Medicine and Health Sciences Commons^™

Power And Sample Size Calculations For Linear Mixed Models Of Longitudinal Data Using The Kenward-Roger Adjusted Wald Test, Tarrant Oliver Mcpherson

All ETDs from UAB

The linear mixed model has become a popular technique for the analysis of longitudinal data, but Wald test statistics of fixed effects for these models frequently lack well defined distributions. A common approach to this problem uses the Kenward-Roger adjustment, which attempts to approximate the distribution of the Wald statistic by matching its moments obtained via Taylor expansion to those of an F distribution. However, this approach only matches moments obtained under the null hypothesis of no effect and cannot currently be used to approximate the distribution of the test statistic under some alternative hypothesis. This limitation prevents a straightforward …

History Of Allergy, Atopy, Infectious And Autoimmune Disease And Risk Of Multiple Myeloma, Tony B. Zbysinski Iii

All ETDs from UAB

Multiple Myeloma (MM) is a plasma cell malignancy, which is defined in part by antibodies and complexes of immunoglobulin (Ig) heavy and light chains (IgH and IgL). Previous associations of immune-stimulating conditions such as allergic, autoimmune, and infectious conditions and the risk of multiple myeloma (MM) are inconsistent. However, these studies were conducted in populations of European ancestry, leaving the possibility that these conditions may contribute to the excess risk of plasma cell proliferative disorders observed among Black Americans. Therefore, we assessed MGUS, a precursor condition to myeloma, and MM risk related to a history of allergy, atopy, infections and …

Regional Variations In The Incidence Of Brain Glioma In Adults In Alabama, Mina Lobbous

All ETDs from UAB

Purpose: Gliomas are the most common primary brain tumor in adults in the US with an annual age-adjusted incidence rate of 4.67 to 5.73 per 100,000 persons. Exposure to ioniz-ing radiation is the only established risk factor for non-hereditary glioma risk. There are several sources of carcinogenic contaminants in northeast Alabama and western Georgia with the Coosa River serving as the region’s primary water source. In this study, we aimed to examine the incidence rate of glioma in northeast Alabama compared to the rest of the state as well as the association of possible environmental exposure on disease risk and …

The Association Between Paraquat Exposure And Parkinson's Disease Mortality: A County-Level Ecological Study In The United States, Alexander Kozuch

All ETDs from UAB

Objectives: The current study reports the results of an ecological study regarding the association between PQ exposure and Parkinson’s disease mortality in the United States. Methods: The outcome of interest for this study was mortality due to Parkinson’s disease, obtained from CDC Wonder. The exposure of interest was PQ exposure at the county level which was obtained from the United States Geological Survey (USGS). Statistical analysis was done using the mortality data, grouped into ten-year age groups, and focused on data from 2015-2019 to account for the lag time between initial Paraquat exposure and Parkinson’s Disease mortality. A Negative Binomial …

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 …

Socioeconomic Status, Hbb, And Ttr Variants, And Cardiorenal Outcomes: The Regards Study, Onika E. Abrams

All ETDs from UAB

Blacks are disproportionately affected by heart failure (HF) and end-stage renal disease (ESRD). While poorer health outcomes in Blacks have been associated with social determinants of health, there are some biological differences worth noting, namely genetic risk variants for both TTR and HBB. These genetic risk variants are known to confer additional risk in the development of heart failure and end-stage renal disease, respectively. While we understand these genetic variants aren’t fully penetrant, and genetics and are not deterministic, we aimed to examine additional factors and mechanisms responsible for the increased risk in HF and ESRD in Blacks. Neighborhood socioeconomic …

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 …

Analysis Of Excess Mortality At The County Level In Alabama By Socioeconomic Factors, Abigail Jo Tucker

All ETDs from UAB

Objective: Analyze county level socioeconomic factors and their association with Covid-19 excess mortality in Alabama.Methods: Linear regression analyses were used to evaluate the association between potential risk factors assessed using the American Community survey (n = 40 counties and county clusters) and excess mortality in 2020 per 100,000 population. Excess mortality came from a previously published paper by Ackley et al. Results: Median household income (per 1,000 dollars); an average county median household income that 1,000 dollars higher was associated with 6 per 100,000 lower excess mortality (β= -5.953 p-value

Planning Patient Safety: Philosophical, Political, And Economic Changes Required For Preventable Death Abolition, Catherine Kiani

CMC Senior Theses

Preventable medical errors are an epidemic. Between 250,000 and 400,000 people die from preventable errors each year in the USA. This investigation questions mechanisms for quality care improvement to eliminate preventable fatalities. I evaluated current patient safety protocols, analyzed their shortcomings, and with additional research recommended actions for better results. Such actions to improve patient safety are explored from three different perspectives: philosophical, economical, and political aspects. In chapter one, improvements within hospitals are reviewed – namely cultural changes needed from both physicians and hospital leadership. Abolishing hierarchical systems which preclude healthy collaboration among medical teams, diverting focus to patient …

An Agent-Centered Approach To Covid-19 Vaccinations, Nila Venkat

CMC Senior Theses

The rise of COVID-19 has dramatically affected the global economy, healthcare systems, and individuals’ daily lives. One of the most controversial attempts to ameliorate the effects of the virus in the United States has been the distribution of COVID-19 vaccinations. In this thesis, I propose a novel agent-centered approach to motivating COVID-19 vaccinations. I begin by exploring the origins and evolution of the virus, along with the growing demographic of “vaccine-hesitant” Americans, to contextualize the debate surrounding vaccinations. I then propose two potential action-based response strategies for vaccine motivation: a vaccine mandate and nudges. Concerning a mandate response strategy, I …

The Syndemic Landscape: A New Paradigm For Montana Suicide Prevention Grounded In Agricultural Renewal, Emory Chandler Padgett

Graduate Student Theses, Dissertations, & Professional Papers

Montana has had one of the highest suicide rates in the nation for half a century, and since 2000, it has risen almost 50%. Despite suicide’s alarming persistence in the state, there has been minimal academic study of suicide or mental health specifically in Montana, so this thesis attempts to answer a few questions: Why does Montana have such a high suicide rate? Is there something culturally, historically, or socially unique about Montana that contributes to suicide? Are current prevention efforts helpful, harmful, or lacking? Could a consideration of culture and land benefit an understanding of suicide in Montana? What …

Spike-And-Slab Additive Models And Scalable Algorithms For High Dimensional Data Analysis, Boyi Guo

All ETDs from UAB

There are proposals that extend classical additive models (AMs) to accommodate high-dimensional data (p >> n) using group sparse regularization. However, the sparse regularization may induce excess shrinkage when estimating smooth functions, damaging predictive performance. Moreover, most of these AMs consider an “all-in-allout” approach for functional selection, rendering them difficult to answer if nonlinear effects are necessary. While some Bayesian models can address these shortcomings, model fitting can create a new challenge, scalability. In this dissertation, we propose Bayesian hierarchical additive models to address the previous shortcomings: we consider the smoothing penalty for proper shrinkage of curve interpolation via reparameterization. A …

Telehealth Delivery Of Acceptance And Commitment Therapy And Recreational Therapy: Supporting People With Chronic Pain During The Covid-19 Pandemic, Grace L. Roy

Honors Theses and Capstones

Chronic pain is a significant public health problem that requires person-centered and comprehensive care to address the many socioecological factors that contribute to pain. Within the context of the COVID-19 pandemic, telehealth options for chronic pain management can help more people access the care that they need. The purpose of the current pilot study was to investigate the efficacy and feasibility of delivering a 6-week Acceptance and Commitment Therapy (ACT) and recreational therapy intervention via telehealth for a group of seven participants with chronic pain. It was found that TeleACT-RT was associated with positive behavioral outcomes including increased psychological flexibility, …

Effectiveness Of Provider Education Concerning Prediabetes Treatment In Mississippi, Marlana Mcfarland

DNP Projects

Prediabetes is defined by the American Diabetes Association (ADA) as having an A1C of 5.7-6.4% or a fasting plasma glucose of 100-125 mg/dl. Prediabetes greatly increases the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular disease (ADA, 2019). The purpose of this Doctor of Nursing Practice (DNP) project was to determine if providing education to PCPs, practicing in MS, regarding the implementation of a prediabetes treatment algorithm improved their knowledge and implementation of the ADA guidelines. The intention was to bring increased awareness of ADA guidelines regarding the current treatment recommendations for patients with prediabetes to PCPs. A …

Examining The Spatial Relationship Between Maternal Morbidity, Access To Health Care, And Community Characteristics In West Virginia, Sarah E. Woolard

Graduate Theses, Dissertations, and Problem Reports

Maternal-related morbidity rates in the United States have risen almost three fold since the early 1990’s. Issues related to rurality, socioeconomic disparities, and pre-existing health conditions increase the risk of poor pregnancy outcomes and introduce barriers to accessing advanced maternal health care. West Virginia (WV) has higher maternal morbidity rates than many other states in the United States (US), and is considered to be driven by all 55 counties being classified as Appalachian, possessing the highest prenatal smoking rate in the US, and having disparities in access to health care. Despite this, no previous studies have evaluated maternal morbidity in …

Psychosocial Influences On And Behavioral Characteristics Of Young Adult Food Addiction, Rachel A. Wattick

Graduate Theses, Dissertations, and Problem Reports

Introduction. Research on food addiction has increased in recent years, but there are few studies focusing on college-attending young adults, who may be at risk of developing food addiction due to the stress of the college environment. Additionally, causes and characteristics of food addiction are under-explored.

Aim. This dissertation aims to 1) determine the impact of adverse childhood experiences (ACEs) and other early life influences on the development of food addiction in college-attending young adults and 2) determine the psychosocial and behavioral characteristics of young adults with food addiction.

Methods. A sequential explanatory mixed-methods design was used for aims 1 …

Examining The Pulmonary Response To Repeated Vishniacozyma Victoriae Exposure And Its Association With Allergic Airway Disease, Rachael Erin Rush

Graduate Theses, Dissertations, and Problem Reports

Allergic airway diseases such as asthma continue to increase in incidence in industrialized nations like the United States. These diseases are complex inflammatory processes involving numerous cells and mediators and are strongly influenced by fungal exposures. Recent developments in fungal detection methods have highlighted the contribution of Basidiomycota yeast species in indoor environments such as Vishniacozyma (syn. Cryptococcus) victoriae. However, despite the high levels of this yeast detected in indoor environments, very little is known about it or its role in respiratory morbidity. V. victoriae is phylogenetically similar to pathogenic Cryptococcus neoformans but lacks a capsule and is …

Review Of Age-Related Trends Of Infection Among People Hospitalized Hospitalized For Infection With Concurrent Substance Use, Julia Catherine Lucia Gregorio

Honors Theses and Capstones

Background: Opioids and related injections are the most common drug associated with infection (Capizzi et al., 2020). Overall, data overwhelmingly shows infection and overdose rates on the rise in recent years (Kaiser Family Foundation, 2019).

Methods: The aim of this study was to identify trends between age and concurrent infection rates related to substance use from 2012 to 2019. This quantitative study utilized data from the NH Hospital Discharge Summaries (Office of Health Statistics, 2021). Specifically, trends among three age groups (young adults (18-34), middle-aged (35-54), and older adults (55+)) who were admitted to an inpatient unit or the emergency …

Characteristics And Regions Of Hospital Locations And The Risk Of Postpartum Hemorrhage., Zahra Shahin

Electronic Theses and Dissertations

Background: Postpartum hemorrhage (PPH) is one of the contributing factors to maternal morbidity and mortality that in addition to maternal risk factors, may be related to other factors such as obstetric practice and clinical management of postpartum hemorrhage. Therefore, this study aimed to explore the association of postpartum hemorrhage with characteristics and regions of hospital locations across the United States, as the outcomes may create opportunities to improve policies and protocols regarding PPH management more effectively. Method: A retrospective study was performed using the 2018 National Inpatient Sample (NIS) database. Low-risk delivery hospitalizations involving the third stage of labor with …

Bridging The Gaps: Exploring Factors Associated With Goal Achievement Within An Accountable Care Organization Care Coordination Program, Jessica L. Polk

Electronic Theses and Dissertations

Background: Healthcare cost in the U.S. has been increasing at an unsustainable rate due to the growing population diagnosed with multiple chronic conditions and a fragmented healthcare system. The high-risk patient population includes persons who over utilize the healthcare system with frequent avoidable hospitalizations, emergency room visits, and exacerbations of their chronic conditions. This high-risk population makes up five percent of the U.S. but accounts for over fifty percent of all healthcare spending. Care coordination models have emerged to focus proactive health interventions for the highest-risk patient populations to reduce overutilization and empower patients to improve long-term health. Evidence has …

Effectiveness Of Telemedicine In Diabetes Management: A Retrospective Study In An Urban Medically Underserved Population Area (Umupa)., Lisa Ariellah Ward

Electronic Theses and Dissertations

The purpose of this research is to assess the efficacy of employing telemedicine (TM) technology compared to traditional face-to-face (F2F) visits as an alternative healthcare delivery service for managing diabetes in populations residing in urban medically underserved areas (UMUPA). Researchers investigating public health and healthcare systems fully grasp the enormous challenges encountered by vulnerable populations as a result of healthcare access barriers.¹ Prior to the COVID-19 pandemic, F2F visits were most often utilized for healthcare delivery service, which frequently posed barriers for vulnerable populations. When marginalized people, encounter healthcare access barriers, a cascade of events generally occur leading to …

Integrating Fema And Scouts For Local Community Hazard Preparedness, Megan Vocatura

Williams Honors College, Honors Research Projects

My goal is to support the development of a comprehensive, evidence-based, plan to connect four counties in eastern Massachusetts with local Scouting resources to enhance preparedness efforts. The counties of Essex, Middlesex, Norfolk, and Suffolk comprise the geographic footprint of the Sprit of Adventure Scout Council (SoA). SoA’s newly established partnership with the Federal Emergency Management Agency (FEMA) needs recommendations on where to stage preparedness and response efforts. My role will be to build a repository of evidence of current and anticipated hazards, vulnerabilities, and risks for the region and specific communities. This part of the project will consist of …

Will Covid-19 Be Eradicated?, Matthew Kieke

Williams Honors College, Honors Research Projects

In this paper I want to define the meaning of “eradication”, explain the history of various diseases that have been eradicated, and compare and contrast them to covid-19, to answer the question of “Will covid-19 be eradicated”?

Parental Status As A Modifying Factor In Covid-19 Vaccination Status: A Mixed Methods Approach, Mackenzie Carter

All Master's Theses

Introduction: Vaccines are the best protection against COVID-19 and have been proven to be safe and effective. Parental efforts to protect their children by complying with or refusing pediatric vaccinations have previously been studied. However, the author found little research on how parental status affects the vaccination decisions for the parents. Using an explanatory sequential mixed-methods approach and the Health Belief Model, this study examines how parental status influences parental COVID-19 vaccination status. Methods: A local health department conducted a quantitative survey on COVID-19 vaccination attitudes and beliefs from September to October 2021. The COVID-19 vaccination status of parents of …

Instrumental And Emotional Social Support Intention And Utilization Among Pregnant And Postpartum Women During The Covid-19 Pandemic, Gracie Minks

All Master's Theses

Postpartum depression impacts 1 in 7 women across the U.S. As a whole population, between 10-16% of women are impacted by maternal depression during pregnancy or the first year postpartum. Those who experience postpartum depression are at risk for repeated depressive episodes and a lower quality of life over time. The postnatal period may reflect the most vulnerable time for mental health concerns such as anxiety and depression. Fear, judgment, and perceived criticism are commonly named as barriers that delay the mobilization of support.

There is a prevailing perception that postpartum depression is a normal part of motherhood which may …

Education And Awareness Of Workplace Hazards: An Educational Intervention For First Responder Trainees, Emily Portune

All Master's Theses

First responder paramedics, emergency medical technicians (EMTs), and firefighters provide emergency services to communities everywhere, often in life-threatening circumstances. At the same time, these first responders face high-stress life and death situations and may also endure unique workplace hazards like racism, sexual harassment and discrimination, verbal and physical patient assault, and extreme sleep deprivation. These hazards make prehospital providers vulnerable to mental illness, a fact proven by preexisting research that found more than 85% of first responders reported negative mental health symptoms and outcomes directly related to their career. Not only are prehospital providers at high risk of mental illness; …

Health And Technology: Online Platform To Facilitate Access To Care And Prevention For Chronic Non-Communicable Conditions In Rwanda, Arnaud Michel Nibaruta Mdp

Regis University Student Publications (comprehensive collection)

Rwanda is confronted with a growing problem of non-communicable diseases (NCD). It is important that people in Rwanda have access to effective prevention and treatment. This paper explores a program that would use a digital platform to facilitate access to information, services, and products that would help NCD at risk populations in Rwanda to access appropriate prevention and care. The program was developed based on the author’s experience in Rwanda’s healthcare industry, the information from review of literature as well as key informant interviews (NCD patients, advocates, and caregivers) and a survey with health professionals. The research conducted highlighted that …

Sexual And Reproductive Health Literacy In Rwanda Kazo Sector Murusenyi Village, Sandrine Nikuze, Mdp

Regis University Student Publications (comprehensive collection)

Unplanned pregnancies and other reproductive health issues are global health problems. Nowadays, young people are highly exposed compared to last time. Internet and other sources of misleading sexual information are available to them. Parents who are supposed to be the health information providers are not responsible because they do not want, but because they have limited knowledge, and they also face different challenges which prevent them from fulfilling their responsibilities towards their children such as education level, income level, gender, and religion. All these issues to young people have increased the number of young people who get pregnancies before and …

Patient Perceptions Of Shared Decision-Making In The Acute Care Hospital And Their Association With Patient Experience And Readmission, Jill Haladay

Electronic Theses and Dissertations, 2020-

Avoidable hospital readmissions continue to be a concerning and costly healthcare issue. While the emphasis on reducing avoidable hospital readmissions persists, incentivization strategies are evolving. Initial strategies prioritized medical care delivery, but recent regulation highlights the value of effective transitional (discharge) care planning, and particularly, patient involvement in that process. This latter aspect of care has a clear indication for the application of shared decision-making. Shared decision-making (SDM) practice in the acute care setting largely represents a gap in the literature; yet understanding patient perceptions of SDM during hospitalization is an important and timely first step in exploring the effectiveness …

Examining Cognitive Empathy Elements Within Ai Chatbots For Healthcare Systems, Lamia Alam

Dissertations, Master's Theses and Master's Reports

Empathy is an essential part of communication in healthcare. It is a multidimensional concept and the two key dimensions: emotional and cognitive empathy allow clinicians to understand a patient’s situation, reasoning, and feelings clearly (Mercer and Reynolds, 2002). As artificial intelligence (AI) is increasingly being used in healthcare for many routine tasks, accurate diagnoses, and complex treatment plans, it is becoming more crucial to incorporate clinical empathy into patient-faced AI systems. Unless patients perceive that the AI is understanding their situation, the communication between patient and AI may not sustain efficiently. AI may not really exhibit any emotional empathy at …