Medicine and Health Sciences Commons^™

Merging Cultures: Organizational Behavior, Leadership, And Differentiation In A Health System Merger, Colin G. Chesley

Electronic Theses and Dissertations

Health system mergers and acquisitions (M&As) have increased exponentially in recent years as a result of the Affordable Care Act (Brown, Werling, Walker, Burgdorfer & Shields, 2012). M&As are consummated as a way to control for interdependencies within the market, control costs and leverage debt, and negotiate better rates among health insurers (Bolman & Deal, 2013; Cooper & Finkelstein, 2010; Mirc, 2013). Regardless of the impetus for a merger, the largest predictor of the success or failure of a M&A lies within the organizational culture (Brown, et al., 2012; Cooper & Finkelstein, 2010; Kastor, 2010; Ovseiko, Melham, Fowler & Buchan, …

Role Of Tlrs, Hippo-Yap1 Signaling, And Micrornas In Cardiac Repair And Regeneration Of Damaged Myocardium During Ischemic Injury, Xiaohui Wang

Electronic Theses and Dissertations

Cardiovascular disease is a leading cause of death in the United States. Toll-like receptor (TLR)-mediated pathways have been demonstrated to play a role in myocardial ischemia/reperfusion (I/R) injury. We and others have shown that PI3K/Akt signaling is involved in regulating cellular survival and protecting the myocardium from I/R induced injury. In this dissertation, we provide compelling evidence that miR-125b serves to “fine tune” TLR mediated NF-kB responses by repressing TNF-a and TRAF6 expression. We constructed lentiviral expressing miR-125b, delivered it into the myocardium. The data showed that delivery of lentivirus expressing miR-125b significantly reduces myocardial infarct size and improves cardiac …

Evaluating Effective Communication Methods: Improving Internal Communication, Amber L. Suthers

Electronic Theses and Dissertations

Relaying information from a Chief Communications Officer (CIO), or centralized communications departments to hospital employees is not always efficient or effective. Employees may not be informed of important changes to department protocols or hospital policies. The purpose of the study was to determine the most efficient and effective forms of internal communications in the hospital setting.

A total of 83 surveys were mailed to communication officers working in Tennessee hospitals in and east of Nashville. Sixteen communication officers responded. This low response rate may be attributed to poor designation of communication responsibilities and an abdication of responsibilities to an off …

Sphingolipids In Models Of Kidney Disease And Injury., Tess V. Dupre

Electronic Theses and Dissertations

Acute kidney injury (AKI), resulting from cisplatin, remains an obstacle in the treatment of cancer. Cisplatin-induced AKI involves cell death pathways regulated by sphingolipids such as ceramide and glucosylceramide. Results indicate that cisplatin-treated mice had increased levels of ceramide and hexosylceramide. Pre-treatment of mice with inhibitors of ceramide synthesis prevented accumulation of ceramide and hexosylceramide in the renal cortex and attenuated cisplatin-induced AKI. To determine the role of ceramide metabolism to hexosylceramides in kidney injury, we treated mice with an inhibitor of glycosphingolipid synthesis. Inhibition of glycosphingolipid synthesis attenuated the accumulation of the hexosylceramide and exacerbated ceramide accumulation in the …

Effects Of Lactobacillus Rhamnosus Mrs6an On Intestinal Gpat3 Pathway Involved In The Lipid Transport In Enterocytes, Ayodeji Oludare Ipinmoroti

Electronic Theses and Dissertations

Accumulation of triglyceride (TG) in enterocytes of the small intestine follows two specific absorption pathways: the monoacylglycerol acyltransferase pathway (MGAT) and glycerol acyltransferase pathway (GPAT), the latter (GPAT) is usually found in the small intestine. In this study, we investigated the effects of Lactobacillus rhamnosus MRS6AN, an isolate from “amabere amaruranu” a Kenyan traditional cultured milk, on triglyceride accumulation and expression of GPAT3, I-FABP, MTP and NPC1L1 in Caco-2 cell enterocyte model. Intracellular triglyceride level (TG) of Caco2 cells was significantly reduced by live L. rhamnosus (LB) compared with other bacterial products. MTP expression in Caco2 cells was minimally reduced …

Outcomes Of An Integrated Approach To Speed And Strength Training With An Elite-Level Sprinter, Eric D. Magrum

Electronic Theses and Dissertations

The purpose of this study was to observe changes in sprint velocity, ground contact time, and peak force demonstrated by a competitive sprinter following an integrated approach to speed development and strength training. As part of an ongoing monitoring procedure the participant completed 20m sprint testing through an optical measurement system and isometric-strength testing before and after each phase of training. Sprint velocity, ground contact time and peak force were analysed using Tau-U, smallest worthwhile and percent change statistics. Results indicate sprinting velocity statistically improved while changes in peak force were practically significant and ground contact time remained trivial throughout …

Relationships Of Weight-Related Dissatisfaction, Body Image Flexibility, And Coping In Women, Pooja Shah

Electronic Theses and Dissertations

Purpose: The present study examined the relationships between body image flexibility, body image dissatisfaction, body image evaluation, and specific coping factors based on the WEIGHTCOPE measure. Body image flexibility was also examined as a mediator of the relationship between body image dissatisfaction and weight-related coping factors in women. Methods: An online link of the survey (Qualtrics Research Software Program) was distributed through social media and word of mouth to women of all body shapes and sizes (N= 267). The survey included the BICS as a measure of body image dissatisfaction, the MBSR (AE) as a measure of body …

The Regulation Of Rotavirus–Infected Ht29.F8 And Ma104 Cells Treated With Arachidin 1 Or Arachidin 3, Caleb M. Witcher

Electronic Theses and Dissertations

Rotavirus (RV) infections cause severe life threatening diarrhea in young children and immunocompromised individuals. Several effective vaccines have been developed for young children but are not protective against all strains of RV, and there are no anti-RV therapeutics. Our laboratory has discovered a decrease in the number of infectious simian RV particles (SA114f) in human intestinal cell line, HT29.f8 cells with the addition of either of two stilbenoids, arachidin-1 (A1) or arachidin-3 (A3). This suggests effects on the host cell and RV replication. We examined the cellular effects of human RV strain (Wa) on a human intestinal cell line (HT29.f8) …

Therapy Dogs And The Impact On Employees In The Pediatric Medical Setting, Laine Foith

Electronic Theses and Dissertations

More than 40% of nurses reported experiencing significant burnout. Burnout is characterized by disengagement, cynicism, negative views of personal accomplishment and ability, and emotional exhaustion. The healthcare providers that experience burnout can possibly expect a decrease in ability to recognize/report errors, increase of negative feelings toward the patient, and decrease levels of patient satisfaction (Ernest, 2014). One of the ways Schub (2015) suggested to regulate burnout for employees was to provide psychosocial support to colleagues to reduce stress. This study is one of the first attempts to bridge the gap between the unknown correlation between qualitative and quantitative benefits of …

Case Study: Healthy Texas Women Program In The Abilene-Taylor County Public Health District, Saul Francisco Delgado

Electronic Theses and Dissertations

The public healthcare system faces continuous transformations and challenges of constant adjustments to the increasing usage of fee for service revenue and the decrease of federal investment to women’s healthcare services and to the safety net healthcare providers (Meit, 2013; Weisman, 1997).

In 2016, the Texas 84^th Legislation Session determined to consolidate two existing women’s healthcare service programs into one a single program: the Healthy Texas Women (HTW) program. The new women’s program is a preventative care program that provides services of family planning and chronic illness care under a complete fee for service reimbursement system as its sourse …

The Effect Of Anxiety And Depression On College Students’ Academic Performance: Exploring Social Support As A Moderator, Katherine H. Bisson

Electronic Theses and Dissertations

The purpose of this study is to explore how social support is related to the overall well-being of college students. Literature suggests social support buffers a negative effect of distress on academic performance. This study attempts to provide practical information for a program called Student Opportunities, Advocacy, and Resources (SOAR) at Abilene Christian University (ACU), which assists students and connects them to resources available to support their path to success. A multiple linear regression was conducted to examine the association between anxiety, depression, social support, and academic performance using a sample of 93 students enrolled in this program in Fall …

Reducing Tobacco-Related Health Disparities : Exploring The Barriers And Facilitators To Smoking Cessation Among Individuals Experiencing Homelessness., Bernadette Guzman Antoon

Electronic Theses and Dissertations

Although the prevalence of smoking has declined in the U.S., vulnerable populations continue to suffer from tobacco-related health disparities. An estimated 68.0-80.0% of homeless adults are current cigarette smokers compared to 15.1% in the general population. The large gap in smoking rates suggests that current tobacco cessation programs designed to reduce smoking have little impact among individuals experiencing homelessness. The purpose of this study was to explore the barriers and facilitators to smoking cessation among the homeless. The second aim of this study was to explore if the barriers and facilitators to tobacco cessation differed among male smokers experiencing homelessness …

Trunk And Respiratory Motor Control In Typically Developing Children And Its Implications In Children With Chronic Spinal Cord Injury., Goutam Singh

Electronic Theses and Dissertations

Independent sitting is a major milestone and is also a prerequisite for optimal performance of activities of daily living (ADLs). Development of sitting posture control is a dynamic process involving control of degrees of freedom of head and trunk. Traditionally, trunk has been modeled as a single unit (segment). However, recent studies have suggested that it is made up multiple spinal units, controlled by a combination of trunk muscles. During typical development, posture control of trunk is different for different trunk segments. This motor development of trunk control is a complex process due to constant interaction between the nervous system …

Prenatal Depression Screening Among A Diverse Healthy Start Population., Evangeline Pierce

Electronic Theses and Dissertations

Prenatal depression has been associated with adverse outcomes for both pregnant women and infants. Data was studied from Healthy Start (n=1093). Healthy Start participants were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Data reported included birthweight, gestational length, ethnicity, and sociodemographic variables. No statistically significant association was found between a positive EPDS screen and birthweight-low/normal (OR 1.02 [95% CI 0.53, 1.70]), birthweight-abnormal (OR 1.02 [95% CI 0.53, 1.70], or gestation-preterm/term (OR 1.29 [95% CI 0.68, 2.45]). An association was observed between a positive screen and race, ethnicity by region of origin, immigrant status, English as …

Spontaneous Vocal Matching In Mothers And Their Hearing Impaired Infants With Cochlear Implants : A Quantitative Analysis., Lydia Doggett

Electronic Theses and Dissertations

Vocal matching, the ability to imitate phonetic properties of speech, was examined in spontaneous interactions of sixteen dyads of mothers and their hearing-impaired (HI) infants with cochlear implants and age-matched normal-hearing (NH) infants. Mother-infant dyads came to three sessions at three, six, and 12 months post-implantation. Vocal matching was defined as an instance of perceptual and acoustic similarity of vowels and consonants between adjacent maternal and infant utterances. Vocal matching occurred in 25% to 50% of infant and in 17% to 64% of mother vocalizations across dyads. Both mothers and infants in the HI group produced fewer matches as compared …

The Particulars About Particulates : Metal Exposure And Self-Regulation Of Children Living Near Coal Ash., Clara G. Sears

Electronic Theses and Dissertations

The use of coal combustion for electricity and the storage of coal combustion by-products known as coal ash occur across the United States and around the world. The most abundant type of coal ash, fly ash, contains small particles with metals, some of which are known neurotoxins. Fly ash is currently stored in open-air landfills and surface impoundments that allow fugitive dust to escape into surrounding communities, potentially exposing children to small neurotoxic particles. This dissertation uses preliminary data from a larger cross-sectional study to investigate the relationship between particulate matter exposure, metal exposure, and problems with self-regulation. Recruitment of …

Inhibition Of Chemotherapeutic-Induced Apoptosis In Esophageal Squamous Cancer Cells By The Keystone Periodontal Pathogen, Porphyromonas Gingivalis., Atul Kumar Agrawal

Electronic Theses and Dissertations

Recent evidence has shown that P. gingivalis, a Gram-negative, anaerobic oral bacterium, is negatively associated with the presence and outcome of esophageal squamous cell carcinoma (ESCC). While potential underlying mechanisms are yet to be established, P. gingivalis infection is known to inhibit apoptosis in gingival epithelial cells. Therefore, we hypothesized that P. gingivalis may also inhibit of the induction of apoptosis in human ESCC cells exposed to the commonly employed anti-ESCC chemotherapeutic agent, cisplatin. The capacity of P. gingivalis, at variant multiplicities of infection, to suppress cisplatin-induced necrosis and apoptosis in EC9706 ESCC cells was established by lactate …

Combating Malignant Melanoma With The Multifaceted Soy-Dervied Peptide Lunasin., Christopher Paul Shidal

Electronic Theses and Dissertations

Lunasin is a 44 amino acid peptide that has been shown to have cancer chemopreventative and chemotherapeutic properties. This study investigated the potential utility of Lunasin as a chemotherapeutic in melanomas. Studies showed that Lunasin had little activity against established melanoma cell lines using adherent culture methods; however, Lunasin’s in vitro activity was significantly higher in non-adherent colony-forming assays and oncosphere formation. These results led to the investigation of whether or not Lunasin has selective effects on cancer initiating cells (CIC) that are known to be present in melanomas. It was revealed that Lunasin selectively inhibited the proliferation of high-ALDH …

Spinal Cord Injury Induced Cardiac Decline And The Limitations Of Exercise., Kathryn Michele Deveau

Electronic Theses and Dissertations

There is a general consensus that the level and the severity of spinal cord injury (SCI) impacts chronic cardiac abnormalities such that high thoracic and cervical SCI are the most severely affected. Furthermore, the extreme degree of immobility/inactivity experienced by the persons with SCI has implications on cardiac decline. Yet it has been difficult to separate the relative contributions of the decentralized autonomic nervous system (ANS) and the immediate and profound inactivity to chronic cardiac abnormalities. As such, this body of work sought to characterize a contusion SCI that results in persistent CV dysfunction. Echocardiography, Dobutamine stress echocardiography and pressure …

Expression Of Zeb Factors In Oral Squamous Cell Carcinoma., Saira Ahmed

Electronic Theses and Dissertations

Objectives: The ZEB family of transcription factors (ZEB1 and ZEB2) have been demonstrated to play a role in metastatic progression of several cancers, and may also influence the initial transformation and generation of cancer stem cells. However, the expression pattern of ZEB proteins in the development of oral squamous cell carcinoma has not been investigated. The purpose of this study was to define changes in expression and subcellular localization of the ZEB family in both precancerous lesions and different grades of OSCC. Materials and Methods: Seventy-nine tongue biopsies were subjected to immunohistochemistry and immunofluorescence to determine the expression and subcellular …

Characterization Of A Mutant Oncolytic Adenovirus And The Role Of Jnk In Enhancing Virotherapy., Stephen L. Wechman

Electronic Theses and Dissertations

Oncolytic adenoviruses (Ads) have great therapeutic potential for lung cancer treatment. Cancer selective E1b-deleted Ads are safe; however, their clinical cancer therapeutic efficacy remains limited. The limited efficacy of Ad virotherapy is due to many factors including inefficient cancer cell lysis, Ad release and spread. Progress in overcoming these barriers to Ad virotherapy are hampered by limited knowledge of the genes associated with enhanced Ad release and spread and the dearth of understanding of the mechanisms by which E1b-deleted Ads cause cancer cell lysis. The role of c-JNK n- terminal kinase (JNK) phosphorylation in this process remains unknown. …

The Interaction Of Homoserine Lactones And Paraoxonase 2 Modulates Cell Death Signaling And Cell Proliferation., Aaron Mackallan Neely

Electronic Theses and Dissertations

Pseudomonas aeruginosa produces N-(3-oxododecanoyl)-homoserine lactone (C12) as a quorum-sensing molecule that functions to facilitate bacteria-bacteria communication. C12 has also been reported to affect many aspects of human host cell physiology, including evoking cell death in various types of cells. However, the signaling pathway(s) leading to C12-triggerred cell death remains unclear. To clarify cell death signaling induced by C12, we examined mouse embryonic fibroblasts (MEFs) deficient in one or more caspases. Our data indicate that, unlike most apoptotic inducers, C12 evokes a novel form of apoptosis in cells, probably through the direct induction of mitochondrial membrane permeabilization. Importantly, C12 induces apoptosis …

Using An Audience Response System To Calibrate Dental Faculty Assessing Student Clinical Competence., Sean A. Aiken

Electronic Theses and Dissertations

In order to best prepare students to become competent and confident practitioners in a clinical environment upon graduating dental school, it is imperative for them to receive consistent and productive feedback from the supervising faculty. Through academic engagement, and more specifically faculty calibration, it may be possible to eliminate the disconnect that sometimes exists between faculty expectations and terminology, and those of the students. In terms of definitions, academic engagement reflects faculty scholarly development activities that support integration of relevant, current theory of best practices consistent with the school's mission, expected learner outcomes, and supporting strategies.1-6, 32 The difficulty lies …

Exploring A Novel Nf-ĸb- Inhibiting Nanoparticle For Periodontitis Therapy., Kameswara Satya Srikanth Upadhyayula

Electronic Theses and Dissertations

Periodontitis is an infection-driven inflammatory disease characterized by gingival inflammation and bone loss. The NF-ĸB signaling pathway is pivotal in osteoclastogenesis and infection-induced pro-inflammatory responses. The use of nanoparticles as a vehicle to deliver drug increases stability, loading capacity, and facilitates transmembrane transportation. The hypothesis was that a novel nanoparticle carrying therapeutic NBD inhibitory peptides (NBD-nanoparticles) will inhibit measures of periodontal disease. In this project, we tested the nanoparticles for their ability to directly inhibit osteoclastogenesis and inflammation as an original strategy for periodontitis therapy. We also tested the capability of the nanoparticles to inhibit gingival inflammation and alveolar bone …

The Effects Of Moderate Alcohol Consumption And Inflammation On The Hepatic Matrisome And The Renal Cortex Proteome., Christine E. Dolin

Electronic Theses and Dissertations

Background. The association of chronic ethanol (EtOH) consumption with extracellular matrix (ECM) changes in alcoholic liver disease (ALD) is well established in the context of hepatic fibrosis. However, it is becoming increasingly understood that the hepatic ECM responds dynamically to stress well before fibrosis. The term “transitional tissue remodeling” describes qualitative and quantitative ECM changes in response to injury that do not alter the overall architecture of the organ; these ECM changes may contribute to early disease initiation and/or progression. The nature and magnitude of these changes to the ECM are currently poorly understood. In contrast to the liver, EtOH …

Neural Coding Of Natural And Synthetic Speech., Allison Brown

Electronic Theses and Dissertations

The present study examined whether natural and synthetic speech are differentially encoded in the auditory cortex. Auditory event-related potential (ERP) waveforms were elicited by natural and synthetic fricative-vowel stimuli (/sɑ/ and /ʃɑ/) in a passive listening paradigm in adult listeners with normal hearing. ERP response components were compared across conditions. The results indicated that peak latencies to natural speech were significantly earlier than those to synthetic speech. Natural speech also produced significant electrode hemisphere site effects, whereas synthetic speech activated left, midline, and right electrode hemisphere sites equally. Overall, the results suggest that cortical processing of natural and synthetic speech …

Evaluating The Impact Of Statewide Policy Implementation On Interorganizational Collaboration At The Regional Level : An Application Of Network Analysis., Nida Moez Ali

Electronic Theses and Dissertations

One challenge to improving population health in the United States is that the systems tasked with the responsibility of providing services across the continuum of care often operate in silos, missing opportunities to provide quality, coordinated care. In 2011, Texas received approval from the Centers for Medicare and Medicaid Services (CMS) for a five-year 1115(a) Medicaid Waiver Demonstration Project. This dissertation focuses on one element of the Waiver, the Delivery System Reform Incentive Payment (DSRIP) Program, which was designed to incentivize activities that support organizations’ collaborative efforts with other organizations in addressing the Triple Aim strategies. DSRIP was implemented through …

Withaferin A Synergistically Enhances The Effects Of Paclitaxel Against Lung Cancer., Al Hassan Kyakulaga

Electronic Theses and Dissertations

Lung cancer is the leading cause of cancer-related deaths among both men and women in the U.S and worldwide. Today, paclitaxel (PAC) or taxol alongside platinum-based drugs is the most widely used agent as the first-line regimen for advanced NSCLC. However, due to toxicity, drug resistance, solubility and efficacy issues, efficacy has plateaued. In the present study, the potential of a novel plant-derived steroidal-lactone, withaferin A (WFA), for clinical use alongside PAC to improve efficacy against NSCLC was explored. The anticancer effects of PAC and WFA alone, and in combination against the in vitro cell proliferation, cell adhesion, migration and …

Diffusion-Weighted Magnetic Resonance Imaging In Diagnosing Graft Dysfunction : A Non-Invasive Alternative To Renal Biopsy., Elizabeth Marie Hollis

Electronic Theses and Dissertations

The thesis is divided into three parts. The first part focuses on background information including how the kidney functions, diseases, and available kidney disease treatment strategies. In addition, the thesis provides information on imaging instruments and how they can be used to diagnose renal graft dysfunction. The second part focuses on elucidating the parameters linked with highly accurate diagnosis of rejection. Four parameters categories were tested: clinical biomarkers alone, individual mean apparent diffusion coefficient (ADC) at 11-different b- values, mean ADCs of certain groups of b-value, and fusion of clinical biomarkers and all b-values. The most accurate model was found …

The Association Between Motor Proficiency, Cognitive Tempo, Academic Skills, Balance And Visual Efficiency In Elementary School Aged Children., Franklin R. Muntis

Electronic Theses and Dissertations

The purpose of this study was to investigate the association between motor proficiency, cognitive tempo, academic skills, balance and visual efficiency in elementary school aged children at a local Spanish immersion school. Forty-nine students and their parents provided consent to participate in the study. Motor proficiency was measured using the Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2), cognitive tempo and academic skills were assessed using the Child and Adolescent Behavior Inventory, Visual Efficiency was measured using Visual Efficiency Rating (VERA) and Balance was measured using a Neurocom^® platform function for stability evaluation test to determine limits of stability. …