 10 3 T, to mitochondria isolated from adult rat hearts, a bell-shaped increase in State 3 respiration (S3R) was observed, up to 40 %. A similar LMF-induced increase in S3R was also observed in mitochondria …

High Variability In Flood Discharge And Stage Accelerates River Mobility, Chenliang Wu, Wonsuck Kim, Shuo Yang, Frank Tsai, Jeffrey A. Nittrouer, Tian Y. Dong, Duhwan Keum, Kyle M. Straub

School of Earth, Environmental, & Marine Sciences Faculty Publications

Lateral channel migration is a fundamental process in natural alluvial rivers; however, the factors that control the rate of migration remain unclear. Despite its importance in shaping river morphology, the impact of water discharge on river mobility is still largely unexplored. Here, we leverage a dataset of 64 rivers across the globe to show that higher variability in river discharge and stage promotes higher rates of river migration. To reveal the physical processes behind this relationship, we focused analyses on the lowermost 500 kilometers of the Mississippi River, where a pronounced gradient in water stage variability and migration rate exists. …

Workplace Policy And Associated Factors Of Minimum Acceptable Diet Practices: An Online Survey Among Working Mothers In Indonesia, Fadhila Iswi Deandra, Judhiastuty Februhartanty, Muchtaruddin Mansyur

Kesmas

Working mothers in Indonesia may influence complementary feeding practices, particularly their ability to ensure that their infants properly meet the minimum acceptable diet (MAD). In this cross-sectional study, an online survey was distributed through various online platforms where participants were recruited using convenience sampling. The questionnaire covered sociodemographic factors, workplace policies, and infant and young child feeding (IYCF) practices. Descriptive and logistic regression analyses were conducted. A total of 394 working mothers participated, of which over 90% of the respondents reported meeting minimum dietary diversity, minimum milk frequency, minimum milk feeding frequency, and MAD indicators as assessed with a standardized …

Burnout Assessment Tool Development And Validation For Healthcare Workers: A Psychometric Approach Using Rasch Modelling And Exploratory Factor Analysis, Rosnah Ismail, Suriya Kumareswaran Vallasamy

Kesmas

Burnout remains a significant occupational threat to healthcare workers (HCWs). Existing instruments, e.g., the Maslach Burnout Inventory, have limited applicability in healthcare-specific contexts. This study aimed to develop and validate the Burnout Scale for Assessing Stress in Healthcare Workers (BSAS-HCW), designed to measure cognitive and emotional exhaustion. A cross-sectional survey was conducted among 245 Malaysian HCWs representing diverse roles, including staff nurses (57.7%), house officers (14.3%), medical officers (13.5%), specialists (5.7%), pharmacists (4.5%), and other HCWs. Exploratory factor analysis revealed a two-factor structure with strong internal consistency (Cronbach's alpha: cognitive = 0.95; emotional = 0.97), and all items loaded above …

Analysis Of Public Knowledge, Attitudes, And Practices In Food And Drug Selection In Indonesia, Tina Wikara, Sri Astuti, Sri Nurhayati, Rotua Uli Carolina, Evi Ratna Sari

Kesmas

As consumers, the public plays a vital role in ensuring the safe and appropriate use of products. This study aimed to assess awareness of food and drug safety and quality among the Indonesian population. Using a cross-sectional survey, the authors measured public awareness across three key dimensions: knowledge, attitudes, and practices. Data were collected from 20,610 respondents aged 17–65 years from 34 provinces in Indonesia. The survey approach employed a three-stage stratified sampling design. Data were collected through structured face-to-face interviews, and the results were presented as an index ranging from 0 to 100 (low to high awareness). The respondents …

Improving Glycemic Control Among Indonesian Urban Adults: A Digital And Behavioral Extension Of The Information–Motivation–Behavioral Skills Model, Imelda Appulembang

Kesmas

Management of type 2 diabetes mellitus (T2DM) in Indonesia continues to face challenges due to behavioral, informational, and technological gaps among patients. This study analyzed the influence of self-regulatory competence and information, motivation, family support, and digital health literacy on glycemic control behavior. A cross-sectional survey was conducted from February to April 2025 among 587 adults aged >30 years with T2DM enrolled in the Chronic Disease Management Program at primary health care in six major cities: Jakarta, Surabaya, Yogyakarta, Medan, Makassar, and Banjarmasin. Data were collected through structured questionnaires and analyzed using partial least squares structural equation modeling. The findings …

Regulating Lithium Metal Nucleation And Growth For Dendrite Suppression: From Liquid-Electrolyte To Solid-State Batteries, Ao Du, Juan Zhang, Pan Xu, Ya-Jie Li, Kang-Yu Yi, Zhen-Zhen Shen, Hui-Lin Ge, Guang-Wen Zhang, Chao-Hui Zhang, Yu-Hao Wang, Chen-Zi Zhao, Meng-Yang Xu, Yu-Lin Jie, Rui Wen, Shu-Hong Jiao, Si-Qi Shi, Qiang Zhang, Chun-Peng Yang, Yu-Guo Guo

Journal of Electrochemistry

Lithium metal anodes, with a theoretical capacity of up to 3860 mAh·g⁻¹, are regarded as the cornerstone for developing next-generation high-energy-density batteries. However, several key challenges hinder their practical applications, including dendrite formation, unstable solid electrolyte interphase (SEI), side reactions with electrolytes, and associated safety risks. This review systematically explores the mechanisms of lithium nucleation, growth, and stripping in both liquid and solid-state battery systems, analyzing critical theoretical concepts like heterogeneous nucleation thermodynamics, surface diffusion kinetics, space charge effects, and SEI-induced nucleation, which are crucial for understanding the genesis of dendrite growth. Additionally, the review discusses the electrochemical-mechanical …

The Impact Of Extramedullary And Paraskeletal Plasmacytomas On Treatment Outcomes In Multiple Myeloma Treated With Teclistamab: U.S. Myeloma Immunotherapy Consortium Real-World Experience, Aimaz Afrough, Danai Dima, Beatrice Razzo, Utkarsh Goel, Aishwarya Sannareddy, Oren Pasvolsky, Mariola Vazquez-Martinez, Christopher Ferreri, Rahul Banerjee, Jack Khouri, James Davis, Mahmoud Gaballa, Alex Lieberman-Cribbin, Masooma Rana, Kelley Julian, Faiz Anwer, Leyla Shune, Shaun Dejarnette, Ariel Grajales-Cruz, Evguenia Ouchveridze, Gabriel De Avila, Sandra Susanibar-Adaniya, Andrew Portuguese, Daniel Schrum, Erin Eberwein, Hitomi Hosoya, Lekha Mikkilineni, Gurbakhash Kaur, Joseph Mcguirk, Adriana Rossi, Megan Herr, Omar Castaneda, Frederick Locke, Shahzad Raza, Yi Lin, Shebli Atrash, Douglas Sborov, Peter Voorhees, Shambavi Richard, Alfred Garfall, Surbhi Sidana, Krina Patel, Doris Hansen, Andrew Cowan, Larry Anderson, Hans Lee

Department of Medical Oncology Faculty Papers

Teclistamab, a bispecific antibody targeting B-cell maturation antigen (BCMA), is effective in relapsed or refractory multiple myeloma (RRMM), but its impact on patients with soft tissue plasmacytomas is unclear. We studied 385 RRMM patients treated with teclistamab at 13 U.S. centers through September 2023, with follow-up to April 2024. Soft tissue plasmacytomas were classified as true extramedullary disease (EMD; not contiguous with bone) or paraskeletal plasmacytomas (PSK; contiguous with bone). Patients with the simultaneous presence of both were classified as true-EMD, reflecting its adverse prognosis. Of those, 109 (28%) had true EMD, 33 (9%) had PSK, and 243 (63%) had …

Fluorosilane-Induced Softening And Collapse Of Micropillar Arrays, Gabriela Moreira Lana, Maja Fehlberg, Petra Herbeck-Engel, Gisela Heppe, Raimund Schlüßler, Torsten Jähnke, Eduard Arzt, Roland Bennewitz

Chemical and Biochemical Engineering Faculty Research & Creative Works

Replica molding is a widely used technique for the fabrication of polymer microstructures. As structural dimensions decrease, anti-stick surface treatment of the mold becomes increasingly critical to ensure clean demolding and preserve structural integrity. We fabricated arrays of micropillars with 20 µm diameter and 60 µm height using medical-grade polydimethylsiloxane (PDMS), MDX4-4210, and observed a high fraction of collapsed pillars for the first molding after fluorosilanization of the mold to reduce sticking. To address this issue, we systematically investigated the surface treatment protocol for the molds, made from the PDMS Sylgard 184. We provide results from complementary measurement methods, to …

Biocompatible And Antibacterial Pcl-Tio2@Ag/Γ-Cd Mof Nanocomposite Coating For Corrosion Resistance Of Magnesium Alloy In Simulated Body Fluid, Sara Dehghan-Chenar, Hamid R. Zare, Zahra Mohammadpour, Maryam Sadat Mirbagheri-Firoozabad

Journal of Electrochemistry

Magnesium alloys are promising candidates for bio-implant applications due to their biodegradability and biocompatibility. However, their rapid corrosion remains a critical limitation. This study presents the development of a multifunctional nanocomposite coating designed to enhance the corrosion resistance and antibacterial properties of magnesium alloy implants. The coating comprised γ-cyclodextrin metal-organic frameworks (γ-CD MOFs) decorated with TiO₂@Ag core-shell nanoparticles, embedded in a polycaprolactone (PCL) matrix. Immersion tests in a simulated body fluid (SBF) revealed an initially higher corrosion rate for the PCL-TiO₂@Ag/γ-CD MOF coating compared to the coating without TiO₂@Ag nanoparticles; however, it demonstrated significant …

Ai-Based Mapping Of Offshore Wind Energy Around The Korean Peninsula Using Sentinel-1 Sar And Numerical Weather Prediction Data, Jason Sung-Uk Joh, Son V. Nghiem, Menas Kafatos, Jay Liu, Jinsoo Kim, Seung Hee Kim

Institute for ECHO Articles and Research

Offshore wind farm projects are being promoted in the seas surrounding the Korean Peninsula to secure renewable energy. To support site selection, offshore wind resource maps were generated using deep neural networks trained on Sentinel-1 SAR imagery, numerical weather prediction data, offshore wind observations, sea surface temperature, and bathymetry. The deep neural network (DNN) framework consisted of six sub-models targeting eastward and northward wind components across three regions—the Yellow Sea, Korea Strait, and East Sea—to account for spatial heterogeneity. The proposed models outperformed existing approaches, achieving mean absolute errors (MAE) ranging from 1.31 to 1.69 m/s and correlation coefficients (CC) …

Mecp2 Interacts With The Super Elongation Complex To Regulate Transcription, Jun Young Sonn, Wonho Kim, Marta Iwanaszko, Yuki Aoi, Yan Li, Guantong Qi, Luke Parkitny, Janice L Brissette, Lorin Weiner, Juan Botas, Ismael Al-Ramahi, Ali Shilatifard, Huda Y Zoghbi

Faculty, Staff and Students Publications

Loss-of-function mutations in methyl-CpG binding protein 2 (MECP2) cause Rett syndrome. While we know that MeCP2 binds to methylated cytosines on DNA, the full breadth of the molecular mechanisms by which MeCP2 regulates gene expression remains incompletely understood. Here, using a genetic modifier screen, we identify the super elongation complex, a P-TEFb–containing elongation factor that releases promoter-proximally paused RNA polymerase II, as a genetic interactor of MECP2. MeCP2 physically interacts with SEC subunits and directly binds AFF4, the scaffold of the SEC, via the transcriptional repression domain. Furthermore, MeCP2 facilitates the binding of AFF4 on a subset …

Risk Exposure And Stakeholder Oversight In College Sports: Lessons From A Lightning Incident, John J. Miller Dr., Jason W. Lee Dr., Elizabeth A. Gregg, Jeffrey F. Levine

The COSMA Journal

The management of collegiate athletic events increasingly demands systematic approaches to risk identification, assessment, and mitigation, yet risk management education within athletics remains inconsistent. As a result, athletic directors, coaches, and facility managers frequently lack the formal preparation necessary to design and implement effective risk management policies, thereby exposing institutions to operational disruption and legal liability. Severe weather events, particularly lightning storms, underscore the importance of integrating legal principles such as duty of care, premises liability, and foreseeability into institutional planning. This case study, based on a real-life incident, shows that athletic administrators, often with limited formal training in risk …

A Forensic Logging Framework For Llms, Giannis Tziakouris, Elio Biasiotto

Defensive Publications Series

Large language models (LLMs) are increasingly embedded in enterprise, operational, and security-sensitive workflows. These include automated coding assistants, knowledge management systems, and multi-agent orchestration platforms where LLMs act as intermediaries between users and external tools. While significant research has been directed toward preventive safeguards such as input filtering, refusal mechanisms, and adversarial robustness, far less attention has been paid to forensic readiness. When incidents occur, ranging from malicious prompt injections to unauthorized tool usage or exfiltration of sensitive data, existing LLM implementations fail to provide investigators with reliable records for reconstruction, containment, or attribution.

To address this deficiency, a comprehensive …

The Great Divide – A New Leader, A New Identity? Examining A Mascot Controversy And The Role Of The New Coach In School Rebranding, Jason W. Lee, Elizabeth A. Gregg, John J. Miller

The COSMA Journal

Divisive school imagery can significantly impact academic branding while raising ethical concerns. In the presented case study, issues such as those encountered by Marty Lundy, a newly hired head football coach, are addressed as he faces divisive imagery at his new school. As Marty is aware of the divisive nature of his school's imagery, he must navigate the challenge of balancing the school's tradition and community heritage with the need to promote a welcoming environment and address the potential impact on the school's reputation. Consequently, this case study encourages examining various brand communication and ethical strategies necessary for addressing such …

Evaluating Large Language Models For Automated Cv Ranking: A Hybrid Embedding Approach For Enhanced Recruitment, Sarah Mohamed Alhindaassi

Thesis/ Dissertation Defenses

Increasing numbers of applications have revealed limitations in legacy keyword-filtering-based Applicant Tracking Systems (ATS), which commonly overlook candidate potential and ignore contextual or transferable skills. Advances in Natural Language Processing (NLP) and Large Language Models (LLMs) offer an exhilarating alternative, supporting context-sensitive and human-crafted reasoning in candidate evaluation. This thesis systematically evaluates four classes of approaches, lexical models, embedding-based methods, Large Language Models (LLMs), and hybrid ensembles, for automation of Curriculum Vitae (CV) to Job Description (JD) matching without exploiting prior annotations or annotations at match time. Using a combination of publicly available datasets and real-world sample data covering three …

Tax Trends, Harry Z. Garian

Tax Adviser

No abstract provided.

Tax Trends, Harry Z. Garian

Tax Adviser

No abstract provided.

Tax Clinic, William T. Diss

Tax Adviser

No abstract provided.

Parallel Nanophotonic Inverse Design With Early Stopping, Zi Jian Wee, Hock Soon Lim, Sabrine Hachmioune, Nidhi Chaudhary, Heonjung Kim

Defensive Publications Series

Nanophotonic inverse design uses gradient-based optimization to design the topologies of devices such as waveguides and lenses. Since the optimization process is sensitive to initial conditions yet computationally expensive, it is advantageous to balance the exploration-exploitation tradeoff by allocating optimization resources only to promising designs. Inspired by hyperparameter tuning in machine learning, this disclosure proposes Asynchronous Topology Optimization with Early Stopping (ATOES), where nanophotonic devices are optimized in parallel and resources are allocated to more promising designs via an early stopping algorithm.

The Master Engineering Compliance Atlas: A Unified Architecture For Automating Global Regulatory Governance, Ai Safety, And Cyber Risk, Ramkumar Bharathan

Defensive Publications Series

This technical disclosure presents the "Master Engineering Compliance Atlas," a comprehensive framework designed to bridge the gap between complex global regulations and modern software engineering practices. As regulatory landscapes fragment across jurisdictions, this document provides a unified methodology for harmonizing requirements from major frameworks, including Sarbanes-Oxley (SOX), GDPR, the EU Digital Markets Act (DMA), the Digital Services Act (DSA), the EU AI Act, NIST SP 800-53, and ISO 27001.

Unlike traditional legal summaries, this framework focuses on technical implementation, offering specific architectural patterns, "L7" control designs, and automation strategies to achieve "Compliance as Code." It introduces a "Mega-Matrix" that maps …

Exploring Communication Strategies With Esports Fans: Signaling Physical Location And Popularity, Gavin Nolin, Ismail Karabas, Skylar King

Faculty & Staff Research and Creative Activity

Purpose

Using signaling theory as a theoretical foundation, this study aims to investigate how consumers respond to message framing emphasizing physical location and popularity of an esports team. Additionally, this research looks at how power distance belief, need for uniqueness, sense of power and pride in community are associated with consumer intentions (e.g. support likelihood, watch likelihood, follow on social media likelihood) as a function of physical location versus popularity-signaling in team communication with prospective fans. Design/methodology/approach

This research uses an experiment to test the effects of physical location and popularity-signaling on consumer intentions toward an esports team, as well …

Met Overexpression Is Associated With Superior Immunotherapy Benefit In Advanced Non-Small Cell Lung Cancer, Hui Li, Lingzhi Hong, Pedro Rocha, Rafael Bach, Luisa M Solis Soto, Waree Rinsurongkawong, Bingnan Zhang, Haniel A Araujo, Yasir Y Elamin, Mehmet Altan, Claudio A Arrechedera, Jianling Zhou, Khaja B Khan, Wei Lu, Elliana Young, Carl M Gay, Tina Cascone, Lauren A Byers, Ferdinandos Skoulidis, George Blumenschein, Frank V Fossella, Anne Tsao, Marcelo V Negrao, Natalie Vokes, Jia Wu, Hai T Tran, Ignacio I Wistuba, J Jack Lee, Don L Gibbons, Ara A Vaporciyan, John V Heymach, Xiuning Le, Jianjun Zhang

Faculty, Staff and Student Publications

Background/objectives: MET overexpression is common in non-small cell lung cancer (NSCLC). The correlation between MET overexpression and immune checkpoint inhibitor (ICI) efficacy in NSCLC is underexplored.

Methods: In this retrospective observational cohort study, we curated a dataset of 279 stage IV NSCLC patients who received ICI treatment and had MET expression assessed by CLIA-certified immunohistochemistry (IHC) assay. MET expression was graded on a scale from 0 to 3+, with overexpression defined as 2+ or 3+. Clinicopathological features associated with MET expression were assessed using logistic regression. Overall survival (OS) and progression-free survival (PFS) were evaluated via Kaplan-Meier analysis and the …

Variation In State Policies On Sideline Medical Coverage Of High School Athletic Events, Marcus Allen, Aravind Athiviraham, Darlington Nwaudo, Lutul D Farrow, Aossm Bold Study Group, Matthew Matava

2020-Current year OA Pubs

BACKGROUND: Certified athletic trainers (ATs) are the primary source of sideline coverage for high school athletic events, providing an essential role in student-athlete health. However, there is a paucity of literature evaluating the existence of state requirements regarding the presence of ATs and mandatory sideline medical coverage of high school athletic events.

HYPOTHESIS: It was hypothesized that there is significant variation among state policies on sideline medical coverage and AT requirements for high school athletic events.

STUDY DESIGN: Cross-sectional study.

METHODS: A 17-question survey was emailed to the executive directors (or analogous position) of the state high school athletic associations …

“I Missed My Other Oncologist”: Established Relationships As Barriers And Facilitators To Accessing Car-T And Autologous Transplantation, Zachary A. K. Frosch, Clark Meshack, Caitlin Meeker, Asya Varshavsky-Yanovsky, Rashmi Khanal, Michael Bromberg, Ashwin Chandar, Emmanuel Quien, Jordan Carter, Shazia K. Nakhoda, Marcus Messmer, Charissa Montgomery, Jason A. Incorvati, Nadia D. Ali, Michael J. Styler, Carolyn Y. Fang

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Autologous stem cell transplantation (ASCT) and chimeric antigen receptor T-cell therapy (CAR-T) can provide significant clinical benefit, but are not equally available to all patients. Oncologist continuity and trust are important to patients, and may act as barriers to receipt of therapy. However, detailed data are lacking on the mechanism by which these might affect receipt of therapy, or how this barrier may be overcome.

METHODS: We conducted a qualitative interview study with patients with non-Hodgkin lymphoma (NHL), classic Hodgkin lymphoma (cHL) or multiple myeloma (MM) eligible for or treated with ASCT/CAR-T. Participants were recruited from a multi-site academic …

The Mediating Role Of Self-Efficacy And Symptom Distress In Cancer Patients, Kailei Yan, Hsiao-Lan Wang, Brent Small, Victoria Marshall, Amanda Elliott, Danielle Tometich, Theresa M. Beckie, Susan C. Mcmillan

Biennial Convention (CONV)

Cancer symptoms significantly impact the quality of life (QOL) among cancer patients (Almståhl et al., 2019; Bashir et al., 2020; Nayak et al., 2019). Self-efficacy plays a key role in managing symptoms and improving QOL (Cox-Martin et al., 2020; Erickson et al., 2021; Frensham et al., 2020; Thieser et al., 2021; Wu et al., 2019). Symptom distress, defined as the suffering from symptom occurrence, predicts QOL in cancer patients with symptoms (Badana et al., 2019). However, it is not clear whether self-efficacy and/or symptom distress mediate the effects of symptoms on QOL. This study seeks to explore if and how …