Digital Commons Network^™

User Behavior Anomaly Detection Approaches To Mitigate Insider Threats, Omar Neil Gonzales

Electronic Theses and Dissertations

Insider threats represent a critical challenge in cybersecurity due to their ability to disguise malicious activity within legitimate user behavior. This dissertation proposes novel approaches to enhance insider threat mitigation through user behavior anomaly detection. First, a systematic survey is conducted to evaluate existing countermeasures, categorizing technical and human-centric strategies while identifying their limitations. building upon these findings, the dissertation introduces two complementary detection frameworks: the contiguous, contextual, and classifying pipeline (C3P), which uses symbolic pattern mining and contextual modeling to autonomously score and classify sequences, and the representation-reconstruction detection (R2D) framework, which leverages causal self-attention and variational autoencoding to …

Anthropogenic And Natural Influences On Beach Geomorphology And Coastal Resiliency, Leanne Hauptman

Electronic Theses and Dissertations

Beaches are complex, dynamic systems that provide important habitat, protection from storm impacts, support tourism, and provide numerous benefits to the economy. Coastal erosion is a natural phenomenon but is becoming a growing problem due to factors such as rising sea levels, intensity of major storms, lack of sand input from rivers, and anthropogenic activities. Florida's 825 miles of sandy beaches are experiencing accelerated erosion and adaptive management practices are needed to ensure sufficient sediment remains in the littoral system. Beach geomorphology and sedimentology research is critical to understand complex coastal processes to improve coastal management strategies for the resiliency …

Crowding Out Whistleblower Altruism: Examining The Impact Of Whistleblower Incentives And Recognition On Retaliatory Behaviors, Megan Nicole Hiner

Electronic Theses and Dissertations

Whistleblowers play an instrumental role in exposing organizational wrongdoing and, thereby, helping to remedy the damage endured by stakeholders. However, whistleblower retaliation is rising, its personal impacts to the whistleblower are severe, and fears of retaliation serve as a strong deterrent to prospective whistleblowers. In this dissertation, I draw on motivation crowding theory, which posits that external interventions can crowd out or crowd in intrinsic motivations for engaging in a behavior. I employ a third-party perspective of motivation crowding theory and utilize a 2x3x2 between-participants experimental design to examine factors that impact employees’ perceptions of whistleblower intent and acts of …

Does Federal Funding Address Fundamentals? Examining The Equity Effects Of Title I On Student Achievement, Veda Hudge

Electronic Theses and Dissertations

This dissertation examines the equity effects of Title I funding on student achievement in Broward County Public Schools, one of the largest school districts in the United States. Title I, established under the Elementary and Secondary Education Act (ESEA) of 1965, aims to address educational disparities by providing financial resources to schools that serve economically disadvantaged students. Despite over five decades of federal intervention, significant achievement gaps persist, particularly among marginalized populations. This study investigates the effectiveness of Title I funding in improving student outcomes in English Language Arts (ELA) and Mathematics during the period 2016–2020.

Using a quantitative research …

Exploring Mindfulness, Mindful Self-Care, And Perceived Burnout Among Professional Counselors: A Latent Profile Analysis, Sheria Kwok

Electronic Theses and Dissertations

Promoting counselor well-being and burnout prevention through research efforts is necessary. This study explored the findings (emerging unobserved profiles) from a latent profile analysis (LPA) examining mindfulness, mindful self-care behaviors, and perceived burnout among licensed professional counselors and supervisors in Ohio (N = 328). The study evaluated the differences in individual demographic variables across the identified latent profile memberships derived from the LPA. As a result, we found two latent profile memberships: Low Mindfulness/Mindful Self-Care and High Burnout Group (n = 146; 44.5%), and High Mindfulness/Mindful Self-Care and Low Burnout Group (n = 182; 55.5%). Based …

Modeling And Numerical Simulation Of A Lifting Surface Controlled Ocean Current Turbine, Kiran Mital

Electronic Theses and Dissertations

As a relatively novel source of energy extraction, many design concepts for ocean current turbines (OCTs) still lack the analyses required to mature their technological readiness. This study addresses this issue as it provides a numerical simulation tool for lifting surface controlled OCTs. The performance of a 1.4 MW moored, dual-rotor, lifting surface-controlled OCT operating in a total water depth of 375 m is then numerically evaluated using this tool. Algorithms are based on published OCT research with modifications developed for the present design. Performance is evaluated at varied flow velocities, turbulence intensities, and control surface positions to represent normal …

Is Infant Fear Related To An Increase In Maternal Stress?, Janairis F. Munoz-Perez

Electronic Theses and Dissertations

The impact of infant fear responses on mother stress throughout the first year of life was investigated in this study. Between six and fourteen months, thirty mother-infant pairs were examined at three different time intervals. Maternal responses from the Infant Behavior Questionnaire-Revised (IBQ-R) and behavioral observations made during standardized lab tasks were used to evaluate infant fear. The Perceived Stress Scale (PSS) was used to measure maternal stress at all time points, and behavioral stress was coded during the first session. The findings showed no overall significant correlation between the mother's subjective stress and the behavioral fear of her infant. …

Exploiting Undulating Fin Kinematics For Multi-Directional Swimming Control, Omar S. Odeh

Electronic Theses and Dissertations

The Black Ghost Knifefish achieves remarkable swimming gait transition by leveraging the distinctive morphology and kinematics of a single, elongated undular fin. Alongside bi-directional swimming, complex maneuvers incorporating vertical movement and pitch control can also be attained. Inspired by the Knifefish, we explore a novel propulsive and directional control method for an undulating membrane affixed to a robotic vessel utilizing counter-propagating waveforms in tandem with a sigmoidal spatiotemporal pattern to control forward, backward, and turning of the vessel. The proposed actuation supplied the propulsion necessary for the robotic vessel to swim bi-directionally with heading control under varying flow speed conditions. …

Longitudinal Changes In Verbal And Nonverbal Memory Among Older Adults: The Relevance Of Demographic Variables, Lauryn Owen

Electronic Theses and Dissertations

The study investigated longitudinal changes in verbal and nonverbal memory among older adults, examining the influence of demographic variables (age, sex, and education), memory associations with cognitive screening performance over time, and short-term practice effects. Linear mixed-effects models and repeated measures ANCOVAs were used to evaluate memory change over time and determine which memory tests were more susceptible to practice effects. Memory was assessed using subscales from the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L), Craft Story 21 (CS), and the Benson Complex Figure Test (BCFT). Results showed that age and sex were significant predictors of verbal memory, with …

Materia Non Medica: Reading Disability And Medical Narratives In The Daughter Of Doctor Moreau, Jessica Elizabeth Young

Electronic Theses and Dissertations

This thesis presents a close reading of The Daughter of Doctor Moreau by Silvia Moreno-Garcia, engaging Indigenous studies and disability studies to illuminate how the novel interrogates embodiment, medical authority, and human difference. By situating the text within historical frameworks of medicine and corporeality in Mexico, and alongside speculative modes that seek to recuperate non-Western epistemologies, the analysis reveals how Moreno-Garcia reimagines the body as mutable, relational, and politically charged. The narrative’s hybrid characters and transgressive identities offer a generative lens through which to explore bodily variance, not as deviation, but as a site of possibility. Ultimately, this thesis argues …

Investigating The Role Of Rps3 In The Homologous Recombination Dna Repair Pathway, Jerome Robert Dorsey

Theses and Dissertations

Ribosomal proteins have been demonstrated to perform extra-ribosomal functions beyond protein synthesis, including roles in cell signaling, transcription regulation, apoptosis, and DNA repair. Ribosomal protein S3 (RPS3), in particular, has been implicated in DNA repair and apoptosis pathways, suggesting a critical role in maintaining genomic stability. However, the specific mechanisms involving RPS3 are still unknown, particularly in the context of double-stranded break (DSB) repair. DSBs are among the most severe types of DNA damage, often resulting in chromosomal instability or cell death if not properly repaired. Nonhomologous End Joining (NHEJ) and Homologous Recombination (HR) are the two primary DNA repair …

Factors Influencing Adherence To Surveillance Guidelines In Individuals With Tuberous Sclerosis Complex, Kashish Khanna

Theses and Dissertations

Tuberous Sclerosis Complex (TSC) is a genetic condition that is caused by pathogenic changes in either the TSC1 or TSC2 gene and is characterized by multiple benign tumors, otherwise known as hamartomas, in various organs such as the brain, skin, lungs, and kidneys. Because of the many different clinical manifestations of TSC, extensive surveillance guidelines are recommended for individuals with TSC. Past studies have shown that there has been a gap in knowledge of these surveillance guidelines. These studies also suggest projects that measure adherence to surveillance guidelines and address specific challenges hindering surveillance guideline adherence. This study aims to …

“Digital Shame Shift”: From Telling The Pain To Recording The Truth — Black Maternal Health And Digital Counter-Narrative Storytelling On Tiktok, Odera Covenant Ezenna

Theses and Dissertations

This dissertation explores how digital storytelling on TikTok is used to challenge medical racism, with a particular focus on Black maternal health. Guided by Critical Race Theory (CRT) and Critical Technocultural Discourse Analysis (CTDA), the study examines how TikTok users—ranging from Black mothers to healthcare professionals—create and circulate counter-narratives through two prominent campaigns: #BlackMaternalHealthWeek and #BlackMamasMatter. These digital stories serve as acts of resistance, disrupting dominant medical discourse and amplifying the lived experiences of Black birthing individuals. The research analyzes over 2900 TikTok videos posted between 2021 and 2024, identifying key themes, storytelling strategies, and rhetorical shifts over time. The …

A Scoping Review Of Population Diversity In The Common Genomic Aberrations Of Clear Cell Renal Cell Carcinoma, Sean S. Kumar, Ninad Khandekar, Komal Dani, Saina R. Bhatt, Vinay Duddalwar, Anishka D' Souza

Department of Medicine Faculty Publications

Introduction: Previous literature has shown that clear cell renal cell carcinoma (ccRCC) is becoming a more prevalent diagnosis and that the incidence and mortality differ both regionally and racially. While the molecular profiles for ccRCC are studied regionally through biopsy and sequencing techniques, the genomic landscape and ccRCC diversity data are not well studied. We conducted a review of the known genomic data on 6 of the most clinically relevant DNA biomarkers in ccRCC: von Hippel-Lindau (vHL), Polybromo-1 (PBRM1), Breast Cancer Gene 1-Associated Protein 1 (BAP1), Histone-Lysine N-Methyltransferase Domain-Containing 2 (SETD2), Mammalian Target of Rapamycin (mTOR), and Lysine-Specific Demethylase 5C …

Generating Real-World Evidence In Early Alzheimer's Disease: Considerations For Applying The Target Trial Emulation Framework To Study The Safety Of Anti-Amyloid Therapies, Xiaojuan Li, Sonal Singh, Bahareh Rasouli, Jennifer Lyons, Noelle M. Cocoros, Richard Platt, Ivan Abi-Elias, Jerry H. Gurwitz

Department of Medicine Faculty Publications

Anti-amyloid beta monoclonal antibodies (anti-Aβ mAbs) have received approval from the US Food and Drug Administration for the treatment of patients with mild cognitive impairment or mild dementia due to Alzheimer's disease (collectively known as early AD) based on evidence from clinical trials. However, whether findings from these trials are generalizable to the real world is uncertain. We need reliable evidence on the real-world safety of these treatments to inform decision making for clinicians, patients, and caregivers. Using lecanemab as an exemplar, we outline the key considerations in designing and implementing an observational study on safety and utilization outcomes using …

Real-World Interventional Outcomes For Cardiogenic Shock Complicating Acute Myocardial Infarction, John E. Brush Jr., Ann M. Harper, Luke C. Kohan, Zachary Bouker, Kaivalya Dandamudi, Deepak R. Talreja

Department of Medicine Faculty Publications

Acute myocardial infarction with cardiogenic shock (AMICS) carries high mortality and remains a major concern. This concern drives use of interventions with marginal benefit and some evidence of harm. The configuration of hospital care and allocation of interventions for AMICS in our health system created a natural experiment to analyze interventional outcomes for patients with AMICS.

Objective

To compare clinical outcomes among AMICS patients treated with mechanical circulatory support (MCS) using a micro-axial left ventricular assist device and intra-aortic balloon counter-pulsation (IABP).

Design, setting, participants, outcome measures

In this observational study in a large health system, we used clinical registry …

Phosphorus Removal Using Novel Carbon Adsorbents Derived From Waste Algae: An Industrial Ecology Approach To Mitigate Algal Blooms, Vithulan Suthakaran

Electronic Theses and Dissertations

High phosphate levels and warm temperatures in surface waters can stimulate the overgrowth of certain alga types, causing harmful algal blooms (HABs). HABs may adversely affect public health and have negative economic impacts due to associated healthcare costs, required clean-up activities, and tourism revenue loss. The overarching objective of this study was to utilize an industrial ecology approach and convert algal biomass into chemically modified activated carbon adsorbent materials for phosphate removal. Cyanobacterial biomass was collected from Lake Okeechobee in Florida and processed before activation using fast and energy-efficient microwave heating. To improve phosphate removal, the surface of the adsorbents …

Drug-Induced Leukocytoclastic Vasculitis From An Unreported Source: Daptomycin, Jennifer K. Priessnitz, Timothy Kuzel, Lindsay Ackerman, Nelson Nicolasora

Department of Medicine Faculty Publications

Leukocytoclastic vasculitis (LCV) is a rare small-vessel vasculitis caused by immune-complex-mediated deposition on endothelial cells of dermal capillaries. Common triggers include medications, infections, autoimmune disorders, and malignancies. We present a case of a 58-year-old male who developed daptomycin-induced LCV after being treated for Methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. The patient experienced painful palpable purpura on his lower extremities, which was diagnosed as LCV by skin biopsy. At the time of the biopsy, warfarin and daptomycin were discontinued, and the patient was transitioned to heparin and ceftaroline. MRSA-induced LCV was ruled out, due to negative blood cultures and adequate source control …

Treatment Of Myocardial Infiltration Of Hodgkins Lymphoma: A Catch-22, Jennifer Priessnitz, Erin Biringen, Fadi Khoury, Christina Bergin

Department of Medicine Faculty Publications

Background: Cardiac sequelae in Hodgkin Lymphoma (HL) can manifest as involvement of the heart and pericardium. Direct cardiac involvement is rare, and myocardial infiltration is distinctly unusual.¹ When it does occur, it is often a late manifestation of lymphoma, with a median onset of 20 months after initial diagnosis, and it is usually associated with advanced-stage disease.²

Case: A 34-year-old male was diagnosed with classic HL by lymph node biopsy. During his hospitalization, the patient remained in sinus tachycardia with heart rate up to 150 with no dysrhythmias. Transthoracic echocardiogram (TTE) revealed a reduced ejection fraction (EF) of 36% concerning …

Emergent Transcatheter Tricuspid Edge-To-Edge Repair For Right Ventricular Shock From Tricuspid Regurgitation In Hypertrophic Cardiomyopathy, Nicholas J. Valle, Amin Yehya, Animesh Rathore, Erich L. Kiehl, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Transcatheter tricuspid edge-to-edge repair (T-TEER) is an emerging technology used to treat severe tricuspid regurgitation (TR). The pivotal trials demonstrating the safety and efficacy of T-TEER exclude patients with severely reduced left ventricular function (≤20%).

Case Summary

We demonstrate the use of T-TEER in a patient with end-stage hypertrophic cardiomyopathy who suffered acute, torrential TR and subsequently developed cardiogenic shock as a complication of high-risk transvenous lead extraction. Why Beyond the Guidelines Currently, there are no guidelines addressing the nonsurgical emergent management of acute TR.

Discussion

The TriClip system (Abbott) may have certain advantages when used in managing acute …

The Timing For Primary Prevention For Icd In The Current Era Of Pharmacotherapy, Anastasia Shchendrygina, Amin Yehya, Hadi Skouri

Department of Medicine Faculty Publications

Recent advances in the pharmacological therapy of heart failure with reduced ejection fraction (HFrEF) have significantly impacted the overall survival, heart failure hospitalisations and rates of sudden cardiac death (SCD). In this context, the relevant timing of placing ICDs as primary prevention is a matter of on-going debate. This manuscript provides evidence for an updated view regarding the timing of implanting ICD in eligible patients with HFrEF receiving optimal guideline-directed medical therapy, accounting for the timing to reverse cardiac remodelling (RCR) occurrence and residual SCD risks over time. Clinically significant RCR occurs beyond 3 months of optimal guideline-directed medical therapy, …

Delayed Hypertension Diagnosis And Its Association With Cardiovascular Treatment And Outcomes, Yuan Lu, John E. Brush Jr, Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Jordan R. Asher, Harlan M. Krumholz

Department of Medicine Faculty Publications

Importance Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk.

Objectives To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes.

Design, Setting, and Participants This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, …

Balancing Regeneration And Resistance: Targeting Dclk1 To Mitigate Gastrointestinal Radiation Injury And Oncogenesis, Landon L. Moore, Jerry Jaboin, Milton L. Brown, Courtney W. Houchen

Department of Medicine Faculty Publications

Ionizing radiation (IR) poses a dual challenge in medicine; while essential for cancer therapy, it inflicts collateral damage to normal tissues, particularly the gastrointestinal (GI) tract. High-dose IR triggers acute radiation syndrome (ARS), characterized by crypt stem cell depletion, mucosal barrier disruption, inflammation, and potential progression to fibrosis and secondary malignancy. Emerging evidence identifies the epithelial kinase doublecortin-like kinase 1 (DCLK1)—highly expressed in GI tuft cells and cancer stem-like cells—as a master regulator of post-IR responses. DCLK1 integrates DNA repair (via p53/ATM), and survival signaling (via NF-κB, TGF-β, and MAPK) to promote epithelial regeneration, yet these same mechanisms contribute to …

Group Antenatal Care Positively Transforms The Care Experience: Results Of An Effectiveness Trial In Malawi, Crystal L. Patil, Kathleen F. Noor, Esnath Kapito, Li C. Liu, Xiaohan Mei, Elizabeth Chodzaza, Genesis Chorwe-Sungani, Ursula Kafuulafula, Elizabeth T. Abrams, Allissa Desloge, Ashley Gresh, Rohan D. Jeremiah, Dhruvi R. Patel, Anne Batchelder, Heidy Wang, Jocelyn Faydenko, Sharon S. Rising, Ellen Chirwa

Department of Medicine Faculty Publications

Background

We developed and tested a Centering-based group antenatal (ANC) model in Malawi, integrating health promotion for HIV prevention and mental health. We present effectiveness data and examine congruence with only the Group ANC theory of change model, which identifies key processes as supportive relationships, empowered partners in learning and care, and meaningful services, leading to better ANC experiences and outcomes.

Methods

We conducted a hybrid effectiveness-implementation trial at seven clinics in Blantyre District, Malawi, comparing outcomes for 1887 pregnant women randomly assigned to Group ANC or Individual ANC. Group effects on outcomes were summarized and evaluated using t-tests, Mann-Whitney, …

Left Ventricular Assist Device Destination Therapy: A Journey To Home And Beyond, Mian Z. Munir, Marissa C. Galicia-Castillo, Mia Achitoov, Amin Yehya

Department of Medicine Faculty Publications

[Case] Mr H is a 74-year-old man with history of end-stage heart failure (ESHF) secondary to hereditary transthyretin cardiac amyloidosis. Our patient underwent placement of a HeartMate II (Abbott) left ventricular assist device (LVAD) as destination therapy (DT) at an outside hospital and later came to us (Sentara Heart Hospital) for continued management because he resided in the area. Over a 2-year period, the patient experienced multiple hospital admissions for acute heart failure (HF) exacerbations, delirium, and recurrent low-flow alarms. During his last hospitalization, the palliative medicine team was consulted to facilitate goals-of-care discussions with the patient and his family, …

Navigating The Complexities In Gender-Diverse Counseling: Understanding The Interplay Of Gender Identity, Racial Inequities, Economic Marginalization, And Aging, C. Gerwe

Department of Medicine Faculty Publications

Gender-diverse individuals continue to face unique challenges in daily life, with intersecting identities related to race, socioeconomic status (SES), and age further compounding these barriers. These overlapping factors profoundly impact mental health and wellbeing, especially within environments that may lack inclusive or responsive frameworks. Despite increasing awareness, limited guidance exists for counselors on implementing practices that validate intersecting identities while addressing the cumulative effects of marginalization (Canvin et al., 2022). This article synthesizes current research and case examples to illuminate these challenges and offers insights for fostering more inclusive and supportive counseling approaches.

Changes In Cardiovascular Risk Factors And Health Care Expenditures Among Patients Prescribed Semaglutide, Yuan Lu, Yuntian Lu, Tedi Totojani, Chungsoo Kim, Rohan Khera, Hua Xu, John E. Brush Jr., Harlan M. Krumholtz, Jason Abaluck

Department of Medicine Faculty Publications

Importance Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated substantial weight reduction and cardiovascular benefits in clinical trials. However, its association with clinical outcomes and health care expenditures remains underexplored.

Objective To evaluate changes in cardiovascular risk factors and health care expenditures among patients prescribed semaglutide across multicenter cohorts.

Design, Setting, and Participants This retrospective cohort study included 23 522 adults (≥18 years) who received an initial semaglutide prescription between January 1, 2018, and January 1, 2025, at Sentara Healthcare and between January 1, 2018, and May 1, 2025, at Yale New Haven Health System.

Exposure The first prescription of …

Educational Case: Bullous Pemphigoid, Ryan C. Saal, Alice A. Roberts, Richard M. Conran

Department of Medicine Faculty Publications

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see https://www.academicpathologyjournal.org/pcme.1

Arthroscopic Inlay Biceps Tenodesis Using A Tendon-Docking Anchor, Mark G. Soliman, Katherine S. Worcester M.S., Thomas E. Herron, Kevin F. Bonner

Department of Medicine Faculty Publications

Pathology of the long head of the biceps tendon can be treated surgically with a multitude of tenodesis techniques; however, there is a lack of consensus on which technique provides the most optimal outcomes. Commonly used methods include inlay tenodesis with a bone tunnel and interference screw construct and onlay tenodesis with anchors or unicortical buttons. Although current methods typically provide satisfactory outcomes, many surgeons believe complications and failure rates remain suboptimal across techniques. In this article, we present an arthroscopic suprapectoral biceps tenodesis technique using an anchor device that was developed to address the shortcomings of current techniques, optimize …

Cultures For Acid-Fast Bacilli: Are We Being Good Stewards?, Jennifer Hanrahan, Julie D. Sill, Patricia Ver Schneider, Jessica F. Copeland, Elsie Frimpongmaa Amoako-Kissi, Ogochukwu O. Ilobi, Angela J. Toepp

Department of Medicine Faculty Publications

Objective: To describe the use of cultures for acid-fast bacilli (AFB) and situations in which AFB cultures are unlikely to be of clinical benefit.

Design: Retrospective descriptive study of AFB cultures submitted to Sentara Health microbiology laboratory from December 1, 2021, to December 1, 2023. Data were collected from the electronic medical record and included patient demographics, the service line that ordered the culture, specimen source, and culture results.

Setting: Sentara Healthcare System.

Patients: All patients who had specimens submitted to the microbiology laboratory during the study period were included.

Results: A total of 13,944 AFB cultures from 8,243 …