The principles of integrative nursing and caring science align with the unitary paradigm in a way that can inform and shape nursing knowledge, patient care delivery across populations and settings, and new healthcare policy. The proposed policies may transform the healthcare system in a way that supports nursing praxis and honors the discipline’s unitary paradigm. This call to action provides a distinct and hopeful vision of a healthcare system that is accessible, equitable, safe, patient-centered, and affordable. In these challenging times, it is the unitary paradigm and nursing wisdom that offer a clear path forward.

This study is an attempt to discover the church members' hierarchy of ministerial roles and the social significance of their evaluations.

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Global climate change imposes physiological constraints on marine ecosystems that can alter the distribution of intertidal organisms. In one such instance, the native cold-adapted mussel Mytilus trossulus is being replaced along its southern range by the invasive warm-adapted Mytilus galloprovincialis. These blue mussels occur throughout rocky intertidal zones where they are subjected to greatly varying environmental conditions known to induce oxidative stress. We hypothesize that while under acute stress, related Mytilus congeners undergo a shift in redox potential from NADH-fueled respiratory pathways to pathways producing NADPH as a way to decrease the production of reactive oxygen species (ROS) and provide reducing equivalents to detoxify ROS. Additionally, we hypothesize that sirtuins (SIRT; a family of NAD-dependent deacetylases) might be involved in the regulation of this metabolic transition. To test the latter, a discovery approach will be used to analyze the proteomic response of M. galloprovincialis and M. trossulus to the pro-oxidant menadione, and sirtuin-inhibitors nicotinamide and suramin. Menadione can induce oxidative stress by increasing endogenous peroxide and superoxide radicals, while suramin and nicotinamde both inhibit sirtuin activity. Organisms were exposed to these compounds in filtered seawater for 8 h, followed by a 24.5 h recovery period under constant aeration. A multivariate analysis utilizing 2D-gel electrophoresis and protein identification via mass spectrometry showed that 18% and 17% of all identified protein spots detected demonstrated changes in abundance in M. galloprovincialis and M. trossulus, respectively. Using matrix-assisted laser desorption ionization (MALDI) tandem time-of-light mass spectrometry, we were able to identify 32-41% of proteins, depending on the species. The two Mytilus congeners showed the greatest differences in changes of protein abundance for oxidative stress proteins (including NADP-dependent isocitrate dehydrogenase). Both congeners showed similar effects in response to simultaneous sirtuin inhibition and MIOS for proteins involved in protein degradation (proteasome), cytoskeletal modifications (actin and tubulin), proteins regulating actin filament growth (F-actin capping protein), amino acid metabolism and stress signaling (G-proteins, small G-proteins and MAPK). Results indicate that protein acetylation plays an important role in the oxidative stress response of M. galloprovincialis. More specifically this suggests that sirtuins play an important role in regulating the general stress response in M. galloprovincialis and thus contribute to the greater stress resistance of this species. Furthermore, changes in the abundance of several molecular chaperones suggest a greater effect of sirtuins in regulating the cellular response to heat stress, which could in part explain why this species is more heat-tolerant than the native M. trossulus.

Upon exposure to environmental stressors, amphibians such as Plethodon montanus will release corticosterone (CORT) thus causing a behavioral and physiological response to cope with the stress. Currently, there are several invasive ways of collecting CORT in salamanders. However, these techniques typically require euthanasia of the organism. We hypothesized that exposure of P. montanus to stressful handling conditions will result in elevations of CORT that can be detected through dermal swabbing. To test this, two experiments were conducted which involved swabbing the dorsal side of the trunk before and immediately after exposing P. montanus to two different environmental stressors. The first experiment involved placing P. montanus into a behavioral chamber for twelve hours while the second experiment involved restraining P. montanus in a plastic bag with a damp paper towel for ten minutes. While both experiments indicated an elevation in CORT after the respective treatments, between-replicate variability were high, and the differences were not statistically significant. The results of the first experiment did reveal a stress response when P. montanus were taken out of the chamber. The second experiment’s results also suggested that P. montanus did have an acute stress response when restrained. Future studies could replicate this research, but with a larger sample size and see if the results are congruent with the data obtained in this study.

For several centuries, Punica granatum L. has been utilized in traditional medicine to treat various ailments including diabetes, diarrhea, and parasitic and microbial infections. Current scientific research suggests that the unique phytochemical composition of the botanical is largely responsible for the range of biological activities demonstrated by the different components of P. granatum L. The objective of this study was to evaluate the effects of the fruit extract of P. granatum L. on the following parameters of skin health: facial wrinkle severity, sebum production, transepidermal water loss, melanin index, and erythema index. The hypothesis was that oral pomegranate supplementation improves the facial appearance of wrinkles and the biophysical properties of the skin because of the well-studied antioxidant and anti-inflammatory properties of the phytochemicals in the fruit extract. A prospective, double-blind, placebo-controlled study was conducted in which subjects were supplemented daily with a punicalagin-enriched oral pomegranate extract for four weeks. The study was performed at Integrative Skin Science and Research (Sacramento, California, USA) and included 18 healthy males and females, aged 25–55 years, who were asked to restrict the intake of other polyphenolic-rich foods. A facial image collection and analysis system was used to assess the facial appearance of wrinkle severity, and standardized, noninvasive tools were used to collect information on facial sebum production, transepidermal water loss, melanin index, and erythema index. In addition, self-reports of quality of life and digestive health were collected from the subjects. These parameters were assessed at pretreatment baseline and after four weeks of oral supplementation. The results showed statistically significant reductions in the melanin index of the cheeks (p < 0.01), transepidermal water loss from the stratum corneum of the cheeks (p < 0.01), and facial appearance of average wrinkle severity (p < 0.01). Furthermore, a significant reduction was found in facial transepidermal water loss among females of the intervention group (p < 0.01). No adverse effects were reported over the four weeks of the study. In conclusion, this study demonstrated an improvement in several biophysical properties of the skin with oral pomegranate extract supplementation. As a result, oral pomegranate extract could be used as an effective agent for the maintenance of skin appearance and skin health.

Individuals within the United States Forest Service, the National Park Service, the Bureau of Land Management, and state park systems were studied to determine their integrative orientation (general problem solving strategies). This orientation involves a preference for trying new ideas, working within a long time frame, generalizing in planning or managing, taking risks, working in close association with others, examining many aspects of a problem, working on difficult problems, developing a variety of skills, and working on problems requiring continual revision. An attempt was made to relate this orientation to education, major field of study, agency, time, tasks, level in the organization, important skills, and situations in which skills are acquired. The results, for the most part, were inconclusive. However, much of this can be attributed to the sampling procedure and the format of the questionnaire. Integrative orientation tested with skills thought to be important yielded significant results, with definite differences appearing between the groups. The overall pattern which developed showed that an individual with a high integrative ability feels that a wider varie y of skills is more important than does an individual with less integrative ability.

Prevalence estimates of child depression are substantial and morbidity leads to an increased risk of recurrence during adolescence and adulthood . Further , early-onset depression is associated with a number of negative outcomes including: poor physical health , social and interpersonal impairments , academic problems , substance abuse , future maladjustment , and suicidal behavior. In light of the prevalence , persistence, and negative outcomes associated with depression in children and adolescents , several treatments ranging from psychosocial to pharmacological interventions have been developed and evaluated. However, the overall efficacy of treatments remains equivocal because the majority of existing reviews of the child and adolescent depression treatment literature are narrative in nature, methodologically flawed , and/or present vague or conflicting conclusions. Although there are a number of good meta-analytic reviews that indicate that psychotherapy is effective with children and adolescents overall, comprehensive meta-analytic reviews focusing on the efficacy of psychological treatments specifically for depressed youth are nonexistent in the published literature. A comprehensive sample of studies on the psychosocial and pharmacological treatment of early-onset depression was located through an extensive literature search. Articles that met the inclusionary criteria were subsequently analyzed. The outcome data from 3 7 outcome studies were extracted and converted into effect sizes. Comparisons of main effects, potential interactions, and other specified variables were conducted. The overall findings of this meta-analysis indicate that several different psychosocial interventions for early-onset depression produce moderate to large treatment gains that are clinically meaningful for many afflicted youth. Further, it appears that psychosocial treatments are, in general, superior to pharmacological regimens in treating depressed children and adolescents. However, there is also recent evidence that selective serotonin reuptake inhibitors such as fluoxetine are efficacious, and they will likely play an increased role in the management of affective illness in youngsters. The clinical implications and limitations of these data are discussed and suggestions for future research are provided.

Marine turtles are distributed in temperate, sub-tropical and tropical waters and beaches worldwide, often in areas heavily impacted by humans. Although there are many threats to marine turtle populations, the growing threats of nutrient pollution and harmful algal blooms are relatively understudied despite their widespread impacts on coastal marine ecosystems that marine turtles depend on. By studying juvenile green turtles (Chelonia mydas) in the Indian River Lagoon, Florida, where nutrient pollution and HABs are a widespread and longstanding issue, I aimed to conduct a case study of how these threats may affect this federally Threatened species. In Chapter 2, I used four concurrent, 18-year data sets to characterize and assess the interrelatedness of long-term trends in seagrass cover, macroalgae occurrence, juvenile green turtle abundance, and juvenile green turtle growth rates. From 2000 to 2018, IRL seagrass cover declined precipitously, macroalgae rose slowly through 2011 then declined during two severe HABs, juvenile green turtle abundance declined slowly, and growth rates declined through 2011 then rose through 2018. In Chapter 3, I conducted a 9-year study of juvenile green turtle foraging ecology using a comparative stable isotope approach. I found that carbon and nitrogen stable isotopic variance declined during and after two severe HABs in the IRL. In Chapter 4, I used two complementary methods to assess the diet of juvenile green turtles after two severe algal blooms in order to assess changes compared to previous diet studies. Visual identification of forage items showed that juvenile green turtle diet remained dominated by nutrient-tolerant red macroalgae with smaller components of seagrass and green algae; metabarcoding techniques largely failed to resolve their diet. My results highlight the web of complex effects and responses that factor in to determining the effects of nutrient pollution and HABs on juvenile green turtles. Future studies of habitat selection, foraging ecology, and the effects of these on juvenile green turtle growth and survival are needed to fully assess the threat of nutrient pollution.

Through genome wide association of nonvolatile metabolites and leaf ecophysiological traits, historic breeding practices were found to have led to germplasm divergence within the cultivated sunflower Helianthus annuus. In genome-wide analyses of single nucleotide polymorphisms (SNPs) in relation to flower petal carotenoid content across the cultivated H. annuus germplasm, alternative methods of analysis proposed differing genetic architectures, which suggests that these methods can be used as complementary approach in prioritizing SNPs for function analysis. Leaf hyperspectral reflectance was leveraged in a machine learning framework to predict herbivore- and volatile induction across the genus with 95% accuracy, while characterizing changes in volatile metabolites. The body of work in this dissertation represents the first characterization of the standing genetic variation for nonvolatile specialized metabolite diversity in cultivated sunflower in the context of modern breeding practices, and the first assessment of hyperspectral reflectance and volatile metabolite diversity across the genus Helianthus.