Digital Commons Network^™

Intracerebral Hemorrhage Hospitalizations And Outcomes: Comparisons Between Institutional And National Data, Zhuobin Huang

All ETDs from UAB

Intracerebral hemorrhage (ICH) is associated with a high risk of in-hospital mortality therefore we decided to define the effect of procedures and other risk factors on in-hospital mortality among different regions in the US. South and UAB Hospital. We used 2 datasets, the University of Alabama at Birmingham Hospital data and the National Inpatient Sample (NIS). We included 425 patients with a diagnosis of intracerebral hemorrhage over 18 years of age from the UAB Hospital stroke registry between 2016 to 2019; in NIS between 2016 to 2018, 68525 patients age 18 or above met inclusion criteria selected by International Classification …

Exploring The Influence Of Family History Before And After Type 2 Diabetes Development Through Statistical Analysis Of Biomarkers And An Educational Intervention, Jessica Johnson Denton

All ETDs from UAB

The prevalence of type 2 diabetes is increasing at an alarming rate in both children and adults worldwide. Timely identification of those at risk for type 2 diabetes is essential to reduce morbidity and mortality and to mitigate the toll on families and the healthcare system. Family history is an effective, universal tool that can be used to identify individuals at risk for type 2 diabetes before they acquire additional risk factors. Understanding how family history contributes to biomarkers associated with diabetes in healthy individuals could facilitate the creation of early screening and prevention strategies designed for this specific at-risk …

A Comparison Of Growth Factor Release Between Platelet Rich Fibrin And Recombinant Human Platelet Derived Growth Factor Bb (Rhpdgf-Bb) And Beta-Tricalcium Phosphate: An In Vitro Analysis, Maggie Ann Misch

All ETDs from UAB

Patients presenting with significant alveolar bone loss can pose challenges for the clinician. Traditional bone augmentation techniques may be inadequate in achieving necessary gains to restore missing teeth with dental implants. The adjunctive use of growth factors may accelerate the healing process and enhance tissue regeneration. GEM21S is a product that includes a recombinant growth factor approved by the Federal Drug Administration for oral surgery. It is delivered as a two-component system: 1) recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and 2) betatricalcium phosphate (β-TCP).[1] The research on GEM 21S for ridge augmentation is mostly limited to case studies.[2- 4] Biologically, …

A Pilot Mixed Methods Study Examining Factors Affecting Return To Work Among African American Stroke Survivors, Kristin D. Ashley

All ETDs from UAB

BACKGROUND: Stroke is a highly prevalent and disabling condition among African Americans. Although there is limited research regarding barriers and facilitators to return to work among stroke survivors, evidence suggests that African American stroke survivors return to work (RTW) less frequently than Caucasians. Most of the research on this topic has been conducted in European countries, leaving significant knowledge gaps on RTW among African Americans in the United States. The purpose of this study was to identify factors that affect RTW for African American stroke survivors and then build upon those results to better understand facilitators and barriers to RTW. …

Contributions Of Off-Season Training And Food Security Status On Body Composition And Performance In Collegiate Football Players, Kathryn Lee Stowers

All ETDs from UAB

Body composition measurements are collected periodically in the collegiate athletic setting to evaluate health and predict athletic performance of individual athletes. However, the effects of remote training and food insecurity on body composition have yet to be fully investigated in this population. The purpose of this research was to evaluate the influence of remote training and food security status on body composition and performance changes during off-season training. Aims 1 and 2 focus specifically on how factors affect body composition changes in collegiate football players during off-season training. Data were collected from routine body composition testing and food security screening …

Adverse Childhood Experiences: Connecting The Dots Between Early Life Stress And Asthma Aming Children And Adolescents With Sickle Cell Disease, Brandi Mcclain Pernell

All ETDs from UAB

Sickle cell disease (SCD) is an inherited red blood cell disorder plagued by increased morbidity and premature mortality. Asthma disproportionally affects individuals with SCD and is strongly associated with an increased incidence of pain, acute lung complications and death among this high-risk population. Psychological stress is a well-established contributor and trigger for asthma development and exacerbations. Adverse Childhood Experiences (ACEs) are defined as traumatic experiences occurring before 18 years of age. ACEs occur at the individual, familial (Original-ACEs) and community level (Expanded-ACEs) and can accumulate with time. Chronic exposure to ACEs leads to toxic stress, widespread inflammation and risk for …

Study Of Microrna-23a Cluster In Bone Formation, Revati Suryawanshi

All ETDs from UAB

The differentiation of mesenchymal stem cells to pre-osteoblasts, lies upon various transcription factors and physiological signaling, but is also governed by the micro-RNA-23a cluster. The miR-23a cluster has miR-23a, miR-27a and miR-24-2 transcribed from a single promoter as a sole RNA primary transcript. Its effects have been observed in embryonic stem cells, mesenchymal stem cells (MSCs), and in cancer (1-2). It regulates the lineage commitment of MSCs. (3). With respect to bone formation, miR-23a cluster is involved MSCs commitment to and osteoblast maturation (4). Here, through in vivo and in vitro experiments, we report that knock down of microRNA-23a cluster …

Guided Exploration Of Military Servicewomen's Healthcare Experiences And Related Outcomes (Gems Hero), Princess Victoria Jane Nash

All ETDs from UAB

Purpose: This study focuses on factors related to healthcare seeking behaviors and utilization of Veterans Affairs primary care services by female African American Veterans. The purpose of this mixed methods study is to assess what factors influence seeking care at VA healthcare facilities. Research Design: This study used a modified explanatory sequential mixed methods design to assess health services utilization and healthcare experiences of African American female Veterans. This research utilized items from the Health Belief model as a guiding framework to highlight factors that could impact VA healthcare utilization. Methodology: Health services utilization analysis used national data from the …

Exploring The Influence Of Psychosocial Stress And Inflammatory Properties Of The Diet On Cardiometabolic Risk And Gut Microbiome Health Among Young Adult Women Of Birmingham, Alabama, Rachel Olivia Knight

All ETDs from UAB

Concerning trends for obesity, diabetes, heart attacks, and obesity-related cancers, or cardiometabolic disease (CMD), are developing within the emerging and young adult/adulthood (EYA) population. Evidence supports the concept that chronic stress leads to physiologic dysregulation, reduced mental health, chronic diseases, and reduced longevity; however, these are not inevitable outcomes, and resilience or vulnerability is determined by interacting environmental and biobehavioral factors. Although CMD manifests clinically in older adulthood, disease pathophysiology begins earlier, and thus, EYA is a critical time for observation and intervention. Growing evidence indicates inflammation is a major risk factor in CMD development and may be exacerbated by …

Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards

All ETDs from UAB

Universal access to palliative care (PC) is a human right that much of the world has not accomplished and educating a PC workforce is critical to PC advancement. Higher PC disparities exist in low-and-middle income countries, such as Jamaica. The World Health Organization Public Health Model and the International PC Initiative’s PC roadmap emphasize the importance of PC education. The purpose of this mixed methods dissertation study was to investigate the PC experiences and educational needs of healthcare interprofessionals who provide care for patients with late-stage serious illnesses in Jamaica. Three specific aims incorporated quantitative investigation of physicians’, nurses’, and …

The Effect Of Integrative Medicine Interventions On Patient Activation Measure, Rochelle F. Richards

All ETDs from UAB

Activated patients believe they have essential roles in achieving and maintaining their health. Patient activation is strongly related to improved clinical outcomes (Hibbard, 2017; Greene, 2013). The study’s primary purpose is to evaluate the use of Integrative Medicine Interventions (IMIs) and their relationship to patient activation levels; and to investigate the association between IMI protocols and patient activation levels on patient reported outcomes (PROs) for those with chronic diseases, specifically chronic fatigue and mental health-related conditions of anxiety and depression, using the principles of Integrative Medicine’s (IM) whole-person approach as the model of care in independent IM practices across the …

The Use Of Vesgen For Analysis Of Retinal Vasculature In Pulmonary Arterial Hypertension, Mariana Desiree Dupont

All ETDs from UAB

Pulmonary artery hypertension is a chronic and progressive disease leading to right heart failure and, ultimately, death if untreated. The goal of the studies in this dissertation was to determine if fluorescein angiography (FA), and color fundus angiography (CF) imaging could be used to garner critical information about retinal changes in individuals with pulmonary artery hypertension (PAH). VESsel GENerational Analysis (VESGEN) is a noninvasive computer program that assigns branching generation to large and small vessels. VESGEN was utilized to investigate vascular alterations in FA, and CF imaging investigating disease progression in PAH. This dissertation demonstrated that PAH patients had aberrant …

Mevisit: Value-Based Approach To Primary Care Delivery By Mtelemedicine Utilization Applied Through Lean Principles, Neil Coyer Thornbury

All ETDs from UAB

Background: Significant issues of inconsistent patient services in the U.S. health system impact health outcomes and create high cost. Limitations of immobility, inefficiency, and accessibility sacrifice patient treatment, delay recovery, and escalate health risks from the lack of primary care physicians. The primary purpose of this study was to examine meVisit, a connective mobile technology, as a feasible primary care solution to address escalating health costs by reducing emergency room (ER) visits and inpatient admissions (IA). Methods: The feasibility study applied descriptive and inferential statistics to secondary data (n=4,024) and compared the two independent patient groups from the same large …

Relationship Between Neighborhood Deprivation And Epigenetic Age Acceleration With Pain In Adults With Musculoskeletal Pain, Pamela Jackson

All ETDs from UAB

Residents of high-deprivation neighborhoods shoulder a greater burden of age-related health conditions, including experiencing worse chronic musculoskeletal pain outcomes, compared to residents of more affluent neighborhoods. Advancing age is a risk factor for chronic health conditions, which epigenetic modifications may explain. Epigenetic age acceleration occurs when an individual’s epigenetic age is older than their chronological age, and that discordance has been identified as a strong predictor of age-related conditions. Epigenetic age acceleration has also been correlated with neighborhood deprivation. However, the mechanisms for neighborhood disparities in chronic musculoskeletal pain remain unclear. The purpose of this dissertation study was to examine …

The Effect Of Maxillary Sinus Anatomical Variations, Surgical Considerations, And Patient Factors On Volumetric Changes Following Lateral Wall Sinus Floor Elevation Technique For Up To 8 Years, Mengyi Shi

All ETDs from UAB

jectives: The aim of this retrospective study is to assess the long-term dimensional stability, or shrinkage, of the lateral window sinus grafts using cone beam computed tomography scans (CBCT) and radiographic software. Material and Methods: All patients from UAB Periodontal Graduate Clinic with available records of sinus augmentation via the lateral window approach with delayed implant placement between 2014 and 2019 were screened for having two follow up CBCT scans of diagnostic quality. The first scan must be completed within 6-9 months of lateral window sinus floor elevation (LWSFE) and prior to implant placement. The second CBCT must be taken …

Optimal Antero-Posterior Position Of The Maxillary Central Incisors And Its Relationship To The Forehead In Adult Hispanic Females, Balraj Bains

All ETDs from UAB

Objective: The objective of this study is to investigate the relationship of forehead inclination to anteroposterior position (AP) of the maxillary central incisors in adult Hispanic females. Materials and Methods: 70 participants were recruited for this study and smiling profile photographs were taken. All images were deidentified and placed in standardized dimension of 7.5” by 6.5”, which were then added to a PowerPoint to be evaluated by a judging panel. 24 Adult Hispanic Females (AHF) made up the control group and were seen to have an optimal incisor AP position. 46 AHF were in the study group and were judged …

Effects Of Covid-19 On Ventilator Associated Events (Vaes) Due To Multi-Drug Resistant Organisms (Mdros), Jeffery Asiedu

All ETDs from UAB

The aim of this study was to assess the association between the coronavirus disease (COVID-19) and the odds of ventilator associated events (VAEs). Retrospective analysis on prospectively collected data from 11,307 patients admitted to the intensive care unit (ICU) at the University of Alabama at Birmingham hospital between January 2018 and June 2022 was used. Outcomes considered were Any VAE, IVAC/PVAP, PVAP and MDRO PVAP. Crude and adjusted logistic regression models were used to evaluate the association between COVID-19 and the outcome variables. When a patient has Prior COVID-19, the odds of getting any VAE during the delta period is …

Evaluating The Association Among Demographic, Disease, And Symptom Profiles And Quality Of Life In Connective Tissue Disease-Related Interstitial Disease, Lanier O'Hare

All ETDs from UAB

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Connective tissue disease-related interstitial lung disease (CTD-ILD) results in an unrelenting symptom burden and may progress to death. The morbidity and mortality associated with CTD-ILD likely has a profound impact on individuals’ quality of life (QOL). Quality of life is a phenomenon that has yet to be sufficiently described in the literature on CTD-ILD. The factors associated with QOL in other chronic lung diseases have been described, but because of the different clinical and demographic characteristics of CTD-ILD, it is unknown if these same factors are associated with QOL in CTD-ILD. The purpose of this study was to examine …

Predicting Change In Quality Of Life In Patients With Advanced Cancer And Family Caregivers Using Gps Data, Kyungmi Lee

All ETDs from UAB

Patients with advanced cancer and their family caregivers often experience poor quality of life. Measuring patient and caregiver physical and mental quality of life is typically performed using participant reported outcome measures, especially validated questionnaires. However, this self-report approach has several limitations, including recall bias, respondent burden, and social desirability bias. One potential solution to these limitations may be to use passive data collected by personally owned smartphones (e.g., GPS data) to model and assess the quality of life in family caregivers and patients with advanced cancer. Yet, there is no evidence to date that passively collected smartphone data is …

Behavioral, Environmental, Social, Psychosocial, And Physiological Factors That Impact The Relationship Between Chronic Lung Disease Status And Susceptibility To Electronic Cigarette Use Or Actual Electronic Cigarette Use, Mohammed M. Alqahtani

All ETDs from UAB

There is surge increase in e-cigarettes among adult vulnerable population such as individuals with chronic lung disease (CLD). Currently, there is a lack of understanding of the factors that may lead to the increase use of e-cigarettes or susceptibility of ecigarette use among individuals who have a history of CLD. Thus, it is crucial to recognize the characteristics of the individuals with CLD and adults without CLD who are susceptible to using e-cigarettes because this may pave the way for the prevention and reduction of tobacco use by identifying the different factors and eventually targeting the related risk factors. In …

The Influence Of Sleep Duration And Sleep Efficiency On Abdominal Adiposity And Blood Pressure In Adolescents Ages 16 To 18 Who Participated In The Cleveland Children's Sleep And Health Study: A Secondary Data Analysis, Shameka Rodgers Phillips

All ETDs from UAB

Introduction: Abdominal adiposity and blood pressure (BP) are two major modifiable risk factors for cardiovascular disease (CVD), the leading cause of death in the world. The impact of abdominal adiposity and BP on health, particularly CVD, begins in childhood. Older adolescents tend to have the highest prevalence of abdominal adiposity and BP in the pediatric population. Despite interventions like diet and exercise, the prevalence of excess abdominal adiposity and elevated BP continues to increase during late adolescence. Evidence suggests that sleep duration and sleep efficiency impact abdominal adiposity and BP in adults and the pediatric population, but limited studies have …

Early Life Stress And Barrier Dysfunction Of The Blood-Brain Barrier, Margaret Ellen Lloyd

All ETDs from UAB

Early Life Stress (ELS) refers to any process or event of chronic and/or sever stress that occurs early in an individual’s development; this can be spurred by environmental or behavioral cues and helps predict inflammation later1 in life. ELS is associated with increased risk of cardiovascular disease (CVD) and other chronic conditions like depression. However, many of the physiological processes that lead to increased risk of chronic illness later in life have yet to be established or examined. The ELS mouse model is used to examine the unknown mechanistic links between childhood stress and risk for chronic disease in adulthood. …

A 15-Year Retrospective Analysis On After-Hours Dental Emergencies In A Children's Hospital Setting, Alexandra An-Yen Chen

All ETDs from UAB

Dental emergencies are one of the most common oral health complications and can exhibit a detrimental impact on a child’s physical and psychological development; additionally, it may impose economic challenges for the family. Purpose: The purpose of this study was to analyze the after-hours dental emergency visits in the past 15 years at the Children’s of Alabama (COA) Hospital Emergency Department. Methods: A retrospective chart review between January 2007 and December 2021 was conducted. Patients’ demographics, type of dental complaint, and management were evaluated for overall characteristics in the 15 years and trends in 5-year increments. The impact of the …

Unexpected And Usual Breaks' Impact On Body Composition In College Athletes, Aston Dommel

All ETDs from UAB

Body composition is an important factor that determines athletic performance. At the elite level, margins of victory are narrow, with small changes in performance making the difference between victory and defeat. Changes in body composition affect performance, in both improvements and decrements. Athletes regularly experience breaks from structured activity and resources caused by expected circumstances (school breaks, off-season) and unexpected circumstances (injury, COVID-19). Due to differences in diet, physical activity, and other factors, breaks may cause changes in body composition that can hinder or help the athlete upon return to structured resources. Currently, there is a plethora of cross-sectional research …

The Association Between Metabolically Healthy Obesity And Coronary Heart Disease Among Regards Study Participants, Kiara N. Aaron

All ETDs from UAB

A major obstacle to the advancement of our understanding of the metabolically healthy obesity (MHO) phenotype is the inconsistent definition of metabolic health and obesity among studies. A harmonized definition of MHO in adults has been proposed based on the diagnosis of obesity (BMI > 30 k/m2) and meeting the cardio-metabolic criteria for triglycerides, high-density lipoprotein (HDL) cholesterol, systolic blood pressure (SBP), diastolic blood pressure (DBP), no antihypertensive treatment, fasting blood glucose, and no drug treatment with glucose-lowering agents. In addition, waist circumference can be associated with increased disease risk when WC is >94 cm in men and >80 cm in …

The Effect Of Federally Qualified Health Centers (Fqhcs) Prevalence On Uncompensated Care In Us Hospitals, Kena R. Norris

All ETDs from UAB

Over the past two decades, uncompensated care in U.S. hospitals has grown at a staggering rate and reached $46.4 billion in 2013. It began to decline in 2014, due to the passage of the Patient Protection and Affordable Care Act (ACA), but is now on the rise again. Uncompensated care is typically affected by policy and market factors such as legislative changes and an increase in the number of uninsured. While hospitals continue to serve as critical safety net providers, they are often not the only or most appropriate facility to serve the indigent in U.S. communities. Instead, federally qualified …

An Examination Of The Relationship Between The Role Of The Chief Diversity Officer And Hospital Financial Performance And Patient Experience Measures, Kemberly L. Blackledge

All ETDs from UAB

Healthcare organizations drive to achieve hospital measures has much to do with strategies put in place by the executive leadership team and resources of the firm. Forces such as regulatory changes reducing hospital payments and external forces such as social injustices leave executives turning to innovative ways to improve the bottomline. This study examined the Chief Diversity Officer (CDO) and the relationship with hospitals measures of financial performance and patient experience for hospitals with a CDO and without a CDO. Hospitals with a CDO can deploy organizational strategies such as diversity management and cultural competencies. These strategies are important because …

Assessing The Impact Of The Covid-19 Pandemic On Metastatic Lung Cancer Time To Treatment Initiation, Health Care Resource Utilization, And Costs In The United States, Teresa M. Zyczynski

All ETDs from UAB

The COVID-19 pandemic has derailed normal operations in the health care delivery systems in the United States (US) and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess time to treatment initiation (TTI) with systemic cancer therapy in patients with newly diagnosed metastatic lung cancer, metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. The retrospective claims …

Effects Of Different Types Of Augmented Feedback On Spatiotemporal Gait Performance And Intrinsic Motivation With Individuals Post Stroke, Saleh M. Alhirsan

All ETDs from UAB

After a stroke, an individual can be left with physical and psychological deficits, including decreased walking speed, reduced step length, and reduced intrinsic motivation. These deficits affect their performance during rehabilitation sessions, limit daily activities such as walking and stepping, and restrict participation in social roles that involve mobility. Current clinical practice guidelines recommend providing augmented feedback using virtual reality (VR) to enhance walking outcomes after six months of stroke onset. This dissertation shows two novel VR applications designed, especially for individuals’ post-stroke, to induce their fast-walking speed and maximum step length performance, and intrinsic motivation. Three performance conditions were …

Life-Space Mobility In The Older Adult, Community-Dwelling Cancer Survivor In The Deep South: A Secondary Data Analysis, Richard A. Taylor

All ETDs from UAB

By 2040, the U.S. is projected to have 26.1 million cancer survivors; 73% of these will be over 65 years old. Much is known about life-space mobility (LSM) in patients with non-cancer serious illnesses. Restricted LSM affects every aspect of an older adult’s life; their independence, autonomy, and quality of life (QOL). To date, there are no studies examining LSM in older cancer survivors. Therefore, we examined LSM, factors that affect LSM, and the relationship between LSM and QOL in older cancer survivors using existing data from the University of Alabama at Birmingham (UAB) Study of Aging (SOA) (NIA AG15062). …