Digital Commons Network^™

Suppression Of Hypothalamic Oestrogenic Signal Sustains Hyperprolactinemia And Metabolic Adaptation In Lactating Mice, Meng Yu, Bing Feng, Jonathan C Bean, Qianru Zhao, Yongjie Yang, Hailan Liu, Yongxiang Li, Benjamin P Eappen, Hesong Liu, Longlong Tu, Kristine M Conde, Mengjie Wang, Xi Chen, Na Yin, Darah Ave Threat, Nathan Xu, Junying Han, Peiyu Gao, Yi Zhu, Darryl L Hadsell, Yang He, Pingwen Xu, Yanlin He, Chunmei Wang

Faculty, Staff and Students Publications

17β-oestradiol (E2) inhibits overeating and promotes brown adipose tissue (BAT) thermogenesis, whereas prolactin (PRL) does the opposite. During lactation, the simultaneous decline in E2 and surge in PRL contribute to maternal metabolic adaptations, including hyperphagia and suppressed BAT thermogenesis. However, the underlying neuroendocrine mechanisms remain unclear. Here, we find that oestrogen receptor alpha (ERα)-expressing neurons in the medial basal hypothalamus (MBH), specifically the arcuate nucleus of the hypothalamus and the ventrolateral subdivision of the ventromedial hypothalamus (vlVMH), are suppressed during lactation. Deletion of ERα from MBH neurons in virgin female mice induces metabolic phenotypes characteristic of lactation, including hyperprolactinemia, hyperphagia …

Words Of Advice: How To Write The Story Of A Patient For A Problem-Based Learning Session In A Healthcare Education Program, Andrew D Bergemann, Matthew Mcmillin, Miriah C Gillispie-Taylor, Gareth Gingell, R Taylor Surles, Rachel Wallace

Faculty and Staff Publications

Medical education is in the process of a pedagogical revolution. Traditional lectures are playing a progressively smaller role, with more of the content being delivered through student-centered small-group sessions. Problem-based learning (PBL) has become a centerpiece of education for many medical schools, in large part because of its focus on the learners identifying their own knowledge gaps. As junior scientists seek faculty appointments in institutions focused on healthcare education, they will find that skills in PBL are valued by the academic community. Among the necessary skills is the capability to lead efforts in PBL case writing. The cases, each of …

Revisions To The Safety Assurance Factors For Electronic Health Record Resilience (Safer) Guides To Update National Recommendations For Safe Use Of Electronic Health Records, Dean F Sittig, Trisha Flanagan, Patricia Sengstack, Rosann T Cholankeril, Sara Ehsan, Amanda Heidemann, Daniel R Murphy, Hojjat Salmasian, Jason S Adelman, Hardeep Singh

Faculty, Staff and Student Publications

The Safety Assurance Factors for Electronic Health Record (EHR) Resilience (SAFER) Guides provide recommendations to healthcare organizations for conducting proactive self-assessments of the safety and effectiveness of their EHR implementation and use. Originally released in 2014, they were last updated in 2016. In 2022, the Centers for Medicare and Medicaid Services required their annual attestation by US hospitals.

Objectives: This case study describes how SAFER Guide recommendations were updated to align with current evidence and clinical practice.

Materials and methods: Over nine months, a multidisciplinary team updated SAFER Guides through literature reviews, iterative feedback, and online meetings.

Results: We reduced …

Crispr/Cas9 Gene Therapy Increases The Risk Of Tumorigenesis In The Mouse Model Of Hereditary Tyrosinemia Type I, Tong Chen, Mercedes Barzi, Nika Furey, Hyunjae R Kim, Francis P Pankowicz, Xavier Legras, Sara H Elsea, Ayrea E Hurley, Diane Yang, David A Wheeler, Malgorzata Borowiak, Beatrice Bissig-Choisat, Pavel Sumazin, Karl-Dimiter Bissig

Center for Medical Ethics and Health Policy Staff Publications

Background & aims: The therapeutic potential of CRISPR gene editing has been demonstrated in various animal models; however, little is known about its long-term consequences. This study seeks to bridge this gap by investigating the lasting consequences of CRISPR gene therapy in an animal model of hereditary tyrosinemia type I (HT-I). We compared the standard of care-nitisinone, a small molecule inhibitor of hydroxyphenylpyruvate dioxygenase (HPD)-with the deletion of the Hpd gene by CRISPR gene therapy. Both treatments block flux through tyrosine catabolism and thereby prevent the accumulation of toxic catabolites in HT-I.

Methods: We assessed the efficacy and safety of …

Amniocentesis In Pregnancies At Or Beyond 24 Weeks: An International Multicenter Study, Roni Zemet, Mohamad Ali Maktabi, Alexandra Tinfow, Jessica L Giordano, Thomas M Heisler, Qi Yan, Roni Plaschkes, Jenny Stokes, Jennifer M Walsh, Siobhán Corcoran, Erica Schindewolf, Kendra Miller, Asha N Talati, Kristen A Miller, Karin Blakemore, Kate Swanson, Jana Ramm, Ivonne Bedei, Teresa N Sparks, Angie C Jelin, Neeta L Vora, Juliana S Gebb, David A Crosby, Michal Berkenstadt, Boaz Weisz, Ronald J Wapner, Ignatia B Van Den Veyver

Center for Medical Ethics and Health Policy Staff Publications

Background: Amniocentesis for genetic diagnosis is most commonly done between 15 and 22 weeks of gestation but can be performed at later gestational ages. The safety and genetic diagnostic accuracy of amniocentesis have been well-established through numerous large-scale multicenter studies for procedures before 24 weeks, but comprehensive data on late amniocentesis remain sparse.

Objective: To evaluate the indications, diagnostic yield, safety, and maternal and fetal outcomes associated with amniocentesis performed at or beyond 24 weeks of gestation.

Study design: We conducted an international multicenter retrospective cohort study examining pregnant individuals who underwent amniocentesis for prenatal diagnostic testing at gestational ages …

Data Driven Multi-Objective Optimization Of The Scheduling For Towing A Floating Offshore Wind Turbine Between Assembly Port And Installation Location Throughout A Year, Frédéric Le Pivert, Adam Roberts, Adan Lopez-Santander, Matthew Craven, Saeid Kazemi

School of Engineering, Computing and Mathematics

High demand for the installation of floating offshore wind turbines over the coming years is likely to place significant pressure on ports and installation vessels. Optimization of the routes between ports and farms and the towing schedule when transporting equipment is therefore critical to reducing operation timescales and carbon emissions. This paper presents two series of multi-objective optimizations for minimizing the timescale and carbon emissions for the case of an IEA 15 MW turbine on a VolturnUS-S platform being wet towed through the English Channel to the Celtic Sea. The study makes use of the Maritime Simulation Laboratory (MSL) Ship …

Machine Learning To Predict Stroke Risk From Routine Hospital Data: A Systematic Review, William Heseltine-Carp, Megan Courtman, Daniel Browning, Aishwarya Kasabe, Michael Allen, Adam Streeter, Emmanuel Ifeachor, Martin James, Stephen Mullin

School of Engineering, Computing and Mathematics

Purpose: Stroke remains a leading cause of morbidity and mortality. Despite this, current risk stratification tools such as CHA₂DS₂-VASc and QRISK3 are of limited accuracy, particularly in those without a diagnosis of atrial-fibrillation. Hence, there is a need for more accurate stroke risk prediction models. Machine-learning (ML) may provide a solution to this by leveraging existing routine hospital databases to build accurate stroke risk prediction models and identify novel risk factors for stroke. Aims: In this systematic review we appraise current research using ML to predict stroke risk from routine hospital data. Based on these findings …

Preparing To Implement Shared Decision Making In Anaesthesia For Hip Fracture Surgery: A Qualitative Interview Study, Eliana C Goldstein, Mark D Neuman, Viktoria Vonder Haar, Aaron C Li, Carlos E Guerra-Londono, Glyn Elwyn, Stacie G Deiner, Adnan Hussain, Joshua W Sappenfield, Christopher J Edwards, Sabry Ayad, James H Baraldi, Karah Whatley, Mary C Politi

2020-Current year OA Pubs

BACKGROUND: Shared decision making is rarely used in anaesthesia consultations. Because either spinal or general anaesthesia can be appropriate for many patients undergoing surgery to repair a hip fracture, this is an appropriate context to implement and test shared decision making and associated resources for anaesthesia decisions. Conversation aids can facilitate shared decision making between clinicians, patients, and caregivers about treatment choices.

METHODS: We conducted semi-structured qualitative interviews at seven sites from April to September 2024 to prepare for implementation of a conversation aid about anaesthesia choices for hip fracture surgery. Interviews elicited feedback on shared decision making and a …

Hypertension Diagnosis And Management In Bamako, Mali, Issiaka Camara, Mohamed Traore, Mamoudou Maiga, Dike Ojji, Jane Holl, Souleymane Coulibaly, Mark D Huffman

2020-Current year OA Pubs

PROBLEM: The capacity and site readiness for delivering hypertension management services in Mali were unknown, hindering the effective implementation of the World Health Organization (WHO) HEARTS technical package for cardiovascular disease management.

APPROACH: We selected one tertiary and two secondary hospitals to be assessed. From December 2021 to January 2022, hospital cardiologists collected data on indicators of capacity and site readiness using an adapted version of the WHO service availability and readiness assessment questionnaire. The study team verified the collected data through site inspection and review of administrative documents.

LOCAL SETTING: Mali, a low-income country with a population of 22 …

Quantitative And Visual Benefits Of Data-Driven Motion Correction On Oncologic Pet/Ct: A Prospective Cross-Sectional Study, Semra Ince, M Allan Thomas, Malak Itani, Christopher Swingle, Richard Laforest, Adeel Haq, Genevieve Muñoz, Saeed Ashrafinia, Paul Schleyer, Richard L Wahl, Tyler J Fraum

2020-Current year OA Pubs

RATIONALE AND OBJECTIVE: Conventional positron emission tomography (PET) respiratory gating utilizes a fraction of acquired PET counts (i.e., optimal gate [OG]), whereas elastic motion correction with deblurring (EMCD) utilizes all PET counts to reconstruct motion-corrected images without increasing image noise. Our aim was to assess the quantitative and visual impacts of EMCD-based motion correction on FDG-PET and DOTATATE-PET images relative to OG and ungated (UG) images.

MATERIALS AND METHODS: This prospective, single-center study enrolled adults undergoing FDG or DOTATATE oncologic PET/CT between June 2020 and October 2022. Subjects underwent a standard-of-care (SOC) PET acquisition while wearing a respiratory gating belt. …

Femoral Nail And Cement Static Spacer Technique For The Treatment Of Chronic Periprosthetic Knee Infection, Katherine Mistretta, Caroline Granger, Joseph Kromka, Andrew M Schneider

2020-Current year OA Pubs

A 2-stage protocol is standard of care treatment in the United States for chronic periprosthetic joint infection of the knee. While many patients benefit from insertion of an articulating spacer, there are instances in which this is not feasible, and a static spacer is indicated. However, many static spacer techniques risk instability and lack durability. The ideal static spacer construct should provide immediate brace-free weight-bearing to maximize function during the spacer stage and, if needed, permit delayed reimplantation in the case of medically high-risk patients. Here, we describe our surgical technique for a femoral nail and cement static spacer in …

Single-Cell Transcriptomic Analysis Of Kaposi Sarcoma, Daniel A. Rauch, Paula Valiño Ramos, Mariam Khanfar, John Harding, Ancy Joseph, Anam Fahad, Paul Simonson, Isabel Risch, Obi Griffith, Malachi Griffith, Lee Ratner

2020-Current year OA Pubs

Kaposi Sarcoma (KS) is a complex tumor caused by KS-associated herpesvirus 8 (KSHV). Histological analysis reveals a mixture of "spindle cells", vascular-like spaces, extravasated erythrocytes, and immune cells. In order to elucidate the infected and uninfected cell types in KS tumors, we examined twenty-five skin and blood samples from sixteen subjects by single cell RNA sequence analyses. Two populations of KSHV-infected cells were identified, one of which represented a CD34-negative proliferative fraction of endothelial cells, and the second representing CD34-positive cells expressing endothelial genes found in a variety of cell types including high endothelial venules, fenestrated capillaries, and endothelial tip …

The Role Of Androgens On Experimental Pain Sensitivity: A Systemic Review And Meta-Analysis, Elizabeth Wu-Chen, Gourav Banerjee, Elise Requadt, Benjamin Hunter, Thomas J. Baranski, Whitney Trotter Ross, Hadas Nahman-Averbuch

2020-Current year OA Pubs

Animal studies have shown androgens, especially testosterone, may have an analgesic effect on nociceptive behavior. However, it is unclear if this effect is present in humans. This review and meta-analysis aim to summarize and synthesize the role of androgens on experimental pain sensitivity in humans. Studies were included if they examined the (1) relationships between androgens and experimental pain sensitivity, (2) group differences in androgen or pain levels, and (3) the effect of androgen interventions on experimental pain sensitivity. After a comprehensive search, 31 papers were identified. When possible, meta-analyses were performed. Most studies examined the impact of testosterone on …

Thrombotic Microangiopathy After Kidney Transplantation: Insights Into Genetic Etiology And Clinical Outcomes, Massini Merzkani, Nyein Chann Wai Lynn, Karen Flores, Gaurav Rajashekar, Kristin Progar, Rowena Delos Santos, John P Atkinson, Daniel C Brennan, Anuja Java

2020-Current year OA Pubs

INTRODUCTION: Thrombotic microangiopathy (TMA), characterized by small-vessel thrombosis caused by endothelial injury, presents significant diagnostic and treatment challenges in kidney transplantation.

METHODS: To investigate the factors associated with posttransplant TMA, we conducted a retrospective study of 3535 kidney transplant recipients at our center from 2008 to 2023.

RESULTS: Sixty-eight patients were diagnosed with TMA, and 93% (63 of 68) underwent genetic testing. Patients were categorized into 3 groups based on the TMA etiology. Group 1 (

CONCLUSION: Our findings underscore the need for comprehensive pre and posttransplantation genetic testing to predict and manage the risk of TMA and prevent graft …

Severe Aortic Stenosis And Chronic Myeloid Leukemia: Considerations For Valve Management, Rebecca Cunningham, Sang Gune K Yoo, Alexander A Brescia, Karolyn A Oetjen, Iskra Pusic, Joshua D Mitchell

2020-Current year OA Pubs

No abstract provided.

Management Aspects Of Medical Therapy In Graves Disease, Rutu Shah, Samantha E Adamson, Sina Jasim

2020-Current year OA Pubs

OBJECTIVE: Graves disease (GD) is the most common cause of hyperthyroidism. Treatment options include antithyroid drugs (ATDs), radioactive iodine, and surgery. In this review, we focus on the medical aspects of managing GD.

METHODS: The authors conducted a literature review of PubMed to include studies and review articles on GD management, ATDs, long-term safety of antithyroid drugs, hyperthyroidism in pregnancy, Graves ophthalmopathy, and special circumstances related to hyperthyroidism.

RESULTS: In adjunction to ATDs, medical management for GD also includes beta-blockers, glucocorticoids, and iodine containing agents. ATDs are currently the preferred option for initial management of GD, reflecting a shift in …

Biliary Metaplasia And Macrophage Activation Define The Cellular Landscape Of Cardiogenic Liver Disease, Arick C Park, Christina F Fu, Adeesh Parvathaneni, Bin Q Yang, Mandy M Chan, Kathleen Byrnes, Joel D Schilling

2020-Current year OA Pubs

Right heart failure significantly impacts liver remodeling and function, a process referred to as cardiogenic liver disease. Although recognized as a risk factor for adverse outcomes, little is understood about the cellular and molecular players that contribute to liver disease in heart failure. Using human liver biopsy samples from patients with heart failure and a mouse model of liver congestion, we unraveled a nexus of macrophages, hepatic stellate cells, and biliary metaplastic cells that shape the pathologic environment of cardiogenic liver disease.

Neuroimmune Mechanisms Of Type 2 Inflammation In The Skin And Lung, Masato Tamari, Aaron M Ver Heul

2020-Current year OA Pubs

Type 2 inflammation has a major role in barrier tissues such as the skin and airways and underlies common conditions including atopic dermatitis (AD) and asthma. Cytokines including interleukin 4 (IL-4), IL-5, and IL-13 are key immune signatures of type 2 inflammation and are the targets of multiple specific therapeutics for allergic diseases. Despite shared core immune mechanisms, the distinct structures and functions of the skin and airways lead to unique therapeutic responses. It is increasingly recognized that the nervous system has a major role in sensing and directing inflammatory processes. Indeed, crosstalk between type 2 immune activation and somatosensory …

The Ten Test And Sensory Evaluation Of Hand And Finger Injuries In The Emergency Department, Emilie H Lothet, Aaron J Lacy, Elizabeth B Odom

2020-Current year OA Pubs

BACKGROUND: Hand and finger injuries are a common presenting complaint to the emergency department (ED) and are associated with significant morbidity. Neurologic evaluation of these injuries is a crucial component of the patient assessment and can be done via a variety of testing methods.

DISCUSSION: Although most taught and cited in the ED literature, the two-point discrimination test for sensation has several drawbacks, including limited reproducibility and reliability. Although often utilized by hand surgical specialists, the Semmes-Weinstein monofilament test and the Weinstein Enhanced Sensory Test are not practical for the emergency physician due to the need for specialized equipment and …

Gene Expression Differences Associated With Alcohol Use Disorder In Human Brain, Caryn Willis, Julie D White, Melyssa S Minto, Bryan C Quach, Shizhong Han, Ran Tao, Joo Heon Shin, Amy Deep-Soboslay, Thomas M Hyde, R Dayne Mayfield, Bradley T Webb, Eric O Johnson, Joel E Kleinman, Laura J Bierut, Dana B Hancock

2020-Current year OA Pubs

Excessive alcohol consumption is a leading cause of preventable death worldwide. To improve understanding of neurobiological mechanisms associated with alcohol use disorder (AUD) in humans, we compared gene expression data from deceased individuals with and without AUD across two addiction-relevant brain regions: the nucleus accumbens (NAc) and dorsolateral prefrontal cortex (DLPFC). Bulk RNA-seq data from NAc and DLPFC (N ≥50 with AUD, ≥46 non-AUD) were analyzed for differential gene expression using modified negative binomial regression adjusting for technical and biological covariates. The region-level results were meta-analyzed with those from an independent dataset (N

Methylomic Signature Of Current Cannabis Use In Two First-Episode Psychosis Cohorts, Emma L Dempster, Emma C Johnson, Et Al.

2020-Current year OA Pubs

The rising prevalence and legalisation of cannabis worldwide have underscored the need for a comprehensive understanding of its biological impact, particularly on mental health. Epigenetic mechanisms, specifically DNA methylation, have gained increasing recognition as vital factors in the interplay between risk factors and mental health. This study aimed to explore the effects of current cannabis use and high-potency cannabis on DNA methylation in two independent cohorts of individuals experiencing first-episode psychosis (FEP) compared to control subjects. The combined sample consisted of 682 participants (188 current cannabis users and 494 never users). DNA methylation profiles were generated on blood-derived DNA samples …

External Validation Of An Algorithm To Detect Vertebral Level Mislabeling And Autocontouring Errors, Tucker J Netherton, Didier Duprez, Tina Patel, Gizem Cifter, Laurence E Court, Christoph Trauernicht, Ajay Aggarwal

Faculty, Staff and Student Publications

Background and purpose: This work performs external validation of a previously developed vertebral body autocontouring tool and investigates a post-processing method to increase performance to clinically acceptable levels.

Materials and methods: Vertebral bodies within CT scans from two separate institutions (40 from institution A and 41 from institution B) were automatically 1) localized and enumerated, 2) contoured, and 3) screened as a means of quality assurance (QA) for errors. Identification rate, contour acceptability rate, and QA accuracy were calculated to assess the tool's performance. These metrics were compared to those calculated on CTs from the model's original training dataset, and …

Immunotherapy Targeting A Leader Sequence Cathepsin G-Derived Peptide, Chunhua Shi, Ze Tian, Jun Yan, Mao Zhang, Pariya Sukhumalchandra, Edward Chang, Guojun Yang, Junping You, Meng Cui, Qing Shi, Celine Kerros, Anne Philips, Na Qiao, Hiroki Torikai, Sathvik Patchametla, Anna Sergeeva, Lisa St John, Helen He, Dmitri Wiederschain, Benjamin H Lee, Geraldine L C Paulus, Dongxing Zha, Jeffrey Molldrem, Gheath Alatrash

Faculty, Staff and Student Publications

Myeloid azurophil granules provide a rich source of intracellular leukemia antigens. Cathepsin G (CG) is a serine protease that has higher expression in acute myeloid leukemia (AML) blasts in comparison to normal myeloid progenitors. Based on the unique biology of HLA-A*0201 (HLA-A2), in which presentation of leader sequence (LS)-derived peptides is favored, we focused on the LS-CG-derived peptide CG1 (FLLPTGAEA). We previously detected CG1/HLA-A2 complexes on the surface of primary HLA-A2+ AML blasts and cell lines, and immunity targeting CG1/HLA-A2 in leukemia patients. T cell receptor (TCR)-mimic (m) antibodies are immunotherapeutic antibodies that target peptide-HLA (pHLA) complexes. Here we report …

Staged Screening Identifies People With Biomarkers Related To Neuronal Alpha-Synuclein Disease, Ethan G Brown, Lana M Chahine, Andrew Siderowf, Caroline Gochanour, Ryan Kurth, Micah J Marshall, Chelsea Caspell-Garcia, Michael C Brumm, Craig E Stanley, Monica Korell, Bridget Mcmahon, Maggie Kuhl, Kimberly Fabrizio, Laura Heathers, Luis Concha-Marambio, Claudio Soto, Sohini Chowdhury, Christopher S Coffey, Tatiana M Foroud, Tanya Simuni, Kenneth Marek, Caroline M Tanner

Faculty, Staff and Student Publications

Objective: Remote identification of individuals with severe hyposmia may enable scalable recruitment of participants with underlying alpha-synuclein aggregation. We evaluated the performance of a staged screening paradigm using remote smell testing to enrich for abnormal dopamine transporter single-photon emission computed tomography imaging (DAT-SPECT) and alpha-synuclein aggregation.

Methods: The Parkinson's Progression Markers Initiative (PPMI) recruited participants for the prodromal cohort who were 60-years and older without a Parkinson's disease diagnosis. Participants were invited to complete a University of Pennsylvania Smell Identification Test (UPSIT) independently through an online portal. Hyposmic participants were invited to complete DAT-SPECT, which determined eligibility for enrollment in …

Biomechanical And Emg Analysis Of Plank Posture Following 6 Weeks Office Chair Intervention Among Office Workers, Darshana Shrestha

Research Papers

No abstract provided.

Case Study - Strong Survivors Participant, Megan R. Rhodes

Research Papers

No abstract provided.

The Distinction Between Direct And Derivative Shareholder Claims, James An

Suffolk University Law School Faculty Works

One of the primary methods for shareholders to seek redress for corporate misconduct is the shareholder suit, in which shareholders may assert either “direct” or “derivative” claims. Under current legal doctrine, direct claims nominally seek to assert a right of the individual shareholder, while derivative claims seek to assert a right that formally belongs to the corporation and is asserted by the shareholder on the corporation’s behalf. Due to legitimate risks of shareholder and judicial overreach, courts have imposed numerous procedural hurdles upon derivative suits, making them much harder to bring than direct suits.

However, although the distinction between direct …

Guest Artist Recital: April 1, 2025, Ji-Youn Shin

School of Music Programs

Center for the Performing Arts

April 1, 2025

Tuesday Evening

8:00 p.m.

Detecting Software Anomalies In Microservices Using Spectrograms, Scalograms, And Convolutional Neural Networks, Snehith Jonnaikode

Master's Theses

The growing complexity of cloud-native microservices has intensified the need for robust anomaly detection mechanisms, particularly for misconfiguration-induced failures that often manifest subtly and propagate across service boundaries. This thesis proposes a comparative framework for runtime anomaly detection by transforming system metrics into frequency-domain representations—spectrograms using Short-Time Fourier Transform and scalograms using Continuous Wavelet Transform—and classifying them with Convolutional Neural Networks (CNNs). Evaluated on DeathStarBench, a production-grade microservices benchmark with injected anomalies in the Reservation and Recommendation services, the framework also includes baseline Long Short-Term Memory (LSTM) models trained on raw time-series features. Stratified 5-fold cross-validation shows that CNNs trained …

Peerproxy: A Webrtc Proxy For Http, Nathan Li-En Lee

Master's Theses

Advances in networking technologies have empowered individuals to easily self-host digital services such as websites and smart home systems. However, accessing these services externally often requires port forwarding, which requires manual router configuration, technical expertise in networking, and is sometimes restricted by internet service providers. Proxy-based services such as Ngrok and Cloudflare Tunnels simplify external access by using publicly hosted proxy servers, but introduce increased infrastructure costs and privacy concerns due to reliance on third-party servers that can inspect or store traffic.

This thesis presents PeerProxy, a novel framework that simplifies access to self-hosted web services without manual network configuration, …