Background Individuals with Down syndrome are likely to develop clinical and neuropathological brain changes resembling Alzheimer's disease dementia by the ages of 35-40 years. Intranasal insulin is a potential treatment for neurodegenerative disease that has been shown to reduce amyloid plaque burden and improve verbal memory performance in normal as well as memory-impaired adults. Investigations have shown that rapid-acting insulins may result in superior cognitive benefits compared with regular insulin. Objectives The primary objective of this study was to measure the safety and feasibility of intranasal rapid-acting glulisine in subjects with Down syndrome. Secondarily, we estimated the effects of intranasal glulisine on cognition and memory in Down syndrome. Methods A single-center, single-dose, randomized, double-blind, placebo-controlled, cross-over pilot study was performed to test the safety of intranasal glulisine vs placebo in 12 subjects with Down syndrome aged ≥ 35 years. Intranasal administration utilized the Impel NeuroPharma I109 Precision Olfactory Delivery (POD ®) device. The primary outcomes were the occurrence of any or related adverse and serious adverse events. Secondary post-treatment cognitive outcome measures included performance on the Fuld Object-Memory Evaluation and Rivermead Behavioral Memory Test. Results Intranasal glulisine was safe and well tolerated in the Down syndrome population. No adverse or serious adverse events were observed. Conclusions Further investigations are necessary to better evaluate the potential cognitive-enhancing role of intranasal insulin in the Down syndrome population. ClinicalTrials.gov ID NCT02432716.

Goal setting is an important component in successful teaching and learning, but relatively little is known about its impact on course persistence and achievement in massive open online courses. Using an experimental design and employing a variety of data including student writings, content-related assignment attempts, and quantitative achievement in the courses, we compared the outcomes of two groups | 1217 PERSISTENCE, PERFORMANCE, AND GOALS IN MOOCSMOOCs on students' persistence and performance in MOOCs and (b) compare persistence and performance between students with a learning goal and a performance goal in MOOCs. This study provides understandings of the relationships among goal setting, performance and persistence, and it adds to the literature on randomized experimental design studies in MOOC contexts. LITERATURE REVIEW Goals, behavior and performanceGoals, to some extent, guide people's behaviors and contribute to human motivation broadly, such as a life goal and specifically a goal for a particular task (Pintrich, 2000). Morin and Latham (2000) stated that "if the person has the requisite ability, a specific difficulty goal not only influences an employee's subsequent behavior through choice, effort and persistence, it affects behavior cognitively through the search for knowledge of ways to attain the goal" (p. 567). Goals should regulate people's behaviors in a conscious way, although some actions that will lead to achieving the goals may not be conscious (Locke, 1968;Pintrich, 2000). People who consciously set goals for themselves are more likely to perform better in jobs (Barrick et al., 1993). Goals and commitmentCommitment to goals is an important component in goal research, and it plays a key role in the relationship between goals and performance. Wofford et al. (1992) reported that goal commitment is significantly related to achievement. Higher and more difficult goals normally result in longer-term persistence and greater commitment to behaviors that will contribute to achieving these goals (Locke & Latham, 2006). When rewards for achieving goals are presented, or when the goals are valued by people, they tend to show a higher commitment to those goals (Locke et al., 1988). Self-set goals usually lead to higher commitment than assigned goals, regardless of the difficulty and specificity of the goals (Locke & Latham, 2002). People who conscientiously set goals often show greater commitments to these goals and obtain higher supervisor ratings at work (Barrick et al., 1993).

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