Correlation of health literacy and learning style preference in persons with heart failure.

OBJECTIVE: The purpose of the study was to describe demographic and health literacy correlates of learning style in older adults with heart failure (HF). METHODS: Cross sectional data on learning styles (VARK Questionnaire, 16 items) and health literacy (S-TOFHLA, 36 items) were collected. Preferred learning style was determined and correlated to health literacy and demographic measures. RESULTS: 116 participants with heart failure (M age = 75.1 (SD 12.5) years, M health literacy of 19 (SD 11.5). Most identified as male (59 %); with inadequate health literacy (67 %). Thirty percent reported a multimodal learning style preference with a kinesthetic (r = .33, p = .03) and not a visual preference (r = -.49, p < .001). Among unimodal learning styles, the most frequent was kinesthetic (26.7 %). Those with lower literacy levels were older (r = -.44, p = <.001), had less education (r = .48, p < .001) and reported a kinesthetic learning preference (r = .37, p = .001). CONCLUSION: Older individuals identifying as male, with low health literacy, preferred a kinesthetic approach to HF education. Future research should consider the linkage between education tailored to learning style, health literacy and outcomes. PRACTICE IMPLICATIONS: Assessment of learning style should be completed prior to an educational encounter.

Competence and Confidence With Quality and Safety Education for Nurses Competencies by Newly Licensed Registered Nurses.

Understanding newly licensed registered nurses' perceived confidence in the Quality and Safety Education for Nurses (QSEN) competency domains and corresponding knowledge, skills, and attitudes will help inform clinical leaders to develop successful transition-to-practice programs. Newly licensed registered nurses and prelicensure nursing students had confidence in their understanding of QSEN competencies as they began their transition to practice. Online learning and virtual practicums were effective for attaining QSEN competencies, offering support for using these interventions in academic settings and transition-to-practice programs.

Voluntary Attrition Among Traditional Baccalaureate Nursing Students: An Integrative Review.

AIM: The purpose of this review is to synthesize what is known about voluntary attrition from baccalaureate nursing education. BACKGROUND: Understanding the reasons behind elective, voluntary attrition from nursing programs can help maximize resources and graduate more nurses into the workforce. METHOD: An integrative review of the literature was conducted using the search strategy outlined by Whittemore and Knafl. The validated Mixed-Methods Appraisal Tool was used to assess the quality of the studies found in the search. RESULTS: Ten studies met review criteria. Studies showed that academic and emotional underpreparedness, economic challenges, feelings of isolation, differences between perceptions of nursing and the realities of professional practice, and incongruence with learning objectives in clinical settings led to dissatisfaction. CONCLUSION: It is important to educate the public about nursing as a rigorous college major. The realities of nursing school, feelings of acceptance, and academic preparedness must be addressed by educators.

Emergent dynamics of adult stem cell lineages from single nucleus and single cell RNA-Seq of Drosophila testes.

Proper differentiation of sperm from germline stem cells, essential for production of the next generation, requires dramatic changes in gene expression that drive remodeling of almost all cellular components, from chromatin to organelles to cell shape itself. Here, we provide a single nucleus and single cell RNA-seq resource covering all of spermatogenesis in Drosophila starting from in-depth analysis of adult testis single nucleus RNA-seq (snRNA-seq) data from the Fly Cell Atlas (FCA) study. With over 44,000 nuclei and 6000 cells analyzed, the data provide identification of rare cell types, mapping of intermediate steps in differentiation, and the potential to identify new factors impacting fertility or controlling differentiation of germline and supporting somatic cells. We justify assignment of key germline and somatic cell types using combinations of known markers, in situ hybridization, and analysis of extant protein traps. Comparison of single cell and single nucleus datasets proved particularly revealing of dynamic developmental transitions in germline differentiation. To complement the web-based portals for data analysis hosted by the FCA, we provide datasets compatible with commonly used software such as Seurat and Monocle. The foundation provided here will enable communities studying spermatogenesis to interrogate the datasets to identify candidate genes to test for function in vivo.

Perceived stigma, barriers, and facilitators experienced by members of the opioid use disorder community when seeking healthcare.

INTRODUCTION: Healthcare professionals, particularly nurses, have negative attitudes towards individuals with opioid use disorder (OUD) and these attitudes can contribute to suboptimal care. The aim of this study was to identify stigma, barriers and facilitators experienced by members of the OUD community when interacting with the healthcare system. DESIGN: A qualitative exploratory design used semi-structured focus group interviews to address the study aim. METHODS: Following IRB approval, purposive sampling was used to recruit participants with a history of OUD, family caregivers of individuals with OUD, and support group leaders from regional recovery groups to provide a broad perspective of stigmatizing issues and barriers to care. Focus group discussions were conducted, and video recorded using web-based conferencing software. Transcripts from the focus groups and field notes were analyzed and coded into themes. RESULTS: Both structural and social determinants of health were identified by participants as stigmatizing and/or barriers to care. Thematic content analysis resulted in eight themes: stigmatizing language, being labeled, inequitable care, OUD as a chronic illness, insurance barriers, stigma associated with medications for OUD (MOUD), community resources, and nursing knowledge and care. CONCLUSION: Members of the OUD community are challenged by both internal and external stigma when seeking healthcare. Stigma negatively affects public support for allocation of resources to treat OUD. Interventions aimed at reducing stigma are critical to support effective OUD treatment and prevent barriers to OUD care. CLINICAL RELEVANCE: Understanding the complex relationships between stigma and structural determinants of health will allow nursing science to develop educational interventions that provide the next generation of nurses with the knowledge, skills, and attitudes needed to advance health equity for individuals with OUD.

Activation of the EGFR/MAPK pathway drives transdifferentiation of quiescent niche cells to stem cells in the Drosophila testis niche.

Adult stem cells are maintained in niches, specialized microenvironments that regulate their self-renewal and differentiation. In the adult Drosophila testis stem cell niche, somatic hub cells produce signals that regulate adjacent germline stem cells (GSCs) and somatic cyst stem cells (CySCs). Hub cells are normally quiescent, but after complete genetic ablation of CySCs, they can proliferate and transdifferentiate into new CySCs. Here we find that Epidermal growth factor receptor (EGFR) signaling is upregulated in hub cells after CySC ablation and that the ability of testes to recover from ablation is inhibited by reduced EGFR signaling. In addition, activation of the EGFR pathway in hub cells is sufficient to induce their proliferation and transdifferentiation into CySCs. We propose that EGFR signaling, which is normally required in adult cyst cells, is actively inhibited in adult hub cells to maintain their fate but is repurposed to drive stem cell regeneration after CySC ablation.

Examination of Factors Affecting Therapeutic Attitude and Empowerment of Perianesthesia Nurses Who Care for Patients With Opioid Use Disorder.

PURPOSE: Patients with opioid use disorder (OUD) and associated complexities are presenting to hospitals in increasing numbers. Preparation of perianesthesia nurses caring for this patient population has lagged, with noted deficits in continuing education, resources, and role support. Previous research found education without considering therapeutic attitude (TA), empowerment and factors that influence nursing practice does not translate into feelings of competence in nursing care. The purpose of this study was to identify correlates and predictors that affect TA and empowerment among perianesthesia nurses caring for patients with OUD. DESIGN: A cross-sectional, correlation design was used to identify correlates and predictors of TA and empowerment in a national sample of perianesthesia nurses (N = 215) METHODS: A national survey collected data from perianesthesia nurses. The Perianesthesia Nurse Empowerment and Therapeutic Attitude Model was the guiding framework. Pearson product-moment correlation and hierarchical multiple regression analyses were used to examine relationships between personal factors, the professional practice environment and societal factors of perianesthesia nurses. FINDINGS: The standardized regression coefficients indicated the professional practice environment (ß = -0.28), drug user stigma (ß = 0.27), access to a pain specialist (ß = 0.25), and exposure to drug users (ß = 0.25) were the strongest predictors of TA. Access to a pain specialist (ß = -0.15) and the professional practice environment (ß = 0.72) were the strongest predictors of empowerment. CONCLUSIONS: The professional practice environment directly influenced the degree of empowerment and TA reported by perianesthesia nurses. Exposure to persons with OUD and personal stigmatization of persons who misuse drugs decreased TA but had no association with empowerment. Access to a pain specialist was moderately predictive of empowerment and negatively associated with TA suggesting a lack of role legitimacy and the need for further research into perianesthesia nurses' perceptions of their role when caring for this population.

Uncertainty levels differ by physical heart failure symptom cluster.

BACKGROUND: The role of uncertainty, unpredictable symptoms, and unknown illness trajectory are frequent concerns reported in heart failure (HF) literature. Illness uncertainty can lead to difficulty interpreting symptoms, potentially impacting outcomes. Impaired functional status, quality of life, all-cause mortality, rehospitalization, and event-free survival are predicted by symptom clusters. No studies to date describe levels of uncertainty by physical symptom cluster in HF. AIMS: Describe physical HF symptom clusters and determine if uncertainty levels differ by symptom cluster. METHODS: Results are based on a secondary analysis of data from patients hospitalized with an acute exacerbation of HF. The Heart Failure Somatic Perception Scale (HFSPS) and Mishel's Uncertainty in Illness Scale (MUIS-C) were completed. Symptom clusters were determined by hierarchical agglomerative clustering. Controlling for age and gender, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group. RESULTS: One hundred and thirty-three primarily older (76.4 ± 12.1), Caucasian (92.5%) adults (55.2% male), with an ischemic HF etiology (71.6%) were enrolled. Three clusters were found: 1. Shortness of breath, n = 47, 2. Edema, n = 39, and 3. Cardiac, n = 43. Adjusting for age and gender, uncertainty levels differed by cluster group (p ≤ 0.001), with edema cluster members reporting greater illness uncertainty than cardiac cluster members (74.6 vs 69.5, respectively, p = 0.033). CONCLUSIONS: Differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.

A Cohort Model of Mentoring as Facilitator to the Transition to an Academic Nurse Faculty Position Following Completion of a PhD.

ABSTRACT: Successful transition to an academic nurse educator role is challenging; it is necessary to identify facilitators and barriers that aide or hinder this process. This study used an autoethnographic qualitative design to explore the lived experiences of a cohort of faculty during their transition into a tenure-track role. Three facilitators (noncompetitive environment, resource sharing, and cohort approach) and two barriers (work-life balance and intrusion of old habits) emerged as themes. A cohort model can be a valuable facilitator for a successful transition. Multitiered mentoring further aided in the transition.

Executive dysfunction is associated with self-care confidence in patients with heart failure.

AIM: To explore differences in self-care maintenance, management and confidence levels between American heart failure (HF) patients with and without executive dysfunction. BACKGROUND: Evidence indicates some aspect of cognitive impairment is prevalent in up to 75% of the HF patient population. Moreover, cognitive impairment has been identified as a barrier to adequate self-care contributing to poor outcomes. There is limited understanding of the role executive function, a domain of cognitive performance, has on self-care behaviors for patients with HF. METHOD: This secondary analysis examined the role of executive function, measured by the Clock Drawing Test (CDT), in relation to self-care measures. The Self Care of Heart Failure Index v6.2 (SCHFI v6.2) was used to measure self-care maintenance, management, and confidence. RESULTS: Participants had a mean age of 75.1 ± 12.5 years, identified as male (59.4%), with New York Heart Association (NYHA) class III (57.3%). Executive function impairment was present in 28% of the sample. Comparison of self-care maintenance and management scores between the two groups were not significant. However, participants with executive dysfunction demonstrated an average self-care confidence score of 48.6 ± 23.3, while participants with no executive function impairment demonstrated a higher average self-care confidence score of 61.5 ± 18.4. Differences in self-care confidence scores between the groups were statistically significant (p = .014). CONCLUSIONS: HF self-care confidence is considered a moderator of self-care behaviors. Understanding the influence executive function has on self-care confidence may lead to a better understanding of those needing greater support with self-care behaviors.

Using Consensus Testing to Enhance Genomic Understanding and Teamwork in Doctoral Advanced Practice Nursing Students.

Nurse educators are challenged to develop effective strategies to teach genomic content, increase communication skills, and encourage teamwork among doctoral advanced practice nursing students. Consensus testing is a collaborative learning strategy where students work together in small groups using communication and teamwork to solve problems. This descriptive survey study evaluated consensus testing as a strategy to increase doctoral students' understanding of genomic content and provide practical experience with teamwork and collaboration in a blended course. Findings from 38 doctoral students indicated that understanding of genomic content increased as students gained practical experience with strategies for collaboration, effective teamwork, and leadership skills.

The CHD Protein, Kismet, is Important for the Recycling of Synaptic Vesicles during Endocytosis.

Chromatin remodeling proteins of the chromodomain DNA-binding protein family, CHD7 and CHD8, mediate early neurodevelopmental events including neural migration and differentiation. As such, mutations in either protein can lead to neurodevelopmental disorders. How chromatin remodeling proteins influence the activity of mature synapses, however, is relatively unexplored. A critical feature of mature neurons is well-regulated endocytosis, which is vital for synaptic function to recycle membrane and synaptic proteins enabling the continued release of synaptic vesicles. Here we show that Kismet, the Drosophila homolog of CHD7 and CHD8, regulates endocytosis. Kismet positively influenced transcript levels and bound to dap160 and endophilin B transcription start sites and promoters in whole nervous systems and influenced the synaptic localization of Dynamin/Shibire. In addition, kismet mutants exhibit reduced VGLUT, a synaptic vesicle marker, at stimulated but not resting synapses and reduced levels of synaptic Rab11. Endocytosis is restored at kismet mutant synapses by pharmacologically inhibiting the function of histone deacetyltransferases (HDACs). These data suggest that HDAC activity may oppose Kismet to promote synaptic vesicle endocytosis. A deeper understanding of how CHD proteins regulate the function of mature neurons will help better understand neurodevelopmental disorders.

Extramacrochaetae promotes branch and bouton number via the sequestration of daughterless in the cytoplasm of neurons.

The Class I basic helix-loop-helix (bHLH) proteins are highly conserved transcription factors that are ubiquitously expressed. A wealth of literature on Class I bHLH proteins has shown that these proteins must homodimerize or heterodimerize with tissue-specific HLH proteins in order to bind DNA at E-box consensus sequences to control tissue-specific transcription. Due to its ubiquitous expression, Class I bHLH proteins are also extensively regulated posttranslationally, mostly through dimerization. Previously, we reported that in addition to its role in promoting neurogenesis, the Class I bHLH protein daughterless also functions in mature neurons to restrict axon branching and synapse number. Here, we show that part of the molecular logic that specifies how daughterless functions in neurogenesis is also conserved in neurons. We show that the Type V HLH protein extramacrochaetae (Emc) binds to and represses daughterless function by sequestering daughterless to the cytoplasm. This work provides initial insights into the mechanisms underlying the function of daughterless and Emc in neurons while providing a novel understanding of how Emc functions to restrict daughterless activity within the cell.

Meditation interventions among heart failure patients: An integrative review.

BACKGROUND: There has been growing interest in meditation techniques as an intervention in chronic disease populations. Little is known of the effect meditation practice has on outcomes among patients with heart failure. PURPOSE: To identify and examine current literature on meditation interventions on heart failure outcomes. METHOD: The review utilized methods described by Whittemore and Knafl. Three electronic databases were searched through March 2018. Terms used were "mindfulness OR meditation" and "heart failure" in combination, generating 58 articles after duplicates were removed. After inclusion and exclusion criteria were applied, six studies qualified for review, including four articles with samples from the United States and two with samples from Brazil and Sweden, respectively. RESULTS: Among the six studies in the final sample, the total number of participants was 320 heart failure patients. Interventional design and length varied among the studies, and 20 different dependent variables were identified. This study distinguished four categories of outcome measures with significant findings: psychosocial, biophysical, quality of life and heart failure symptom burden. Compared with controls meditation practice significantly improved depression (p<.05), social support (p<.05), biophysical factors and quality of life (p<.05), in addition to reducing heart failure symptom burden. Across-study comparisons were limited due to variation in intervention definitions and designs. Additionally, the intervention dose and reporting method varied, limiting comparisons. The sample size in five out of six studies was fewer than 50 participants. Over 20 different measures were used across the six studies to measure outcome variables. CONCLUSION: Meditation may offer a patient-driven practice to reduce heart failure symptoms as well as improve psychosocial wellness and quality of life. Future research among heart failure patients should include the following: rigorous definition of meditation interventions, consistency in intervention characteristics, larger controlled trials, and standardized outcome instruments.

The Drosophila Chromodomain Protein Kismet Activates Steroid Hormone Receptor Transcription to Govern Axon Pruning and Memory In Vivo.

Axon pruning is critical for sculpting precise neural circuits. Although axon pruning has been described in the literature for decades, relatively little is known about the molecular and cellular mechanisms that govern axon pruning in vivo. Here, we show that the epigenetic reader Kismet (Kis) is required for developmental axon pruning in Drosophila mushroom bodies. Kis binds to cis-regulatory elements of the steroid hormone receptor ecdysone receptor (ecr) gene and is necessary for activating expression of EcR-B1. Kis promotes the active H3K36 di- and tri-methylation and H4K16 acetylation histone marks at the ecr locus. We show that transgenic EcR-B1 can rescue axon pruning and memory defects associated with loss of Kis and that the histone deacetylase inhibitor SAHA also rescues these phenotypes. EcR protein abundance is the cell-autonomous, rate-limiting step required to initiate axon pruning in Drosophila, and our data suggest this step is under the epigenetic control of Kis.

Mannitol ingestion causes concentration-dependent, sex-biased mortality in adults of the fruit fly (Drosophila melanogaster).

Mannitol, a sugar alcohol used in commercial food products, has been previously shown to induce sex-biased mortality in female Drosophila melanogaster when ingested at a single concentration (1 M). We hypothesized that sex differences in energy needs, related to reproductive costs, contributed to the increased mortality we observed in females compared to males. To test this, we compared the longevity of actively mating and non-mating flies fed increasing concentrations of mannitol. We also asked whether mannitol-induced mortality was concentration-dependent for both males and females, and if mannitol's sex-biased effects were consistent across concentrations. Females and males both showed concentration-dependent increases in mortality, but female mortality was consistently higher at concentrations of 0.75 M and above. Additionally, fly longevity decreased further for both sexes when housed in mixed sex vials as compared to single sex vials. This suggests that the increased energetic demands of mating and reproduction for both sexes increased the ingestion of mannitol. Finally, larvae raised on mannitol produced expected adult sex ratios, suggesting that sex-biased mortality due to the ingestion of mannitol occurs only in adults. We conclude that sex and reproductive status differences in mannitol ingestion drive sex-biased differences in adult fly mortality.

Epigenetic crosstalk: Pharmacological inhibition of HDACs can rescue defective synaptic morphology and neurotransmission phenotypes associated with loss of the chromatin reader Kismet.

We are beginning to appreciate the complex mechanisms by which epigenetic proteins control chromatin dynamics to tightly regulate normal development. However, the interaction between these proteins, particularly in the context of neuronal function, remains poorly understood. Here, we demonstrate that the activity of histone deacetylases (HDACs) opposes that of a chromatin remodeling enzyme at the Drosophila neuromuscular junction (NMJ). Pharmacological inhibition of HDAC function reverses loss of function phenotypes associated with Kismet, a chromodomain helicase DNA-binding (CHD) protein. Inhibition of HDACs suppresses motor deficits, overgrowth of the NMJ, and defective neurotransmission associated with loss of Kismet. We hypothesize that Kismet and HDACs may converge on a similar set of target genes in the nervous system. Our results provide further understanding into the complex interactions between epigenetic protein function in vivo.

Repeated recall as an intervention to improve memory performance in heart failure patients.

BACKGROUND: Up to 50% of heart failure patients demonstrate aspects of cognitive impairment, including memory deficit. Novel interventions are needed to address memory deficit among heart failure patients. AIM: The goal of this study was to evaluate the testing effect as an intervention to improve memory performance in heart failure patients. METHODS: This was a randomized controlled clinical trial ( N=84) comparing the memory performance of heart failure patients with and without mild cognitive impairment after a repeated testing intervention. Memory performance was measured by verbal word pair associates recall scores, between attention control and experimental subjects. RESULTS: Patients had a mean age of 71.7 ± 13.3 years and similar baseline memory (immediate p=.79 and delayed p=.47). Overall, there were no significant differences in memory between experimental and control subjects, respectively (67.2±18.87 vs. 61.9±22.3, verbal word pair associates, t = -1.179, p=.24). In the final hierarchical regression model, age ( p=.018) and education ( p=.006) were significant predictors of memory performance, with the intervention approaching significance ( p=.079). CONCLUSIONS: Although not statistically significant, the intervention group reported better memory. Age and education continue to be significant contributors to memory performance in the heart failure population. Continued development of interventions to improve memory performance in heart failure patients is indicated.