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Full-Text Articles in Medical Humanities
Financial Distress – Causes And Consequences: An Examination Of The Nursing Home Industry, Justin Caleb Lord
Financial Distress – Causes And Consequences: An Examination Of The Nursing Home Industry, Justin Caleb Lord
All ETDs from UAB
Nursing homes operate in a tumultuous and changing environment and are under increasing financial pressure, risk of closure, and financial distress. The issue of financial distress has been explored tangentially within the nursing home industry. This study is the first to validate the Altman Z-Score, a financial distress prediction model, within the nursing home context. The Altman Z-Score model uses multiple discriminate analysis (MDA) to examine multiple financial ratios (liquidity, efficiency, profitability and net worth) simultaneously to predict the likelihood of a firm’s financial distress. After calculating the Z-Score, clustering was used to classify the observations into three groups, distressed, …
Prenatal And Postnatal Factors Regulate Food Intake And Body Composition, Minsung Kang
Prenatal And Postnatal Factors Regulate Food Intake And Body Composition, Minsung Kang
All ETDs from UAB
This research sought to identify the effects of prenatal and postnatal factors on systemic metabolism and the regulation of food intake, weight, and body composition. It was found that the manipulation of maternal diets influenced the systemic metabolism of offspring. The offspring of dams fed an isocaloric, low protein diet were significantly smaller and consumed less food than offspring from dams fed a control diet. In the case of the offspring from dams fed a western diet, they were significantly heavier and consumed more food than offspring from dams fed a control diet. In addition, the offspring showed altered glucose …
Interactions Between Posture And Locomotion In Nonimpaired And Poststroke Walking, Sarah Anne Graham
Interactions Between Posture And Locomotion In Nonimpaired And Poststroke Walking, Sarah Anne Graham
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Background: Inappropriate paretic-limb force generation is a hallmark of impaired walking function poststroke. In addition to weakness, the paretic limb misdirects foot forces during stance, which may be due to inappropriate postural influence over weakened locomotor control. Purpose: Investigate neural control interactions between posture and locomotor functions by manipulating postural influence during walking of nonimpaired and individuals poststroke. I present four studies investigating measures associated with locomotor function and foot-force direction under varying postural demands during walking. Methods: Study 1 compared comfortable walking speed (CWS) outcomes following two body-weight-support (BWS) training protocols for N=29 participants with chronic (≥5 months) poststroke …
Constraint-Induced Movement Therapy To Improve Gait And Mobility Of People With Chronic Stroke: A Mixed Methods Study, Sarah Monteiro Dos Anjos
Constraint-Induced Movement Therapy To Improve Gait And Mobility Of People With Chronic Stroke: A Mixed Methods Study, Sarah Monteiro Dos Anjos
All ETDs from UAB
Walking impairment after stroke impacts on participation and quality of life. Different techniques have been developed in the last decades to overcome walking difficulties after stroke, however, few have been shown to be efficacious. Constraint-induced Movement Therapy (CIMT) is a family of techniques that has been reported as one the most effective intervention for improving functional use and motor skills of a more-affected upper extremity (UE). The intervention protocol includes: 1) intensive supervised training; 2) use of shaping as a strategy for the motor training, 3) a group of behavioral strategies called the transfer package, and 4) procedures to increase …
Effects Of Dietary R,S-1,3 Butanediol Diacetoacetate On Components Of Energy Balance, Rachel A H Davis
Effects Of Dietary R,S-1,3 Butanediol Diacetoacetate On Components Of Energy Balance, Rachel A H Davis
All ETDs from UAB
Ketogenic diet (KD) has been used to attenuate the decline in energy expenditure occurring from calorie restriction-induced weight loss, but long-term adherence can be difficult due to the strict nature of the diet. The growing body of evidence supporting KD-treatment of neurologic and metabolic diseases, as well as obesity, has prompted interest in the ability to increase circulating ketones via exogenous delivery. Ketone esters (KE) can raise blood ketone concentrations similarly to fasting and appear to reduce food intake acutely, but studies assessing effects on energy balance are limited and provide a potentially promising direction for weight control. Previous investigations …
Examining The Relationship Between Operational And Clinical Performances Of Federally Qualified Community Health Centers, Ganisher K. Davlyatov
Examining The Relationship Between Operational And Clinical Performances Of Federally Qualified Community Health Centers, Ganisher K. Davlyatov
All ETDs from UAB
This dissertation studied the role of Health Information Technology (HIT) adoption on clinical performance; the effects of clinical performance on chief executive officer (CEO) compensation; and the association between CHC’s financial and clinical performances in Community Health Centers (CHC). Data from the Uniform Data System (UDS) and the Internal Revenue System (IRS) 990 Forms were extracted for the period 2011-2016. Generalized estimating equations models with state and year fixed effects were performed. To test the relationship between the age and extent of HIT adoption and clinical performance, Resource-Based View of the Firm constructs were used. The age of HIT adoption …
Diet, Physical Activity, And Healthy Aging In People Living With Hiv, Josh Newson Muhammad
Diet, Physical Activity, And Healthy Aging In People Living With Hiv, Josh Newson Muhammad
All ETDs from UAB
As life expectancy for people living with HIV (PLWH) has increased, healthy aging in this community has become an emerging public health concern. Although the benefits of adopting healthy diets and regular physical activity are well-documented, implementing strategies for lifestyle modifications among older PLWH remains a challenge. The complex milieu of social, physiological and economic burdens encountered by PLWH exposes this population to increased risk for adverse health outcomes, especially from preventable metabolic diseases. The interaction of diet, physical activity and social determinants of health in persons who are HIV positive is an understudied area. The aim of this dissertation …
Adiposity And Health In Zoo African And Asian Elephants, Daniella Chusyd
Adiposity And Health In Zoo African And Asian Elephants, Daniella Chusyd
All ETDs from UAB
African (Loxodonta africana) and Asian (Elephas maximus) elephant populations are rapidly declining due to poaching, and habitat fragmentation and loss. Due to the precarious situation elephants are facing worldwide, captive elephant populations are being viewed as an insurance policy against extinction. Unfortunately, captive elephant populations are not self-sustaining, in part because of reproductive and health issues. One hypothesis for the observed reproductive and health issues is zoo elephants are obese. The current method of assessing obesity in elephants is based on a qualitative visual tool, the body condition score, which does not quantify fat mass. The purpose of this dissertation …
Vestibular And Oculomotor Function In Children With Cerebral Palsy, Anwar B. Almutairi
Vestibular And Oculomotor Function In Children With Cerebral Palsy, Anwar B. Almutairi
All ETDs from UAB
Cerebral palsy (CP) is the most common motor disability of childhood, caused by non-progressive permanent injury to the fetal or infant’s brain. Visual and balance impairments are prominent hallmarks of these disorders. Although musculoskeletal and neuromuscular causes are well established in the literature, the role of vestibular and oculomotor disabilities was not explored in this population. Because of that, this dissertation aims to describe the vestibular and oculomotor function in children with CP, aged 7-12years, GMFCS levels I-III, and to determine the feasibility, sensitivity, specificity and retest reliability of vestibular and oculomotor clinical tests in children with CP, compared to …
Patient Safety: Organizations, Culture, And Information Technology, Soumya Upadhyay
Patient Safety: Organizations, Culture, And Information Technology, Soumya Upadhyay
All ETDs from UAB
The purpose of this dissertation is to explore factors that influence patient safety culture and patient safety outcomes, and whether patient safety culture affects hospital performance. The findings of these studies have important implications to hospital managers in the context of macro environmental changes regarding quality and safety. As managers look for ways to improve patient safety, results from this dissertation suggest strategies (for example, RN staffing; EHR presence) that may help improve safety culture and hospital performance. Specifically, having at least basic EHR as compared to not having any EHR supports safety culture to positively influence quality and financial …
Acute And Chronic Regulation Of Skeletal Muscle Mitochondrial Function, Jonathan Lund Warren
Acute And Chronic Regulation Of Skeletal Muscle Mitochondrial Function, Jonathan Lund Warren
All ETDs from UAB
Obesity and type 2 diabetes (T2D) represent a growing global burden on healthcare and financial resources. One hypothesis for the onset and exacerbation of these diseases is related to the role of mitochondria as the end users of products of the metabolism of the nutrients we consume and in mediating the oxidative state of the body through the production of reactive oxygen species (ROS). In order to meet the demands of a metabolic challenge and prevent excessive ROS production, there appear to be adaptations to mitochondrial physiology and morphology that can occur and we hypothesize that the ability of the …
Circulating Mirnas And Human Insulin Resistance, Elizabeth Ma
Circulating Mirnas And Human Insulin Resistance, Elizabeth Ma
All ETDs from UAB
Insulin resistance (IR) is central to the pathophysiology of Type 2 diabetes (T2DM), and is a risk factor for cardiovascular disease. The mechanisms behind IR are not clear, but microRNA (miR; short, non-coding RNA strands that base-pair with mRNA to modify gene expression) have garnered interest as potential contributors. miRs have recently been shown to be detectable in the circulation, and can be taken up and regulate target genes within recipient cells. Our primary objective was to identify circulating miRs (c-miRs) that play a role in regulating systemic metabolism and participate in the pathophysiology of IR and cardiometabolic disease. Three …
Hospital Purchasing Alliance: Contextual Factors And Financial Performance, William Opoku-Agyeman Opoku-Agyeman
Hospital Purchasing Alliance: Contextual Factors And Financial Performance, William Opoku-Agyeman Opoku-Agyeman
All ETDs from UAB
Collectively, the purpose of the three papers included in this dissertation was to provide empirical evidence on the contextual factors that influence hospital utilization of services of group purchasing organizations and how utilization of group purchasing organizations impacts hospitals’ financial performance. The findings of these studies are important both to researchers and to managers as it sheds light on the relationship between hospitals and group purchasing organizations. The results of this dissertation suggest that better financial performance is associated with hospital utilization of group purchasing organizations. Additionally, some measures of environmental munificence and dynamism are associated with hospital utilization of …
Teleexercise For People With Disabilities, Byron Lai
Teleexercise For People With Disabilities, Byron Lai
All ETDs from UAB
Exercise is recognized as a method of improving health and function and preventing deconditioning for adults with neurological disabilities. However, they experience a multitude of barriers that prevent them from regular participation in exercise. To address these barriers, the goal of this dissertation was to explore the use of monitoring technology as a means for delivering exercise to adults with neurological disabilities at home. This pursuit involved three studies. The first study reviewed the extant literature for current trends in exercise interventions for people with disabilities. Regarding technology, the review indicated that technology is rarely used to deliver one-on-on supervised …
Type I Myofiber Grouping: Myofiber Phenotype And Implications For Muscle Performance In Older Adults And Parkinson Disease, Kelley Grace Hammond
Type I Myofiber Grouping: Myofiber Phenotype And Implications For Muscle Performance In Older Adults And Parkinson Disease, Kelley Grace Hammond
All ETDs from UAB
Neuromuscular morphology and function undergo changes with increasing age and Parkinson disease (PD) pathology. Motor unit reorganization occurs by denervation-reinnervation events which lead to diminishing random distribution of myofibers and type I myofiber grouping. Grouped type I myofibers maintain type II features such as hypertrophic capacity and myonuclear addition, sarco(endo)plasmic reticulum Ca2+ ATPase 1 expression, and lower capillarization. Though age-related type I myofiber grouping has been qualitatively described in the literature, this was the first study to characterize the phenotype of grouped type I myofibers in older adults. Furthermore, we identified a magnified degree of type I myofiber grouping in …
Behavioral Markers Of Supraspinal Pain In Clinically Relevant Models Of Spinal Cord Injury, Kathryn Yamamoto Henley
Behavioral Markers Of Supraspinal Pain In Clinically Relevant Models Of Spinal Cord Injury, Kathryn Yamamoto Henley
All ETDs from UAB
The majority of people suffering from neuropathic pain as a result of a spinal cord injury (SCI) do not experience effective pain relief with currently available therapeutics. One aspect of preclinical studies that may be limiting the development of successful analgesics is the assessment of pain in animal models of SCI. Previous work has relied primarily on withdrawal reflexes to indicate pain; however, there is evidence that suggests this is an inadequate measure of pain sensation as spinal reflexes do not reflect the supraspinal processing of nociceptive information. The use of withdrawal responses is especially challenging in the context of …
Increasing The Accessibility Of A Falls Prevention Intervention For Community-Dwelling Older Adults With Low Vision, Sarah Blaylock
Increasing The Accessibility Of A Falls Prevention Intervention For Community-Dwelling Older Adults With Low Vision, Sarah Blaylock
All ETDs from UAB
Falls remain a costly problem as a leading cause of injuries and fatalities for individuals over the age of 65. Older adults with low vision, or non-correctable visual impairment, are estimated to be two times more likely to fall than those without vision loss. There appear to be limited falls prevention interventions available for older adults that have been tested on or designed specifically for individuals with visual impairment. The goals of this dissertation were to learn more about the availability of visually accessible falls prevention interventions and to develop an intervention that can be used with veterans receiving services …
A Multilevel Perspective On Health Information Exchange, Claudia Guerrazzi
A Multilevel Perspective On Health Information Exchange, Claudia Guerrazzi
All ETDs from UAB
As the health care sector faces pressure to improve quality and contain costs, sharing information among the various care providers will become an essential practice among health care providers. Many countries are now adopting policies to foster Health Information Exchange (HIE), which is defined as the electronic transfer of data or information among health care organizations involved in the delivery of care. The literature about HIE reports contradictory evidence about the adoption and the use of HIE and more research is needed to understand this complex phenomenon. Specifically, HIE is a complex phenomenon that produces outcomes at different levels and …
Motor Abilities And Social Participation In Young Children With Autism Spectrum Disorder, Jamie M. Holloway
Motor Abilities And Social Participation In Young Children With Autism Spectrum Disorder, Jamie M. Holloway
All ETDs from UAB
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that primarily affects social communication and behavior, however, a number of motor impairments have been identified in children with ASD. In children who are typically developing, the development of social, communication, and cognitive skills is thought to be influenced by motor development. However, the impact of these motor skill deficits on overall development in children with ASD is not yet known. The purpose of this dissertation was to explore the relationship between gross motor ability and social function and participation in young children with ASD. The first study described changes in peer …
Diabetes Risk In Women: Pschosocial And Lifestyle Determinants, Sarah Katherine Sweatt
Diabetes Risk In Women: Pschosocial And Lifestyle Determinants, Sarah Katherine Sweatt
All ETDs from UAB
Type 2 diabetes (T2D) is a major public health concern. Physical inactivity, poor diet, and psychosocial distress have emerged as factors contributing to T2D. Women may be uniquely affected by these factors as obesity, physical inactivity, and the prevalence of psychosocial distress are higher in women. Additionally, polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women and increases the risk of both T2D and psychosocial distress. However, the relationship between physical activity (PA), psychosocial distress, and metabolic health is not fully understood, particularly in at risk populations such as minorities and women with PCOS. Therefore, the goal …
The Dietary Context Of Nut Intake Among Overweight And Obese African-American Women Living In The Rural South: An Exploratory Study, Samara Sterling
The Dietary Context Of Nut Intake Among Overweight And Obese African-American Women Living In The Rural South: An Exploratory Study, Samara Sterling
All ETDs from UAB
Obesity has become a national epidemic over the last few decades, and lays its heaviest burden on certain populations (eg, rural residents, African-Americans, and African-American women in the Southeast). Obesity increases medical costs substantially, and is a significant risk factor for various chronic conditions, including certain cancers. There is a need to identify specific dietary behaviors that may contribute to obesity and obesity-related cancers among African-American women in the rural South, and to recommend dietary modifications that may alleviate those risks. Previous research has shown that nuts offer numerous health benefits, including weight loss and cancer protection. More research is …
Pay For Performance In Dentistry: Is It Worth It?, Andreea Voinea-Griffin
Pay For Performance In Dentistry: Is It Worth It?, Andreea Voinea-Griffin
All ETDs from UAB
Introduction: The variability of dental care and the slow implementation of evidence-based dentistry point to the need for change. Pay for performance (P4P) programs may foster quality improvement if appropriately designed. This work demonstrates the use of modeling and simulation to evaluate such programs prior to deployment. An example is provided in the form of a P4P program for the treatment of occlusal early caries (EC) in permanent teeth. Research Design: The proposed P4P program evaluation consists of two steps. First step is to determine the optimal treatment. In this example, three non-invasive treatments (NTs), watchful-waiting (WW), sealants, and fluoride …
Rural Hos[Ital Closure In Alabama - Post Aca, Dennis Otto Mccay
Rural Hos[Ital Closure In Alabama - Post Aca, Dennis Otto Mccay
All ETDs from UAB
RURAL HOSPITAL CLOSURES IN ALABAMA: POST ACA DENNIS O. MCCAY HEALTH SERVICES ADMINISTRATION ABSTRACT Rural hospitals differ from their urban counterparts with regard to two main areas. First, rural hospital patients are usually older, of lower income, and less healthy than those in urban areas. Second, their facilities tend to be smaller, older, and more prone to staff shortages than those in an urban environment. Rural hospitals have been closing at higher rates than their urban counterparts for a number of years, but more so since the implementation of the Affordable Care Act in 2010. The objective of this research …
Dietary Patterns, Insulin Resistance, And Cognitive Outcomes In A Cohort Of Black And White Americans, Keith Pearson
Dietary Patterns, Insulin Resistance, And Cognitive Outcomes In A Cohort Of Black And White Americans, Keith Pearson
All ETDs from UAB
As life expectancy continues to increase and the number of elderly Americans rises, public health initiatives are seeking to identify modifiable risk factors to preserve cognitive function and increase quality of life in advanced ages. The primary objective of this dissertation was to investigate dietary patterns, carbohydrate consumption, and insulin resistance as modifiable risk factors that may contribute to the development of cognitive impairment and cognitive decline. Three separate studies were performed in the REasons for Geographic And Racial Differences in Stroke study, a prospective cohort containing 30,239 black and white participants. Cognitive impairment was defined using the Six-Item Screener. …
Comparing The Quality Of End Of Life Cancer Care In The Medicare Population Prior To And After The Enactment Of The Medicare Prescription Drug, Improvement And Modernization Act Of 2003, Rene Jooste
All ETDs from UAB
Reimbursement for chemotherapy could account for two thirds of the income for oncologists in private practice. The Medicare prescription drug improvement and modernization act of 2003 (MMA) brought about a dramatic change in the way physicians were reimbursed for delivering chemotherapy in an attempt to slow the skyrocketing costs of drugs and Medicare costs for covering these drugs . The MMA reduced Medicare reimbursements for covered outpatient prescription drugs from 95% to 85% of the average wholesale price. In 2005, a new payment system was instituted that reimbursed fee-for-service providers for drugs at the national average sales price plus 6%. …
Hospital Vertical Integration Into Sub-Acute Care Services, Carolyn Tory Harper Hogan
Hospital Vertical Integration Into Sub-Acute Care Services, Carolyn Tory Harper Hogan
All ETDs from UAB
The purpose of this dissertation was to examine the antecedents and outcomes of hospital vertical integration into Sub-Acute Care (SAC). Using a sequential quanqual mixed methods design, we examined why hospitals adopt a vertical integration strategy and the relationship this strategy has to performance. Findings from this dissertation are important to hospital administrators as they seek to find ways to respond to the changing payment structures established during the Affordable Care Act. The results of this dissertation suggest that not all market and organizational factors are associated with vertical integration strategies toward SAC. They also suggest that vertical integration into …
The Role Of Ppar-Delta In Regulating Cardiomyocyte Proliferation And Angiogenesis In Post-Myocardial Infarction Adult Heart, Yishu Ding
All ETDs from UAB
immediately before, soon after, and one month after intervention. Average daily calcium
Patient Engagement Functionalities Facilitated By Health Information Technology: An Examination Of The Adoption Rate And Financial Performance Among U.S. Hospitals, Oghale Elijah Asagbra
Patient Engagement Functionalities Facilitated By Health Information Technology: An Examination Of The Adoption Rate And Financial Performance Among U.S. Hospitals, Oghale Elijah Asagbra
All ETDs from UAB
The Centers for Medicare and Medicaid (CMS) meaningful use requirement, as well as documented evidence suggest that health information technology (HIT) has the potential to promote patient engagement and consequently improve quality and reduce cost. This prompts a better understanding of hospital adoption of HIT for patient engagement. The purpose of the three papers presented in this dissertation is to examine hospital adoption of health information technology (HIT) to facilitate patient engagement. Emphasis is placed on the functionalities (i.e., functions or capabilities) offered by these technologies that have been determined to allow patients be more involved in their care because …
The Relationships Between Patient Satisfaction, Market Share, And Hospital Financial Performance, David W. Au
The Relationships Between Patient Satisfaction, Market Share, And Hospital Financial Performance, David W. Au
All ETDs from UAB
Quantitative scores enumerating patient experience with care have been introduced to healthcare via the Patient Protection and Affordable Care Act of 2010. Consumers can now compare with relative ease, different healthcare providers on the basis of standardized metrics. As government mandated transparency initiatives become commonplace as a result of the law, hospitals are more cognizant of how patient experience with care (operationalized using Hospital Consumer Assessment of Healthcare Providers and Systems: HCAHPS) has an impact on where patients decide to seek treatment. The proliferation of technological tools now enables patients to make meaningful quality and cost comparisons across providers. HCAHPS …
Correlating High Reliability Organization Practices With Preventable Harms Across Children’S Hospitals Participating In The Children’S Hospitals’ Solutions For Patient Safety Collaborative, Kelly H. Randall
All ETDs from UAB
Background: Despite significant effort, focus, and resources dedicated to reducing patient safety risk, the healthcare system continues to have high error rates. Approaches and strategies implemented to decrease human error have been marginally successful in achieving sustainable reduction in patient harm. Purpose: The purpose of this study was to examine the association between high reliability and patient safety outcomes by testing the following hypotheses: Organizations exhibiting more advanced high reliability practice will have fewer hospital acquired conditions (as defined by the Serious Harm Event Index (SHE) than organizations exhibiting less advanced high reliability practices; and organizations exhibiting more advanced high …