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Full-Text Articles in Medical Humanities
Hospital-Based Skilled Nursing Facilities: Predictors Of Survival And Performance, Shivani Gupta
Hospital-Based Skilled Nursing Facilities: Predictors Of Survival And Performance, Shivani Gupta
All ETDs from UAB
This three-paper dissertation examined the organizational and market factors predicting the response of hospital-based skilled nursing facilities (HBSNFs) to the changes in their environment such as the implementation of prospective payment system in 1998 and their role in coordination of care for patients in transition from acute care to home or a post-acute care facility. In the first study, population ecology of organizations framework was used to evaluate the organizational and market factors associated with HBSNFs’ closure after 1998. The event histories of all acute-care hospitals which had an open HBSNF in 1998 were examined across 15 years (1998-2012) to …
Linking Adiponectin And Autophagy In The Regulation Of Breast Cancer Metastatic Potential, Emily Libby
Linking Adiponectin And Autophagy In The Regulation Of Breast Cancer Metastatic Potential, Emily Libby
All ETDs from UAB
Curative approaches for metastatic breast cancer remain elusive. Adiponectin is the most abundant of the adipocyte-secreted adipokines, and there is recent interest in development of adiponectin-based therapies for this disease. Yet, while multiple epidemiological studies have indicated that low levels of circulating plasma adiponectin portend poorer prognosis, recent work has reported that elevated adiponectin expression in breast tissue correlates with advanced disease. Further, isoform-specific roles of this molecule are not well understood. Thus, the overarching purpose of this work was to elucidate how adiponectin isoforms contribute to the microenvironmental regulation of the early steps of breast cancer metastasis. We show …
The Interrelationships Among Obesity, Insulin Sensitivity, And Bone Phenotype In Pre-Pubertal Girls, Anna L. Newton
The Interrelationships Among Obesity, Insulin Sensitivity, And Bone Phenotype In Pre-Pubertal Girls, Anna L. Newton
All ETDs from UAB
Impaired insulin sensitivity as a consequence of childhood obesity has been implicated as a contributor to skeletal fragility. There is a need to understand the interrelationships among insulin sensitivity and skeletal parameters (i.e. cortical, trabecular, marrow) in obesity during the pubertal transition. Further, calorie restricted weight loss to stabilize these relationships warrants investigation as well. The goal of this project was to examine the relationships among body composition, skeletal parameters, and insulin sensitivity. The first aim was to evaluate the relationships among total body fat, bone mineral content (BMC) and femoral bone marrow adipose tissue (BMAT) during childhood and underlying …
Examining The Interplay Of Diet Composition, Cardiometabolic Diseases, And Economics, Kenneth Patton Kell
Examining The Interplay Of Diet Composition, Cardiometabolic Diseases, And Economics, Kenneth Patton Kell
All ETDs from UAB
Despite the invaluable contributions that both randomized controlled trials and longitudinal studies have made to our understanding of the relationships between diet and cardiovascular disease (CVD), a comprehensive understanding of these relationships does not yet exist from birth to death. Furthermore, the longest running of these longitudinal studies have not included a representative portion of racial minority participants. Lastly, given the financial impacts of CVD, as well as how socioeconomic status (SES) can influence diet, the interplay between these three merits consideration. Therefore, the objective of this dissertation was to evaluate the associations between diet and cardiovascular disease (CVD): 1) …
Drivers Of Inter-Organizational Network Participation, Kimberly S. Davey
Drivers Of Inter-Organizational Network Participation, Kimberly S. Davey
All ETDs from UAB
The purpose of this dissertation was to study market and organizational drivers associated with inter-organizational network participation. Inter-organizational networks are increasingly emerging across industries as a strategy for adapting to fundamental changes in competitive market environments. Specifically, this study empirically examined the association between market and organizational drivers for a sample of U.S. hospitals relative to their participation or non-participation in Medicare ACOs as a newly emergent inter-organizational network in the healthcare sector. This was a cross-sectional study of U.S. hospitals participating in Centers for Medicare and Medicaid Services (CMS) designated ACOs as of January 1, 2014 and hospitals not …
Intensivists And Organizational Performance, Glenn Barthwick Liddle
Intensivists And Organizational Performance, Glenn Barthwick Liddle
All ETDs from UAB
Because of the high intensity of care and the extremely complex medical conditions being treated, intensive care units (ICUs) represent one of the most significant units within a hospital. Despite the significance of the ICU, the majority of the care provided in the ICU has historically been managed and coordinated by referring or attending physicians, who often do not have the specialized training needed to effectively care for the exceedingly acute patients in the ICU. More recently, however, a growing number of hospitals have begun staffing the ICU with intensivists. Intensivists are uniquely trained physicians that specialize in providing care …
Hospital Community Orientation: Predictors And Performance Outcomes, J'Aime Jennings
Hospital Community Orientation: Predictors And Performance Outcomes, J'Aime Jennings
All ETDs from UAB
The three publishable manuscripts contained within this dissertation examine the predictors and performance outcomes of hospital community orientation. Community orientation is the customization of hospital services to meet identified community health needs. Together, these papers fill gaps in the literature regarding the factors that assist or hinder hospitals from being community-oriented, as well as the effects of community orientation. The first paper uses longitudinal data to examine the organizational and environmental factors that may influence how engaged hospitals are in a community orientation strategy based on the number of activities performed. The remaining papers consider the performance outcomes of community …
Towards An Understanding Of Patient Satisfaction In The Military Health System, Alan Alexander Jones
Towards An Understanding Of Patient Satisfaction In The Military Health System, Alan Alexander Jones
All ETDs from UAB
The Military Health System (MHS) is the most expansive health care system in the world. The MHS provides health care services to 9.7 million eligible beneficiaries spread across six continents. The MHS budget exceeded $52 billion in 2013 or 10 percent of the total 2013 Defense budget. The cost of health care in the MHS is of great concern to the Department of Defense and the US Congress. The MHS needs a strong framework to measure the value of the health care it provides. The purpose of this study was to develop a framework to better understand Patient Satisfaction in …
Effectiveness Of Functional Electrical Stimulation Assisted Rowing To Improve Shoulder Pain And Aerobic Fitness In Manual Wheelchair Users With Spinal Cord Injury, Susan Wilbanks
All ETDs from UAB
Exercise is beneficial to adults with spinal cord injury (SCI) because of its ability to improve function and increase life expectancy. The goal of this dissertation was to determine an effective intervention for increasing aerobic fitness and decreasing shoulder pain in manual wheelchair users with SCI by identifying underlying mechanisms for shoulder pain, optimizing training and utilizing appropriate outcome measures. Three studies were conducted. The first study indicated that exercise interventions for adults with SCI are of low to moderate methodological quality, frequently using outcome measures associated with changes in body structures and functions, and not frequently examining effects on …
The Roles Of Mammalian Tribbles Homolog 3 (Trib3) In Coordinating Energy Metabolism And Development Of Insulin Resistance, Wei Zhang
All ETDs from UAB
Insulin resistance in diabetics comprises of a reversible component treatable with intensive glycemic control and a non-reversible component present in pre-diabetes that may lead to the development of overt diabetes. The reversible component is induced and exacerbated by hyperglycemia in both uncontrolled type 1 and type 2 diabetes, a process known as glucose-induced insulin resistance (GIIR) or glucose toxicity. The tribbles homolog 3 (TRIB3) has been identified as a pseudokinase that inhibits Akt activity by physically blocking its phosphorylation site. Expression of TRIB3 has been associated with various signals such as endoplasmic reticulum (ER) stress and nutrient availability in pancreatic …
Development And Testing Of The Primary Care Homeless Organizational Assessment Tool (Pc-Hoat) To Evaluate Primary Care Services For The Homeless, Jocelyn Louise Steward
Development And Testing Of The Primary Care Homeless Organizational Assessment Tool (Pc-Hoat) To Evaluate Primary Care Services For The Homeless, Jocelyn Louise Steward
All ETDs from UAB
The purpose of this dissertation is to develop and test an organizational assessment tool that can used to evaluate primary care services for the homeless. The research evaluates the importance, feasibility, reliability, and validity of organizational processes and structures of primary care services for the homeless. The final product is the validated Primary Care Homeless Organizational Assessment Tool (PC-HOAT). This tool provides stakeholders with information regarding the organizational structures and processes associated with greater quality of primary care for the homeless. This tool will help managers better understand their organization's strengths and weaknesses, guide discussions regarding operations, and provide information …
An Economic Evaluation Of A Peer Support Intervention For Diabetes Self-Management, Caresse Campbell
An Economic Evaluation Of A Peer Support Intervention For Diabetes Self-Management, Caresse Campbell
All ETDs from UAB
Appropriate management of diabetes has the potential to affect not only health outcomes associated with diabetes, but also its economic burden. Peer support has emerged as a promising intervention to improve diabetes self-management, with demonstrated effects on improving clinical outcomes. Whether the health improvements obtained with peer support are worth its implementation cost, has not been established. This dissertation sought to close the gap in the literature by conducting an economic evaluation of a peer support intervention for diabetes self-management. We conducted analyses of secondary data from Encourage, a randomized trial testing a peer advisor intervention conducted in rural Alabama. …
Risk Assessment And Staging Of Cardiometabolic Diseases, Fangjian Guo
Risk Assessment And Staging Of Cardiometabolic Diseases, Fangjian Guo
All ETDs from UAB
Obesity is associated with elevated risk for morbidity and mortality and has become an epidemic both in the United States and around the world. Insulin resistance is essentially involved in the pathogenic process of cardiometabolic diseases in obese people, which involves defects in glucose production by the liver and insulin-stimulated glucose uptake and utilization by peripheral tissues. Insulin resistance appears at an early stage of life and is the first step in the development of cardiometabolic diseases. Long-term insulin resistance will induce metabolic syndrome and prediabetes and eventually will cause type 2 diabetes and cardiovascular diseases. Obesity may exacerbate insulin …
Gut Microbiome And Its Role In Obesity And Aging In C57bl/6j Mice, Yongbin Yang
Gut Microbiome And Its Role In Obesity And Aging In C57bl/6j Mice, Yongbin Yang
All ETDs from UAB
turtles and its’ ecological and evolutionary significance regarding certain aspects of
Freestanding Emergency Departments: Strategic And Policy Implications, Nitish Patidar
Freestanding Emergency Departments: Strategic And Policy Implications, Nitish Patidar
All ETDs from UAB
The dissertation examined the role of Freestanding Emergency Departments (FSEDs) in the current United State health care system. The study collected the primary data on FSEDs in the United States and analyzed the factors associated with the hospitals operating FSEDs and its effect on hospital financial performance. The relationship of presence of FSEDs in the market and Medicare expenditure per person was also studied. The Resource Dependency Theory was used to study the effect of market and organizational factors on the hospital decision to operate an FSED. Panel data from 2002 to 2011 was analyzed using logistic multivariate regression with …
Measuring The Relationship Between Contextual Factors, Nurse Staffing Patterns, And Hospital Performance, Dong Yeong Shin
Measuring The Relationship Between Contextual Factors, Nurse Staffing Patterns, And Hospital Performance, Dong Yeong Shin
All ETDs from UAB
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Insulin Resistance, Lipids, And The Metabolic Syndrome Trait Cluster: Impact Of Race And Very Low Calorie Diet, Veeradej Pisprasert
Insulin Resistance, Lipids, And The Metabolic Syndrome Trait Cluster: Impact Of Race And Very Low Calorie Diet, Veeradej Pisprasert
All ETDs from UAB
Insulin resistance (IR) is central to the pathogenesis of cardiometabolic disorders. Early detection, along with appropriate interventions, is paramount to reduce the morbidity and mortality of IR-related diseases. The gold standard measurement for IR is the hyperinsulinemic-euglycemic clamp, which is markedly sophisticated for clinical evaluation but costly and invasive for clinical practice. Several alternative surrogate indicators of IR have been identified and used by clinicians, including insulin sensitivity indices derived from plasma glucose and insulin values, as well as other indicators that are independent of direct insulin measurements. In addition, lipid panel and lipoprotein subclass profile have emerged as markers …
Hospital Financial Performance: A Look At Governance And Hit Strategies, Taleah Collum
Hospital Financial Performance: A Look At Governance And Hit Strategies, Taleah Collum
All ETDs from UAB
Taken together, the purpose of the three papers included in this dissertation is to provide empirical evidence on the relationship between strategies employed by hospital managers and hospital financial performance. The findings of these studies are important to managers as they search for ways to sustain and improve hospital financial performance in light of environmental changes that have taken place over the last three decades. The results of this dissertation suggest that to improve financial performance hospital leaders (e.g. management, board of directors) should choose strategies that are more amenable to their control. Specifically, having BOD members that are independent …
Understanding The Predictors Of Patient Trust And Its Role In Utilization And Outcomes, Sheikilya Lewis Thomas
Understanding The Predictors Of Patient Trust And Its Role In Utilization And Outcomes, Sheikilya Lewis Thomas
All ETDs from UAB
The purpose of this dissertation is to examine patient-related factors that predict trust in one's physician, and subsequently identify the role of patient trust in health care utilization and clinical outcomes among African Americans with hypertension. Three separate studies are conducted using an adapted version of the Interaction Model for Client Health Behavior (IMCHB). The first paper is a three-step review of quantitative studies investigating the (a) patient characteristics that influence trust; (b) impact of trust on health care utilization; and (c) impact of trust on outcomes. Based on the predictors identified, the second study examines the significance of these …
Hospitalists And Organizational Performance, Josué Patien Epané
Hospitalists And Organizational Performance, Josué Patien Epané
All ETDs from UAB
Two decades ago, a group of hospital-based physicians (hospitalists) specializing in the practice of hospital medicine were introduced in the U.S. health care system. Since then, this group of physicians has experienced an unprecedented growth. Prior studies on hospitalists have focused on benefits associated with the use of hospitalists. Compared to non-hospitalists, these studies revealed that hospitalists are more efficient as they are able to reduce length of stay and costs while achieving similar or better quality of care. However, most of these studies have been cross-sectional, limited to few hospitals, and limited to pediatric and teaching hospitals. Very little …
Impact Of Quality Performance On Financial Risk And Cost Of Capital In Hospitals, James D. Byrd
Impact Of Quality Performance On Financial Risk And Cost Of Capital In Hospitals, James D. Byrd
All ETDs from UAB
This study evaluated the relationship of hospital quality of care as measured by mortality scores to hospital cost of capital as represented by average cost of debt. A composite mortality score (weighted average of Hospital Compare's risk adjusted mortality rate for each hospital) was regressed against the hospitals' average cost of debt using OLS and the Stata 11 robust clustering function to adjust for repeated occurrences of hospitals across years. The data base consisted of acute care hospitals with interest expense observed over the three year period 2008 - 2010 (n=3420). Control variables included a number of hospital characteristic (e.g., …
The Relation Of Hospital Choices In It Infrastructure Spending And Deployment With Hit/Ehr Strategies And Operational Efficiency, Harold Neumeier
The Relation Of Hospital Choices In It Infrastructure Spending And Deployment With Hit/Ehr Strategies And Operational Efficiency, Harold Neumeier
All ETDs from UAB
This study examined certain aspects of the association between information technology (IT) strategy and structure changes within hospitals, as well as the effects of IT infrastructure changes on measures of financial performance for these hospitals during the period of 2009-2011. Following the Process School of the Resource Based View, both internal and external information technology resources were examined to see how hospitals had responded to Federal policies related to the "meaningful use" of Health IT and Electronic Health records. Specifically, this study examined changes in information technology spending by hospitals based on size, hospital type, and percentage of revenue derived …
High-Tech Services And Hospital Performance In The United States, Ferhat Devrim Zengul
High-Tech Services And Hospital Performance In The United States, Ferhat Devrim Zengul
All ETDs from UAB
This dissertation examined the relationship between high-technology medical services and hospital performance by focusing on financial and quality performance dimensions. An initial systematic review disclosed the paucity of research and mixed findings about the technology-performance relationship. The review indicated the need for further analyses by emphasizing some limitations of existing studies. The resource-based view (RBV) of a firm was used as a conceptual framework in examining the relationship between high-tech medical services and hospital financial performance. It was hypothesized that large breadth (number) of high-tech services and the use of rare high-tech services would be positively associated with hospitals' financial …
Soy And Breast Cancer, Mandeep K. Virk-Baker
Soy And Breast Cancer, Mandeep K. Virk-Baker
All ETDs from UAB
The incidence of breast cancer is lower in Asia as compared to Western countries. However, the breast cancer risk among Asian immigrants living in Western countries reaches nearly as high as the Western country, suggesting environmental factors (e.g. diet and lifestyle) may be important for this geographical disparity. One dietary change of Asian immigrants is a reduction in soy consumption. Soy is rich in isoflavones, which compete with estrogen for receptor (ER) binding, and may protect against breast cancer. S-(-)equol, a metabolite of the soy isoflavone daidzein (DZ) has a higher bioavailability and greater affinity for ER than DZ. The …
An Examination Of The Relationship Between The External Environment And Care Coordination, Olena Mazurenko
An Examination Of The Relationship Between The External Environment And Care Coordination, Olena Mazurenko
All ETDs from UAB
This study addressed a gap in the care coordination literature by exploring the factors predictive of care coordination, with particular attention to the external environment. The first paper of this dissertation conducted a systematic review of empirical studies that looked at the predictors of care coordination. Based on the 22 papers that fulfilled the inclusion criteria, the evidence to support the relationships between care coordination and factors that are predictive of care coordination was shown to be weak to moderate depending on the types of factors you look at. This study has revealed a significant inconsistency in how predictors of …
Apolipoprotein E Mimetic Peptide Improves Hdl Functionality And Inhibits Atherosclerosis Progression In Mouse Models Of Atherosclerosis, Gaurav Nayyar
Apolipoprotein E Mimetic Peptide Improves Hdl Functionality And Inhibits Atherosclerosis Progression In Mouse Models Of Atherosclerosis, Gaurav Nayyar
All ETDs from UAB
Despite major advances in diagnosis and treatment, coronary artery disease (CAD) is still the number one cause of morbidity and mortality in United States. An ideal treatment for lipid-mediated inflammatory disorders would not only reduce plasma cholesterol dramatically but also improve high density lipoproteins (HDL) function. Apolipoprotein E (apo E), a protein component of HDL and very low density lipoprotein (VLDL), is necessary for the receptor mediated hepatic uptake of apolipoprotein-B (apo B) containing remnant lipoproteins and also possesses strong anti-inflammatory properties. We hypothesized that a synthetic dual domain apo E mimetic peptide, Ac-hE18A-NH2 (a 28-residue peptide) containing receptor binding …
The Relationship Between Hospitalists And Primary Care Physicians, James Robert Burkhart
The Relationship Between Hospitalists And Primary Care Physicians, James Robert Burkhart
All ETDs from UAB
THE RELATIONSHIP BETWEEN HOSPITALISTS AND PRIMARY CARE PHYSICIANS JAMES R. BURKHART EXECUTIVE DOCTOR OF SCIENCE IN ADMINISTRATION-HEALTH SERVICES ABSTRACT A study of the relationship between primary care physicians (PCPs) and hospitalists was conducted by surveying the Florida Academy of Family Physicians (FAFP) membership to determine whether they had an established relationship with a hospitalist or hospitalist group. The survey responses were then matched with Blue Cross and Blue Shield of Florida (BCBSF) administrative claims data to provide two groupings of study respondents with data regarding patients' average length-of-stay, average 30 day readmission rate, and average hospital claims payment. The survey …
Career Satisfaction Of Physicians Employed By Health Systems, Edward L. Heath
Career Satisfaction Of Physicians Employed By Health Systems, Edward L. Heath
All ETDs from UAB
CAREER SATISFACTION OF PHYSICIANS EMPLOYED BY HEALTH SYSTEMS EDWARD L HEATH, JR ADMINISTRATION-HEALTH SERVICES ABSTRACT Background:Higher career satisfaction has been shown to result in better patient outcomes, higher patient satisfaction and less turnover among physicians. The purpose of this study is to examine the relationship between physician employment and career satisfaction. Methods:Data from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey was used in the study. The study is a cross sectional, quantitative study of the relationship between physician employment and career satisfaction. A total of 4,720 respondents responded to the survey, with a weighted …
Are Enabling Services In Federally Qualified Health Centers Associated With Women Receiving Prenatal Care In The First Trimester?, Forrest A. Daniels
Are Enabling Services In Federally Qualified Health Centers Associated With Women Receiving Prenatal Care In The First Trimester?, Forrest A. Daniels
All ETDs from UAB
The purpose of this study was to examine whether enabling services in federally qualified health centers (FQHCs) were associated with women receiving prenatal care services in the first trimester. The population for this study included FQHCs providing prenatal care services for the years 2008, 2009, and 2010. Data for this study were derived from two sources: Uniform Data System (UDS) and the Area Resource File (ARF). This study adopted the Andersen's (1973) Behavioral Model of Health Services Use. The study consisted of longitudinal panel data analysis. Univariate and bivariate statistics were calculated using PASW/SPSS statistical software, version 18. For the …
Influences Of Habitual Diet, Ethnicity, And Age On Circulating Total Ghrelin, Amy Ellis
Influences Of Habitual Diet, Ethnicity, And Age On Circulating Total Ghrelin, Amy Ellis
All ETDs from UAB
Ghrelin is a hormone known to stimulate appetite and food intake. Although certain macronutrients differentially suppress ghrelin on an acute basis, it is unknown whether habitual macronutrient intake affects circulating ghrelin. Thus, the first experimental aim was to determine whether 8-week habituation to diets differing in carbohydrate or fat would affect fasting ghrelin or ghrelin response to a mixed meal. Recent reports also suggest that ghrelin regulation may relate to propensity for obesity. Obesity is more prevalent among AA compared to EA, with the highest rates among AA females. This disparity becomes apparent before puberty, and childhood obesity tends to …