Examining the Relationship Between Modifiable Risk Factors and Levels of Functioning Among Appalachian Patients With Heart Failure

Background: Heart failure is becoming more prevalent in the United States due to our aging population. More than 10% of people over the age of 70 have heart failure. Risk factors include coronary artery disease (CAD), which includes myocardial infarction and angina. Hypertension precedes heart failure in 75% of cases. Risk factors for CAD include obesity, high glycemic intake, high dietary sodium intake, sedentary lifestyle, and cigarette smoking. In West Virginia, the heart failure death rate is 32.6 per 100,000 population, accounting for 3% of all deaths. The highest rates of hospitalization for heart failure in the nation are found in Appalachia yet a gap exists in the literature on how modifiable risk factors are related to the well-being of people living in this region.;Aims: The aims of this study were to determine the relationship between nutrition, obesity, physical activity, and smoking on physical, social, and emotional well-being among Appalachian patients with heart failure.;Methods: A cross-sectional, descriptive, correlational study using a convenience sample of 115 patients from a nursing home, two outpatient clinics, and a tertiary-care hospital was conducted to examine the relationship between modifiable risk factors and well-being as measured by the Minnesota Living With Heart Failure Questionnaire (MLHFQ). Modifiable risk factors were measured using (1) the American Heart Association Life\u27s Simple 7 Questionnaire to assess nutrition habits, (2) BMI as a measure of obesity, (3) the Duke Activity Status Index (DASI) for physical activity, and (4) the Global Adult Tobacco Survey (GATS) to determine smoking status. Bivariate and descriptive analyses were performed and nonparametric analogs were used to examine the relationship between predictor and outcome variables. One-way analysis of variance (ANOVA) tests were used to further analyze risk factors in relation to levels of well-being.;Results: A majority of participants in this study were older, white, obese or overweight, and of lower socioeconomic status and had New York Heart Association (NYHA) class III or IV disease. Statistically significant findings included higher levels of physical activity being related to enhanced levels of physical, social, and emotional well-being. Nutritional status was found to be significantly related to higher levels of social well-being.;Conclusion: Knowledge of modifiable risk factors and their relationship to the well-being of individuals with heart failure in Appalachia is necessary to develop appropriate secondary prevention measures aimed at reducing or eliminating these risk factors. Physical activity programs may have the greatest impact on physical, social, and emotional well-being in this study population. Identifying resources in rural areas of Appalachia is necessary to promote behavior modification to reduce modifiable risks to ultimately minimize disease progression

Getting to the Heart of It: Examining Intergenerational Sensemaking of Heart Disease

Using Communicated Narrative Sense-Making Theory (Koenig Kellas, 2018), this study tested how grandchildren’s perceptions of risk and knowledge about heart disease in the family, as well as relational satisfaction, changed over the course of 3 weeks as a result of engaging in a storytelling experiment. Participants included 17 grandchild participants who interviewed their grandparents to tell stories about family heart health or discuss everyday events based on random assignment into a treatment or comparison group. Additionally, participants completed measures surrounding their knowledge of heart disease, relational satisfaction with their grandparent, and their perception of risk to develop heart disease in their lifetime. Thematic analysis of the stories revealed three parts to the storytelling sequence: (a) the HD Family Tree, (b) the grandparent’s story and reaction, and (c) advice/lessons learned. Story themes included (a) confusion/shock, (b) acceptance of their health, and (c) disjointed reporting. Statistical analyses revealed trends for an increase in heart disease knowledge in the treatment group over time, as well as increased perceptions of dread risk over time, although relational satisfaction for grandchildren in their grandparent-grandchild relationship did not change over the 3 weeks. The results of this study provide a deeper look into how grandparents may help to socialize their grandchildren in this understudied family relationship, especially in regards to health. Moreover, these results also help to shed light on how CNSM’s proposition relating to intergenerational values, attitudes, and beliefs are communicated through retrospective stories about health and what living family members should be aware of for their own health moving forward. Advisor: Jody Koenig Kella

Study Protocol of Coaching End-of-Life Palliative Care for Advanced Heart Failure Patients and Their family Caregivers in Rural Appalachia: A Randomized Controlled Trial

Background Heart failure (HF) afflicts 6.5 million Americans with devastating consequences to patients and their family caregivers. Families are rarely prepared for worsening HF and are not informed about end-of-life and palliative care (EOLPC) conservative comfort options especially during the end stage. West Virginia (WV) has the highest rate of HF deaths in the U.S. where 14% of the population over 65 years have HF. Thus, there is a need to investigate a new family EOLPC intervention (FamPALcare), where nurses coach family-managed advanced HF care at home. Methods This study uses a randomized controlled trial (RCT) design stratified by gender to determine any differences in the FamPALcare HF patients and their family caregiver outcomes versus standard care group outcomes (N = 72). Aim 1 is to test the FamPALcare nursing care intervention with patients and family members managing home supportive EOLPC for advanced HF. Aim 2 is to assess implementation of the FamPALcare intervention and research procedures for subsequent clinical trials. Intervention group will receive routine standard care, plus 5-weekly FamPALcare intervention delivered by community-based nurses. The intervention sessions involve coaching patients and family caregivers in advanced HF home care and supporting EOLPC discussions based on patients’ preferences. Data are collected at baseline, 3, and 6 months. Recruitment is from sites affiliated with a large regional hospital in WV and community centers across the state. Discussion The outcomes of this clinical trial will result in new knowledge on coaching techniques for EOLPC and approaches to palliative and end-of-life rural home care. The HF population in WV will benefit from a reduction in suffering from the most common advanced HF symptoms, selecting their preferred EOLPC care options, determining their advance directives, and increasing skills and resources for advanced HF home care. The study will provide a long-term collaboration with rural community leaders, and collection of data on the implementation and research procedures for a subsequent large multi-site clinical trial of the FamPALcare intervention. Multidisciplinary students have opportunity to engage in the research process. Trial registration ClinicalTrials.gov NCT04153890, Registered on 4 November 201

Cryopreservation of specialised Chicken Lines using cultured primordial germ cells

Biosecurity and sustainability in poultry production requires reliable germplasm conservation. Germplasm conservation in poultry is more challenging in comparison to other livestock species. Embryo cryopreservation is not feasible for egg-laying animals, and chicken semen conservation has variable success for different chicken breeds. A potential solution is the cryopreservation of the committed diploid stem cell precursors to the gametes, the primordial germ cells (PGCs). Primordial germ cells are the lineage-restricted cells found at early embryonic stages in birds and form the sperm and eggs. We demonstrate here, using flocks of partially inbred, lower-fertility, major histocompatibility complex- (MHC-) restricted lines of chicken, that we can easily derive and cryopreserve a sufficient number of independent lines of male and female PGCs that would be sufficient to reconstitute a poultry breed. We demonstrate that germ-line transmission can be attained from these PGCs using a commercial layer line of chickens as a surrogate host. This research is a major step in developing and demonstrating that cryopreserved PGCs could be used for the biobanking of specialized flocks of birds used in research settings. The prospective application of this technology to poultry production will further increase sustainability to meet current and future production needs

Basic student nurse perceptions about clinical instructor caring

Abstract: Background: Caring is the core of nursing and should be cultivated in student nurses. However, there are serious concerns about the caring concern in the clinical environment and in nursing education. Clinical instructors are ideally positioned to care for student nurses so that they in turn, can learn to care for their patients. Methods: A descriptive, comparative, cross-sectional and correlational quantitative research design with convenience sampling was conducted to describe the perceptions of junior student nurses (n ¼ 148) and senior student nurses (n ¼ 168) regarding clinical instructor caring. A structured self administered questionnaire using the Nursing Student Perceptions of Instructor Caring (NSPIC) (Wade & Kasper, 2006) was used. Descriptive statistics and hypotheses testing using parametric and non parametric methods were conducted. The reliability of the NSPIC was determined..

5-hydroxymethyl-cytosine enrichment of non-committed cells is not a universal feature of vertebrate development

5-hydroxymethyl-cytosine (5-hmc) is a cytosine modification that is relatively abundant in mammalian pre-implantation embryos and embryonic stem cells (Esc) derived from mammalian blastocysts. Recent observations imply that both 5-hmc and Tet1/2/3 proteins, catalyzing the conversion of 5-methyl-cytosine to 5-hmc, may play an important role in self renewal and differentiation of Escs. here we assessed the distribution of 5-hmc in zebrafish and chick embryos and found that, unlike in mammals, 5-hmc is immunochemically undetectable in these systems before the onset of organogenesis. In addition, Tet1/2/3 transcripts are either low or undetectable at corresponding stages of zebrafish development. however, 5-hmc is enriched in later zebrafish and chick embryos and exhibits tissue-specific distribution in adult zebrafish. Our findings show that 5-hmc enrichment of non-committed cells is not a universal feature of vertebrate development and give insights both into evolution of embryonic pluripotency and the potential role of 5-hmc in its regulation

The associations between loneliness, social exclusion and pain in the general population : a N=502,528 cross-sectional UK Biobank study

Chronic pain presents a huge burden for individuals and society and evidence suggests intrinsic links with loneliness, social exclusion and sleep. Research examining how these factors interact is warranted. We aimed to explore the relationships between social exclusion, loneliness, acute and chronic pain, and the influence of poor sleep, in the general UK population. A cross-sectional analysis of UKBiobank participants with baseline data for acute and chronic pain, loneliness and sleep. Principal components analysis (PCA) used data relating to social isolation and deprivation to establish a composite measure of social exclusion. Binary logistic regression analyses were performed. 502,528 UKBiobank participants (mean age=56.6years, 54.4%female, 94.6%white) were included in the analysis. PCA suggested three social exclusion factors “social participation”, “individual deprivation” and “area deprivation”. Loneliness significantly predicted acute (OR:1.887;95%CI1.857-1.917) and chronic pain (OR:1.843;95%CI1.816–1.870). Each social exclusion factor alone and in combination significantly predicted pain with largest effects for individuals scoring high on all social exclusion factors, for acute (OR:2.087;95%CI2.026-2.150) and chronic (OR:2.314;95%CI2.249-2.380) pain. Coefficients remained statistically significant when models were adjusted for demographics and sleep. Social exclusion (as a multifaceted construct) and loneliness are associated with an increased prevalence of acute and chronic pain. Poor sleep has a potential mediating effect on these associations. Exploration of the incidence of pain in loneliness and social exclusion in the general population is warranted. From a public health perspective these findings could be used to design social interventions to prevent or manage pain and mitigate social exclusion