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Tripathi A, Pandey VK, Sharma G, Sharma AR, Taufeeq A, Jha AK, Kim JC. Genomic Insights into Dementia: Precision Medicine and the Impact of Gene-Environment Interaction. Aging Dis 2024; 15:2113-2135. [PMID: 38607741 PMCID: PMC11346410 DOI: 10.14336/ad.2024.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The diagnosis, treatment, and management of dementia provide significant challenges due to its chronic cognitive impairment. The complexity of this condition is further highlighted by the impact of gene-environment interactions. A recent strategy combines advanced genomics and precision medicine methods to explore the complex genetic foundations of dementia. Utilizing the most recent research in the field of neurogenetics, the importance of precise genetic data in explaining the variation seen in dementia patients can be investigated. Gene-environment interactions are important because they influence genetic susceptibilities and aid in the development and progression of dementia. Modified to each patient's genetic profile, precision medicine has the potential to detect groups at risk and make previously unheard-of predictions about the course of diseases. Precision medicine techniques have the potential to completely transform treatment and diagnosis methods. Targeted medications that target genetic abnormalities will probably appear, providing the possibility for more efficient and customized medical interventions. Investigating the relationship between genes and the environment may lead to preventive measures that would enable people to change their surroundings and minimize the risk of dementia, leading to the improved lifestyle of affected people. This paper provides a comprehensive overview of the genomic insights into dementia, emphasizing the pivotal role of precision medicine, and gene-environment interactions.
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Affiliation(s)
- Anjali Tripathi
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Vinay Kumar Pandey
- Division of Research & Innovation (DRI), School of Applied & Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Garima Sharma
- Department of Biomedical Science & Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Ashish Ranjan Sharma
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Republic of Korea
| | - Anam Taufeeq
- Department of Biotechnology, Faculty of Engineering and Technology, Rama University, Kanpur, Uttar Pradesh, India
| | - Abhimanyu Kumar Jha
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Jin-Chul Kim
- Department of Biomedical Science & Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon 24341, Republic of Korea
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Flynt S, Koscinski B, Accorso C, Knapp A, Gorka S, Suhr J, Austin M, Allan NP. A One-Arm Pilot Trial of a Telehealth CBT-Based Group Intervention Targeting Transdiagnostic Risk for Emotional Distress. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.23.24306218. [PMID: 38712129 PMCID: PMC11071586 DOI: 10.1101/2024.04.23.24306218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The COVID-19 pandemic had a significant impact on mental health, straining an already overburdened healthcare system. A modular, transdiagnostic approach to treating psychopathology may be ideal to target common transdiagnostic risk factors for emotional distress and related disorders likely to be impacted by circumstances related to this once-in-a-lifetime environmental stressor. Anxiety sensitivity (AS), or fear of anxious arousal, intolerance of uncertainty (IU), or distress when confronted with uncertainty, and loneliness are three transdiagnostic risk factors impacted by the pandemic and robust predictors of emotional distress beyond that. We completed a pilot feasibility, acceptability, and utility trial of Coping Crew, our group, telehealth-delivered transdiagnostic treatment protocol in 17 participants who completed the intervention (M age = 22.00, SD = 4.46; 71% female). The intervention and study protocol were feasible to deliver and were rated as acceptable and useful to address intervention targets. Evidence was mixed regarding feasibility, acceptability, and usefulness of the mobile app component. Sixteen of 17 participants (94%) completed at least one survey a day on 80% of the days but only 6 participants (35%) completed at least 80% of the mobile app surveys delivered over the course of the intervention. Most participants rated use of the app as acceptable and relevant to psychological improvements made due to the intervention. Sizeable effect size reductions in transdiagnostic risk factors were found at post-intervention and maintained at 1- and 3-month follow-up, supporting next steps in the development of this modular transdiagnostic treatment.
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Affiliation(s)
- Sierra Flynt
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | | | - Ashley Knapp
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | | | | | - Nicholas P. Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States
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Martin SE, Tam MT, Robillard JM. Technology in Dementia Education: An Ethical Imperative in a Digitized World. J Alzheimers Dis 2024; 97:1105-1109. [PMID: 38189750 PMCID: PMC10836540 DOI: 10.3233/jad-230612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/09/2024]
Abstract
Technology can support the delivery of care and improve the lives of people living with dementia. However, despite a substantial body of evidence demonstrating the benefits and opportunities afforded by technology, gaps remain in how technology and technology ethics are addressed in dementia care education. Here we discuss disparities in current educational programming and highlight the ethical challenges arising from underdeveloped knowledge exchange about dementia care technology. We put forward that for technology to be ethically deployed and maximized to improve outcomes, it must be embedded into dementia education programs and made widely accessible to the caregiver community.
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Affiliation(s)
- Susanna E. Martin
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- BC Children’s and Women’s Hospital, Vancouver, BC Canada
| | - Mallorie T. Tam
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- BC Children’s and Women’s Hospital, Vancouver, BC Canada
| | - Julie M. Robillard
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- BC Children’s and Women’s Hospital, Vancouver, BC Canada
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Bhargava Y, Baths V. Technology for dementia care: benefits, opportunities and concerns. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.39606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The rise in incidence and prevalence of dementia globally is driving the technological revolution to develop effective healthcare solutions for dementia patients and caretakers. These solutions promise enhanced mechanisms to manage lifestyle, monitor cognitive performance, ensure the security and safety of the elderly, and deliver rehabilitation services. In this viewpoint, we contextualize the role of technology in dementia care by elaborating on these solutions and discussing the associated benefits, opportunities, and concerns.
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Affiliation(s)
- Yesoda Bhargava
- Cognitive Neuroscience Lab, BITS Pilani K K Birla Goa Campus, Zuarinagar, Goa, India
| | - Veeky Baths
- Cognitive Neuroscience Lab, BITS Pilani K K Birla Goa Campus, Zuarinagar, Goa, India
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Berridge C, Zhou Y, Lazar A, Porwal A, Mattek N, Gothard S, Kaye J. Control Matters in Elder Care Technology:: Evidence and Direction for Designing It In. DIS. DESIGNING INTERACTIVE SYSTEMS (CONFERENCE) 2022; 2022:1831-1848. [PMID: 35969716 PMCID: PMC9367632 DOI: 10.1145/3532106.3533471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Studies find that older adults want control over how technologies are used in their care, but how it can be operationalized through design remains to be clarified. We present findings from a large survey (n=825) of a well-characterized U.S. online cohort that provides actionable evidence of the importance of designing for control over monitoring technologies. This uniquely large, age-diverse sample allows us to compare needs across age and other characteristics with insights about future users and current older adults (n=496 >64), including those concerned about their own memory loss (n=201). All five control options, which are not currently enabled, were very or extremely important to most people across age. Findings indicate that comfort with a range of care technologies is contingent on having privacy- and other control-enabling options. We discuss opportunities for design to meet these user needs that demand course correction through attentive, creative work.
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Yuan X, Li X. Pledging Patent Rights for Fighting Against the COVID-19: From the Ethical and Efficiency Perspective. JOURNAL OF BUSINESS ETHICS : JBE 2021; 179:683-696. [PMID: 34177015 PMCID: PMC8211307 DOI: 10.1007/s10551-021-04873-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/10/2021] [Indexed: 05/28/2023]
Abstract
In response to the great crises of the COVID-19 coronavirus, virtually all new technologies protected by patent rights have been used in practice from diagnostics, therapeutic, medical equipment, and vaccine to prevention, tracking, and containment of COVID-19. However, the moral justification of patent rights is questioned when pharmaceutical patents conflict with public health. This paper proposes a revised approach of deciding on how to address the conflicts between business ethics and patent protections and then compares the different mechanisms of clearing patent thickets. Our findings highlight that patent pledges may not only contribute to achieving the maximized substantive justice of the public but also help patent pledgors fulfill procedural justice. The advantages of patent pledges have attracted many patent holders to make public statements during the COVID-19 pandemic. In contrast, the disadvantages of a free license may make patent pledges not sustainable for a long time without the related supporting measures. Our findings will be helpful for policymakers or company managers to make an appropriate decision on rationally utilizing patent portfolios for fighting against public health crises.
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Affiliation(s)
- Xiaodong Yuan
- School of Management, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xiaotao Li
- School of Literature, Law and Economics, Wuhan University of Science and Technology (WUST), Wuhan, China
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Grigorovich A, Kontos P. Towards Responsible Implementation of Monitoring Technologies in Institutional Care. THE GERONTOLOGIST 2021; 60:1194-1201. [PMID: 31958118 PMCID: PMC7491435 DOI: 10.1093/geront/gnz190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Indexed: 11/17/2022] Open
Abstract
Increasing awareness of errors and harms in institutional care settings, combined with rapid advancements in artificial intelligence, have resulted in a widespread push for implementing monitoring technologies in institutional settings. There has been limited critical reflection in gerontology regarding the ethical, social, and policy implications of using these technologies. We critically review current scholarship regarding use of monitoring technology in institutional care, and identify key gaps in knowledge and important avenues for future research and development.
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Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Berridge C, Demiris G, Kaye J. Domain Experts on Dementia-Care Technologies: Mitigating Risk in Design and Implementation. SCIENCE AND ENGINEERING ETHICS 2021; 27:14. [PMID: 33599847 PMCID: PMC7892732 DOI: 10.1007/s11948-021-00286-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
There is an urgent need to learn how to appropriately integrate technologies into dementia care. The aims of this Delphi study were to project which technologies will be most prevalent in dementia care in five years, articulate potential benefits and risks, and identify specific options to mitigate risks. Participants were also asked to identify technologies that are most likely to cause value tensions and thus most warrant a conversation with an older person with mild dementia when families are deciding about their use. Twenty-one interdisciplinary domain experts from academia and industry in aging and technology in the U.S. and Canada participated in a two-round online survey using the Delphi approach with an 84% response rate and no attrition between rounds. Rankings were analyzed using frequency counts and written-in responses were thematically analyzed. Twelve technology categories were identified along with a detailed list of risks and benefits for each. Suggestions to mitigate the most commonly raised risks are categorized as follows: intervene during design, make specific technical choices, build in choice and control, require data transparency, place restrictions on data use and ensure security, enable informed consent, and proactively educate users. This study provides information that is needed to navigate person-centered technology use in dementia care. The specific recommendations participants offered are relevant to designers, clinicians, researchers, ethicists, and policy makers and require proactive engagement from design through implementation.
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Affiliation(s)
- Clara Berridge
- School of Social Work, University of Washington, Seattle, WA USA
| | - George Demiris
- School of Nursing and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jeffrey Kaye
- School of Medicine, Oregon Health and Science University, Portland, OR USA
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Portacolone E, Halpern J, Luxenberg J, Harrison KL, Covinsky KE. Ethical Issues Raised by the Introduction of Artificial Companions to Older Adults with Cognitive Impairment: A Call for Interdisciplinary Collaborations. J Alzheimers Dis 2020; 76:445-455. [PMID: 32250295 PMCID: PMC7437496 DOI: 10.3233/jad-190952] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Due to the high costs of providing long-term care to older adults with cognitive impairment, artificial companions are increasingly considered as a cost-efficient way to provide support. Artificial companions can comfort, entertain, and inform, and even induce a sense of being in a close relationship. Sensors and algorithms are increasingly leading to applications that exude a life-like feel. We focus on a case study of an artificial companion for people with cognitive impairment. This companion is an avatar on an electronic tablet that is displayed as a dog or a cat. Whereas artificial intelligence guides most artificial companions, this application also relies on technicians "behind" the on-screen avatar, who via surveillance, interact with users. This case is notable because it particularly illustrates the tension between the endless opportunities offered by technology and the ethical issues stemming from limited regulations. Reviewing the case through the lens of biomedical ethics, concerns of deception, monitoring and tracking, as well as informed consent and social isolation are raised by the introduction of this technology to users with cognitive impairment. We provide a detailed description of the case, review the main ethical issues and present two theoretical frameworks, the "human-driven technology" platform and the emancipatory gerontology framework, to inform the design of future applications.
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Affiliation(s)
- Elena Portacolone
- Institute for Health & Aging, University of California San Francisco, San Francisco, CA, USA
| | - Jodi Halpern
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | | | - Krista L. Harrison
- Division of Geriatric Medicine, University of California San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth E. Covinsky
- Division of Geriatric Medicine, University of California San Francisco, San Francisco, CA, USA
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McKeown A, Turner A, Angehrn Z, Gove D, Ly A, Nordon C, Nelson M, Tochel C, Mittelstadt B, Keenan A, Smith M, Singh I. Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape. J Alzheimers Dis 2020; 77:339-353. [PMID: 32716354 PMCID: PMC7592677 DOI: 10.3233/jad-191300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought. OBJECTIVE Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease. METHODS Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience. RESULTS Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk. CONCLUSION These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Andrew Turner
- The National Institute for Health Research Applied Research Collaboration West [NIHR ARC West] at University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | | | - Amanda Ly
- MRC Integrative Epidemiology Unit & Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Mia Nelson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire Tochel
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Alex Keenan
- Janssen Pharmaceutica NV, Titusville, NJ, USA
| | - Michael Smith
- Alzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Paisley, Scotland, UK
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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