The purpose of this study was to assess the association between hospital readmission and demographic variables (age, BMI, gender, income, marital status, comorbidities, and smoking history), and size and type of tracheostomy among African American chronic obstructive pulmonary disease (COPD) patients with tracheostomies. The Andersen model was the theoretical framework for this quantitative study. Secondary data were obtained from a long-term acute care facility. The sample comprised 438 African American adult patients admitted between 2010 and 2017. Logistic regression was used to analyze each research question and assess the odds of 30-day hospital readmission. The results indicated that the odds of readmission did not differ based on age, gender, marital status, income, smoking history, BMI, sepsis, congestive heart failure, hypertension, stoma cellulitis or size of tracheostomy. There was a significant relationship between the type of tracheostomy and odds of readmission, diabetes diagnosis, and odds of readmission. These findings suggest when controlling for length of stay, there is no association between age, gender, marital status, income, smoking history, BMI, sepsis, congestive heart failure, hypertension, stoma cellulitis or size of tracheostomy and hospital readmissions among African American COPD patients with tracheostomies. The results of this study provide information that may be useful for discharge planning and program implementation research. Such planning and research might help to reduce rates of hospital readmissions and as a result lower healthcare costs for African American COPD patients with tracheostomies.

The factors associated with the decision of African American women to undergo/forego breast reconstruction after mastectomy has not been well researched. The purpose of this quantitative, correlational study was to determine the extent to which certain factors (age, religion, confidence level, and education) were associated with the decision to forgo or undergo breast reconstruction after mastectomy among African American women. Using the social-cognitive theory as the framework, the study focused on the decision-making process regarding breast reconstruction after mastectomy among African American women in Florida. The research questions for this study were to determine to what extent age, religion, confidence level, and education are associated with the decision of African American women to forego or undergo breast reconstruction after mastectomy. Data were collected using the Decision Self-efficacy and Religious Coping Activities scales from 88 African American women living in North Central Florida who had a mastectomy. Data were analyzed using Chi-square test and logistic regression. The results showed a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (p = .042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the confidence level of decision-making and the decision to forego or undergo breast reconstruction after mastectomy. It was important to examine the extent to which certain factors contributed to decision-making about breast reconstruction after mastectomy in African American women as this can provide an opportunity to cultivate positive social change by being able to tailor support services for African American women after mastectomy based on the role various factors may play.

Obstructive sleep apnea (OSA) is a sleep-related disorder that pauses or decreases air flow during sleep as a result of an obstructed upper airway. About 25 million people in the United States are affected by OSA. OSA has low identification and referral rates, especially in primary care facilities as indicated by the lack of patients' sleep histories. Screening tools such as questionnaires ensure an effective detection of OSA. The practice-focused question examined whether implementing the Epworth sleepiness scale (ESS) in an outpatient primary care setting would increase the number of referrals of high-risk patients. The purpose of the project was to improve the referral rates of high-risk patients for OSA evaluation through ESS in a primary care clinic. The plan-do-study-act model was used to guide and evaluate the intervention and analysis of outcomes to determine the success and failure rates of the intervention in relation to the project goal. The data were collected from an outpatient primary care clinic. Measures of central tendency were used to summarize the data, and a 2-proportion z test was employed to analyze the efficiency of the education procedure. The findings showed that the implementation of the ESS increased the number of referrals for high-risk patients (z = 4.140, p = 0.000), indicating that the ESS is an effective tool in facilitating the management of OSA. The findings of this project could be used to increase awareness of the positive benefits of the ESS, which can encourage the implementation of the tool in other clinical facilities and further education about the ESS. The project might contribute to positive social change and nursing practice through the increase of referrals for OSA, which improves the quality of life of patients.

In recent years advances in technology have begun to permeate the everyday lives of citizens in the United States. Technology has affected the way people send and receive information, communication, and entertainment. The world is more connected today than at any other time in history. However, despite this connectivity, there are still rural populations in the United States that remain underserved and disconnected in many areas, including mental health services. This study seeks to understand the feasibility of serving the mental health needs of rural residents through a method of delivery called technology-assisted intervention (TAI). This study polled referral sources, service providers, service facilities, state and professional organizations' rules and regulations, and insurance reimbursement as they pertain to the delivery of mental health services through TAI. The results of this study suggest that there would be a referral base from the sources polled, interest from the service providers, and a willingness to provide space from service facilities. State laws and professional organizations that mental health professionals belong to did not identify any ethical issues that would be associated with TAI, and reimbursement from insurance companies was also discovered to be accessible. Suggestions and recommendations for further research into the establishment of rural mental health and TAI were also discussed.

When clinicians practice therapy without a clear theoretical foundation, they lack direction and purpose. When training to be a marriage and family therapist, understanding and clarifying one's integrated theory and practice of therapy is essential. This mixed methods study was designed to elucidate and apply my theory of therapy in order to identify fidelity to my model as well as understand the effects it has on clients. This study also focused on how experiences in each session of therapy influenced the next session. Three couples who presented for therapeutic services at the Utah State University Marriage and Family Therapy clinic participated in the study. Then therapy sessions were conducted. Each session was videorecorded and coded with an intervention checklist at well as a videorecording coding chart. Case notes and a reflection journal were used to understand the course of each session as well as the therapist's decisionmaking during each session. The Outcome Questionnaire 45.2 was administered to each couple during every session. The Revised Dyadic Adjustment Scale was administered before the inital session and after the fourth session. In the third couple's case, the RDAS was administered before the initial session and after the second session. The results of this study suggest that the therapist applied interventions consistent with her integrated model of therapy using emotionally-focused therapy as her base theory, adding interventions from cognitive behavioral therapy and Gottman couple therapy. She found that she also used interventions from solution-focused therapy. This application of therapy was shown to be beneficial to every couple in certain ways. Sessions were found to inform subsequent sessions in a variety of ways. Unexpected findings, implications, and limitations are discussed.

The purpose of this study was to determine whether there is a significant difference between measured values of thoracic gas volume (MTGV) and predicted values of thoracic gas volume (PTGV) using the Bod Pod®. One hundred and thirteen college freshmen, both males and females, were tested using the Bod Pod® by first measuring thoracic gas volume with the Bod Pod® technique, then by using pre-determined values based on height, weight, and age that predict thoracic gas volume. Results of a paired t test showed that measured thoracic gas volume and predicted thoracic gas volume were significantly different. A Pearson’s product-moment correlation coefficient was calculated to be r = .60 which is significant at the p ≤ .05 level. A Bland and Altman plot was used to reveal any variability about the mean for individual participants MTGV and PTGV and the averages of each. A Pearson’s product-moment correlation coefficient was calculated for the data in the Bland and Altman plot. The correlation was calculated as .56, which is significant at the p ≤ .001 level. It was concluded that within the limitations of this study, there is a significant difference between MTGV and PTGV when using the Bod Pod® air displacement plethysmography system.

A survey was taken of selected high schools in Utah to determine their methods of selecting girls for a drill team and also how they organize and govern these groups. There are similarities in the requirements the girls have to meet in order to be selected: age limit, grade average , skill, rhythm, coordination and flexibility. Most schools have tryouts, but not all. Those that do, have some pre-training before tryouts. Some of the schools just use class time for practice while others include before and after school. Summer practice is held by most of the schools varying from two weeks to six weeks before school starts . A few practice all summer. Nearly all of the schools organize and govern their drill team with the help of a constitution. However, these are not used as often as they should be in order to be effective . Leadership responsibility is encouraged and developed. The objectives of education are slightly more evident in being fulfilled than the objectives of physical education in the drill teams. All except seven of the advisors are physical education majors and most of them thought this is how it should be. There were very few advisors who did not have any training in drill team work before they were assigned a drill team.

2.9 mM etoposide in CDCl3 and CDCl3/(D20) were studied at 300 and 500 MHz NMR. One dimensional (1D) NMR spectra and truncated lD Nuclear Overhauser Effect (NOE) buildup experiments were used to find direct information on the structure of etoposide. Results showed that the E-ring rotates freely about the C1’-C4 bond and is oriented to the side where H2’, H4 project. The C and D rings have a "trans" junction at C2-C3 bond. The ethylidene-glucopyranosyl group approaches the D ring allowing close interaction between H1” and H8. Water spin - transfer experiments were done to determine the interaction between water and the etoposide molecule. Chemical shifts of 2" -OH, 3" -OH were found to be affected remarkably by changes in water concentration due to the hydration of these hydroxide groups by H-bonding with water. Relaxation experiments were done to measure the longitudinal relaxation time and the whole molecular tumbling speed in solution (τc is 0.6 ns at 500 MHz). Higher than average T1 differences between wet sample and dry samples were observed for 4'-0H, H8, H3, H5, H2”. It is suggested that some water residues are associated with these nuclei. The 4'-0H is obviously hydrated by water via H-bonding (as above). Two dimensional NOE spectroscopy (NOESY & ROESY) experiments were done to give the distance constraints for running molecular dynamics (MD). Computer simulation and modeling were carried out to build up the molecule with restraint molecular dynamics (rMD) calculations by Amber 4.1. Temperature annealing, time-averaged distance restraint and water-solute interactions were applied to in these simulations. Several water bridges were found by calculation to correspond to the interactions seen to effect hydrogens by NMR. The hydration of etoposide also accounts for the slower relaxation rates in partially aqueous CDCl3 solution.

HrpA is a poorly characterized DEAH-box helicase found in many enterobacteria, including Escherichia coli. For unknown reasons, HrpA causes sickness in cells lacking Elongation Factor P, a transpeptidation enhancer that prevents ribosome stalling at proline-rich motifs during protein synthesis. HrpA's C-terminal RNA binding motifs and association with the degradosome suggest this protein interferes with an important translational process. Deletion of hrpA does not produce an overt phenotype, obscuring its role in cellular physiology. This thesis sought to identify pathways affected by this highly conserved protein. A bioinformatic analysis of HrpA's predicted interactome was conducted using a database called STRING. In an effort to verify HrpA's predicted enzymatic partners, a synthetic lethal screen was performed in order to identify hrpA-dependent mutants. Although the screen failed to identify mutant colonies dependent on HrpA for optimal growth, this thesis will serve as a foundation for further investigation of HrpA's role in translation.

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