Assessing Alzheimer's Disease Knowledge and Cognitive Risk Among a Rural Older Afro-Caribbean Cohort.

PURPOSE: Older, rural Afro-Caribbeans are a growing subset of the Black population who face increased risk for Alzheimer's disease and related dementias (ADRD), but research targeting ADRD is scarce in this group. The purpose of this study was to investigate dementia risk among older Afro-Caribbeans living in a rural area. We also examined age, sex, and years of education, and knowledge about Alzheimer's disease as potential predictors of dementia risk. DESIGN: A pre-post, correlational design was employed. METHODS: Cognitive screenings were conducted using Nasreddine's Mini-MoCA, with tests of language fluency/orientation/recall, and linear regression analysis. A basic knowledge of Alzheimer's disease survey (BKAD) was also administered. FINDINGS: A total of 55 Afro-Caribbean participants (67.0 +10.8y (M ± SD), 65.5% with 10y or less of education residing in a rural area within the last 20 years were included.Over 50% of the convenience sample scored in the cognitive risk range. Significant associations were found between Mini-MoCA Total and Language scores and education (p < 0.01). Further, there was a significant change from pretest to posttest in BKAD scores. BKAD pretest and posttest scores were also significantly higher for those without dementia risk based on the Mini-MoCA Total. CONCLUSION: While the Mini-MoCA showed good reliability in less-educated older Afro-Caribbeans, scores were strongly dependent on years of education. Offering a limited intervention resulted in increased BKAD scores in this Afro-Caribbean sample, and a low BKAD score was associated with a higher dementia risk category. CLINICAL EVIDENCE: This study contributes to the limited but growing body of research about Alzheimer's disease knowledge, cognitive risk, and dementia detection among Afro-Caribbeans. The use of language-neutral cognitive assessments is recommended among rural older immigrants.

Testing the 'Faith Moves Mountains model' to increase Alzheimer's disease awareness, detection, and diagnosis among rural, racially, and ethnically diverse older adults.

OBJECTIVES: Racially and ethnically diverse populations have recently contributed to the majority of rural and small-town growth. Consequently, the disproportionately high risk and prevalence of Alzheimer's disease and related dementias (ADRD) among rural and minoritized older residents will likely increase. To address this threat, we tested the hypotheses that (1) a faith-based, resident-led approach would increase basic ADRD knowledge and diagnosis, and (2) older age, female gender, lower educational levels, and more years lived rural would predict number of referrals, new dementia diagnoses, and treatment. METHODS: An adaptation of Schoenberg's Faith Moves Mountains model, previously successful in detection and management of other chronic illnesses in rural settings, guided this community-based participatory research. Local faith community members were trained as research assistants to recruit, administer surveys, conduct brief memory assessments, teach brain health strategies, and follow-up with residents. Outreaches were offered virtually during the pandemic, then in-person monthly at rotating church sites, and repeated ∼1 year later. RESULTS: This rural sample was racially and ethnically diverse (74.5% non-White), with 28% reporting eight or less years of formal education. Findings included that referrals and years lived rural were significant and positive predictors of new ADRD treatments [(b = 3.74, χ2(1, n = 235) = 13.01, p < 0.001); (b = 0.02, χ2(1, n = 235 = 3.93, p = 0.048)], respectively, regardless of participant characteristics. CONCLUSION: Resident-led action research in rural, diverse, faith communities is a successful approach to increasing ADRD disease knowledge, detection, diagnosis, and treatment.

Online Chair Yoga and Digital Learning for Rural Underserved Older Adults at Risk for Alzheimer's Disease and Related Dementias.

OBJECTIVES: We evaluated the feasibility and preliminary efficacy of a home-based online chair yoga (OCY) program for racially and ethnically diverse rural community-dwelling older adults. METHODS: We randomly assigned participants to OCY or a computer brain game (CBG). After a computer literacy training led by high school students, participants engaged in remotely supervised OCY or CBG in twice-weekly 45-minute sessions for 12 weeks. Outcome data (pain interference, cognitive function, mobility, computer skills) were collected at baseline, post-intervention, and 3-month follow-up. RESULTS: A total of 32 eligible residents with mean age of 71 years participated in this intervention study. The interventions were feasible (100% recruitment rate, 96.8% retention rate, 100% safety rate). There were significant improvements in pain interference, cognitive function, mobility, and computer skills from baseline to follow-up among participants in both OCY and CBG but no significant differences in outcomes between groups. CONCLUSIONS: Preliminary results indicated that the CBG was as effective as online OCY in clinical outcomes in these participants. However, this should be confirmed in future studies. CLINICAL IMPLICATIONS: This telehealth-based intervention is feasible for older adults in rural and digitally underserved communities and could provide a strategy for delivering health-promoting interventions for home-bound older adults at risk for Alzheimer's disease and related dementias (ADRD) and connect caregivers to online resources.

The impact of a pilot telehealth coaching intervention to improve caregiver stress and well-being and to increase dietary protein intake of caregivers and their family members with dementia - Interrupted by COVID-19.

The prevalence of dementia is growing as the population and longevity increase. Caregivers of adults with dementia report stress and fatigue and often neglect their health. They also indicate the need for information to address health-related issues, including nutritional problems, of their family members with dementia (FMWD). This study examined the impact of coaching to improve family caregiver (FCG) stress and well-being and to increase the protein intake of both FCGs and their FMWD. All participants received nutrition education including a protein prescription (1.2 g/kg body weight/day) and FCGs received stress-reduction materials. Coached-group randomized participants also received weekly diet coaching and stress-reduction coaching. At baseline and 8 weeks, anthropometrics, a mini-nutritional assessment questionnaire, and diet (protein intake) were assessed in FCGs and FMWD; well-being, fatigue and strain were assessed in FCGs. Repeated two words measures analysis of variance and Fisher's exact tests examined within group and intervention effects. Twenty-five FCGs (13 coached group, 12 not-coached group) and 23 FMWD (12 coached group, 11 not-coached group) completed the study. No significant differences were found between coached and not-coached FCGs and FMWD at baseline. After 8- weeks, FCGs' protein intake significantly increased from 1.00 ± 0.17 to 1.35 ± 0.23 g/kg/body weight in the coached group and from 0.91 ± 0.19 to 1.01 ± 0.33 g/kg/body weight in the not-coached group; there was also an intervention effect (p=.01, η2 = .24). The percentage of FCGs with baseline protein intake less than prescription guidelines and with an end-of-study protein intake meeting/exceeding the prescription significantly differed, with 60% of coached FCGs versus 10% of not coached FCGs meeting the prescription. No intervention effects were shown for protein intake in FMWD or for well-being, fatigue or strain among FCGs. Diet coaching with nutrition education successfully assisted FCGs with improving their protein intake versus nutrition education alone.

Whither nursing philosophy: Past, present and future.

A version of this paper was given as the Inaugural Steven Edwards Memorial Lecture at the 25th conference of the International Philosophy of Nursing Society 16th August 2022. Using the literary meaning of 'whither', that is 'to what place', this paper will explore the role of philosophy in nursing, past, present, and future. The paper will begin with some thoughts on the history of nursing philosophy, its development as a subject and the scholarly activities that have led to where it sits today. The establishment of the journal Nursing Philosophy, the Annual Nursing Philosophy Conference, the International Philosophy of Nursing Society (IPONS) and their influence on nursing both in the academy and in practice will be discussed. The concept of nursing philosophy as a discipline will be considered, and how this fits with nursing theory, and nursing knowledge. Philosophical questions central to understanding contemporary nursing in a globalised world will be explored and the use of analytical philosophy and philosophical method in addressing such questions. The paper will conclude by looking to the future; what the role of philosophy might be in shaping nursing as a discipline and in the preparation of future practitioners.

Ethical issues arising from the assisted dying debate.

The assisted dying debate is complex, with confusion over definitions and the stance taken by professional bodies. It can also be challenging to make sense of the claims made by those who support changes in the law regarding assisted dying. End of life care is an important aspect of a nurse's role and therefore understanding the ethical issues arising from the debate is useful for nurses in clinical practice. This article outlines the legal position in the UK and the bills currently before the Westminster and Scottish parliaments proposing changes in the law. It also considers major ethical issues arising from the debate, along with the nurse's role in caring for patients requesting assisted dying.

Applying utilitarianism to the presumed consent system for organ donation to consider the moral pros and cons.

In May 2020, England adopted an opt-out approach for organ donation, also referred to as the deemed consent system, with the aim of alleviating the demand for organs in the UK. This system dictates that those who have not opted out will have their organs donated following their death, with the exception of those meeting certain criteria. This article applies the philosophical theory of utilitarianism to the deemed consent system for organ donation, focusing particularly on topics such as that of informed consent and family refusal. Utilitarianism is a consequentialist theory that attempts to determine whether an action is morally right or wrong based on whether or not it maximises the preferences of the greatest number of people, with each person's satisfaction being considered as equal to another's.

Optimised patient information materials and recruitment to a study of behavioural activation in older adults: an embedded study within a trial.

Background: Printed participant information about randomised controlled trials is often long, technical and difficult to navigate. Improving information materials is possible through optimisation and user-testing, and may impact on participant understanding and rates of recruitment. Methods: A study within a trial (SWAT) was undertaken within the CASPER trial. Potential CASPER participants were randomised to receive either the standard trial information or revised information that had been optimised through information design and user testing. Results: A total of 11,531 patients were randomised in the SWAT. Rates of recruitment to the CASPER trial were 2.0% in the optimised information group and 1.9% in the standard information group (odds ratio 1.027; 95% CI 0.79 to 1.33; p=0.202). Conclusions: Participant information that had been optimised through information design and user testing did not result in any change to rate of recruitment to the host trial. Registration: ISRCTN ID ISRCTN02202951; registered on 3 June 2009.

Dynamin 2-dependent endocytosis is essential for mouse oocyte development and fertility.

During folliculogenesis, oocytes are dependent on metabolic and molecular support from surrounding somatic cells. Here, we examined the role of the dynamin (DNM) family of mechanoenzymes in mediating endocytotic uptake into growing follicular oocytes. We found DNM1 and DNM2 to be highly expressed in growing follicular oocytes as well as in mature germinal vesicle (GV) and metaphase II (MII) stage oocytes. Moreover, oocyte-specific conditional knockout (cKO) of DNM2 (DNM2Δ) led to complete sterility, with follicles arresting at the preantral stage of development. In addition, DNM2Δ ovaries were characterized by disrupted follicular growth as well as oocyte and follicle apoptosis. Further, the loss of DNM activity, either through DNM2 cKO or through pharmacological inhibition (Dyngo 6a) led to the impairment of endocytotic pathways in preantral oocytes as well as in mature GV and MII oocytes, respectively. Loss of DNM activity resulted in the redistribution of endosomes and the misslocalization of clathrin and actin, suggesting dysfunctional endocytosis. Notably, there was no observable effect on the fertility of DNM1Δ females. Our study has provided new insight into the complex and dynamic nature of oocyte growth during folliculogenesis, suggesting a role for DNM2 in mediating the endocytotic events that are essential for oocyte development.

Cardiologists' and patients' views about the informed consent process and their understanding of the anticipated treatment benefits of coronary angioplasty: A survey study.

BACKGROUND: Percutaneous coronary intervention is a common revascularisation technique. Serious complications are uncommon, but death is one of them. Seeking informed consent in advance of percutaneous coronary intervention is mandatory. Research shows that percutaneous coronary intervention patients have inaccurate perceptions of risks, benefits and alternative treatments. AIM: To assess cardiologists' and patients' views about the informed consent process and anticipated treatment benefits. METHODS: Two cross-sectional, anonymous surveys were distributed in England: an electronic version to a sample of cardiologists and a paper-based version to patients recruited from 10 centres. RESULTS: A sample of 118 cardiologists and 326 patients completed the surveys. Cardiologists and patients shared similar views on the purpose of informed consent; however, over 40% of patients and over a third of cardiologists agreed with statements that patients do not understand, or remember, the information given to them. Patients placed less value than cardiologists on the consent process and over 60% agreed that patients depended on their doctor to make the decision for them. Patients' and cardiologists' views on the benefits of percutaneous coronary intervention were significantly different; notably, 60% of patients mistakenly believed that percutaneous coronary intervention was curative. CONCLUSIONS: The percutaneous coronary intervention informed consent process requires improvement to ensure that patients are more involved and accurately understand treatment benefits to make an informed decision. Redesign of the patient pathway is recommended to allow protected time for health professionals to engage in discussions using evidence-based approaches such as 'teach back' and decision support which improve patient comprehension.

The small non-coding RNA profile of mouse oocytes is modified during aging.

Oocytes are reliant on messenger RNA (mRNA) stores to support their survival and integrity during a protracted period of transcriptional dormancy as they await ovulation. Oocytes are, however, known to experience an age-associated alteration in mRNA transcript abundance, a phenomenon that contributes to reduced developmental potential. Here we have investigated whether the expression profile of small non-protein-coding RNAs (sRNAs) is similarly altered in aged mouse oocytes. The application of high throughput sequencing revealed substantial changes to the global sRNA profile of germinal vesicle stage oocytes from young (4-6 weeks) and aged mice (14-16 months). Among these, 160 endogenous small-interfering RNAs (endo-siRNAs) and 10 microRNAs (miRNAs) were determined to differentially accumulate within young and aged oocytes. Further, we revealed decreased expression of two members of the kinesin protein family, Kifc1 and Kifc5b, in aged oocytes; family members selectively targeted for expression regulation by endo-siRNAs of elevated abundance. The implications of reduced Kifc1 and Kifc5b expression were explored using complementary siRNA-mediated knockdown and pharmacological inhibition strategies, both of which led to increased rates of aneuploidy in otherwise healthy young oocytes. Collectively, our data raise the prospect that altered sRNA abundance, specifically endo-siRNA abundance, could influence the quality of the aged oocyte.

Learning from interprofessional education: A cautionary tale.

BACKGROUND: Interprofessional education (IPE) is time consuming to develop and sustain and presents many logistical and practical challenges to curriculum developers. Drawing on findings from an evaluation study of an IPE pilot, this paper brings new insights into both positive implications and potentially negative consequences of delivering large scale IPE. OBJECTIVE: The aim of the study was to evaluate a large scale IPE pilot delivered to students in the first year of their training. DESIGN AND SETTING: The IPE pilot took place on campus and was focused on patient safety (human factors). PARTICIPANTS: The study involved 630 first year undergraduates across 10 programmes at a UK university. METHODS: A mixed methods evaluation was conducted comprising a paper-based survey circulated at the end of the taught session followed by uni-professional focus groups (n = 4). Questionnaire data was subject to descriptive statistical analysis and key themes were generated from the focus group data. RESULTS: Three overarching themes emerged from analysis of the qualitative data: Understanding differences in roles, Learning about stereotypes and Unintended perpetuation of stereotypes. CONCLUSIONS: IPE is an important part of the training of all health and social care professionals and the study revealed many benefits of this approach. However, we should be sensitive to the possibility of inadvertently perpetuating negative stereotypes as a consequence of IPE activities. Our work highlights the need for caution when considering the planning and executing IPE activities.

Proxy decision making and dementia: Using Construal Level Theory to analyse the thoughts of decision makers.

AIMS: This study explored the feasibility of using Construal Level Theory to analyse proxy decision maker thinking about a hypothetical ethical dilemma, relating to a person who has dementia. BACKGROUND: Proxy decision makers make decisions on behalf of individuals who are living with dementia when dementia affects that individual's decision making ability. Ethical dilemmas arise because there is a need to balance the individual's past and contemporary values and views. Understanding of how proxy decision makers respond is incomplete. Construal Level Theory contends that individuals imagine reactions and make predications about the future by crossing psychological distance. This involves abstract thinking, giving meaning to decisions. There is no empirical evidence of Construal Level Theory being used to analyse proxy decision maker thinking. Exploring the feasibility of using Construal Level Theory to understand dementia carer thinking regarding proxy decisions may provide insights which inform the support given. DESIGN: Descriptive qualitative research with semi-structured interviews. METHODS: Seven participants were interviewed using a hypothetical dementia care scenario in February 2016. Interview transcripts were analysed for themes. Construal Level Theory was applied to analyse participant responses within themes using the Linguistic Category Model. RESULTS: Participants travelled across psychological distance, using abstract thinking to clarify goals and provide a basis for decisions. When thinking concretely participants established boundaries regarding the ethical dilemma. CONCLUSION: Construal Level Theory gives insight into proxy decision maker thinking and the levels of abstraction used. Understanding what dementia carers think about when making proxy decisions may help nurses to understand their perspectives and to provide appropriate support.

Reproductive failure in mice expressing transgenic follicle-stimulating hormone is not caused by loss of oocyte quality.

Human female reproductive aging features declining ovarian follicle reserve and oocyte quality, and rising levels of circulating follicle-stimulating hormone (FSH). We determined the effects of elevated FSH on oocyte-embryo development in mature mice exhibiting premature infertility caused by progressively rising transgenic human FSH (TgFSH) levels. Oocyte-embryo developmental competence and quality were examined using oocyte maturation and aneuploidy rates, biomarkers of oocyte quality, and reciprocal embryo transfers assessed for implantation and pregnancy. In vitro maturation suggested that TgFSH exposure only hindered oocyte developmental competence in old females, as significantly more oocytes from ≥12-month-old TgFSH females remained at germinal vesicle stage compared with age-matched control oocytes. Aneuploidy rates were equivalent in oocytes from aging TgFSH compared with wildtype females. Cumulus cell expression levels of candidate biomarker Inhba, Egfr, and Rgs2 transcripts were elevated in associated aneuploid vs euploid oocytes from both TgFSH and wildtype females. In vivo, embryos transferred from subfertile 6-month-old TgFSH females to wildtype recipients yielded normal implantation rates and more pups born compared with controls. Transfer of wildtype embryos rescued the fertility of 6-month-old TgFSH-recipient females, although pup birth weight was reduced in TgFSH vs wildtype recipients. Our current findings show that elevated FSH had minimal disruption of either embryo developmental capacity or uterine function when examined in isolation, and the subfertility of TgFSH female mice was not caused by altered oocyte aneuploidy or quality.

Input Subject Diversity Accelerates the Growth of Tense and Agreement: Indirect Benefits From a Parent-Implemented Intervention.

Purpose: This follow-up study examined whether a parent intervention that increased the diversity of lexical noun phrase subjects in parent input and accelerated children's sentence diversity (Hadley et al., 2017) had indirect benefits on tense/agreement (T/A) morphemes in parent input and children's spontaneous speech. Method: Differences in input variables related to T/A marking were compared for parents who received toy talk instruction and a quasi-control group: input informativeness and full is declaratives. Language growth on tense agreement productivity (TAP) was modeled for 38 children from language samples obtained at 21, 24, 27, and 30 months. Parent input properties following instruction and children's growth in lexical diversity and sentence diversity were examined as predictors of TAP growth. Results: Instruction increased parent use of full is declaratives (ηp2 ≥ .25) but not input informativeness. Children's sentence diversity was also a significant time-varying predictor of TAP growth. Two input variables, lexical noun phrase subject diversity and full is declaratives, were also significant predictors, even after controlling for children's sentence diversity. Conclusions: These findings establish a link between children's sentence diversity and the development of T/A morphemes and provide evidence about characteristics of input that facilitate growth in this grammatical system.

Percutaneous coronary intervention patients' and cardiologists' experiences of the informed consent process in Northern England: a qualitative study.

OBJECTIVE: Informed consent is central to ethical medical practice, but little is known about how the process takes place in clinical practice. Percutaneous coronary intervention (PCI) is a common revascularisation procedure. Studies report that patients overestimate benefits, forget the risks and are unaware of alternative treatments. The aim of this study was to describe PCI patients' and cardiologists' experiences of the informed consent process in acute care settings. DESIGN/SETTING/PARTICIPANTS: A qualitative study with a maximum variation sample of elective and acute PCI patients and cardiologists taking their consent, recruited from a district general hospital and tertiary centre. In-depth interviews were conducted, and consent discussions were audio recorded. Data collection, coding and theorising occurred simultaneously. FINDINGS: Forty-one (26 male) patients scheduled for elective (20) or urgent (21) PCI and 19 cardiologists (5 female) participated. Despite diversity in patients' experiences of informed consent, elective and acute patients experienced a common four-stage process of consent. Most patients made the decision to have treatment at PCI referral and took a passive role in the discussions we recorded. They recognised cardiologists as experts, trusted the medical system to 'fix' their health problem and were unaware of their role in the informed consent process. Informed consent discussions functioned as a formal 'event',enabling cardiologists to check patients' understanding and enabling patients to access treatment. CONCLUSIONS: The configuration of services and patients' perceptions of their role in informed consent underpin a mismatch between legal and ethical principles of informed consent and current practice. The variation in patients' experiences of the current place of informed consent in service delivery represents a missed opportunity for cardiologists to work in decision-making partnerships with patients. In light of recent changes in the law, a new approach to informed consent is required.

Motoring through: the role of kinesin superfamily proteins in female meiosis.

BACKGROUND: The kinesin motor protein family consists of 14 distinct subclasses and 45 kinesin proteins in humans. A large number of these proteins, or their orthologues, have been shown to possess essential function(s) in both the mitotic and the meiotic cell cycle. Kinesins have important roles in chromosome separation, microtubule dynamics, spindle formation, cytokinesis and cell cycle progression. This article contains a review of the literature with respect to the role of kinesin motor proteins in female meiosis in model species. Throughout, we discuss the function of each class of kinesin proteins during oocyte meiosis, and where such data are not available their role in mitosis is considered. Finally, the review highlights the potential clinical importance of this family of proteins for human oocyte quality. OBJECTIVE AND RATIONALE: To examine the role of kinesin motor proteins in oocyte meiosis. SEARCH METHODS: A search was performed on the Pubmed database for journal articles published between January 1970 and February 2017. Search terms included 'oocyte kinesin' and 'meiosis kinesin' in addition to individual kinesin names with the terms oocyte or meiosis. OUTCOMES: Within human cells 45 kinesin motor proteins have been discovered, with the role of only 13 of these proteins, or their orthologues, investigated in female meiosis. Furthermore, of these kinesins only half have been examined in mammalian oocytes, despite alterations occurring in gene transcripts or protein expression with maternal ageing, cryopreservation or behavioral conditions, such as binge drinking, for many of them. WIDER IMPLICATIONS: Kinesin motor proteins have distinct and important roles throughout oocyte meiosis in many non-mammalian model species. However, the functions these proteins have in mammalian meiosis, particularly in humans, are less clear owing to lack of research. This review brings to light the need for more experimental investigation of kinesin motor proteins, particularly those associated with maternal ageing, cryopreservation or exposure to environmental toxicants.