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.

Understanding the processes that generate novel adaptive phenotypes is central to evolutionary biology. We used comparative analyses to reveal the history of tetrodotoxin (TTX) resistance in TTX-bearing salamanders. Resistance to TTX is a critical component of the ability to use TTX defensively but the origin of the TTX-bearing phenotype is unclear. Skeletal muscle of TTX-bearing salamanders (modern newts, family: Salamandridae) is unaffected by TTX at doses far in excess of those that block action potentials in muscle and nerve of other vertebrates. Skeletal muscle of non-TTX-bearing salamandrids is also resistant to TTX but at lower levels. Skeletal muscle TTX resistance in the Salamandridae results from the expression of TTX-resistant variants of the voltage-gated sodium channel NaV 1.4 (SCN4a). We identified four substitutions in the coding region of salSCN4a that are likely responsible for the TTX resistance measured in TTX-bearing salamanders and variation at one of these sites likely explains variation in TTX resistance among other lineages. Our results suggest that exaptation has played a role in the evolution of the TTX-bearing phenotype and provide empirical evidence that complex physiological adaptations can arise through the accumulation of beneficial mutations in the coding region of conserved proteins.

The potent neurotoxin tetrodotoxin (TTX) is known from a diverse array of taxa, but is unknown in terrestrial invertebrates. Tetrodotoxin is a low molecular weight compound that acts by blocking voltage-gated sodium channels, inducing paralysis. However, the origins and ecological functions of TTX in most taxa remain mysterious. Here, we show that TTX is present in two species of terrestrial flatworm (Bipalium adventitium and Bipalium kewense) using a competitive inhibition enzymatic immunoassay to quantify the toxin and high phase liquid chromatography to confirm the presence. We also investigated the distribution of TTX throughout the bodies of the flatworms and provide evidence suggesting that TTX is used during predation to subdue large prey items. We also show that the egg capsules of B. adventitium have TTX, indicating a further role in defense. These data suggest a potential route for TTX bioaccumulation in terrestrial systems.

Research has shown that people reduce their use of health care after individual, marital, and family therapy, which is known as the "offset effect." However, little research has been done to learn if high utilizers of health care reduce health care usage after therapy. Medical records of research participants (n = 65) from a health maintenance organization (HMO) were randomly selected and examined for 6 months before, during, and after therapy. Persons who received individual, marital, or family therapy all reduced their health care use after therapy, with the largest reductions coming from those participants who had some form of conjoint therapy.

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

A new species of an archaic primate (Pleisadapiformes) is described based on a maxilla containing the first and second upper molars from the Fort Union Formation, Atwell Gulch Member in northwestern Colorado. The preserved teeth show the unusual dental characteristics of members of the rare and poorly documented Picrodontidae family, including an elongated centrocrista and wide occlusal surface. The new species is placed within the genus Zanycteris (represented by a single specimen from southern Colorado). This placement is based on similarities in regard to the parastyle, curvilinear centrocrista, and wider anterior stylar shelf on the upper molars. However, the new species differs from the only known species of Zanycteris in exhibiting an upper first molar that is 30% larger in area, while retaining a similarly sized upper second molar. Phylogenetic analysis supports the separation of the Picrodontidae family from the Paromomyidae, while still recognizing picrodontids position within Pleisadapiformes. The unusual dental features of the upper molars likely functioned in life as an enhanced shearing surface between the centrocrista and cristid obliqua crests for a specialized diet of fruit. A similar arrangement is found in the living bat Ariteus (Jamaican fig-eating bat), which feeds on fleshy fruit. The new species showcases the rapid diversification of archaic primates shortly after the extinction of the dinosaurs during the Paleocene, and the unusual dental anatomy of picrodontids to exploit new dietary specializations.

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 Electronic Device). Our travails with FRED were reported in the medical literature2; the University of Virginia had a similar experience with the same system around the same time.3 Similar to work reported by Murff and Kannry, a survey of residents at the hospital was performed after FRED had been in place for a year. About 120 residents were surveyed; more than 90 questionnaires were returned, for a response rate of 75 percent. Of those who completed the survey, 90 percent reported that working with FRED took more time than working with paper charts, 95 percent thought the system was difficult to use, and 63 percent thought the quality of patient care had declined since its implementation. Rating overall satisfaction with FRED on a scale of 1 to 10, residents gave it a mean score of 2.4 (95% CI, 1.4–3.4). In written comments returned with the survey, residents frequently remarked that FRED appeared to be an antiquated system. At the time, I had just purchased a state-of-the-art 386 personal computer, with a sizzling 16 MHz chip and a whopping 2 MB of RAM. The awesome power and speed of my desktop machine put ol' mainframe FRED to shame. I predicted confidently that FRED, like the Edsel and disco boots, would soon be consigned to the dustbin of history. A few years later, as I completed a master's degree in medical informatics at the University of Utah, I discovered that many of the faculty were familiar with FRED and largely shared my impressions. Imagine, therefore, my surprise when I read in the paper by Murff and Kannry that FRED is alive and well and living in New York. Although not named specifically, FRED is instantly recognizable by its pathognomonic clunky user screens, shown in Figure 1 of their paper. According to the article, this antediluvian system was implemented and its use made mandatory in the Mount Sinai Hospital in 1999, almost a decade after the fiasco in our hospital. Predictably, the results of the survey among Mount Sinai house staff closely parallel those of our assessment 10 years earlier. Surely the choice of FRED so recently was a triumph of marketing over prudence, since far superior systems now exist. I wonder if the decision makers at Mount Sinai were aware of the Calgary and Virginia experiences with FRED, both published in medical journals. If not, I doubt that the vendor took the time or effort to inform them. I believe strongly in the concept of computerized physician order entry, but think that the physician community will make the migration from paper-based records only if they are enticed by carrots, not beaten by sticks. As noted by Murff and Kannry, user satisfaction is crucial to acceptance of hospital information systems, and it, in turn, is dependent on intuitive and responsive software. Unfortunately, inefficient proprietary systems such as FRED do little to impress doctors and serve only to give the specialty of medical informatics a bad name.—Robert Patterson, MD, MSC, FRCSC

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.

We present a case of a 27-year-old female patient with recurrent soft tissue Rosai-Dorfman disease in the right leg. This report highlights the fact that tumor recurrence may arise in different sites and show rapid growth.

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.