Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations of relationship-based care and the logic model. A 14 member interdisciplinary team of institutional stakeholders from 2 acute care hospitals identified an evidence-based oral assessment tool, developed policy and practice guidelines to inform oral care, and developed both implementation and evaluation plans to pilot the project. The short-term goal of the project was to increase staff knowledge, evaluated with direct observation of assessments and documentation reviews. The long-term goal of this project was to reduce the risk of aspiration and resulting complications as evidenced by discharge diagnosis. The standards developed in this project create a process to ensure that care-dependent adults outside of the intensive care unit setting will receive an oral assessment daily, or every shift, as determined by the oral assessment score. The project advances nursing practice by addressing a gap in practice and promotes positive social change by improving the quality of care provided to all care-dependent patients. Improvement of patient outcomes from reduced risk for aspiration and reduced financial burden of unnecessary resources used to care for patients who aspirate and suffer complications are additional outcomes expected of this initiative.

Internal and personal strengths are associated with positive academic outcomes in the higher educational setting and are particularly relevant to the 21st century learner in the modern complex and global society. There is limited research addressing the connection between intrapersonal intelligence, resilience, and academic success. This information is important to better assist students in developing qualities that foster academic success and sustainability. The purpose of this study was to investigate the correlations between intrapersonal intelligence, as measured by the Multiple Intelligences Development Assessment Scales (MIDAS); resilience, as measured by the Connor-Davidson Resilience Scale (CD-RISC); and academic success, as measured by the Scale of Implicit Theory of Intelligence (SITI), grade point average (GPA), and grade level. Ninety-one undergraduate students recruited through an online research pool and flyers distributed on campus participated in the study. Participants were asked to complete 3 surveys and a demographic questionnaire. Constructivist and transformative learning theories were used to frame the study and address self-development in the learning process. Results of a multiple regression analysis revealed a significant correlation between intrapersonal intelligence and GPA (a component of academic success). This research study promotes positive social change by emphasizing the intrinsic strengthening and transformation of the learner for a sustainable education. To enhance academic outcomes, academic leaders could focus on developing curricula with objectives that support the increase of intrapersonal intelligence. Building awareness of the significance of intrapersonal intelligence and resilience is important for the development of a sustainable education and to equip students for the problem solving challenges of the 21st century.

Empathy skills are necessary to form therapeutic relationships. Previous research showed that participating in the arts engaged similar neuropathways as those needed to produce empathy. The theoretical framework for this study was art therapy relational neuroscience. The purpose of this pretest, posttest quantitative research study, using the Toronto Empathy Questionnaire, was to examine if a single art session could effectively prime for empathy. Using nonprobability, convenience sampling method, 74 graduate counseling students completed online surveys. Four findings are of note: (a) a t-test showed a significant difference between mean values of pre-post test scores, (b) an independent groups t-test indicated no difference in empathy gain scores as related to gender, (c) a Pearson's correlation indicated that age and art experience were positively correlated to empathy gain scores, (d) a multiple regression indicated that none of the variables examined moderated each other or empathy. Age, and art experience, independently, were found to be positively correlated with empathy scores. The results suggest that the self-conducted art session could enhance empathy. This research is an important contribution to the existing literature and enhances social change by studying a previously underrepresented population and investigating the possible effectiveness of a single art session prime for empathy. Using art to enhance empathy in graduate counseling students may aid with securing graduation, licensure, and therapeutic alliances with future clients.

The normative development of language is often taken for granted, yet problems with language development can result in stress for the individual and family. A challenge with these language development problems lies within the contemporary education system, which assumes that children have appropriate skills when they begin school. The purpose of the study was to test a theoretical model of language readiness known as language-based cognitive fitness, which includes measures associated with structural concepts of language involving receptive language, expressive language, spontaneous narrative speech, and writing fluency. The sample included children from a private school who received an extensive battery of tests at admission and annually thereafter. Scores from a variety of cognitive measures were used in a structural equation modeling framework to test the model. Results demonstrated language-based cognitive fitness to be an interplay of verbal reasoning abilities, visual synthesis, and active analysis broadly representing receptive language, expressive language, spontaneous narrative expression, and writing fluency. Verbal reasoning, visual synthesis, and active analysis explained 91% of the variance in achievement. Implications for positive social change include an improved understanding for those who work with children's language development, specifically of the language structures responsible for language deficits and how these relate to overall cognitive fitness; interventions can be provided to help children more quickly make up language deficits.

Orientador: Carlos Camargo Alberts / Banca: Fernando Frei / Banca: Beatriz de Mello Beisiegel / Resumo: Entre os grupos de vertebrados, os mamíferos carnívoros têm sido utilizados como espécies-alvo em diversos projetos ambientais. Atualmente, apresentam populações pequenas e muitas vezes em declínio classificados com algum grau de ameaça de extinção, consequência das alterações na paisagem causadas pelas atividades humanas. No Brasil, atualmente, a maior causa da diminuição das populações de mamíferos carnívoros é a redução ou perda de habitat ocasionada pela expansão agrícola, pecuária, exploração mineral e urbanização. A predação por onças-pardas tem sido documentada em diversas regiões e, como consequência, a perseguição a esses animais é fortemente observada. A fim de identificar os fatores que poderiam estar associados às predações aos rebanhos domésticos por onças-pardas no oeste do Estado de São Paulo, realizamos entrevistas com produtores rurais, utilizando para isso questionários semiestruturados, abordando características das propriedades, do manejo e da paisagem. Realizamos 54 entrevistas e identificamos propriedades que passaram por eventos de predação nos últimos oito anos. Bovino foi o grupo de animais mais frequentemente predado. Através da Regressão Logística, foi possível obter um modelo de previsão de ataques com 83% de concordância entre estimado e observado, onde o número de suínos e a distância do rio para a sede, presentes em cada propriedade, foram positivamente relacionados aos casos de predação. Através das análises das Redes Neurais Artificiais, foi possível especular a presença de um ciclo predador-presa ocorrendo entre o puma concolor e uma presa ainda desconhecida. Práticas de manejo adequadas podem reduzir significativamente as perdas de animais domésticos e assim reduzir possíveis conflitos humanos com predadores selvagens / Abstract: Among the vertebrate groups, carnivorous mammals have been used as target species in several environmental projects. Currently they present small and often declining populations, classified as with some degree of threat of extinction, consequence of the changes in landscape caused by human activities. In Brazil, the major current cause of the decline in carnivorous mammal populations is the reduction or loss of habitat caused by agricultural expansion, livestock farming, mineral exploration, and urbanization. Predation by pumas has been documented in several regions and as a consequence the chase of these animals is strongly observed. In order to identify the factors that could be linked to domestic herds predation by pumas in the west of São Paulo State, we conducted interviews with rural producers, using semi-structured questionnaires, addressing properties characteristics, management and landscape. We have made 54 interviews and identified some rural properties that experienced predation events in the last eight years. Bovines was the group most frequently predated. Throught the Logistic Regression, it was possible to get a model of prediction of attacks with 83% of agreement between estimated and observed, where the number of swines and the distance from the river to the principal house present in each property was positively related to predation cases. Through the analysis of Artificial Neural Networks it was possible to speculate the presence of a predator-prey cycle occurring between the puma concolor and a prey still unknown. Appropriate management practices can significantly reduce the losses of domestic animals and thus reduce possible human conflicts with wild predators / Mestre

Natural aging leads to substantial brain changes. These biological changes can, and often do, precede changes in affect, cognition, and behavior. Even subtle changes, for example in affective experience, can create problematic outcomes in day-to-day emotion regulation and decision-making. For example, poor emotion regulation may lead an individual to fall prey to an emotionally potent scam. Similarly, an overly positive individual may not fully attend to or consider potentially negative future outcomes when faced with a decision. This work characterizes changes in affect across the lifespan, and how affect corresponds to brain function, as indexed by the blood oxygen dependent signal, during tasks taxing emotion regulation and decision-making functions. I predicted that age would correlate with greater positive relative to negative emotions and with a more global (i.e., less specific and less complex) representation of emotions. The former predicted pattern indicates increased "affective optimization" and the latter indicates reduced "affective complexity." I predicted that affective optimization and complexity would correlate with brain function during emotion regulation and decision-making. I used time-based experience sampling, self-reported affect, implicit measures of affect, and performance based measures of affect to determine the associations between age and affective optimization and complexity. Results show that age negatively correlates with affective complexity. Specifically, older age was associated with less negative affect complexity, less positive emotion regulation, less affective awareness. Also, older age corresponded to lower levels of negative affect, as indexed by their experiences and an implicit measure of affect. Next, I examined emotion regulation using a cognitive reappraisal task. I found that older age was associated with less successful reappraisal of negative and positive affect. I also found individual differences in the ventromedial prefrontal cortex among older adults during emotion regulation. Lastly, I examined decision-making patterns using an intertemporal choice task. I found that younger adults’ experienced affect aligned more closely with their decision patterns. Among older adults, affective acceptance correlated with individual differences in the striatum and insula. Taken together, these results support the idea that lower levels of affective competence, rather than higher levels, characterize older age. Also, individual differences in affect parallel individual differences in brain function in the somatic marker circuitry. This suggests possible deficits in interpreting visceral information important to emotion regulation and decision-making. The findings from this work will be important for understanding why some older adults are more susceptible to scams, fraud, and decision-making problems.

The microtubule-associated protein tau is known for its ability to bind to and stabilize microtubules and for its ability to nucleate microtubule assembly. In neurodegenerative tauopathies such as Alzheimer's disease, tau becomes hyperphosphorylated and loses the capacity for microtubule binding, possibly contributing to microtubule destabilization and axonal degeneration. However, evidence now indicates that soluble forms of hyperphosphorylated tau might have a toxic gain of function linked to abnormal signal transduction and cell cycle events in normally post-mitotic neurons. In support of this hypothesis, tau has been found to associate with numerous signaling proteins such as tyrosine kinases, adaptor proteins, and scaffold proteins. During early brain development, fetal tau is also more phosphorylated than tau in the adult brain and weakly binds microtubules, suggesting tau has functions in addition to microtubule stabilization. The aim of this dissertation research is to investigate the possible role of tau in neuronal signaling, using tau-expressing and tau-depleted cell lines. Here, we provide evidence that during growth factor stimulation of neuronal cells, tau functions in advance of the neurite elongation stage. Tau is required for neurite initiation in a manner that does not require its microtubule binding function, and in addition, tau potentiates AP-1 transcription factor activation in response to nerve growth factor (NGF). The effect of tau on AP-1 activation is mediated through the enhanced activation of extracellular signal-regulated kinase (ERK), in response to both NGF and epidermal growth factor (EGF). We show that phosphorylation of tau at Thr231 also occurs in response to NGF and is required for tau to impact on ERK signaling, whereas the ability of tau to bind to microtubules is not required. Together, these findings indicate a new functional role for tau in neuronal signal transduction and have implications for tau function during early brain development and in neurodegenerative disease.

Acid-sensing ion channels (ASICs) are proton-gated cation channels expressed throughout the nervous system. These channels are activated by acidic pH conditions within an attainable physiologic range. The specific function of these channels has proven to be elusive, but it is clear that they are involved in various neuronal processes, both in the central nervous system as well as in the periphery.In order to further study the functions of these channels in an animal model system, transgenic animals were generated that overexpress individual ASIC subunits: ASIC2a and ASIC3. Transgenic proteins were detectable in brain and peripheral nervous tissue, and each had differential effects on acid-gated current properties in cultured neurons.Transgenes included N-terminal epitope tags to distinguish from endogenous ASICs, and expression was driven by a pan-neuronal promoter. Mechanical thermal sensory behaviors were tested in the transgenic mice. However, no effect was observed in these behaviors. The most interesting effect of overexpressing ASIC3 was the resulting impairment of conditioned fear behaviors in the transgenic animals without effect on unconditioned fear. ASIC3 transgenic behave like ASIC1a knockout mice in conditioned fear behaviors. Transgenic ASIC3 interacts with endogenous ASIC1, and is likely altering subunit composition of ASIC channels in the brain without abolishing proton-gated currenst like in the ASIC1a knockout. Overexpressing these two ASIC subunits in transgenic animals has produced tools that may be used to further study the functions of these channels. While this still is an artificial setting for studying ASIC functions, it nonetheless provides an in vivo method to study the effects of altering subunit composition in a whole animal and its behavioral effects, as well as in vivo expression of transgenes that can be studies biochemically. It is hopeful that studying localization in the transgenic mice will afford a better understanding of the localization and function of endogenous channels without the limitations of generating antibodies against endogenous mouse ASIC proteins, which is still in progress.

Medulloblastoma is the most common malignant brain tumor in children. Genetic profiling has identified four principle tumor subgroups; each subgroup is characterized by different initiating mutations, genetic and clinical profiles, and prognoses. The two most well-defined subgroups are caused by overactive signaling in the WNT and SHH mitogenic pathways; less is known about Groups 3 and 4 medulloblastomas. Identification of tumor subgroup using molecular classification is poised to become an important component of the medulloblastoma diagnosis and staging and will likely guide therapeutic options. G-protein coupled receptors (GPCR) possess characteristics that make them ideal targets for molecular imaging and therapeutics. While expression patterns of many proteins in human medulloblastoma subgroups have been discerned, the expression pattern of GPCRs in medulloblastoma has not been investigated. We have found that clusters of medulloblastoma tumors arise based solely on differential GPCR expression patterns. Further, two of these clusters correspond with high fidelity to the WNT and SHH subgroups. Distinct over-expressed GPCRs emerge; for example, LGR5 and GPR64 are significantly and uniquely over-expressed in the WNT subgroup of tumors, while PTGER4 is over-expressed in the SHH subgroup. Uniquely under-expressed GPCRs were also observed. Our results identify GPCRs with potential to act as imaging and therapeutic targets; elucidating tumorigenic mechanisms is a secondary benefit to identifying differential GPCR expression patterns in medulloblastoma tumors. Current imaging for diagnosis, staging, and measuring response to therapy for medulloblastoma patients relies heavily on MRI; single photon emission tomography (SPECT) using 111In-DTPA-Octreotide targeting the somatostatin type 2 receptor (SSTR2) is also available. Positron emission tomography (PET) affords a more sensitive and specific imaging modality than SPECT; however, the most common tracer 18FDG, is of limited usefulness for the delineation of brain tumors. Smoothened (SMO) is a GPCR that is overexpressed in a subset of medulloblastoma; we hypothesized that SMO overexpression could be exploited as a specific PET target in these tumors. Genentech generously provided the synthetically-derived small-molecule SMO ligand, GDC-0449, for use as the lead compound for development of a PET tracer. GDC-0449 has already been demonstrated to localize in brain tumors and has Cl- atoms incorporated in positions that are predicted to readily exchange with fluorine-18 to generate a fluorinated analog of the compound. We have successfully fluorinated GDC-0449, with very high radiochemical purity. Binding assays reveal affinities of the fluorinated analog of GDC-0449 for SMO to be comparable to precursor GDC-0449, and biodistribution experiments demonstrate accumulation of the fluorinated compound in tumors. The fluorinated analog of GDC-0449 holds promise as a novel PET imaging agent in medulloblastoma, providing highly specific and sensitive imaging for use in diagnosis, staging and measurement of response-to-treatment.

Semantic memory includes vocabulary and word meanings, conceptual information, and general facts about the world (Tulving, 1972). According to the standard view of semantic memory in cognitive neuroscience, the hippocampus is necessary to first acquire new semantic information (Gabrieli, Cohen, & Corkin, 1988), but these representations are then consolidated in the neocortex and become independent of the hippocampus with time (McClelland, McNaughton, & O'Reilly, 1995). Remote semantic memory is considered independent of the hippocampus, and the hippocampus is not thought to play a critical role in the processing and use of such representations. The current work challenges the notion that previously acquired semantic knowledge, and its use during communication, is independent of the hippocampus. A group of patients with bilateral hippocampal damage and severe impairments in declarative memory were tested. Intact naming and word-definition matching performance in amnesia, has led to the notion that remote semantic memory is intact in patients with hippocampal amnesia. Motivated by perspectives of word learning as a protracted process where additional features and senses of a word are added over time, and by recent discoveries about the time course of hippocampal contributions to on-line relational processing, reconsolidation, and the flexible integration of information, we revisit the notion that remote semantic memory is intact in amnesia. Using measures of semantic richness and vocabulary depth from psycholinguistics and first and second language-learning studies, we examined how much information is associated with previously acquired, highly familiar words in hippocampal amnesic patients. Relative to healthy demographically matched comparison participants and a group of brain-damaged comparison participants, the patients with hippocampal amnesia performed significantly worse on both productive and receptive measures of vocabulary depth and semantic richness. In the healthy brain, semantic memory appears to get richer and deeper with time. Healthy participants of all ages were tested on these measures and strong correlations are seen with age as older healthy adults displayed richer semantic knowledge than the younger adults. The patient data provides a mechanism: hippocampal relational binding supports the deepening and enrichment of knowledge over time. These findings suggest that remote semantic memory is impoverished in patients with hippocampal amnesia and that the hippocampus supports the maintenance and updating of semantic memory beyond its initial acquisition. The use of lexical and semantic knowledge during discourse was also examined. Amnesic patients displayed significantly lower levels of lexical diversity in the speech they produced, and showed a strong trend toward producing language with reduced levels of semantic detail suggesting that patients cannot use their semantic representations as richly during communication. These results add to a growing body of work detailing a role for the hippocampus in language processing more generally. By documenting a role for the hippocampus in maintaining, updating, and using semantic knowledge, this work informs theories of semantic memory and it's neural bases, advances knowledge of the role of the hippocampus in supporting human behavior, and brings more sensitive measures to the neuroscientific study of semantic memory.