Pre-hospital patient protocols standardize medical procedures for EMTs and increase the quality of care for patients. In Washington state, these protocols vary by county and often contain a section for psychiatric emergencies with variant restraint protocols. The immediate use of restraints in these situations can be seen as dismissive to the patient and can lead to agitation and violence. Verbal de-escalation can enhance provider-patient relations and decrease likelihood of restraints, seclusion, and hospital admissions.  The goal of this project was to explore restraint and de-escalation methods used in WA state county-level EMS pre-hospital patient protocols. To complete the project, a codebook was created with binary variables with definitions that determined whether the procedures listed in the protocol satisfied the definition. Using the codebook, each protocol was independently coded by 2 people and disagreements were reviewed by a third person. Finally, we created descriptive statistics from the restraint protocols and stratified based on rurality. Of the 39 counties in WA state, 77% of counties mentioned verbal de-escalation methods in their pre-hospital patient protocol. The de-escalation method with the highest proportion in all counties recommended reassuring the patient that the providers care for them (28%). The second highest proportion in all counties was to mention the use of de-escalation methods without explicit instructions (23%). Counties that do not have specific instructions and just mention the use of de-escalation methods can be confusing if the provider does not have de-escalation training or has not trained recently. These findings highlight the need for future research concerning the adherence of EMTs to these protocols and to see the what the outcomes are of the different protocols. More research can be done through contacting individual EMS agencies to see if internal protocols exist outside of county protocols.

Autism Spectrum Disorder (ASD) is a developmental disorder in which individuals experience challenges with their behavior, social skills, and communication. There is a significant disparity between the numbers of males and females diagnosed with ASD; males are 4x more likely to receive a diagnosis, and it has been suggested that females with ASD are less likely to receive a diagnosis because they may “mask” their symptoms. Females with equally-high levels of autistic traits are less likely than males to be diagnosed with ASD, and females with ASD demonstrate enhanced social skills and higher levels of social motivation compared to males. Additionally, research by Parish-Morris shows that school-aged ASD females had stronger pragmatic language ability than ASD males. Pragmatic language is an individual’s ability to communicate verbally and nonverbally, understand and reciprocate social cues, and express appropriate social behavior. If females with ASD have stronger pragmatic language skills, it may serve as a linguistic camouflage and contribute to their ability to conform. The goal of this project is to examine sex differences in pragmatic language in children with ASD and explore what factors are related social communication differences between males and females with ASD. 15 male and 15 female participants with a confirmed diagnosis of ASD between the ages of 8 and 17 participated in this study. All participants completed a recorded conversational interview with a clinician. Videotapes were then rated by coders using the Pragmatic Rating Scale-Modified (PRS-M). First, we evaluated sex differences in PRS-M scores. We predicted that females with ASD will be rated as having better pragmatic language than males with ASD. Second, we investigated whether IQ, Age, and Autism Severity predicts PRS scores, and if Sex moderates these relationships. The results of this study shed light on sex differences in social communication in autistic children.

Young adults are susceptible to a whole range of psychological disorders. Approximately 39.6% of young adults (ages: 18-25) in the United States have had a heavy drinking episode in the past year, and 9.6% of young adults have had a major depressive episode in the past year. Previous research has shown that young adult males tend to drink more alcohol, while females have higher rates of anxiety and depression. There is, however, limited research about the extent to which certain groups of young adults, based on living situation and college enrollment, may exhibit higher alcohol use and poorer mental health. The purpose of this research is to examine differences in alcohol use, alcohol-related consequences, and mental health by demographic characteristics (i.e. attending 4-year college or not, living with parents or not, biological sex) among a community sample of young adults (ages 18-23). Analyses use baseline data (N=764; 55.9% female, mean age 20.6 (SD = 1.72) from a larger longitudinal study on health behaviors. Outcomes will be alcohol use, alcohol consequences, depression, and anxiety. Separately for each outcome, an analysis of covariance (ANCOVA) will be conducted. The sample includes 352 4-year college students and 412 individuals not attending a 4-year college, 468 individuals not living with parents and 296 individuals living with parents, and 428 females and 336 males. We hypothesize that higher alcohol use and consequences will be found for males, individuals not living with parents, and individuals enrolled in a 4-year college. We also hypothesize poorer mental health for females, individuals not living with parents, and individuals enrolled in a 4-year college. Results from this study will provide a better understanding of which young adults are experiencing poorer mental health and higher alcohol use, thus providing valuable information to guide interventions.

Stress-related disorders impact over 18% of the United States population. Further definition of the mechanisms behind stress responses in the brain is necessary for understanding and treating stress related disorders, such as anxiety and depression. Specifically, the lateral habenula (LHb) is a brain region known to modulate stress and anxiety responses, but the ways in which it modulates these responses is relatively unknown. In order to investigate potential mechanisms for this modulation, we examined differential gene expression in the pathways from the LHb to three brain regions: the ventral tegmental area (VTA), the dorsal raphe nucleus (DRN) and rostromedial tegmental nucleus (RMTg). Rats were stressed using a forced swim protocol and tissue from the LHb was homogenized in order to extract RNA using RiboTag. Using a combination of transgenic mice and a RiboTag viral vector we were able to extract highly specific RNA from complext brain tissue. We used a portion of our collected RNA to perform RNAseq, a molecular tool used to identify differential gene expression in certain pathways. Using the results from our RNAseq analysis, we used extracted RNA to perform quantitative PCR to verify the pathway specific genes found in the LHb. By determining the pathway specific patterns of differential gene expression, we propose a molecular mechanism for neuronal response to stress in the LHb.

Abstinence-based treatment has long been considered the standard of care for people with alcohol use disorders (AUD). However, abstinence-based treatment fails to engage severely affected populations (e.g., homeless people affected by AUD) because many are not yet ready, willing or able to stop drinking. A recent randomized controlled trial tested the efficacy of a lower-barrier harm-reduction treatment for alcohol (HaRT-A), in which participants could define their own harm-reduction and quality-of-life (QoL) goals. The aim of this present secondary study was to describe participants’ own harm-reduction and QoL goals and document their achievement of these goals over the course of HaRT-A. Participants were people currently experiencing homelessness and AUD (N = 86) who attended the 4-session HaRT-A, during which interventionists elicited participants’ own harm-reduction and QoL goals. The Safer-drinking and Harm Reduction Efforts (SHaRE) form was administered to elicit and record participant-generated harm reduction goals, which were entirely participant-driven with no suggestions from study interventionists for any specific drinking-related goals. Directed content analysis was performed to classify participant-generated treatment goals. Results indicated that goals fell into 7 primary categories, the top 3 being drinking-related goals, quality of life goals, and health-related goals. These findings suggest that a client-driven, goals-setting approach could inform accessible and appropriate treatment and QoL-enhancing interventions for people experiencing homelessness and AUD.

Previous research has found descriptive drinking norms (i.e., how much someone thinks others drink) are associated with increased risky drinking and intentions to drink among college students. However, this research has mostly focused on self-reports of typical drinking, whereas some students report low levels of drinking except on specific high-risk events such as birthdays. This study expands on previous research by examining how descriptive birthday drinking norms moderate the relationship between drinking on a previous birthday and intentions to drink on an upcoming birthday. We hypothesized a positive relationship between previous birthday drinking and intentions to drink that would be more pronounced in students with increased norms. A total of 248 University of Washington students (aged 18-24) who reported at least one heavy episodic drinking event (5+/4+ drinks for Males/Females) and three alcohol-related consequences in the past month were assessed. Participants reported the number of alcoholic beverages they drank on their most recent birthday, how much they intended to drink on their upcoming birthday, and the number of drinks they thought a typical University of Washington student drinks on their birthday. Results from moderated linear regression demonstrated both previous birthday drinking and birthday norms were positively associated with intended birthday drinking (b = 0.477, SE = 0.063, p < 0.001; b = 0.189, SE = 0.054, p = 0.001, respectively). The cross-product of birthday norms and intended birthday drinking also had a significant effect (b = -0.036, SE = 0.013, p = 0.005), such that the effect between previous birthday drinking and intended birthday drinking was strengthened in those with higher norms, supporting our hypothesis. This research contributes to critical literature addressing high-risk alcohol use among students and helps to better understand the role of norms and high-risk drinking events, such as birthdays, in research.

Many children in the United States experience mental health issues that impact their performance in school. Evidence-based practices (EBP) have demonstrated effectiveness at improving student outcomes for students impacted by their mental health. However, many factors affect the successful implementation of these programs. Mental health services, particularly those for youths with the most mental health needs, typically involve multi-organizational processes to implement EBP. The Inter-Organizational Alignment study strives to examine these multi-organizational frameworks, and how they impact the school mental health services provided. The research study examined the association between race and the degree of inter-organizational alignment on climate for EBP implementation. Researchers surveyed 28 school mental health clinicians and 57 school staff in the states of Washington and Minnesota. The sample included 22 white or Caucasian participants and 14 non-white participants. Non-white participants were either American Indian or Alaskan Native, Asian, Black or African American, multiracial, or other. Implementation climate of EBP in school settings was rated on a Likert scale of 0 (not at all) to 3 (great extent) on a standard, multi-item scale. Researchers evaluated schools on a range from an open and positive implementation climate to a closed and negative implementation climate. The degree of alignment was determined between clinician and school staff scores, with misalignment defined as a difference of one standard deviation. Quantitative analysis of the results suggested more alignment in implementation climate between clinician and school staff of different races, which suggests that racial factors impact EBP implementation in racially diverse environments. An independent t-test determined that these differences were statistically significant. Consequently, these findings suggest that EBP may be impacted when implemented by more diverse organizations.

c-fos is an immediate early gene that is commonly used to mark cell activation and can be identified using immunohistochemistry techniques. In this project, we optimized immunohistochemistry conditions for a phosphorylated c-fos antibody in brain tissue obtained from the rat lateral habenula (LHb). Male, Long-Evans rats (n=4) were injected with cocaine (10 mg/kg) or saline. Ninety minutes following intraperitoneal injections, rats were perfused with 4% paraformaldehyde. Brains were dissected and 40-micron slices across the rostro-caudal axis of the LHb were collected. We tested two dilutions of the rabbit phospho c-fos antibody (1:500 and 1:800), three blocking agents (normal goat serum, donkey serum and bovine serum albumin) and two secondary Alexa Fluor antibodies (goat anti-rabbit Alexa Fluor 488, and donkey anti-rabbit Alexa Fluor 488) to determine which combination allowed for the best visualization of c-fos in the LHb. Fluorescence microscopy analysis of the tissue sections is underway, and imaging is expected to show differences in brightness and visibility of c-fos with respect to the varying conditions. These results will identify the optimal conditions for more accurate identification and quantification of cell activation in the lateral habenula.

High psychological resilience has been significantly linked to better medical recoveries, psychological recoveries, and resistance to psychological deterioration. Currently, many African American grandmothers are engaged in emergent childcare due to serious family trauma. I have identified key aspects of the lives of these women which are relevant to their resilience through a literature review, personal cultural experience, and focused interviews. This preliminary research informed my creation of a theoretical model relating resilience to faith, music, and justice. Utilizing thoroughly tested psychological measures which correspond to each aspect of my theoretical model, I am performing a pilot study to determine the strength of the relationships between all four of these constructs. More frequent, and deeply shared, music experience within a family is anticipated to covary with higher scores of resilience. This is due to shared emotional experiences fostering positive attachment amongst the family members. Also, stronger perceptions of injustice as well as doubt in one’s faith are both expected to negatively correlate to one’s resilience. If a person expects the world to unjustly not return their efforts or expects their personal coping techniques to fail, they will be less likely to utilize these avenues. Immediately, I am returning my findings to support groups for grandmothers and, under the guidance of a psychiatric professor, also sharing general information about resilience. Findings from this pilot study will guide future experiments to determine how best to support grandmothers, concerning resilience. Information yielded by larger scale research of this type will inform the development of fast, inexpensive, culturally appropriate, and non-invasive techniques for detecting individuals with low resilience.

The ability of an organism to dissociate environmental cues for either safe or threatening situations is key for survival. Generalized fear is an adaptation in which behavioral responses for threatening stimuli are produced to non-threatening cues. In mice, discriminative or generalized fear responses are modeled using a fear conditioning paradigm of two shock intensities, 0.3 mA or 0.5 mA. Mice trained at 0.3 mA intensities could discriminate between safe and threatening cues, yet mice trained at a 0.5 mA intensities displayed generalized fear behavioral responses. Previously, we had identified that dopaminergic neural activity was critical for the ability to discriminate between cues when shocked at 0.3 mA. Dopamine neurons express Kv7.3 potassium channel subunits, which modulate neural activity. I hypothesized that Kv7.3 subunits on dopamine neurons would be critical to threat discrimination and mice that had undergone mutagenesis of Kv7.3 would show generalized fear discrimination. My approach used transgenic mice expressing Cre-recombinase and viral-mediated gene delivery of cre-inducible CRISPR-Cas9 plasmids targeted for the specific mutagenesis of Kv7.3. Mice underwent a three day paradigm known as fear conditioning. Baseline freezing behavior was assessed by playing two tones, A and B. This was followed by fear conditioning trials where at the end of tone A, mice received a shock of either 0.3 mA or 0.5 mA (CS+) and at the end of tone B, mice received no shock (CS-). On the third day, mice underwent a probe trial to assess final ability to discriminate between threatening and non-threatening cues. These findings could provide insights into the mechanisms underlying neurological disorders and serve as a guide for future pharmacological interventions.

Autism Spectrum Disroder (ASD) occurs in one in every 59 children, yet the causal mechanisms remain widely unknown. Research is advancing through genetic testing as well through speculation of external environmental influences. Recent stuides have examined in greater depth gene by environment interactions and have found an impact on severity symptoms of ASD. This research follows the two-hit model of gene by enviornment effects and investigates the link of auoimmune disorders, specifically thyroid disfunction, Likely Gene Disrupting (LGD) mutations to genes related to ASD, and the relation to IQ and regression. Behavioral and cognitive data are collected using clinician-administered questionnaires and assessments. Those who carry an LGD mutation with exposure to maternal thyroid dysfunction lean towards a trend that show more severe behavioral phenotypes than those without an LGD mutation. These results spotlight the importance of gene by environment contributions in addition to mechanisms involved in the disorder. These findings may help improve future treatment and intervention for those with ASD. 

Fetal Alcohol Spectrum Disorders (FASD) encompass medical conditions resulting from prenatal alcohol exposure (PAE), including brain-based central nervous system deficits and physical impairments. Previously, FASD conditions that did not meet Fetal Alcohol Syndrome (FAS) diagnostic criteria were diagnosed as having Fetal Alcohol Effects (FAE). Beginning in 1974, Ann Streissguth, Ph.D. and colleagues at UW led multiple studies on FAS and FAE. The primary investigation was conducted from 1992 to 1996 among over 400 diagnosed individuals age three to 51 years old, with the purpose of examining types and magnitudes of secondary disabilities, i.e., problems not present at birth but occurring across the lifespan as a consequence of PAE. In a study recently funded by NIH, UW researchers are recruiting prior study participants to ascertain current physical health, mental health, and functional status. During online searches for former subjects, researchers discovered that many with FAS or FAE were deceased. Among 438 diagnosed subjects, 23 (5.25%) were deceased (mean age at death 36.8 years), compared to one of 60 (1.67%) control subjects (age 35 years). Death certificates have been obtained for 18 individuals. Causes of death among the diagnosed included physical health conditions: heart-related (27.8%), cancer (16.7%), kidney-related (5.6%), liver-related (5.6%), diabetes (5.6%); and conditions related to mental health: alcohol and/or drug abuse (16.7%), accidents (11.1%), suicide (5.6%), and violence (5.6%). Cause of death for the control was cancer. These data indicate a three-fold greater proportion of deaths among FAS/FAE diagnosed individuals compared to controls in this study population. Death certificate information suggests a high proportion of FAS/FAE deaths were related to physical and mental health conditions known to be associated with PAE. Our findings speak to the importance of preventing PAE, early diagnosis among the exposed, and medical and social interventions to reduce risk factors associated with FASD.

Research has shown that positive outcome expectancy (i.e., anticipated positive consequences as a result of engaging in a behavior) and positive affective responses to exercise play an important role in predicting exercise behavior as well as future exercise intentions. Unlike most research in which the valence (i.e., positive - negative) of outcome expectancy and affective responses are typically assessed through survey items whose valence is predetermined, the current study used a spontaneous word association test (WAT) to examine the subjective meaning of exercise-related outcome expectancy and mood before exercise, and how they are related to exercise intentions and behaviors. One-hundred and eleven undergraduate and graduate students (74 females; 64 undergraduate students) performed an exercise-related WAT in which they were asked to write down the first word or a short phrase that comes to mind when they thought of (a) things that might happen from exercising and (b) their mood right before exercising. Subsequently, they were instructed to rate their subjective valence (i.e., positive-negative) to each of their responses to the WAT. They also completed a series of online self-report surveys that included assessments of exercise intentions and past exercise behavior. Path analyses will be conducted to test our hypotheses that the subjective valence of their mood right before exercising is expected to be directly associated with exercise behavior whereas the subjective valence of outcome expectancy is expected to be indirectly associated with exercise behavior through exercise intentions. This study examines the potential value and usefulness of a spontaneous word association procedure to more accurately measure affective evaluations of an individual’s feelings and thoughts toward exercise behavior.

Dysregulation of the dopamine system is a central mechanism driving substance use disorders. Our laboratory has shown that chronic cocaine consumption decreases dopamine release in the nucleus accumbens of the rat, which is a brain area that is important in reinforcement learning. This study also found that restoring dopamine transmission through the administration of the dopaminergic drug, L-DOPA, decreased their cocaine consumption. Recently, we have also shown that acute administration of L-DOPA decreases ethanol (EtOH) intake. Thus, the present study sought to examine the effects of chronic L-DOPA on operant responding for EtOH in adult male rats. Rats were presented with a 2-bottle choice between an EtOH (20%) solution or water, daily for 21 days. Next, animals made nose poke responses (FR1) for 0.2 mLs of an EtOH (20%) solution over 1-h daily sessions for 35 days. On Days 26-35, rats consecutively received either vehicle or L-DOPA (30 mg/kg) for 5 days, counterbalanced across days, and L-DOPA decreased operant responding for EtOH compared to VEH. We are presently examining the effects of L-DOPA on dopamine release during operant responding for EtOH. Together, these data may suggest the efficacy of L-DOPA as a treatment for patients with alcoholism.

Establish-Maintain-Restore (EMR) is a professional development training for teachers to strengthen their relationships with their students. Previous studies have shown that the strategies presented in the training have significantly improved academically engaged time and reduced disruptive behavior among elementary and middle school students. The proposed study will examine 9th grade high school student perceptions of the appropriateness and effectiveness of the EMR strategies to improve student-teacher relationships within the school context. Additionally, this study will analyze whether there is a significant difference in these perceptions between the genders of students. It is predicted that male students will tend to perceive the EMR strategies as less effective and appropriate in improving student-teacher relationships compared to their female peers. A focus group was held to present the EMR strategies to 9th grade students at a racially/ethnically diverse high school in the Pacific Northwest. After the strategies were presented, students were asked to provide ratings and comments regarding the appropriateness and effectiveness of each individual strategy. The students were asked about the following items for each of the EMR strategies: appropriateness for school context, appropriateness for both students and teachers, and effectiveness at improving relationships with high school students. Findings from this study will offer insight for improving student-teacher relationships with consideration for the students’ genders. Research has shown that strong student-teacher relationships can serve as a protective factor against high school dropout, and this study may help provide information about culturally responsive strategies to reduce the dropout rates among students of color and male students.

Rats produce ultrasonic vocalizations (USVs) in a range from 20-kHz to 95-kHz that vary in frequency and shape across social and motivational contexts and can correspond to the affective state of the animal. To assess these USVs accurately and efficiently, our lab created DeepSqueak, a novel machine learning software package that expedites the detection and analysis of rat USVs by using neural networks to differentiate them from noise. DeepSqueak also allows for automatic and unbiased classification of USVs into discrete categories using call parameters such as shape, frequency and duration. Prior to this unbiased categorization method, identified 14 subjective categories in 50-kHz rat vocalizations that could be manually identified by a trained experimenter. These categories have received some limited study, but the excessive labor and time needed for manual classification restricted broad adoption. We aim to use neural networks to quickly and automatically classify USVs into these categories to promote broad adoption and better our understanding of the relationship between USVs and behavior. The process of training our neural network to differentiate between vocalizations was approached in two ways. Audio files were converted to sonograms through DeepSqueak and manually labeled. Thousands of these labeled calls were then inputted as training data for the neural network. This method allowed the network to learn using a large set of labeled vocalization data. The second method is based around the manual selection of an optimal call for each subtype using DeepSqueak's "call clusters" function; the neural network was then trained around how closely vocalizations matched the optimal calls. We now plan to compare DeepSqueak's automated calls and clustering to manual scoring in order to develop the best possible system that reliably categorizes USVs, thus allowing for more specific analyses of USV categories and behavior.

Drug addiction is a neuropsychiatric disease characterized by compulsive and uncontrolled drug use. Rodent self-administration models can represent certain aspects of substance abuse in humans. Studies have shown drug use and drug-associated cues increase dopamine transmission. Data from the Paul Phillip’s Lab demonstrated rats that escalated in their cocaine intake had a decrement in dopamine release to cues in the nucleus accumbens. Administration of Levodopa (L-DOPA), the molecular precursor to dopamine, decreased cocaine consumption to pre-escalated levels. However, we have not yet confirmed whether the impact of drug-associated stimuli and its dopamine-mediated aspects can be generalized to opioid use. Thus, the current study investigates if increased dopaminergic signaling via L-DOPA decreases consumption of fentanyl, a highly potent synthetic opioid. We tested L-DOPA’s effect in two separate behavioral assays. The first assay is a two-bottle choice paradigm in which the animal is given 3-hour access to liquid fentanyl (50μg/mL) and water. Additionally, animals were trained to self-administer fentanyl, in which rats were required to nose poke for liquid drug delivery. Preliminary data shows intraperitoneal injection of L-DOPA significantly decreases overall fentanyl consumption in both two-bottle choice (p<0.05) and in the instrumental task (p<0.05). These data imply that dopamine release is regulating opioid consumption. A second aim of the current work is to characterize drug-taking patterns in animals self-administering fentanyl orally. Permitting animals to extended access to drugs of abuse is known to induce escalation of drug intake. Utilizing this paradigm we provide six hours of liquid fentanyl access and examine intake patterns of individual animals across sessions. Future studies will utilize electrochemical detection techniques to examine subsecond changes in dopaminergic signaling during oral self-administration. Overall, this work provides evidence that dopaminergic signaling regulates fentanyl consumption and treatment with L-DOPA can stabilize and reduce drug intake.

Polymorphisms in the gene, FKBP5, and its resulting protein, FKBP51, are associated with stress-related disorders. Although FKBP51 inhibitors may have antidepressant-like effects, the relevant brain regions mediating this effect are still unknown. We found that FKBP51 expression is elevated in serotonin neurons of the mouse dorsal raphe nucleus (DRN) after stress, so we tested whether FKBP51 inhibition in the DRN by the novel FKBP51 antagonist, SAFit2, has antidepressant-like effects. First, we implanted guide cannulas into the DRN of wildtype mice stereotaxically, then we habituated the mice to 2.5% sucrose-containing bottles in their home cages overnight. On the following two days, the mice were stressed through repeated forced swims after receiving either SAFit2 (n=8) or a vehicle (n=7) to the DRN via the cannulas, prior to each swim session. That evening, the mice underwent a sucrose preference test to assess motivation by quantifying sucrose versus water preference using lickometers. On the next day, the mice were tested in a three-chambered social interaction test, where one chamber contained a wired cup enclosing another mouse of the same sex and the other chamber had an empty wired cup. Our results show that the SAFit2 and vehicle mice had the same immobility time during the forced swim stress, signifying that SAFit2 did not interfere with our immediate stressor. The SAFit2 mice demonstrated an increased preference for sucrose after stress compared to the vehicle mice, indicating greater motivation to consume a pleasurable liquid. However, there was no significant difference in the time spent interacting with the same sex during the social interaction test. This suggests that SAFit2 may have blocked stress-induced anhedonia by inhibiting FKBP51 activity in serotonergic neurons, as measured by the sucrose preference test. Further studies of FKBP51 inhibition in the DRN can lead to potential therapeutic treatments of neuropsychiatric disorders.

Prostate cancer, the second most common cancer in American men, has a relatively low fatality rate – only around 2% of men will actually die of the disease. Prostate cancer has many treatment options. Each of these treatments comes with varying and oftentimes severe symptoms, so choosing a treatment plan is often based on patient preference. Since treatment is based heavily on patient’s values, it is important that patients are well informed about various treatments and related side-effects. This study aims to reveal how a patient’s socioeconomic background influences their decision making processes, with particular focus on how they receive information related to prostate cancer treatments. We review articles and studies from the past 10 years to determine how they address ethics in prostate cancer decision-making. The three framework topics used are: 1) how healthcare providers influence the decision-making process with their ethics and values, 2) how the socioeconomic and cultural factors of a patient informs their decision-making in prostate cancer treatment, and 3) how patients receive information and whether that information is reliable and accurate. In this literature review we find that patients are presented treatment options differently based on their education levels, race, and socioeconomic background, which has potential ethical implications. As this review progresses, we expect to organize these studies to inform how to best provide information to patients of varying cultural backgrounds. We aim to clarify future areas of study towards arriving at ethical consensus in decision-making in prostate cancer. Since decision-making in prostate cancer is a cost-benefit analysis, usually a trade-off between quantity and quality of life, studying how to best involve patients of varying backgrounds in the decision-making process is crucial to treating the disease.

Dysregulation of the dopamine system is a central mechanism driving substance use disorders. Our laboratory has shown that chronic cocaine consumption decreases dopamine release in the nucleus accumbens of the rat, which is a brain area that is important in reinforcement learning. This study also found that restoring dopamine transmission through the administration of the dopaminergic drug, L-DOPA, decreased their cocaine consumption. Recently, we have also shown that acute administration of L-DOPA decreases ethanol (EtOH) intake. Thus, the present study sought to examine the effects of chronic L-DOPA on operant responding for EtOH in adult male rats. Rats were presented with a 2-bottle choice between an EtOH (20%) solution or water, daily for 21 days. Next, animals made nose poke responses (FR1) for 0.2 mLs of an EtOH (20%) solution over 1-h daily sessions for 35 days. On Days 26-35, rats consecutively received either vehicle or L-DOPA (30 mg/kg) for 5 days, counterbalanced across days, and L-DOPA decreased operant responding for EtOH compared to VEH. We are presently examining the effects of L-DOPA on dopamine release during operant responding for EtOH. Together, these data may suggest the efficacy of L-DOPA as a treatment for patients with alcoholism.

Many of the world’s most important countries are experiencing large increases in their populations of older adults (e.g. Japan, China, Italy, Germany). Such longevity is requiring a greater need for long term care. However, societies can not afford to pay for formal care, so informal (unpaid family) caregivers (CGs) are becoming increasingly important. Unfortunately, many CGs are at high-risk for psychosocial/health problems. Moreover, caregivers with pre-existing health problems are particular risk. Our goal is to examine factors that may make cancer caregivers vulnerable. We used a vulnerability (have a cancer history or not) by exposure (being a caregiver or not) model, and stratified our participants into four groups: Cancer Caregivers, Non-Cancer Caregivers, Cancer Non-Caregivers, and Non-Cancer Non-Caregivers. At baseline and 15-18 months later, we measured indicators of life quality and caregiver demands: satisfaction with support, well-being, perceived support, loneliness, and hours spent caregiving. Cancer Caregivers reported poorer social supports and more time caregiving. This is important because previous work has shown that Cancer Caregivers have more negative and fewer positive life experiences and that these are related to the ability to fight tumor growth. Despite innovations, this study only included white Americans. Also, to increase participation among persons with cancer, we only included those who were not treated for at least one year and who had not suffered from serious forms of cancer. Our results would probably have been stronger had we included persons with more serious cancers, but such individuals might not have participated or been able to be caregivers. Given the rapid rise of cancer in China, we suggest that research examine cancer and caregiving in China and that cross-cultural research be done in the U.S. and China. To understand the dynamics of caregiving, health and well-being, one needs to study these processes cross-culturally.

Mental illness is a national concern; for rural residents, the availability of mental health services magnifies the problem. The 2017 National Survey on Drug Use and Health found close to 1.5 million non-urban residents had psychiatric illness or serious thoughts of suicide during 2017. Hypothesis: In Washington State, there is less access for outpatient mental health services in rural areas than in urban areas. The 2018 Washington State Directory of Certified Mental Health, Substance Use Disorder, and Problem & Pathological Gambling Services contains 503 entries of mental health facilities. Using the Office of Community Health Systems Series on Rural-Urban Disparities, facilities with available information were categorized as urban or rural. Statistics were calculated to characterize the availability of individual therapy, and crisis intervention information via public-facing websites for included clinics. The association between rural-urban status and the availability of outpatient psychotherapy and crisis intervention contact information was tested via the chi-squared test of independence. Approximately half (n=131, 50.6%) of clinics with available information regarding outpatient psychotherapy indicated that these services were available. Similarly, nearly half (n=120, 46.1%) of clinics with available information had crisis lifeline information presented via their public-facing website. There was no significant association between urban-rural status and availability of outpatient psychotherapy services (_X²=0.21, p=.647), nor between urban-rural status and publicly available crisis lifeline information on mental health clinic websites (_X²=0.80, p=.371). Washington State rural clinics are not significantly different from urban clinics with respect to saying they provide outpatient psychotherapy and crisis lifeline information. Limitations include methods relying on public reporting of services and limited scope, not allowing the study of other factors that might affect rural residents, such as distance traveled to obtain care. Rural counties in Washington State do not differ from urban counties with respect to the presence of clinics providing outpatient psychotherapy.

Major Depressive Disorder (MDD) has the largest life time prevalence (17%) of mood and anxiety-related disease. The prevalence of MDD is also 1.7 times greater in women than men. Chronic stress and anhedonia are the primary symptoms of depression, and decisions are affected. Our laboratory has shown that corticotropin releasing factor (CRF), the stress hormone, potentiates dopamine release in the core of the nucleus accumbens (NAc), suggesting a relationship between stress and reward processing. While it is known that an individual’s decision making is altered in a depressed state, the precise neurological pathway between stress and reward processing in the brain is unclear. To characterize this “stress-reward” pathway, I used a novel decision-making framework where a cohort of male and female mice performed an operant concurrent-choice task choosing between 0.1M sucrose solution or water. Mice were injected intracranially with α-CRF, a non-selective CRF antagonist, or vehicle in the NAc prior to performing the task. I measured task performance. I hypothesize that mice injected with α-CRF demonstrate less appetitive and reward-seeking behavior compared to the vehicle group, implicating a lower sucrose nosepoke percentage, sucrose choice percentage, and higher sucrose latency during the decision-making task. I also hypothesize that females have a greater reward sensitivity system than males, resulting in an augmented decline in appetitive and reward-seeking behavior compared to males. If these results indicate a significance in further elucidating the “stress-reward pathway” through the decision-making task, this can pave way for potential new treatments targeting this pathway for depression.

The recent large number of world-wide disasters has catapulted disaster research to a highly important endeavor. 2017 was the most expensive on record with 16 U.S. climate events’ losses totaling $306 billion. Research suggests the costliest effects may result from emotional and psychosocial health. Those who are: seniors, distressed, and/or experience early-life vulnerabilities are at increased risk for negative health responses. This study addresses the need to reduce vulnerability and increase preparedness by evaluating how older adults perceive/prepare for disasters, including psychological factors that may influence their motivation to prepare. Literature review results from 26 references indicate older adults are: (1) among our most vulnerable populations for natural disasters, (2) underprepared, though resources are available, and (3) preparing close friends/family before themselves. The Socioemotional Selectivity Theory (SST) posits that as we age, our time perceptions become constrained, motivations shift, and we prefer positive over negative information. Therefore, I asked: (1) if older adults are intuitively resistant to negative information, such as impending disasters, how might we reframe it to be congruent with their desire for positive information? (2) If we approach older adults through more positive experiences, will they be receptive and motivated to prepare? I employed a model, namely: disaster preparedness behavior (PB) is a function of vulnerability (V) and resilience (R). To test this, a survey was developed to assess how factors of V and R would interact and influence PB. I will pilot test this survey through the evaluation of community-living older adults. PB is expected to be negatively related to V, positively related to R. This study extends disaster research by using psychological variables to predict preparedness and evaluating motivation to prepare using SST as a guiding framework. Results should increase knowledge about older adults’ perceptions of disaster preparedness and factors to mitigate increased preparedness.

Alzheimer's disease has been labeled the disease of the 21st Century. Societies around the world have not properly prepared for the expected massive increase in cases projected for the next 30 years. It is unclear who will care for the increase in numbers of people who will not be able to care for themselves.  At present, the vast majority of care is provided in the home by family members. Spouses represent a sizable percent of these family members. Research on spouse caregivers (CGs) has focused mostly on Whites, with relatively little research on minorities.  Research that has examined minorities has mostly examined self-rated measures, with little work on biological indices. The current study compares four groups of spouses: Black CGs (n = 7), Black Non-Caregivers (NCGs) (n = 8), White CGs (n = 115) and White NCGs (n = 108).  We observe differences in perceived stress, coping, burden/distress and physiological measures. The outcome of our research recommends interventions that could be used to mitigate health problems in caregivers that may allow them and their care-recipients to remain in their homes and live independently.

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders to date, affecting 5-7% of school-age children. Characterized by inattention, impulsivity, and hyperactivity, those diagnosed with ADHD often have difficulty in navigating multiple tasks, sustaining attention, and inhibiting impulses. Although prior research suggests increased attention to sensory stimuli enhances task performance temporarily when the stimuli are task-related, little is known about the effect of irrelevant stimuli on task performance. The current study evaluates whether irrelevant stimuli decreases response accuracy and speed during computer tasks among children with ADHD. Children between the ages of seven and eleven, with (n=50) and without (n=30) ADHD, are recruited to participate in comprehensive neurocognitive phenotyping, including completion of two computer games varying in difficulty (i.e. easy and hard versions). The tasks involve ignoring irrelevant visual stimuli that are presented alternatively with task-related visual stimuli. Irrelevant stimuli consist of three stimulus types, including standard (60%; white bracket-shaped image), deviant (20%; white bracket in opposite orientation to standards), and novel (20%; white line drawings of animals and vehicles). The current study hypothesizes that compared to non-ADHD children, children with ADHD will have lower accuracy and slower reaction times in response to task stimuli that immediately follow novel irrelevant stimuli, as compared to standard irrelevant stimuli. Preliminary results (n = 23) support this hypothesis through a variance analysis, indicating children with ADHD show worse accuracy following novel, i.e. more distracting, stimuli than standard stimuli compared to typical, non-ADHD children, F(1, 19) = 5.028, p = .037. Through this study, we will gain a greater understanding of children’s needs of attention maintenance. Implications of this study include reduction in classroom distractions could improve task-related accuracy and processing speed among children with ADHD.

Self-efficacy has been shown to be associated with fewer problem behaviors in adolescence. However, the research investigating this association has been primarily based on self-report measurements of delinquency. The purpose of this study is to see if this association is maintained with a more objective measure of delinquency by examining juvenile offenders’ self-efficacy, and its predictive relationship with probation violations. Using self-report survey data of juvenile offenders’ self-efficacy along with probation violation data from Pierce County Juvenile Court, we conducted a statistical analysis of self-efficacy measurements and official probation violations. The self-reported self-efficacy measures address feelings in desire of academic and career success, prosocial behavior, and a reduction in the desire to express aggressive behaviors. If self-efficacy is shown to be a good predictor of fewer probation violations, further research can investigate determinants of high versus low self-efficacy, or how to improve self-efficacy, in order to promote probation adherence of juvenile offenders.

Autism Spectrum Disorder (ASD) is a collection of neurodevelopmental disorders characterized by social-communicative and behavioral impairments that affects approximately 1 in 59 children in the US. Children with ASD, on average, exhibit increased rates of externalizing behaviors compared to their typically developing peers. Studies have shown that children with relatively low familial risk for ASD are more likely to develop ASD if they have a history of pregnancy complications and that presence of pregnancy or birth complication can exacerbate the severity of externalizing behaviors. In typical development, pregnancy complications are associated with a number of child psychiatric disorders and externalizing behaviors and males have increased levels of externalizing behaviors compared to females. In a sample of children with ASD, this study (1) investigated the relationship between pregnancy complications and externalizing behaviors and (2) compared sex differences in externalizing behaviors. The study involved 200 children with and without pregnancy complications, between the ages of 8 and 17 years. Pregnancy complications were provided by the parent during a medical history interview and refer to a wide range of complications including, among other things, health concerns for the mother or child, difficult birth, or coexisting pregnancy diagnosis such as gestational diabetes or preeclampsia. To assess for externalizing problems, parents of participants completed the Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire about their child. We predict that ASD children (1) with pregnancy complications (compared to those without complications) will demonstrate more externalizing behavior problems and (2) males with ASD will exhibit more externalizing behavior problems than females in the subscale mean scores. The results of this study provide insight to the connection between pregnancy complication and externalizing behaviors in children with ASD.

The growing use of opioids in the United States has become a dangerous epidemic. The people most susceptible to overdosing on opioids are those who relapse after extended drug abstinence, whether forced or by choice. This study investigates the effects of heroin addiction on KCNQ channels in the basal ganglia, which plays an integral role in addiction.  More specifically, our research is focused on relapse after a prolonged period of no drug use. If the population of KCNQ channels are affected by heroin use and addiction, then these channels are a possible site for treatment to target. The drug retigabine, a KCNQ channel opener, has shown promise in reducing self-administration after abstinence by affecting dopamine levels in the striatum, a neurological center often involved in addiction. Given that dopamine release is critical in establishing and affecting addiction, retigabine is a likely candidate to diminish relapse behaviors and, therefore, reduce the occurrence of relapse-related overdoses. This study measures the effect of a global administration of retigabine. Catheters were surgically into the animals’ jugular vein to allow for self-administration of heroin with limited researcher interference. Over the course of three weeks, we ran our animals inoperant boxes for periods of self-administration following various drug availability periods and ending with forced abstinence. After two weeks of forced abstinence, the animals with high and low responding on self-administration were separated into three different treatment groups: Retigabine, XE991 — a  drug that has the opposite effects of retigabine — and a control solution (all administered intraperitoneally). Our animals then underwent one hour of continuous access self-administration where they could relapse. Behaviors such as drug intake, drug seeking, drug taking, and motivation to administer were measured across all six groups.The results from this study will provide evidence on the efficacy of retigabine in reducing relapse behavior after abstinence.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by clinically recognized deficits in social communication, repetitive behaviors, and restricted interests. While the etiological underpinnings of ASD have yet to be determined, biological indicators of the disorder (e.g. biomarkers) hold promise as valuable diagnostic methods. Neurological biomarker initiatives are particularly essential in their potential to pinpoint the neural activity that gives rise to the disorder’s hallmarks. Resting state electroencephalography (EEG) studies suggest altered default signaling associated with ASD, with particular deviations in the power of the alpha frequency band. However, previous work has produced contradictory findings regarding the directionality of these abnormal power patterns, which motivate the need to better understand the implications of certain methodological decisions. In this study, we acquired EEG recordings during resting state paradigms in individuals with ASD and a neurotypical control group. We hypothesized that individuals with ASD would display reduced alpha activity, in comparison. We suspect that activity will be reduced, both when analyzed by peak power and average power over the entire frequency band.

Autism Spectrum Disorder (ASD) is neurodevelopmental disorder that impairs an individual’s social, communicational, and behavioral skills. Boys are 4.5 times more likely to be diagnosed with ASD compared to girls. A potential cause for differences in diagnostic rates may be that girls tend to be more socially focused, allowing them to better camouflage their autism symptoms. Puberty is a period in an adolescent’s life where teens experience significant changes in social experiences and expectations. While puberty often increases social motivation, it’s unclear if males and females improve in the same ways or at the same rates. The goal of this study is to investigate sex differences in the relation between autism behaviors and stages of pubertal development. Participants included 140 children (70 males, 70 females) between the ages of 8 and 17 with a diagnosis of autism. Participants or their parents completed the Pubertal Developmental Scale, which provides a score of the child’s physical progression through puberty. Parents of the children also completed the Social Responsiveness Scale (SRS-2) which scores their child’s social and autism-related impairments. Our analyses (1) Compare SRS scores between youth with ASD based on their pubertal groups (pre/early/mid/late/post). We expect an increase in social awareness, motivation, and cognition for children going through puberty or in post puberty relative to those who have not yet started puberty. (2) Examine sex differences in SRS subdomain scores within each pubertal group and in the pattern of differences between pubertal groups. We expect to find no sex differences before puberty, but lower SRS scores in girls during and after puberty. Investigating the relationship between puberty and social behaviors could help us develop better supports for youth with ASD that incorporate biological and physical changes that come with development and consider how that might impact the youth’s social environment.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that involves challenges in speech and nonverbal communication, social interaction and repetitive behaviors. ASD can manifest in a variety of ways hypothesized to be the result of multiple environmental and genetic factors. Two such genetic factors are disruptive mutations to genes ADNP and DYRK1A, which have been associated with ASD and other developmental problems. While both genes are known to impact neuroplasticity, DYRK1A mutations impair dendritic spine growth and ADNP mutations impact the cytoskeletal system. Little is known about the behavioral phenotypes resulting from DYRK1A and ADNP. The aim of this project is to illuminate phenotypes associated with disruptive variations to both genes by comparing learning, memory, verbal and adaptive skills of people with mutations to these genes to each other. In this study, participants included individuals who have either a disruptive mutation to ADNP (n=9, ages 4-13 years) or to DYRK1A (n=10, ages 4-24 years). The following assessments were administered to each participant: Vineland Adaptive Behavior Scales II (adaptive behaviors), Differential Ability Scales (cognition) and California Verbal Learning Test (speech and learning). These assessments provided a selection of different behavioral phenotypes related to neurological functioning and development. We hypothesize that DYRK1A and ADNP will have differing impacts on phenotype due to their varying contribution to early brain development. This study will contribute to a better understanding of how disruptions to different gene functions can lead to differences in learning, memory, verbal and adaptive skills. In addition, examining these mutations’ differing phenotypes will give a better idea of the implications of living with these gene events and may inform treatment recommendations for families and individuals affected by rare mutations.

 Alcohol use disorder (AUD) is associated with both acute and chronic alcohol-related harm. Marginalized populations, such as those experiencing homelessness, are both less inclined to successfully achieve abstinence and at higher risk of experiencing alcohol-related harm. Identifying strategies for safer use are thus particularly important for this population. To this end, we analyzed interview data collected from 86 adults experiencing homelessness and AUD who received harm reduction treatment (HaRT-A) during the parent randomized controlled trial. Participants were administered the demographic and alcohol measures at baseline (week 0) and were provided with HaRT-A, at which point interventionists introduced a list of safer-drinking strategies. Participants’ endorsement of safer-drinking strategies was assessed at HaRT-A appointments at weeks 0, 1, 2, and 6. For the current analysis, we conducted a mixed methods approach to characterize and evaluate endorsement and implementation of safer-drinking strategies at week 0 and week 6. Findings indicated use of strategies to buffer the effects of alcohol (e.g., eating while drinking), change the manner in which one drinks (e.g., counting drinks), and reduce alcohol use. Quantitative analysis indicated all participants were able to successfully endorse and implement safer-drinking strategies over the course of the study. These findings support that people experiencing homelessness and AUD adopt strategies that minimize alcohol-related harm, including ways that change the amount and manner of drinking and buffering the effects of alcohol. This extends the findings from our parent study among chronically homeless individuals to people experiencing transitional or episodic homelessness.

Risk taking is strongly associated with many disordered behaviors. Many studies implicate the orbitofrontal cortex (OFC) in such behaviors, though its modulation yields inconsistent results. This could be due to possible contrasting effects of intratelencephalic (IT) and pyramidal tract (PT) neurons, which have distinct morphologies and projections. Despite this, specific functionality differences are unknown. Given that 5-HT2A and D1 receptors have predominant expression in IT neurons over PT neurons, and antagonism of these receptors decreases risk-seeking, it was hypothesized that inhibition of all IT neuron activity in the OFC would also result in risk aversion. IT neurons in rats were inhibited during a risky-decision making task (RDT). To modulate IT neurons, an inhibitory designer receptor exclusively activated by designer drugs (DREADD) was injected into lateral OFC bilaterally, conjugated to CRE and FLP drivers injected into contralateral nucleus accumbens. In the full RDT, animals were presented with two levers: The “safe” lever delivered one pellet reward per press, while the “risky” lever delivered four pellets, with descending probability of reward administration (100%, 50%, 25%, 12.5%). Two test sessions were conducted whereby animals received intraperitoneal injections of clozapine-N-oxide (CNO) or a vehicle (DMSO) 30 minutes prior to task onset. Animals receiving CNO the first time received vehicle the second time. To determine if IT neurons were involved in perseverative responding, animals underwent a reversal task. They were presented with an active lever -which administered a food pellet per press -, and an inactive lever. Five consecutive responses on the active lever switched the inactive lever to the “active” lever. Results showed no significant changes in decision-making or reversal learning upon receiving CNO or vehicle. IT neuron modulation may need to be more temporally specific; future studies will focus on monitoring IT activity during decision-making paradigms to further elucidate their contributions within OFC.

Many psychiatric disorders, including substance abuse, have been linked to risky decision-making, but the mechanisms underlying these pathologies remain unclear. Cortical intratelencephalic and pyramidal tract (PT) neurons have distinct projections, morphology, and firing properties, but their role in behavioral regulation remains unknown. PT neurons have been identified in the orbitofrontal cortex (OFC), which is known to be heavily involved in the cognitive process of decision making. Based on previous studies in our lab demonstrating that inactivation of PT neurons increases reward preference, we hypothesized that PT neuron inhibition would increase risky decision-making. To test this hypothesis, rats were trained on a risky-decision task (RDT) in which they were trained to lever press for a food pellet reward. In order to target PT neurons in the OFC, CAV2-CRE virus was bilaterally injected into the pontine reticular nucleus (PnC), and an inhibitory Designer Receptor Exclusively-Activated by Designer Drugs (DREADD; DIO-hM4Di) was injected bilaterally into the OFC; this strategy allows selective expression of DREADDs in PT neurons. In the RDT, two options were presented: a “risky” choice associated with descending probability of administration (100%, 50%, 25%, and 12.5%) for delivery of four food pellets, or a “safe” lever that always delivers one food pellet. To evaluate response flexibility, rats underwent a reversal task whereby five consecutive responses on the active lever switched the “active” lever to the previously inactive one. In both tasks, rats underwent two sessions: in the test session, animals received an injection clozapine-N-oxide (CNO) to activate DREADDs, and in the control session, animals received an injection of vehicle (DMSO). Interestingly, we found that inhibiting PT neurons did not significantly alter decision-making or reversal-learning. Future studies will monitor activity of PT neurons using in vivo calcium imaging to determine the contribution of this cell population to decision-making tasks.