Frank Puga

Functional networks underlying latent inhibition learning in the mouse brain

The present study reports the first comprehensive map of brain networks underlying latent inhibition learning and the first application of structural equation modeling to cytochrome oxidase data. In latent inhibition, repeated exposure to a stimulus results in a latent form of learning that inhibits subsequent associations with that stimulus. As neuronal energy demands to form learned associations changes, so does the induction of the respiratory enzyme cytochrome oxidase. Therefore, cytochrome oxidase can be used as an endpoint metabolic marker of the effects of experience on regional brain metabolic capacity. Quantitative cytochrome oxidase histochemistry was used to map brain regions in mice trained on a tone-footshock fear conditioning paradigm with either tone preexposure (latent inhibition), conditioning only (acquisition), conditioning followed by tone alone (extinction), or no handling or conditioning (naive). The ventral cochlear nucleus, medial geniculate, CA1 hippocampus, and perirhinal cortex showed modified metabolic capacity due to latent inhibition. Structural equation modeling was used to determine the causal influences in an anatomical network of these regions and others thought to mediate latent inhibition, including the accumbens and entorhinal cortex. An uncoupling of ascending influences between auditory regions was observed in latent inhibition. There was also a reduced influence on the accumbens from the perirhinal cortex in both latent inhibition and extinction. The results suggest a specific network with a neural mechanism of latent inhibition that appears to involve sensory gating, as evidenced by modifications in metabolic capacity and effective connectivity between auditory regions and reduced perirhinal cortex influence on the accumbens.

Risk assessment and avoidance in juvenile golden hamsters exposed to repeated stress.

Juvenile hamsters are typically less vulnerable to social subjugation than adults, although they will avoid aggressive individuals in some situations. The purpose of this study was to determine the extent to which social subjugation stimulates fear- or anxiety-like behavior in juvenile hamsters in both social and non-social contexts. Social context testing was conducted in a Y-maze while the non-social context apparatus consisted of an open field arena and a lat-maze. In the Y-maze, subjects were exposed to an unfamiliar aggressive adult hamster. Compared with non-subjugated controls, subjugated juveniles spent significantly more time in the area furthest from the aggressive adult stimulus. In addition, socially stressed animals were more likely to avoid the arm of the maze containing the social stimulus. When they did walk in the arm containing the social stimulus, subjugated individuals were more likely to ambulate slowly. Subjugated hamsters also performed fewer olfactory investigations in the proximity of the unfamiliar aggressive individual. Despite these behavioral differences detected between groups during testing in a social context, we observed no differences between groups in the open field and lat-maze. This suggests that the effects of subjugation observed in the Y-maze are specific to exposure to a social context and that social subjugation in juvenile hamsters does not result in a generalized state of fear. Instead, subjugated juveniles learned to avoid adult males and were otherwise behaviorally similar to non-subjugated controls.

Variations in Institutional Review Board Approval in the Implementation of an Improvement Research Study

The purpose of this paper is to report the variance in institutional review board (IRB) reviews as part of the implementation of a multisite, quality improvement study through the Improvement Science Research Network (ISRN) and recommend strategies successful in procuring timely IRB approval. Using correspondence documents as data sources, the level of review was identified and time to submission, time to approval, and time to study start were analyzed. Thirteen of the 14 IRBs conducted independent reviews of the project. Twelve IRBs approved the study through expedited review while two IRBs reviewed the project at a full board meeting. Lastly, 11 of the 14 sites required documented consent. The greatest delay in approval was seen early on in the IRB process with site PIs averaging 45.1 ± 31.8 days to submit the study to the IRB. IRB approvals were relatively quick with an average of 14 ± 5.7 days to approval. The delay in study submission may be attributed to a lack of clear definitions and differing interpretations of the regulations that challenge researchers.

Adopting Best Practices from Team Science in a Healthcare Improvement Research Network: The Impact on Dissemination and Implementation

Healthcare is a complex adaptive system, and efforts to improve through the implementation of best practice are well served by various interacting disciplines within the system. As a transdisciplinary model is new to clinicians, an infrastructure that creates academic-practice partnerships and builds capacity for scientific collaboration is necessary to test, spread, and implement improvement strategies. This paper describes the adoption of best practices from the science of team science in a healthcare improvement research network and the impact on conducting a large-scale network study. Key components of the research network infrastructure were mapped to a team science framework and evaluated in terms of their effectiveness and impact on a national study of nursing operations. Results from this study revealed an effective integration of the team science principles which facilitated the rapid collection of a large dataset. Implications of this study support a collaborative model for improvement research and stress a need for future research and funding to further evaluate the impact on dissemination and implementation.

Chronic social stress in puberty alters appetitive male sexual behavior and neural metabolic activity.

Repeated social subjugation in early puberty lowers testosterone levels. We used hamsters to investigate the effects of social subjugation on male sexual behavior and metabolic activity within neural systems controlling social and motivational behaviors. Subjugated animals were exposed daily to aggressive adult males in early puberty for postnatal days 28 to 42, while control animals were placed in empty clean cages. On postnatal day 45, they were tested for male sexual behavior in the presence of receptive female. Alternatively, they were tested for mate choice after placement at the base of a Y-maze containing a sexually receptive female in one tip of the maze and an ovariectomized one on the other. Social subjugation did not affect the capacity to mate with receptive females. Although control animals were fast to approach females and preferred ovariectomized individuals, subjugated animals stayed away from them and showed no preference. Cytochrome oxidase activity was reduced within the preoptic area and ventral tegmental area in subjugated hamsters. In addition, the correlation of metabolic activity of these areas with the bed nucleus of the stria terminalis and anterior parietal cortex changed significantly from positive in controls to negative in subjugated animals. These data show that at mid-puberty, while male hamsters are capable of mating, their appetitive sexual behavior is not fully mature and this aspect of male sexual behavior is responsive to social subjugation. Furthermore, metabolic activity and coordination of activity in brain areas related to sexual behavior and motivation were altered by social subjugation.

Advancing Care for Family Caregivers of persons with dementia through caregiver and community partnerships

BackgroundThere are currently 15 million Americans who provide over 80% of the care required by their family members with Alzheimer’s disease and other dementias. Yet care for caregivers continues to be fragmented and few evidence-based interventions have been translated into routine clinical care and therefore remain inaccessible to most family caregivers. To address this gap, the Caring for the Caregiver program is being developed at UT Health San Antonio, School of Nursing to improve support services and health outcomes for family caregivers. Our purpose is to describe the engagement process undertaken to assess caregiver and community needs and how findings are informing program development.MethodsWe are using a model of public engagement that consists of communication of information, collection of information from stakeholders, and collaboration where stakeholders are partners in an exchange of information to guide program activities. An assessment of the community was undertaken to identify resources/services for family caregivers. Subsequently, stakeholders were invited to a community-academic forum to discuss strategies to build on existing strengths for family caregiving and to identify gaps in care. Detailed notes were taken and all discussions were recorded and transcribed for analysis. Data were analyzed using thematic content analysis.ResultsWe conducted site visits with 15 community agencies, interviewed 13 family caregivers, and attended community events including support groups and health and senior fairs. Fifty-three diverse stakeholders attended the community-academic forum. Participants identified existing assets within our community to support family caregivers. Consistent among groups was the need to increase awareness in our community about family caregivers. Themes identified from the discussion were: making the invisible visible, you don’t know what you don’t know, learning too late, and anticipating and preparing for the future.ConclusionsIncorporating caregiver and community stakeholders was critical to ensure that the priorities of our community are addressed in a culturally responsive accessible program for family caregivers. The forum served as important mechanism to partner with the community and will be an annual event where we can continue to work with our stakeholders around needs for practice, education, and research.

Beyond the Horizon: International Learning Experiences, Community Engagement, and Mental Health in Guatemala.

Untreated mental health is a global issue that needs attention. A lack of resources and services in low-income communities underscore the persistent disparities in mental healthcare services. In 2013, the World Health Organization (WHO) published a global action plan that calls for healthcare reform and increased support for vulnerable populations that are disproportionately affected by mental illness. In this report, WHO advocates a focus on determinants of health, including social, cultural, economic, political and environmental factors, to expand services and decrease the stigma of mental health (WHO, 2013). The next generation of clinicians will need to be prepared to act as advocates for mental health in socially marginalized populations from a social justice perspective. Education of healthcare professionals needs to move beyond the classroom and usual clinical placements to community settings with culturally diverse populations. Doing so will not only build cultural capacity in students, but will also foster partnerships with communities that can lead to sustainable change. International learning experiences (ILEs), in the form of clinical immersions in other countries, can serve as a potential mechanism to enhance educational opportunities and promote effective community engagement. Every summer since 2006, our nursing students have joined a team of over 100 volunteers who travel to Guatemala to provide medical and surgical care to the indigenous Maya population. Over seven days, students provide direct patient care in pre-operative, intraoperative, post-anesthesia, and post-operative settings. Students also participate in community development by installing stoves and water purification systems for families who live in rural and remote villages. This ILE is structured such that students gain experience working with a socially marginalized population whose culture and language differs from their own. These types of ILEs have been shown