Uintah Basin Applied Technology College

Due to methodological limitations, past meta-analytic research was not able to identify which treatment was most effective for specific marital distress levels. By converting pre-and post-test scores from marital research into equivalent Dyadic Adjustment Scale scores, it was possible to isolate mild, moderate, and severe levels of marital distress. Results show that Emotionally Focused Therapy is significantly more effective than isolated Behavioral Marital Therapy interventions for the treatment of moderate marital distress. Future directions of outcome research are also discussed.

A random sample of 176 patients seen at least once during 1997 in a University hospital outpatient clinic serving rheumatology and geriatric patients were surveyed in a telephone interview to determine the prevalence of, and reasons for taking, alternative medications. Interviews were conducted from November 1997-March 1998. The survey elicited information about patients' ability to provide self-care, demographics, work status, satisfaction with current disease management, types of alternative medications taken, sources of information about the products, where they obtained the products, and reasons for taking the products. Patients also were questioned as to their knowledge of safety of these products. Statistical comparisons were determined between patients who used alternative agents and those who did not. Prevalence of use was 66%. Most patients thought that the agents were safe and took them because they believed they have "added benefits."

Abstract Adaptive evolution in response to one selective challenge may disrupt other important aspects of performance. Such evolutionary trade-offs are predicted to arise in the process of local adaptation, but it is unclear if these phenotypic compromises result from the antagonistic effects of simple amino acid substitutions. We tested for trade-offs associated with beneficial mutations that confer tetrodotoxin (TTX) resistance in the voltage-gated sodium channel (NaV1.4) in skeletal muscle of the common garter snake (Thamnophis sirtalis). Separate lineages in California and the Pacific Northwest independently evolved TTX-resistant changes to the pore of NaV1.4 as a result of arms race coevolution with toxic prey, newts of the genus Taricha. Snakes from the California lineage that were homozygous for an allele known to confer large increases in toxin resistance (NaV1.4LVNV) had significantly reduced crawl speed compared to individuals with the ancestral TTX-sensitive channel. Heterologous expression of native snake NaV1.4 proteins demonstrated that the same NaV1.4LVNV allele confers a dramatic increase in TTX resistance and a correlated decrease in overall channel excitability. Our results suggest the same mutations that accumulate during arms race coevolution and beneficially interfere with toxin-binding also cause changes in electrophysiological function of the channel that may affect organismal performance. This trade-off was only evident in the predator lineage where coevolution has led to the most extreme resistance phenotype, determined by four critical amino acid substitutions. If these biophysical changes also translate to a fitness cost—for example, through the inability of T. sirtalis to quickly escape predators—then pleiotropy at this single locus could contribute to observed variation in levels of TTX resistance across the mosaic landscape of coevolution.

INTRODUCTION: The elderly population has proven to be vulnerable in times of a disaster. Many have chronic medical problems for which they depend on medications or medical equipment. Some older adults are dependent on caregivers for managing their activities of daily living (ADLs), such as dressing, and their instrumental activities of daily living (IADLs), such as transportation. Problem A coordinated effort for disaster preparation in the elderly population is paramount. This study assessed the potential needs and plans of older adults in the face of a local disaster. METHODS: The setting was a community-based, university-affiliated, urban emergency department (ED) that sees more than 77,000 adult patients per year. A survey on disaster plans and resources needed if evacuated was distributed to 100 community-residing ED patients and visitors aged 65 years and older from January through July 2013. Means and proportions are reported with 95% confidence intervals (CIs). RESULTS: Data were collected from 13 visitors and 87 patients. The mean age was 76 years, and 54% were female. Thirty-one responded that they had a disaster plan in place (31/100; CI, 22.4-41.4%). Of those 31, 94% (29/31; CI, 78.6-99.2%) had food and water as part of their plan, 62% (19/29; CI, 42.2-78.2%) had a supply of medication, and 35% (12/31; CI, 21.8-57.8%) had an evacuation plan. When asked what supplies the 100 subjects might need if evacuated, 33% (CI, 23.9-43.1%) needed a walker, 15% (CI, 8.6-23.5%) needed a wheelchair, 78% (CI, 68.6-85.7%) needed glasses, 17% (CI, 10.2-25.8%) needed a hearing aid, 16% (CI, 9.4-24.7%) needed a glucometer, 93% (CI, 86.1-97.1%) needed medication, 14% (CI, 7.8-22.4%) needed oxygen, 23% (CI, 15.2-32.5%) needed adult diapers, and 21% (CI, 13.2-30.3%) had medical equipment that required electricity. Many of the subjects also required help with one or more of their ADLS, the most common being dressing (17%; CI, 10.3-26.1%), or their IADLS, the most common being transportation (39%; CI, 29.7-49.7%). Only 42% (CI, 32.3-52.7%) were interested in learning more about disaster preparation. CONCLUSION: Only a minority of the older adults in the study population had a disaster plan in place. Most of the respondents would require medications, and many would require medical supplies if evacuated.

This paper discusses algebraic and topological conditions that are consequences of a convergence group action.

BACKGROUND: Therapeutic modalities (TM) are used by sports physical therapists (SPT) but how they are used is unknown. PURPOSE: To identify the current clinical use patterns for cryotherapy among SPT. STUDY DESIGN: Cross-sectional survey. METHODS: All members (7283) of the Sports Physical Therapy Section of the APTA were recruited. A scenario-based survey using pre-participation management of an acute or sub-acute ankle sprain was developed. A Select Survey link was distributed via email to participants. Respondents selected a treatment approach based upon options provided. Follow-up questions were asked. The survey was available for two weeks with a follow-up email sent after one week. Question answers were the main outcome measures. RESULTS: Reliability: Cronbach's alpha=>0.9. The SPT response rate = 6.9% (503); responses came from 48 states. Survey results indicated great variability in respondents' approaches to the treatment of an acute and sub-acute ankle sprain. CONCLUSIONS AND CLINICAL RELEVANCE: SPT applied cryotherapy with great variability and not always in accordance to the limited research on the TM. Continuing education, application of current research, and additional outcomes based research needs to remain a focus for clinicians. LEVEL OF EVIDENCE: 3.

Geology of the

To the Editor: —I read with interest the recent article by Murff and Kannry on physician satisfaction with computerized order entry systems.1 In brief, house staff were fairly satisfied with one system, and displeased with another. The authors conclude that user satisfaction is an important marker for the usability of any system, and that not all order entry systems are created equal. They further stress that only well-received, high-quality order entry systems should be implemented. When I was a resident in 1990, our tertiary-care teaching hospital in Calgary, Canada, installed a commercially available patient information system, complete with physician order entry. The institution's official name for the system was OSCAR (Online System for Communication and Records), but it soon became known as FRED (Friggin' Ridiculous …

The paper summarizes the experience of a 4-year research project conducted in a large Health Maintenance Organization. Obstacles and solutions related to doing research in this type of system are presented. Suggestions for those seeking to conduct research programs in similar settings are provided.

Joyce Ward, BSN, RNBC, is Clinical Supervisor, Home Health, Uintah Basin Medical Center, Roosevelt, UT. Address for correspondence: Joyce Ward, BSN, RNBC, Certified OASIS, Clinical Supervisor, Home Health, Uintah Basin Home Health Agency, 26 West 200 North (78–15) Roosevelt, UT 84066.

The northeastern Utah Telelearning Project began in 1985. A cooperative effort by the Northeastern Utah Educational Service Center, local school districts, and the Area Vocational Center pooled their resources and talents to identify alternative delivery methods for providing education to rural schools separated by geography and economic resources. Computers, telephones, dedicated phone lines, simplex and duplex microwave, and UHF television were used to provide classes to six area schools. These communication tools were shown to be effective methods of delivery when traditional means were no longer available. The planning, implementation, and operation of the telelearning system are examined.

Literacy teacher educators play a pivotal role in developing future PreK-12 classroom teachers for the task of literacy leadership. However, little is known about literacy teacher educators and how they engage as literacy leaders. In the current study, we retrieved data from 132 literacy teacher educators and analyzed it descriptively using teacher educator identify as a theoretical lens. Findings revealed 15 different literacy leadership practices that represented five distinct groups. Among these groups, respondents demonstrated high and low levels of engagement with literacy leadership practices that pointed to important implications for administrators of teacher education programs.

The well-known Hasse-Brauer-Noether theorem states that a simple algebra with center a number field k splits over k (i.e., is a full matrix algebra) if and only if it splits over the completion of k at every rank one valuation of k. It is natural to ask whether this principle can be extended to a broader class of fields. In particular, we prove here the following extension.

Bu çalışmada 1603-1622 tarihleri arasında Hassa Baş Mimarı olarak görev yapan Sedefkâr Mehmet Ağa'nın Edirne'de yaptığı eserler ile bu eserler arasında önemli bir yer tutan Defterdar Ekmekçioğlu Ahmet Paşa'nın yaptırdığı yapılar mimari form ve işçiliklerinde görülen devirsel yenilemeleri ele alınarak irdelenmektedir.

Which is more innovative: the decentralized, diversified corporation or the smaller, more narrowly focused entrepreneurial firm? The finance literature argues that larger, diversified firms have a natural innovation advantage, as their operating units have access to an internal capital market. In contrast, the strategy and entrepreneurship literatures argue that managers of large, decentralized firms suffer from “managerial myopia” which prevents them from investing in projects with long-term, uncertain payoffs. This paper takes a fresh look at the relationship between innovation and diversification using a comprehensive sample of diversified and non-diversified firms along with a novel analytical approach that enables us to tease out the mechanisms influencing the relationship between diversification and innovation. Consistent with the conceptual and empirical work in strategy, we find a robust negative correlation with diversification strategy and research and development intensity, and we also find support for the hypothesis that diversification reduces innovation by discouraging investment. However, our analysis suggests that internal capital market inefficiencies, rather than managerial myopia, is responsible for this negative relationship.

Cutaneous angiosarcomas (CASs) are aggressive malignancies with a poor prognosis. Although rare, most cases are seen 1) on the head and neck of elderly men, 2) in irradiated skin after therapy for breast carcinoma, and 3) in the setting of long-standing lymphedema (Stewart-Treves syndrome). Only 5 cases of cutaneous external genital CAS have been reported, usually in the setting of pelvic radiation for gynecologic malignancies.1 Here, we describe a case of rapidly progressive and fatal inguinal epithelioid CAS with visceral involvement.

Words – the symbolic language used to communicate – are portrayed by social scientists as at the same time powerful and powerless in affecting social change. The question is, however, not whether words are powerful – it is not clear if these theories can be reconciled – but when they are powerful and towards what consequence. This panel symposium facilitates a multi-diciplinary dialogue on the topic, by bringing four eminent scholars from sociology, psychology, economics and communication studies to reflect on their fields' insights and engage in dialogue.

The medical specialty of public health deals with making recommendations and creating legislation that benefit entire populations. This discipline has a proud record of major achievements, such as ensuring safe drinking water, childhood immunizations and seat-belt laws. Several major challenges

Following the global economic crisis of 2008 which ushered in a period of high unemployment, the job search plight of university graduates has received much attention both in the scholarly community and the popular press. Despite the increased attention given to job search as an area of scholarly interest, there is a paucity of in-depth longitudinal qualitative studies examining the experiences of graduate jobseekers as they unfold over time. Through the analysis of interview data from 29 Human Resource Management (HRM) graduates we explored how their search experiences evolved over a three-month period. The unique contribution of this study is that it represents a move toward a more robust understanding of the job search experience. It also adds paradigmatic diversity to our understanding of graduates’ job search experiences by using a qualitative methodology. In addition, by allowing interviewees to talk about their experiences ‘in their own words’, it provides, what Denzin (2001) calls “thick description”, not only of the job search experience itself, but also of the context in which job searching takes place, and the behaviours associated with job searching.

Background:Opioid related deaths are rapidly increasing and are a national focus1. Uintah Basin Medical Center is a 49-bed hospital located in eastern Utah. Following 3 unplanned home deaths in patients taking opioids as prescribed post-operatively who had undergone Ear, Nose and Throat (ENT) procedures, we piloted an initial study of a home monitoring protocol to earlier identify and intervene with pts most at risk for opioid induced respiratory depression (OIRD). This is our second study. Methods:From July 2017-June 2018, all pediatric and adult ENT post-op pts prescribed opiates were discharged with a Masimo RAD 8 or Masimo Rad 97 monitor for 7 days. Data was recorded during sleep/naps and analyzed after device return. Pts were educated on risks of opioid use, the relation between OIRD and falling blood oxygen levels. They were instructed to call/come to the hospital if oxygen saturation (SpO2) alarmed and read < 85%. Conclusions:It was our impression that using the Masimo technology would diminish false alerting since it differentiates between artifact and actual out-of-range alerting. Our collaborating hospital is conducting a side-by-side study comparing SpO2 and end-tidal carbon dioxide in home monitoring of pts. With 210 (98%) of the patients studied being opioid naive, we agree with guidelines from the CDC which recommends short-acting opioids rather than long-acting or extended release opioids for the treatment for acute pain in opioid naïve patients. Other factors such as age, gender, hepatic/renal impairment, comorbidities, polypharmacology and drug metabolism should also be considered. We have identified the need for more education to ED staff regarding protocol compliance and recognize that relying on patients/caregivers to identify and respond to out of range parameters is not ideal. We are considering remote monitoring in the home via Telemedicine for our higher risk pts. It is our impression that opioid related deaths are under diagnosed and reported and are often reported as “pneumonia” by medical examiners. We are pursuing validation of this impression. Our initial work facilitated Utah SCR004 being signed into law March 2018. Utah legislators requested more studies regarding home monitoring of high-risk opioid patients, and our goal is to meet that request. RTs are in a unique position to further this work. Reference: https://www.cdc.gov/drugoverdose/epidemic/index.html2017-2018 Post-Operative High Risk Opioid Patient Home Monitoring OutcomesTotal Pts Monitoredn=215Adult Pts# (%)n=79 (37)Pediatric Pts# (%)n=136 (63)Previously Diagnosed OSA*19 (24)4 (3)Pts on Opioids Prior to Surgery5 (6)0 (0)Pre-op Adult STOPBANG® Score ≥ 3 (non-previously diagnosed OSA)n=5510 (18)NA**# (%) Pts with SpO2 ≤ 85% for 8-35% of Time Home Monitored (during napping/sleeping)14 (17)9 (6)Total # (%) Pts with Documented SpO2 ≤ 85% Requiring Home Oxygen (who followed protocol)Adults n=14; Pediatrics n=96 (43)4 (44)Interventions Resulting from Home MonitoringTotal Pts# (%)n=215Admitted for Observation or as Inpatient12 (6)Seen in ED25 (12)Patient Followed Up with Physician20 (12)Desaturation Noted Post Data Download (pts not calling/coming in as directed)109 (51)*Obstructive Sleep Apnea **NA in pediatric patients ^5 (20%) of 25 pts coming to the ED did not have protocol followed in ED