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Articles 91 - 120 of 290
Full-Text Articles in Medical Humanities
Fixed And Variable Costs At Critical Access Hospitals, Jeremy J. Lyman
Fixed And Variable Costs At Critical Access Hospitals, Jeremy J. Lyman
All ETDs from UAB
Cost structures (the ratio of fixed to variable costs) vary across and within indus-tries. Hospital managers and policymakers can make better decisions when they under-stand cost structures, including marginal costs (the change in the total cost that arises when the quantity produced is increased by one unit). Although some studies have inves-tigated hospital cost structures, the results have been mixed and less than definitive, and very little attention has been given to critical access hospitals and marginal costs specifi-cally. Rural hospitals, including critical access hospitals, have increasingly experienced financial distress. Between 2005 and 2019, 159 rural hospitals closed across the …
Impact Of Ncqa Pcmh-Level On Low Income Diabetics In Louisiana, Michael G. Griffin
Impact Of Ncqa Pcmh-Level On Low Income Diabetics In Louisiana, Michael G. Griffin
All ETDs from UAB
While past studies have examined the relationship between safety-net provider sites that are certified as Patient Centered Medical Homes (PCMH) and quality health care outcomes, no previous studies have evaluated the relationship between NCQA PCMH certification levels at primary care sites and quality health care outcomes. NCQA is the largest national certification program for PCMH, and for 10 years was the only national program that offered a tiered level of certification based on provider level of patient engagement and deployed resources. The Donabedian Model, which focuses on structure, process, and outcomes, was used to develop the theoretical framework to address …
Impact Of Registered Nurse Staffing Ratio On Nursing Home Operating Margins And Quality Measure Star Ratings, Douglas R. Whitman
Impact Of Registered Nurse Staffing Ratio On Nursing Home Operating Margins And Quality Measure Star Ratings, Douglas R. Whitman
All ETDs from UAB
Today’s nursing homes are under immense pressure from government regulators to improve quality while the government simultaneously tightens reimbursement rates. These two forces squeeze operating margins. The question facing nursing home operators is how to improve quality without breaking the bank. This study looks at the association of more registered nurses (RN) with quality and margins in U.S. nursing homes. This research project fills literature gaps which previously found improved nursing home quality correlates with more RNs. However, prior studies used self-reported data and typically considered only two or three quality measures. This study uses recently released electronic payroll data …
Examining The Impact Of Baldrige On Hospital Performance, Jennifer O. Strahan
Examining The Impact Of Baldrige On Hospital Performance, Jennifer O. Strahan
All ETDs from UAB
The national Baldrige program has supported performance excellence within healthcare for over twenty years, yet it has seen recent declines in the number of applications despite Baldrige award recipients claiming noteworthy improvements across operational, clinical, and financial outcomes. Previous studies have compared Baldrige hospital recipients to non-recipients, but no studies have empirically investigated the value of pursuing the Baldrige award, regardless of award recognition or not. Furthermore, it is unclear if specific categories of the Baldrige Excellence Framework (BEF) are associated with standardized industry performance outcomes. This study used propensity score matching with linear and quantile regression techniques to understand …
The Relationship Between Asthma And Electronic Cigarette Use Among Youth And Young Adults: Mediation And Moderation Approaches, Abdullah M M Alanazi
The Relationship Between Asthma And Electronic Cigarette Use Among Youth And Young Adults: Mediation And Moderation Approaches, Abdullah M M Alanazi
All ETDs from UAB
Asthma is associated with a higher likelihood of electronic cigarette (e-cigarette) use, which may increase the risk of pulmonary complications. Therefore, we sought to identify factors that influence e-cigarette use that may inform future behavior interventions targeting e-cigarette use prevention. In this dissertation, we used mediation and moderation to model the relationship of health beliefs, psychosocial and behavioral factors that may affect the relationship between e-cigarette use and asthma. We used national samples from public datasets, and a clinical sample recruited from healthcare facilities in Alabama. The results of this study are reported in three different papers. In the first …
Restless Legs Syndrome And Multiple Sclerosis: The Possible Role Of Physical Activity For Managing Symptoms, Katie Cederberg
Restless Legs Syndrome And Multiple Sclerosis: The Possible Role Of Physical Activity For Managing Symptoms, Katie Cederberg
All ETDs from UAB
Restless legs syndrome (RLS) is an idiopathic neurological disorder characterized by unpleasant sensations in the legs that affects 26% of persons with multiple sclerosis (MS). The current pharmacological treatments for RLS are associated with a number of side effects, including the worsening of symptoms (i.e., augmentation). Physical activity represents a promising, behavioral approach for managing symptoms of RLS in MS. To date, physical activity has demonstrated tremendous benefits for managing many consequences of MS, but there is no evidence on its efficacy for managing RLS in MS. This dissertation described the current literature regarding physical activity and RLS in adults …
Obesity-Induced Immune Dysfunction: Implications For Anti- Tumor Immunity And Immunotherapeutic Efficacy, Justin Tyler Gibson
Obesity-Induced Immune Dysfunction: Implications For Anti- Tumor Immunity And Immunotherapeutic Efficacy, Justin Tyler Gibson
All ETDs from UAB
In the US, nearly 40% of adults have obesity. Further, obesity is known toincrease the risk for development, recurrence, and mortality associated with multiple types of cancer. However, despite such high prevalence, the impact of excess body weight on anti-tumor immunity and response to immunotherapeutics remains poorly and incompletely understood. In order to address these deficiencies, we have utilized multiple approaches to study obesity-associated perturbations in the immunogenetic, soluble protein, and cellular profiles of mice bearing mammary tumors and treatment naive human subjects with clear cell renal cell carcinoma (ccRCC). In a pre-clinical murine model of breast cancer, we find …
The Relationship Between Accreditation And Performance Among Federally Qualified Health Centers, Henry Thompson
The Relationship Between Accreditation And Performance Among Federally Qualified Health Centers, Henry Thompson
All ETDs from UAB
While past studies have examined the relationship between accreditation and hospital performance, no previous studies have evaluated the relationship between Joint Commission accreditation and Federal Qualified Health Center (FQHC) performance. Multiple regression analyses were used to evaluate the relationship between Joint Commission accreditation and variables of interest. Joint Commission accreditation was utilized as the dependent variable in the evaluation of organizational and environmental market factors, and utilized as the independent variable in the evaluation of clinical and non-clinical performance outcomes. This study applies a novel approach to determine the relationship between Joint Commission accreditation and adoption among FQHCs, and organizational …
Mechanisms Of Virtual Reality To Improve Walking And Reaching Behavior In Individuals With Chronic Low Back Pain, Rebecca Hennessy
Mechanisms Of Virtual Reality To Improve Walking And Reaching Behavior In Individuals With Chronic Low Back Pain, Rebecca Hennessy
All ETDs from UAB
Chronic low back pain (cLBP), low back pain persisting longer than three to six months, is a prevalent condition that can greatly interfere with movement quality. Specifically, cLBP can result in slower walking speeds and negatively affect reaching movements. Virtual reality (VR) encompasses a variety of technologies which may potentially improve therapeutic interventions for individuals with cLBP by presenting users with fun, distracting, and engaging challenges that align with their rehabilitative goals. While VR systems have become more accessible to everyday users, there is limited research which specifically examines VR mechanisms to improve walking and reaching quality. This dissertation presents …
The Effect Of Gi Patients' Health Literacy Levels On Gi Patients' Health Outcomes, Dae Hyun Kim
The Effect Of Gi Patients' Health Literacy Levels On Gi Patients' Health Outcomes, Dae Hyun Kim
All ETDs from UAB
The paper in this dissertation provide empirical evidence on the effect of GI patients’ health literacy levels on GI patients’ health outcomes. The findings of this study contribute to existing body of literature on health literacy and health outcomes. Furthermore, the findings also offer both theoretical and practical implications to physicians, healthcare administrators, and policymakers. Overall, the results of this study show that GI patients’ health literacy levels are negatively associated with GI patients’ health outcomes (hospital length of stay, readmission, and complication). However, partial support was shown for different types of GI surgeries accentuating the negative association between GI …
Competitive Strategies Of Hospitals: Antecedents And Association With Financial Performance, Akbar Ghiasi
Competitive Strategies Of Hospitals: Antecedents And Association With Financial Performance, Akbar Ghiasi
All ETDs from UAB
In this three-paper dissertation, first, we examined the relationship between strategic group membership and hospital financial performance in terms of operating margin. The results revealed the important role of strategy on financial performance of a hospital. In the second paper, organizational and environmental antecedents of hospital’s business strategy choice were studied. The results showed that environmental and organizational factors may predict the business strategy choice of hospitals. The third paper investigated the moderating effect of environmental instability on the relationship between strategic group membership and financial performance. Environmental instability does not strongly affect the relationship between hospital strategic group membership …
Using Behavioral Health Data From A Health Information Exchange: An Examination Of Facilitators And Barriers, Randyl Cochran
Using Behavioral Health Data From A Health Information Exchange: An Examination Of Facilitators And Barriers, Randyl Cochran
All ETDs from UAB
Behavioral health disorders are common, and they frequently co-occur with chronic physical illnesses. Behavioral health patients with chronic physical illnesses are three times more likely to be readmitted to the hospital within 30 days of discharge than non-behavioral health patients. Readmissions among behavioral health patients are costly: $817 million in readmissions costs are related to mood and psychiatric disorders. High readmission rates are attributed, in part, to poor exchange of health-related information between various care providers. Health information exchanges (HIEs) are effective in chronic disease management, but their effectiveness in integrated care delivery is unclear. This study examined facilitators of …
Effects Of Protein Timing And Energy Balance On Body Composition In Collegiate Athletes, Ashley Licata
Effects Of Protein Timing And Energy Balance On Body Composition In Collegiate Athletes, Ashley Licata
All ETDs from UAB
The current literature indicates that energy balance and protein consumption influence body composition. However, the effects of protein intake, timed protein supplementation, and energy balance on body composition have not yet been fully investigated in collegiate athletes. The purpose of this research was to assess collegiate athletes using hourly food and exercise data to examine how protein timing and energy balance relate to body composition. Aims 1 and 2 focus on collegiate female soccer athletes and further our understanding of the potential roles that protein amount and frequency and hourly energy balance play in optimizing fat mass and fat-free mass. …
The Mechanism Of Glucose-Induced Trib3 Expression In Myoblasts And Myotubes, Xiaobing Liu
The Mechanism Of Glucose-Induced Trib3 Expression In Myoblasts And Myotubes, Xiaobing Liu
All ETDs from UAB
Our previous data indicates that glucose-toxicity is dependent upon upregulation of TRIB3 expression in muscle. TRIB3 is a glucose-responsive gene and, as a pseudokinase, it blocks phosphorylation of AKT resulting in insulin resistance. The purpose of the current study was to identify the role of the differentiation process and the minimal functional sequence of TRIB3 promoter region in modulating glucose-induced TRIB3 gene expression in C2C12 myocytes. First, C2C12 myocytes were collected every 48 hours during the whole differentiation, totally 4 intervals. Before collection, cells were treated with either 5mmol glucose or 25mmol glucose for 24 hours. Under 5mmol glucose, the …
Organizational Characteristics And Environmental Factors Associated With Hospitals Identified As Consolidation Targets, Christi Pierce
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 …
Three Essays In Hospital Financial Distress: Prediction, Antecedents And Organizational Response, Neeraj Avinash Puro
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 …
Insuring Graduation: An Analysis Of The Association Between Student Health Insurance And Graduation, John Robert Lovett
Insuring Graduation: An Analysis Of The Association Between Student Health Insurance And Graduation, John Robert Lovett
All ETDs from UAB
Most college students have access to basic health services through their campus’ college health program. Unfortunately, students who lack health insurance may be limited in their access to health services beyond the acute care provided, which may manifest in a myriad of adverse outcomes; ultimately resulting in withdrawal from college without graduating. Student health insurance plans (SHIPs) are high-quality, affordable insurance plans specially designed to meet this need. This study utilized survival analysis to examine the temporal nature of college graduation behavior, as it related to student health insurance status. The results of this study show no significant relationship between …
Healthcare Cybersecurity: Building A Cyber Vulnerability Profile For U.S. Hospitals, Gemini O. Majkowski
Healthcare Cybersecurity: Building A Cyber Vulnerability Profile For U.S. Hospitals, Gemini O. Majkowski
All ETDs from UAB
Digital transformation in healthcare has offered exponential advances in capabilities and efficiencies improving access, quality of care, chronic disease management, public health surveillance, and population health. However, the speed of change left security lagging, exposing cyber vulnerabilities that cost the U.S. $6.2 billion dollars annually, at an average cost of $2.2 million dollars, and 3,128 records breached per incident. Despite significant investments to close the gap on cyber vulnerabilities, cybersecurity remains a critical issue. Little research has been done to build a cyber vulnerability profile for U.S. hospitals. In this study, U.S. hospitals with reportable breach and without reportable breach …
Provider-Sponsored Health Plans In The Post-Reform Era, Katherine Ann Meese
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 …
Reported Clinical And Financial Performance Of Hospitals With Physician Ceos Compared To Those With Nonphysician Ceos, Leon Moores
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 …
Effects Of Differential Fore Aft Resistance On Propulsive Force Generation During Walking In Nonimpaired And Poststroke Individuals, Avantika Naidu
Effects Of Differential Fore Aft Resistance On Propulsive Force Generation During Walking In Nonimpaired And Poststroke Individuals, Avantika Naidu
All ETDs from UAB
Background: Impaired paretic limb-loading dynamics and force-generation ability due to hemiparesis are partially responsible for permanent locomotor deficits poststroke. During walking, inability of the paretic limb to generate sufficient propulsive-forces causes reliance on compensatory strategies, wherein the nonparetic limb generates the majority of propulsive-forces needed for forward progression and speed modulation. Purpose: To investigate factors that can improve paretic limb propulsion and walking function, I present four studies. The first pertains to a protocol for a poststroke body-weight-support treadmill-training (BWSTT) study, while the others concern a mechanistic exploration of propulsive-force generation during walking against combined and differential FA resistance. Methods: …
Exploring The Link Between Dietary Fiber, The Gut Microbiota And Estrogen Metabolism Among Women With Breast Cancer, Ayse G. Zengul
Exploring The Link Between Dietary Fiber, The Gut Microbiota And Estrogen Metabolism Among Women With Breast Cancer, Ayse G. Zengul
All ETDs from UAB
Breast cancer continues to be a very prevalent disease and impacts over 260,000 new patients per year in the United States. The gut microbiota composition may affect breast cancer risk by modulating various hormonal metabolites including endogenous estrogens. Dietary factors impact gut microbial ecology and influence the regulation of estrogen metabolism. Current evidence supports the potential role of dietary fiber in breast cancer prevention and its possible modulating influence on serum estrogen levels through the gut microbiota associated with β-glucuronidase activity. However, this mechanism is not clearly understood. In this study, we aimed to explore the associations between dietary fiber, …
Significance Of Acculturation, Assimilation, And Allostatic Load As Risk Factors For Obesity Among Hispanics, Yenni Elvia Cedillo Juare
Significance Of Acculturation, Assimilation, And Allostatic Load As Risk Factors For Obesity Among Hispanics, Yenni Elvia Cedillo Juare
All ETDs from UAB
Obesity has increased during the last two decades in the United States (U.S.) and is considered a major risk factor for chronic diseases within the Hispanic community. The burden of obesity in Hispanics is associated with higher rates of morbidity and mortality and an increase in healthcare costs. Hispanics’ challenges after migration extend to subsequent generations, putting the population at risk for disease development. Specifically, migration can lead to the adoption of health behaviors, beliefs, values, and language of the host country, a process known as acculturation, which has been associated with changes in health behaviors. Among the Hispanic population, …
The Strategy Of Federally Qualified Health Centers: The Influence Of Context And Performance Implications, Seongwon Choi
The Strategy Of Federally Qualified Health Centers: The Influence Of Context And Performance Implications, Seongwon Choi
All ETDs from UAB
The three papers included in this dissertation attempt to provide empirical evidence on the relationship among strategies employed by Federally Qualified Health Centers (FQHCs), the contextual factors and consequent performance. The findings of these studies contribute to the existing body of literature on FQHC strategies and performance. In addition, the findings also provide key practical implications to FQHC managers as well as policymakers. Overall, the results of this dissertation suggest that the FQHC strategy on spatial differentiation is associated with a set of organizational and environmental factors. However, there was little support for the relationship between Medicaid expansion and FQHC …
Effects Of A Ketogenic Diet On Body Composition, Metabolic Health, And Quality Of Life In Ovarian And Endometrial Cancer Patients, Caroline Whitney Cohen
Effects Of A Ketogenic Diet On Body Composition, Metabolic Health, And Quality Of Life In Ovarian And Endometrial Cancer Patients, Caroline Whitney Cohen
All ETDs from UAB
Ketogenic diets (KDs) have garnered considerable research attention in recent years, having been investigated as a therapy for neurologic, metabolic, and even dermatologic diseases. Recent research has also focused on KDs as a potential intervention for cancer, with preclinical studies demonstrating profound effects such as inhibiting tumor growth, enhancing the effects of radiation and chemotherapy, and prolonging survival. However, to date few studies have been conducted in cancer patients. In order to determine if KDs might augment existing cancer treatment protocols, additional research is needed. Accordingly, the objective of this project was to conduct the first randomized, controlled trial examining …
Obesity In People With Spinal Cord Injury: Secondary Data Analysis Of National Spinal Cord Injury Database, Huacong Wen
Obesity In People With Spinal Cord Injury: Secondary Data Analysis Of National Spinal Cord Injury Database, Huacong Wen
All ETDs from UAB
People with disabilities are 1.5-2.5 times more likely to be obese than those without disabling conditions. We have learned a lot about obesity in the general population. However, the neurological deficits of people with spinal cord injury (SCI) make it difficult to generalize the findings in the general population to the SCI population. Therefore, the purposes of this dissertation were to 1) assess racial differences in body mass index (BMI) change over 5 years; 2) evaluate the role of neighborhood in the relationship between race and obesity; 3) examine the impact of BMI at the time of injury on 1-year …
A Crisis In Care: Evaluating The Causes And Consequences Of Burnout Among Emergency Physicians, Michael Allyn Wiechart
A Crisis In Care: Evaluating The Causes And Consequences Of Burnout Among Emergency Physicians, Michael Allyn Wiechart
All ETDs from UAB
For many physicians, the growing list of mandates and the unrelenting pace of change in today’s health care have taken a toll, leading to burnout. The consequences of burnout extend well beyond the impact on the individual provider, with physician burnout linked to a decrease in patient satisfaction, an increase in preventable medical errors, and increased levels of staff turnover. Consequently, the high rates of burnout reported among U.S. physicians might be considered not only as a symptom of dysfunction in the health care delivery system but also as a factor contributing to the dysfunction. While burnout exists to a …
[68ga] Labeled Radiopharmaceuticals For Diagnostic Applications Beyond Sstr And Psma Imaging, Abdullah Alosaimi
[68ga] Labeled Radiopharmaceuticals For Diagnostic Applications Beyond Sstr And Psma Imaging, Abdullah Alosaimi
All ETDs from UAB
Imaging with radiolabelled peptides is an important technique used in medical imaging fields that can lead to significant advances in patient care. These tracers are utilized to target a variety of receptors, in particular, specific-receptors which are overexpressed on tumor cells. Recently, the application of Positron Emission Tomography (PET) radiotracers for medical imaging has grown significantly due to the high sensitivity and specificity of this technique. In particular, 68Ga is one of the most favorable PET radioisotopes, due to its short half-life, low radiation dose, generator production, and same day imaging procedures. [68Ga]-DOTATATE, which targets somatostatin receptors (SSTR) overexpressed on …
Postpartum Body Composition And Breast Milk Hormones, Camille Schneider
Postpartum Body Composition And Breast Milk Hormones, Camille Schneider
All ETDs from UAB
The prevalence of both adult and child obesity continues to rise. Children born to mothers with obesity have a greater risk for future obesity and chronic disease. There is an increasing body of literature suggesting that pregnancy and infancy are critical periods influencing the child’s risk for obesity. However, little is known about whether consumption of breast milk from an obese mother might influence the child’s metabolic programming and growth. The purpose of this dissertation was to examine the association of maternal adiposity with insulin and leptin in breast milk and, in turn, whether breast milk insulin, leptin, and glucose …
Physical Activity Promotion Among Adolescents With Pediatric Onset Multiple Sclerosis, Elizabeth Morghen Sikes
Physical Activity Promotion Among Adolescents With Pediatric Onset Multiple Sclerosis, Elizabeth Morghen Sikes
All ETDs from UAB
Pediatric onset multiple sclerosis (MS) is a chronic and disabling disease of the central nervous system with an onset before 18 years of age. Youth with pediatric onset MS may benefit from physical activity as evidenced by past research suggestsing higher levels of physical activity are associated with reduced physical and psychosocial disease manifestations. Unfortunately, published estimates of physical activity participation among those with pediatric onset MS are very low (<10 min/day). This dissertation aimed to describe the current literature regarding physical activity among youth with pediatric MS, and to further explore experiences, patterns, correlates, and potential confounders of physical activity for the ultimate purpose of informing future behavior change interventions. Results are presented through five single study chapters. Briefly, interventions developed to promote physical activity for adolescents with pediatric onset MS should be individually tailored, include a strong social component, aim to educate regarding safety and outcomes of physical activity, and differentially target weekday and weekend day activity and sedentary behavior. Social cognitive theory (SCT) is an appropriate method for promoting physical activity behavior change among youth with pediatric onset MS, and SCT constructs including exercise goal setting, barriers self-efficacy, outcome expectations, and social support should be incorporated in the intervention as appropriate. Further, physical activity is seemingly an appropriate method for the management of functional limitations for youth with pediatric onset MS. Clinicians and researchers seeking to promote physical activity among those with pediatric onset MS may find this dissertation especially useful in providing a framework for the development of behavior change interventions.