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Full-Text Articles in Medical Humanities
Service Profiles In Substance Use Disorder Treatment: The Role Of Institutional And Organizational Factors, Reena Joseph Kelly
Service Profiles In Substance Use Disorder Treatment: The Role Of Institutional And Organizational Factors, Reena Joseph Kelly
All ETDs from UAB
Substance use disorders (SUDs) are a growing crisis globally and in the US, and place an enormous health, social, and financial burden on the nation. To address the complex nature of SUDs, treatment typically involves a combination of different types of services to address the medical, behavioral and social needs of the patient and care is often delivered by specialized SUD treatment facilities. Despite recommendations for a broad suite of services, individual facilities vary in the specific services that they offer. This study examined whether and why systematic differences exist between treatment facilities based on their service mix and whether …
Value Analysis Of Electronic Health Records, Shikha Shah Modi
Value Analysis Of Electronic Health Records, Shikha Shah Modi
All ETDs from UAB
The Electronic Health Record (EHR) is defined as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting” (HIMSS, 2011). EHRs have become an important part of the current health system as a result of government regulations, technology advancements, health care challenges, and market conditions. EHRs are considered an expensive investment; however, the complexity of adopting and implementing EHRs also demands attention. Given the complexity of health information technology (HIT) systems and the hefty investment that is required in the adoption of EHRs, a return on investment is expected, and it …
The Assessment Of Neuro-Mechanics Of Inspiratory Muscles During Mechanical Ventilation, Hassan Y. Abunurah
The Assessment Of Neuro-Mechanics Of Inspiratory Muscles During Mechanical Ventilation, Hassan Y. Abunurah
All ETDs from UAB
The decline in inspiratory muscles function for patients undergoing mechanical ventilation may further extend the duration of mechanical ventilation leading to lethal complications. Thus, the assessment of neuro-mechanics of inspiratory muscles may help us understand the pathophysiology for mechanical ventilation failure to avoid its complications. In this dissertation, we assessed the characteristics of inspiratory neuromechanics under different conditions. This dissertation is reported in three different papers. In the first paper, we sought to assess the quality of the available literate that used surface EMG of extra-diaphragmatic muscles during invasive mechanical ventilation. We demonstrated that the use of sEMG of extra-diaphragmatic …
The Role Of Obesity, Gdm, And Lifestyle Factors On Metabolic Syndrome Scores In Mothers And Their Children 4-10 Years After Pregnancy, Makenzie Callahan
The Role Of Obesity, Gdm, And Lifestyle Factors On Metabolic Syndrome Scores In Mothers And Their Children 4-10 Years After Pregnancy, Makenzie Callahan
All ETDs from UAB
Metabolic syndrome (MetS) is a cluster of symptoms that increase risk for heart disease and type 2 diabetes. Therefore, early detection of MetS is vital for disease prevention. Gestational diabetes (GDM) and/or obesity during pregnancy are associated with a greater risk for MetS in mothers and their children compared to mothers with no GDM. However, little is known about how much a GDM history or in utero exposure to maternal GDM contributes to MetS risk years after that pregnancy in addition to risk attributable to obesity itself. Therefore, the overall objective of this dissertation was explore how a history of …
Central Vestibular Integration In Concussion And Multiple Sclerosis, Graham Dean Cochrane
Central Vestibular Integration In Concussion And Multiple Sclerosis, Graham Dean Cochrane
All ETDs from UAB
Dizziness and imbalance are commonly reported by people with concussion and people with multiple sclerosis (MS). Dysfunction of the vestibular system is likely a major cause of dizziness and imbalance in both diseases, but it is not well understood whether this dysfunction typically occurs in peripheral vestibular organs and pathways or higher-level central vestibular integration pathways. As these systems are assessed and targeted with rehabilitation differently, understanding how both are affected in these diseases will improve management of dizziness and imbalance. In addition, balance has been demonstrated to correlate with self-reported fatigue in people with MS, presumably through shared dysfunction …
Identifying Factors To Inform The Development Of Adaptive Interventions For Increasing Physical Activity Behavior Among People With Multiple Schlerosis, Yumi Kim
All ETDs from UAB
People with multiple sclerosis (MS) can benefit from physical activity, specifically exercise, for the management of disease symptoms, including walking impairments, fatigue, and depression, and improvements in quality of life. However, people with MS do not engage in adequate amounts of physical activity for the accrual of health benefits. Researchers have focused on the delivery of exercise training and behavioral interventions to improve levels of physical activity in MS. To date, there is an emerging body of research supporting the efficacy of these interventions for increasing and potentially sustaining physical activity behavior in people with MS. Yet, people with MS …
Pain-Related Injustice Appraisal And Chronic Low Back Pain Among Arabs In The United States, Albatool Homoud Alnojeidi
Pain-Related Injustice Appraisal And Chronic Low Back Pain Among Arabs In The United States, Albatool Homoud Alnojeidi
All ETDs from UAB
Pain-related injustice appraisal has emerged as a psychosocial predictor of deleterious chronic low back pain (CLBP) outcomes. The appraisal is defined as the individual’s perception regarding the magnitude and irreparability of pain-related loss and suffering, externalized blame, and unfairness. Research in diverse samples revealed racial differences in pain-related injustice appraisal, suggesting that it may reflect broader racial/ethnic, sociocultural, and socioeconomic factors. This agrees with theories recognizing the role of ethnic and cultural characteristics in ethnic minorities’ health. Despite global data showing that Arabs represent the population with the second-highest prevalence of CLBP worldwide, a reliable characterization of CLBP among Arabs …
Financial Performance Of Participating Hospitals In Accountable Care Organizations, Abdulrhman Alzhrani
Financial Performance Of Participating Hospitals In Accountable Care Organizations, Abdulrhman Alzhrani
All ETDs from UAB
The study examines the influence of accountable care organizations ACO participation on hospital financial performance. It poses two research questions: 1) how does ACO participation influence hospital financial performance? 2) How do organizational factors- hospital size, electronic health records (EHR) utilization, and ambulatory services- moderate the relationship between hospital ACO participation and financial performance? The study used longitudinal sample of general and surgical hospitals operating in United States from 2009 to 2017. The data were obtained from several sources including American Hospital Association (AHA), AHA survey of care system and payment, hospital cost reports, AHA information technology and Area Health …
Actual And Perceived Balance Abilities While Performing Tasks That Challenge Balance In Older Adults And Individuals With Parkinson's Disease., Jutaluk Kongsuk
Actual And Perceived Balance Abilities While Performing Tasks That Challenge Balance In Older Adults And Individuals With Parkinson's Disease., Jutaluk Kongsuk
All ETDs from UAB
Walking is a fundamental activity for one to interact effectively with one’s environment. Walking in the community often requires both a wide range and constant modification of walking speed. Decreased walking capacity, that is the maximum speed that a person can physically achieve, results in a decline in both functional mobility and personal independence, contributing to decreased community participation among individuals whose walking is impaired. The most common test of walking speed (i.e., overground comfortable and maximum walking speed) may not reflect the full capacity of individuals to regulate gait control. Whereas walking with progressively increasing treadmill speeds allows researchers …
Disrupting The Perioperative Opioid Gateway: Identification Of Risk Factors For New Persistent Post-Surgical Opioid Use, Gia Marie Pittet
Disrupting The Perioperative Opioid Gateway: Identification Of Risk Factors For New Persistent Post-Surgical Opioid Use, Gia Marie Pittet
All ETDs from UAB
A large portion of the American Opioid Crisis is due to opioid naïve patients who become new persistent post-surgical opioid users, although the risk factors for the development of this addiction are not well studied. The objective of this study was to analyze multiple layers of pre-operative and procedural risk factors using an ecological perspective theoretical framework in adult patients undergoing invasive surgery. We performed a retrospective analysis of 13,970 opioid naïve adults in a mixed surgical cohort with data available at the University of California Los Angeles that was merged with narcotics data for the State of California (IRB#19-000625). …
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 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 …
Dietary Nitrate And The Oral Microbiome In Obesity, Health And Exercise, Christian E. Behrens
Dietary Nitrate And The Oral Microbiome In Obesity, Health And Exercise, Christian E. Behrens
All ETDs from UAB
Obesity ranks among the top growing health concerns worldwide. The prevalence of obesity at all life stages continues to rise with nearly 40% of adults and 35% of children/adolescents being affected. Equally troublesome is the increased risk for a number of comorbidities associated with obesity including cardiovascular disease, stroke, type 2 diabetes mellitus, and certain types of cancer. The successful treatment of obesity, particularly long-term, continues to prove challenging and is often met with limited success. This highlights the importance of continued investigation into alternative strategies that may reduce the incidence and severity of obesity and associated pathophysiologies. Regular physical …
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 …
Exploring Diet Quality In Early Care And Education Centers: Measures, Policies, And Center Characteristics, Elizabeth Kroeger
Exploring Diet Quality In Early Care And Education Centers: Measures, Policies, And Center Characteristics, Elizabeth Kroeger
All ETDs from UAB
Over 65% of children ages 2-5 years attend Early Care and Education (ECE) centers where they consume most of their daily caloric intake; however, children at these centers are not meeting the Dietary Guidelines for Americans (DGA). This could suggest poor diet quality, which is a risk factor for diet-related diseases. Currently, diet quality in ECE centers is measured through the assessment of either the food/beverages listed on the lunch menu (menu), served to the children during lunch (served), or consumed by the children during lunch (consumed). However, the lunch meal may be better viewed as a process, rather than …
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 …
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 …
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.
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 …
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 …
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 …
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 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 …
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, …
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. …
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 …
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 …
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 …
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: …
The Effects Of Body Size, Growth, And History Of Diabetes On Glioma Risk, Rebecca Barnhill Little
The Effects Of Body Size, Growth, And History Of Diabetes On Glioma Risk, Rebecca Barnhill Little
All ETDs from UAB
Many dietary exposures have weak or null associations with glioma risk. As nutrition can affect growth rate in adolescence, body size throughout the lifespan, and the propensity for Type 2 diabetes, the goal of this project was to examine the relationships between these surrogates of nutritional states and the risk of glioma. The aims of this project were to examine the associations between glioma risk and 1) self-reported body measures; 2) age when full height was attained; 3) and a history of diabetes. To investigate the first aim, 1,111 glioma cases and 1,096 community controls completed a structured interview to …