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2019

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Provider-Sponsored Health Plans In The Post-Reform Era, Katherine Ann Meese Jan 2019

Provider-Sponsored Health Plans In The Post-Reform Era, Katherine Ann Meese

All ETDs from UAB

The rise and fall of managed care in the 1980s and 1990s saw many hospitals and health systems in the United States enter and subsequently exit the health insurance market in the form of provider-sponsored health plans (PSHP). The passage and implementation of the legislation such as the Patient Protection and Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA) has ushered in an era of value-based reimbursement methods and a heightened focus on population health management, which has stimulated health care organizations to contemplate health plan ownership as a logical strategy. This study examined market …

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Reported Clinical And Financial Performance Of Hospitals With Physician Ceos Compared To Those With Nonphysician Ceos, Leon Moores Jan 2019

Reported Clinical And Financial Performance Of Hospitals With Physician Ceos Compared To Those With Nonphysician Ceos, Leon Moores

All ETDs from UAB

Leaders impact organizational behavior and performance, and CEOs may have greater impact via numerous proposed mechanisms. Because of this, organizations expend considerable resources recruiting and selecting CEOs and may benefit from information suggesting a positive impact on organizational performance based upon measurable CEO characteristics. Little work has been done comparing the performance of hospitals with physician CEOs versus non-physician CEOs, in spite of the ease of identification of this characteristic and extant leadership theories suggesting a relationship between technical expertise and success in leading highly technical organizations. We compared multiple measures of reported clinical and financial performance and our linear …

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The Benefit Of Resilience: Examining The Roles Of Family Resilience And Parental Education In Child Anxiety, Bria Kathryn Morgan Jan 2019

The Benefit Of Resilience: Examining The Roles Of Family Resilience And Parental Education In Child Anxiety, Bria Kathryn Morgan

All ETDs from UAB

Extensive literature addresses the associations between parental education and children’s mental health outcomes; however, the role of parental education and family resilience in child anxiety is unclear. The purpose of this study is to obtain a greater understanding of the role of parental education in child anxiety. Additionally, the study aims to investigate the role and potential varying effects of family resilience. Building upon Bowen’s Family Systems Theory and Walsh’s Systems Theory of Family Resilience, I hypothesize that parental education will be negatively associated with child anxiety and that family resilience will be negatively associated with child anxiety. I also …

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Identification Of Bottleneck Locations From Analysis Of National Performance Management Research Data Set (Npmrds) Records, Xinyun Pan Jan 2019

Identification Of Bottleneck Locations From Analysis Of National Performance Management Research Data Set (Npmrds) Records, Xinyun Pan

All ETDs from UAB

The traveling public is enduring traffic congestion on a regular basis which is a serious problem for the society. Congestion has negative impacts on transportation users’ convenience and satisfaction, results in lost productivity, increases stress and health related issues, has negative environmental impacts, increases fuel consumption, negatively affects travel reliability and increases travel time and delays. Traffic bottlenecks are often associated with traffic congestion. They represent a localized disruption of traffic flow due to a specific physical condition (such as insufficient roadway capacity or poor geometric design) or due to a temporary situation that restricts traffic flow such as a …

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The Real-Time Extractiion Of Neural Spikes For Brain-Machine Interface Application Using Deep Learning Algorithm, Patel Sahaj Anilbhai Jan 2019

The Real-Time Extractiion Of Neural Spikes For Brain-Machine Interface Application Using Deep Learning Algorithm, Patel Sahaj Anilbhai

All ETDs from UAB

The detection of neural spikes in real-time and accurately has become the center of interest for the researchers in the field of brain-machine/computer interface (BMI/BCI). The primary challenge in the Brain-Machine interface is to translate raw neuronal response signals into the control of electrical actuators. Only accurate and rapid classification of neural response can help efficiently and conveniently to disable peoples, particularly those suffering from spinal cord injury, stocks, etc., Recording from neurons and analyzing them with many different methods are not new. However, the primary challenge here is the real-time recording and classifying the spikes with higher accuracy. In …

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Automating Personal Safety Among Different Age Groups, Jayun Patel Jan 2019

Automating Personal Safety Among Different Age Groups, Jayun Patel

All ETDs from UAB

Personal Safety has always been crucial to one’s life. Many different threats are faced by people in their day to day lives. These threats differ with different age groups that affect their health and well being. Different threats affect people, which include birth defects, falls, drowning, health problems, abuse, suicide, homicide, and sexual violence [39]. Many other threats occur every day but these threats are the common threats that are faced by most of the people at different ages. These threats can affect the victims in terms of the health of the person, and the physical and mental well being …

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Examining Teachers' Perceptions And Practices Of Family Engagement With Families Of Emergent Bilinguals In Pre-Kindergarten And Kindergarten Classrooms: A Mixed Methods And Multiple Case Study, Julie I. Paul Jan 2019

Examining Teachers' Perceptions And Practices Of Family Engagement With Families Of Emergent Bilinguals In Pre-Kindergarten And Kindergarten Classrooms: A Mixed Methods And Multiple Case Study, Julie I. Paul

All ETDs from UAB

This study addressed pre-K and kindergarten teachers’ perceptions and practices of family engagement with families of students who are Dual Language Learners/Emergent Bilinguals. The study employed an explanatory sequential mixed methods design (Quan --> QUAL) (Creswell & Plano-Clark, 2018). To address the purpose of the study, the overarching mixed methods question was: How do pre-K and kindergarten teachers engage families of all their students and families of students who are emergent bilinguals? Mixing of the strands occurred after the quantitative data was collected. Quantitative results helped develop the semi-structured interview protocol for the qualitative phase of the study. Qualitative results …

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Enhanced Proangiogenic Activity Of Endothelial Cells In Response To Polyglutamate Domain-Modified Qk Peptides Delivered On Bone Grafting Materials, Nicholas Weldon Pensa Jan 2019

Enhanced Proangiogenic Activity Of Endothelial Cells In Response To Polyglutamate Domain-Modified Qk Peptides Delivered On Bone Grafting Materials, Nicholas Weldon Pensa

All ETDs from UAB

Over 2 million bone grafting procedures are performed annually. To meet the high demand for these surgeries, commercial grafting materials sourced from allograft, xenograft, and synthetic calcium phosphate have become widely popular clinically. One limitation of these grafts, however, is their lack of growth factors that drive angiogenesis during bone tissue regeneration. Insufficient revascularization of the injured bone tissue leads to poor fracture healing. However, reincorporating angiogenic factors on grafting materials has proven challenging due to limited surface interactions between the protein and mineral graft surface. To address this challenge, we have synthesized a polyglutamate domain to the VEGF mimetic …

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Bayesian Hierarchical Negative Binomial And Zero-Inflated Negative Binomial Models For High-Dimensional Analyses With Applications To Human Microbiome Count Data, Amanda H. Pendegraft Jan 2019

Bayesian Hierarchical Negative Binomial And Zero-Inflated Negative Binomial Models For High-Dimensional Analyses With Applications To Human Microbiome Count Data, Amanda H. Pendegraft

All ETDs from UAB

The human microbiome was first described as an “ecological community of commensal, symbiotic, and pathogenic microorganisms that literally share our bodyspace”. These microorganisms, also known as microbes and bacteria, are known for participation in human health. For example, microbes extract energy from foods that are otherwise indigestible, synthesize vitamins and amino acids necessary for important bodily functions, and protect hosts against disease-carrying pathogens. Therefore, the pursuit of human microbiome research is important for understanding the influence of microorganisms throughout human systems. Human microbiome research is founded on advances in next-generation sequencing technology. Namely, the identification of microbes that constitute the …

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Organizational Characteristics And Environmental Factors Associated With Hospitals Identified As Consolidation Targets, Christi Pierce Jan 2019

Organizational Characteristics And Environmental Factors Associated With Hospitals Identified As Consolidation Targets, Christi Pierce

All ETDs from UAB

In today’s dynamic healthcare landscape, hospitals face uncertainty and pressure from changing reimbursement schemas, intense government regulation, technological advances, consumer demand and workforce scarcity. These increased pressures have led to an acceleration of consolidation activities as hospitals position themselves to cope with a dynamic and complex external environment by maximizing resources, creating economies of scale and expanding access to care. Despite increased hospital consolidation activity, little is known about what makes a hospital attractive as a consolidation target to an acquiring hospital, particularly post-ACA. The purpose of this study was to evaluate the organizational characteristics and environmental factors associated with …

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Three Essays In Hospital Financial Distress: Prediction, Antecedents And Organizational Response, Neeraj Avinash Puro Jan 2019

Three Essays In Hospital Financial Distress: Prediction, Antecedents And Organizational Response, Neeraj Avinash Puro

All ETDs from UAB

The following essays examine the financial distress in acute care hospitals in the United States. The first essay examines the accuracy of prediction models of financial distress, the second explores the factors associated with financial distress and the third essay examines organizational response to financial distress. The first essay compares the predictive ability of three financial distress prediction models: modified Altman Z score (1993), Ohlson O score (1980) and Zmijewski (1984) to more accurately predict financial distress in U.S acute care hospitals. Building on the first essay, the second essay uses the most accurate predictive model to examine acute care …

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The Reductive Stress Reducto-Mir: Emerging Insight Into Microrna-671, Justin Michael Quiles Jan 2019

The Reductive Stress Reducto-Mir: Emerging Insight Into Microrna-671, Justin Michael Quiles

All ETDs from UAB

Excessive accumulation of reactive oxygen and nitrogen species (ROS/RNS) promotes cardiac pathophysiology. Although extreme oxidative burden is cytotoxic, ROS/RNS are continually generated within multiple domains of cardiac myocytes, and these species play fundamental roles in signal transduction through reversible thiol oxidation. Nuclear factor, erythroid 2 Like 2 (Nfe2l2/NRF2) is activated by ROS/RNS and binds cis regulatory antioxidant response elements (AREs) to induce the expression of a host of thiol oxidoreductases which regulate signaling events at the post-translational, transcriptional and epigenetic levels. Although oxidative stress has been linked to cardiac disease, adaptive processes in the heart require reduction-oxidation (redox) reactions as …

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Determination Of The Role Of Smu_833 In The Fitness And Virulence Of Cariogenic Streptococcus Mutans, Katherine Lynn Rainey Jan 2019

Determination Of The Role Of Smu_833 In The Fitness And Virulence Of Cariogenic Streptococcus Mutans, Katherine Lynn Rainey

All ETDs from UAB

Dental caries, commonly known as tooth decay, is the most common infectious disease worldwide. The main etiological agent of dental caries is Streptococcus mutans which can readily form a biofilm on the surface of teeth and produce acids through the metabolism of dietary sugars, which is largely responsible for the demineralization and subsequent destruction of tooth enamel. In addition, S. mutans synthesizes extracellular glucosyltransferases (Gtfs) capable of breaking apart dietary sucrose and polymerizing the glucose subunits into the sticky glucan matrix of the biofilm, imperative for the formation of robust, three-dimensional biofilms. Currently used caries therapies are not species-specific and …

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Increasing Living Kidney Donation Through Advocacy And Patient Navigation, Rhiannon Deierhoi Reed Jan 2019

Increasing Living Kidney Donation Through Advocacy And Patient Navigation, Rhiannon Deierhoi Reed

All ETDs from UAB

As the prevalence of kidney disease continues to increase in the United States, the gap between the need for organs and available kidney donors is growing as well. Deceased donor organs alone are insufficient to meet this need, and transplant centers have turned their focus to living donation to address the shortage. However, the frequency of living kidney donation has been declining in the US since 2004. Changes in the health of the US population have been suggested as one possible explanation for the decline, but currently these assertions remain anecdotal. A second theory with more published evidence attributes the …

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The Role Of Suppressor Of Cytokine Signaling 3 In Neuroinflammatory Disease, Zhaoqi Yan Jan 2019

The Role Of Suppressor Of Cytokine Signaling 3 In Neuroinflammatory Disease, Zhaoqi Yan

All ETDs from UAB

The Janus Kinase/Signal Transducers and Activators of Transcription (JAK/STAT) pathway plays a critical role in cytokine-mediated responses in both innate and adaptive immunity, and dysregulation of the JAK/STAT pathway is linked to many inflammatory disorders. Multiple Sclerosis (MS) is an inflammatory demyelinating disease that affects the central nervous system, and both innate and adaptive immunity are involved in disease progression. STAT3 signaling is critically involved in MS pathology and is negatively regulated by Suppressor Of Cytokine Signaling 3 (SOCS3). Both increased STAT3 activation and reduced SOCS3 expression are observed in immune cells from patients with MS. Although the role of …

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The Effect Of Right Ventricular Insertion Cooling On Wavebreak Initiation Following Defibrillation Shocks, Han Yu Jan 2019

The Effect Of Right Ventricular Insertion Cooling On Wavebreak Initiation Following Defibrillation Shocks, Han Yu

All ETDs from UAB

Although strong defibrillation shocks can save patients from life-threating tachyarrhythmias, the function of the heart may be compromised. We found in an earlier study that the right ventricular insertion (RVI) is responsible for most of the initial propagation failure (wavebreak) that drives the transition from ventricular tachycardia (VT) to ventricular fibrillation (VF). To determine whether suppression of wavebreak at the RVI region can decrease VF re-occurrence after defibrillation, thereby decreasing the defibrillation shock strength threshold (DFT), a cooling method was developed to impede waves from propagating between the right ventricle (RV) and the left ventricle (LV) through the RVI. The …

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A Deep Learning Framework For Medical Image Segmentation, Zheng Zhang Jan 2019

A Deep Learning Framework For Medical Image Segmentation, Zheng Zhang

All ETDs from UAB

Deep Learning (DL) has rapidly become a methodology of choice for analyzing medical images and increasingly attracts researcher’s attention in the medical research community. The brain is one of the most important organs in the human body. Within the context of human brain disease, research and care, accurately detecting, evaluating and segmenting human brain abnormalities play an important role in brain disease diagnosis, prognosis, and treatment planning. A significant challenge in developing good brain abnormalities segmentation methods is the high variation of brain abnormalities such as differences in shape, size, location, appearance, and regularity. Deep Learning approach ad-dresses this challenge …

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Wireless Smart Bandage For Real-Time Monitoring And Healing Of Chronic Wounds, Ting Zhang Jan 2019

Wireless Smart Bandage For Real-Time Monitoring And Healing Of Chronic Wounds, Ting Zhang

All ETDs from UAB

Chronic wound recovery time is long and easy to recur, which brings a high burden on the patient's physical and psychological aspects. The increase in the cost of per capita medical services and the increase in the number of people in demand for medical services have led to an increasing requirement for real-time monitoring and healing in patient's health outside of the hospital. For this purpose, the smart bandage is being developed to monitor the real-time situation of the wound. With the development of wireless sensor networks, the increasing number of sensing units has placed a great burden on the …

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Self-Tracking Practices: The Roles Of Social Contexts And Chronic Conditions, Aowen Zhu Jan 2019

Self-Tracking Practices: The Roles Of Social Contexts And Chronic Conditions, Aowen Zhu

All ETDs from UAB

The rapid development of mobile health (mHealth) technologies is propelled by the culture of disease prevention and management. Smartphone applications and wearable devices provide valuable personal data for self enhancement. In addition to health promotion, people with chronic conditions are using apps and devices to monitor symptoms and behaviors. There is great potential for self-tracking practices to reduce health care cost and improve population health. However, the emphasis on personal responsibility of individuals’ health may hinder the long-term effectiveness of self-tracking practices. The purpose of the study is to examine the associations between social contexts and self-tracking practices, chronic health …

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Exposure Assessment Of Ultrafine Particles And Hazardous Chemicals In Electronic Cigarettes, Oluwabunmi Magret Dada Jan 2019

Exposure Assessment Of Ultrafine Particles And Hazardous Chemicals In Electronic Cigarettes, Oluwabunmi Magret Dada

All ETDs from UAB

The widespread use of electronic cigarettes (e-cig) among youths and adolescents is a growing public health problem due to exposures to harmful byproducts formed during heating. These byproducts include particulate matter, benzene, and toluene. However, the mechanisms and variables governing their formation including the chemical content of e-cig liquid (e-liquid) are not fully understood. This study aimed to assess exposures to particulate matter, benzene, and toluene in e-cig vapors (e-vapors) and their coupling to e-liquid chemical content. A novel nuclear magnetic resonance spectroscopy method was developed to characterize e-liquids (propylene glycol, glycerol, and nicotine) and the functional content of flavorings. …

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Kidney Resident Macrophages Utilize Developmental Programming During Healing From Acute Kidney Injury, Jeremie Matthew Peabody Lever Jan 2019

Kidney Resident Macrophages Utilize Developmental Programming During Healing From Acute Kidney Injury, Jeremie Matthew Peabody Lever

All ETDs from UAB

Acute kidney injury (AKI) can be a devastating condition, affecting up to sixty percent of critically ill patients in the United States. Despite the fact that AKI is associated with an increased risk of chronic kidney disease (CKD) and mortality, there are no targeted therapies available to treat it. Kidney resident macrophages (KRM) are likely necessary for healing and resolution of animal models of AKI. However, there remains a gap in knowledge regarding how KRM effect this function. The purpose of my thesis was to elucidate lineage relationships and functionally relevant adaptations of KRM and monocyte-derived mononuclear phagocytes (infiltrative MP) …

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High-Pressure Studies On Borosilicate And Bulk Metallic Glasses, Kathryn Jinae Ham Jan 2019

High-Pressure Studies On Borosilicate And Bulk Metallic Glasses, Kathryn Jinae Ham

All ETDs from UAB

Multi-angle energy-dispersive X-ray diffraction (EDXD) and white-beam radiography studies were conducted on a borosilicate glass sample (17.6% B2O3) to 13.7 GPa in a Paris-Edinburgh (PE) press at Beamline 16-BM-B, HPCAT, The Advanced Photon Source, Argonne National Laboratory. The measured structure factor S(q) to q = 19 Å-1 was used to determine internuclear bond distances between various species of atoms contained in the glass sample. Bond distances for Si-O, O-O, and Si-Si were determined from the reduced pair distribution function G(r) and were measured as a function of pressure. The sample height, as determined via white-beam radiography, showed an overall …

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Recycling Of Secondary Composite Materials, Kristin Nicole Hardin Jan 2019

Recycling Of Secondary Composite Materials, Kristin Nicole Hardin

All ETDs from UAB

Over the past two decades, composites have shown their ability to help shape and define sustainability through many of their inherent characteristics, such as having high strength-to-weight ratio with long life cycles. However, composites in general are not widely recycled. Current production scrap, reject parts and end of life components are disposed of in landfills, which is costly and damaging to the environment. Driven largely by public perception and technology, the composites industry is starting to put efforts into research and design of composite recycling. Two of the biggest hurdles to widespread composite recycling is the lack of knowledge for …

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Characterizing The Hiv-1 Envelope N-Glycan Shield, Audra Ann Hargett Jan 2019

Characterizing The Hiv-1 Envelope N-Glycan Shield, Audra Ann Hargett

All ETDs from UAB

In 2017, there was an estimated 1.8 million new HIV-1 infections worldwide. Development of an effective HIV-1 vaccine would begin to quell this global pandemic. HIV-1 envelope (Env) glycoprotein is the main vaccine candidate target due to the immune systems ability to generate broadly neutralizing antibodies (bnAbs) against Env. Approximately 90 N-glycans form a glycan shield that is the primary interface between the virus and host immune system. Key glycan motifs within the glycan shield are targets for bnAbs and are necessary for HIV-1 infectivity. Herein, we explore how naturally occurring mutations alter the glycan shield and HIV-1 Env function. …

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Applying Markov Processes To Model Disability In Relapsing Multiple Sclerosis Patients, Anastasia Hartzes Jan 2019

Applying Markov Processes To Model Disability In Relapsing Multiple Sclerosis Patients, Anastasia Hartzes

All ETDs from UAB

Modeling disability in multiple sclerosis (MS) is challenging due to its complexity and non-linearity, with utilized methodology having many limitations. Lack of a suitable biomarker has led to relying on statistical models to understand disease progression. Markov methodology has been limitedly applied to the clinically-assessed Expanded Disability Status Score (EDSS), but not to patient-reported Patient Determined Disease Steps (PDDS); both measure disease progression and disability, and neither have been analyzed using the Test of Lumpability (TOL). It is common practice to aggregate these scores for computational or inferential convenience; in the case of Markov Chains (MC), combining states is referred …

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Connection Strengthening Scheme For Coastal Bridges Under Hurricane Induced Surge And Wave Load Using C-Iepm, Li He Jan 2019

Connection Strengthening Scheme For Coastal Bridges Under Hurricane Induced Surge And Wave Load Using C-Iepm, Li He

All ETDs from UAB

Considerable damage to the highway bridge system in the Gulf Coast area was observed during the Hurricane Katrina disaster, of which the primary failure mode, caused primarily by the storm-induced loading, is believed to be the superstructure-substructure connection failure which caused further unseating and drifting of the decks. A new Carbon-fiber Interfacial Epoxy-Polyurea Matrix (C-IEPM) composite is investigated as a potential retrofit option for vulnerable girder-to-cap connection-details in coastal highway bridges. Six scaled concrete girders were tested using a modified simulated storm surge and slamming wave force function, derived using regional maps for a 100-year return-period Hurricane Katrina. Two girders, …

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Investigating The Rho-Kinase (Rock) Signaling Pathway As A Therapeutic Target In Alzheimer’S Disease, Benjamin Wade Henderson Jan 2019

Investigating The Rho-Kinase (Rock) Signaling Pathway As A Therapeutic Target In Alzheimer’S Disease, Benjamin Wade Henderson

All ETDs from UAB

Current estimates project that there are approximately 5.4 million Americans affected by Alzheimer’s disease (AD). While this number is expected to dramatically increase in the years to come, there is currently no disease modifying therapeutic to prevent or slow AD progression. Cognitive decline is a clinical hallmark of AD, while accumulation of amyloid-β (Aβ) is a pathological hallmark. Work in the field has demonstrated that mitigating Aβ levels may serve as a rational therapeutic avenue to slow progression of the disease. Pharmacologic inhibition of the Rho-associated protein kinases (ROCK1 and ROCK2) is proposed to curb Aβ levels, and mechanisms that …

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Bdnf/Trkb.T1 Signaling: A Novel Mechanism Of Astrocyte Morphological Maturation, Leanne Holt Jan 2019

Bdnf/Trkb.T1 Signaling: A Novel Mechanism Of Astrocyte Morphological Maturation, Leanne Holt

All ETDs from UAB

Astrocytic morphogenesis and maturation are critical steps in central nervous system (CNS) development. During morphological maturation, astrocytes extend fine peripheral processes which infiltrate the neuropil and form intimate partners with neuronal structures, including synapses, where they facilitate neurotransmitter and K+ uptake and contribute to synaptic development and stabilization. The developmental time window of astrocyte morphological maturation and refinement is well defined, but the molecular mechanisms that underlie this process are not understood. Brain derived neurotrophic factor (BDNF) is a critical growth factor involved in the development and maturation of neurons. We developed a novel technique for the specific isolation of …

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Social And Emotional Development In Early Childhood: Examining The Relationship Between Teacher Beliefs, Assessment, And Teaching Practices, William Hooper Jan 2019

Social And Emotional Development In Early Childhood: Examining The Relationship Between Teacher Beliefs, Assessment, And Teaching Practices, William Hooper

All ETDs from UAB

The purpose of this sequential explanatory mixed methods study was to examine the relationship between teachers’ perceptions of the effectiveness of both the Devereux Early Childhood Assessment (DECA-P) and the Conscious Discipline program and their connections with teaching practices that support children’s social and emotional development. Quantitative data collected during phase one of the study examined the relationship between teachers’ perceptions of the effectiveness of the DECA-P and the Conscious Discipline program used for undertaking social and emotional assessments and supports for teaching practices. Quantitative data was collected through the distribution and completion (n = 72) of an adapted Treatment …

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Modeling And Optimization Of Advanced Hybrid Ground Source Heat Pump Systems, Gaoyang Hou Jan 2019

Modeling And Optimization Of Advanced Hybrid Ground Source Heat Pump Systems, Gaoyang Hou

All ETDs from UAB

Heating, Ventilation and Air Conditioning (HVAC) systems contribute significantly to building energy efficiency. Most conventional HVAC systems, such as electrical resistance heater or air to air heat pumps, require high energy consumption while generating a large amount of carbon emission. Therefore, the HVAC system of a building has become the core part of the building design process to improve energy efficiency. Ground source heat pumps (GSHP) offering a relatively high coefficient of performance (COP) and low carbon emission have become a widely-accepted choice. By adding assistive components or alternative heat exchangers, the overall performance can be boosted to a new …

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