Implementation and program evaluation pilot study: educating health care providers about protecting population health during climate change.

Recommendations regarding the need to prepare nurses and other health care providers (HCPs) for the health impacts of climate change (CC) have grown ubiquitous in the literature. Timely, efficient and sustainable strategies by the health care industry are necessary. Failure to act is predicted to result in catastrophic and lethal population health consequences. A growing body of research identifies related knowledge gaps and supports HCP competencies and best practice interventions to mitigate adverse population health impacts of CC. A social ecological framework and the PRECEDE-PROCEED approach were employed to develop and evaluate a series of online webinars designed to equip nurses and other HCP’s to incorporate strategies to mitigate, adapt and build resilience to the health impacts of climate change into their practice and professional ethic. A pilot Program Evaluation project was undertaken to examine the constructs of awareness, motivation, concern, and engagement in personal and professional climate related behaviors and the impact that the series of educational webinars had on participants. Comparison was made to determine differences between groups and any self-reported changes in the constructs between pre and post webinar participation. Participants were highly aware, motivated, concerned and engaged in personal mitigation and resilience building behaviors. They indicated a sense of knowledge deficit, lack of confidence, and being overwhelmed as barriers to HCP engagement in climate related professional behaviors. Study results indicate that although participants are willing to speak with personal associates about the population health risks associated with climate change, they do not feel prepared, knowledgeable, or confident to participate in professional behaviors or communicate with colleagues and legislators in order to protect the population from these risks which are predicted to be imminently associated with climate change. The study was limited by small sample size, data collection challenges, and presumable ceiling effect and social desirability bias. This pilot program evaluation study supports the need for immediate development of competency based curricula and practice guidelines to equip, and empower HCP’s to meet their professional ethical obligation to protect human health. Keywords: Health care providers, climate change, environmental sustainability, educatio

Feeling the Burn: A Discursive Analysis of Organizational Burnout in Seasonal Wildland Firefighters

This qualitative study of seasonal wildland firefighters examined stress and burnout in firefighters, the discourse that helps to systematically form firefighters’ conceptualizations of burnout, and what factors enable firefighters to manage or mitigate burnout. Traditionally, burnout is studied in long-term, year-round positions, and this study took a unique angle in considering a temporary/seasonal workforce. A discursive lens was used to investigate the enduring systems of meanings that firefighters draw upon in their everyday talk to more comprehensively understand burnout. Three main Discursive resources emerged from the data: teamwork, a can-do attitude, and bureaucracy. Teamwork and a can-do attitude serve as double-edged swords in firefighters’ experience of burnout, both enabling and constraining the firefighter experience, while bureaucracy emerged as a hindering force in firefighters’ conceptions of burnout. This paper will discuss the causes of burnout, as well as the ways firefighters manage burnout

Cumberland County, Virginia, in the late antebellum period, 1840-1860

The purpose of this thesis is to examine and describe the lives of the citizens of a rural, agricultural Virginia County which had a social and economic order based on the institution of slavery. This system was dominated by a wealthy white minority which had the ability to use the existing components of government to perpetuate itself. All aspects of the county were explored, including its origins, geography, population, county court system, representation in state and federal government, economy, transportation, communication, religion, education, and health care. There was an abundance of available primary sources which gave insights into the county\u27s internal functioning including county court order books, overseer of the poor reports, registers of free Negroes, land tax and property tax books, and license returns. Also, reports of internal improvement companies to the Board of Public Works and other sources gave insights into the available means of transportation. In addition, the reports of the school commissioners provided information on the county\u27s educational situation. Also available were the journals of the Virginia General Assembly, legislative petitions from the county, poll returns, and the Congressional Globe, all of which mirrored the county\u27s attempts to externally influence matters of importance. Insights into religion were drawn from the more numerous records of the Baptist and Presbyterian churches. Newspapers from Richmond and Petersburg were also used. This study illustrates a county which was economically and politically secure. All indications suggested that it would have continued for many years with little change in the absence of the catalyst of the civil War

Nursing’s Emerging Role to Protect Population Health in a Changing Climate

See attached file

Clothing Size Dissatisfaction: A Stronger Predictor of Size-related Avoidance than Body Mass Index

Participants in the current study (N = 2,997) were age and race-representative U.S. adults perceiving themselves as larger in body size than their ideal. Participants completed an internet survey inquiring about size and size-related avoidance behavior. Body mass index (BMI) was measured as well as a novel construct called relative size (RS; current-ideal size) to predict a variety of avoidance behaviors using a 10-item scale. A principal components analysis was performed on the 10-item avoidance scale, and components entitled general avoidance and body display avoidance emerged. Multiple regression analyses were then performed to examine gender differences in avoidance as well as the posited predictive utility of RS above and beyond BMI for the two components of avoidance using the following hierarchical series: BMI, RS, gender, gender/BMI interaction, and gender/RS interaction. RS was found to offer more predictive utility for general avoidance than BMI. For body display avoidance, results suggested that female gender was the sole significant predictor. We believe our findings reinforce previous literature stating that poor body image has more of an adverse impact on the lives of women compared to men and that one’s perception of size can deter involvement in varied life events

Change in health-related quality of life in the context of pediatric obesity interventions: A meta-analytic review.

Objective: To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. Method: Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. Results: The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. Conclusion: This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Selective suppression of the α isoform of p38 MAPK rescues late-stage tau pathology

BACKGROUND: Hyperphosphorylation and aggregation of tau protein are the pathological hallmarks of Alzheimer's disease and related tauopathies. We previously demonstrated that the microglial activation induces tau hyperphosphorylation and cognitive impairment via activation of p38 mitogen-activated protein kinase (p38 MAPK) in the hTau mouse model of tauopathy that was deficient for microglial fractalkine receptor CX3CR1. METHOD: We report an isoform-selective, brain-permeable, and orally bioavailable small molecule inhibitor of p38α MAPK (MW181) and its effects on tau phosphorylation in vitro and in hTau mice. RESULTS: First, pretreatment of mouse primary cortical neurons with MW181 completely blocked inflammation-induced p38α MAPK activation and AT8 (pS199/pS202) site tau phosphorylation, with the maximum effect peaking at 60-90 min after stimulation. Second, treatment of old (~20 months of age) hTau mice with MW181 (1 mg/kg body weight; 14 days via oral gavage) significantly reduced p38α MAPK activation compared with vehicle-administered hTau mice. This also resulted in a significant reduction in AT180 (pT231) site tau phosphorylation and Sarkosyl-insoluble tau aggregates. Third, MW181 treatment significantly increased synaptophysin protein expression and resulted in improved working memory. Fourth, MW181 administration reduced phosphorylated MAPK-activated protein kinase 2 (pMK2) and phosphorylated activating transcription factor 2 (pATF2), which are known substrates of p38α MAPK. Finally, MW181 reduced the expression of interferon-γ and interleukin-1β. CONCLUSIONS: Taken together, these studies support p38α MAPK as a valid therapeutic target for the treatment of tauopathies

Impact of TREM2R47H variant on tau pathology-induced gliosis and neurodegeneration

Alzheimer\u27s disease (AD) is characterized by plaques containing amyloid-β (Aβ) and neurofibrillary tangles composed of aggregated, hyperphosphorylated tau. Beyond tau and Aβ, evidence suggests that microglia play an important role in AD pathogenesis. Rare variants in the microglia-expressed triggering receptor expressed on myeloid cells 2 (TREM2) gene increase AD risk 2- to 4-fold. It is likely that these TREM2 variants increase AD risk by decreasing the response of microglia to Aβ and its local toxicity. However, neocortical Aβ pathology occurs many years before neocortical tau pathology in AD. Thus, it will be important to understand the role of TREM2 in the context of tauopathy. We investigated the impact of the AD-associated TREM2 variant (R47H) on tau-mediated neuropathology in the PS19 mouse model of tauopathy. We assessed PS19 mice expressing human TREM2CV (common variant) or human TREM2R47H. PS19-TREM2R47H mice had significantly attenuated brain atrophy and synapse loss versus PS19-TREM2CV mice. Gene expression analyses and CD68 immunostaining revealed attenuated microglial reactivity in PS19-TREM2R47H versus PS19-TREM2CV mice. There was also a decrease in phagocytosis of postsynaptic elements by microglia expressing TREM2R47H in the PS19 mice and in human AD brains. These findings suggest that impaired TREM2 signaling reduces microglia-mediated neurodegeneration in the setting of tauopathy

Pharmaceutical screen identifies novel target processes for activation of autophagy with a broad translational potential

Autophagy is a conserved homeostatic process active in all human cells and affecting a spectrum of diseases. Here we use a pharmaceutical screen to discover new mechanisms for activation of autophagy. We identify a subset of pharmaceuticals inducing autophagic flux with effects in diverse cellular systems modelling specific stages of several human diseases such as HIV transmission and hyperphosphorylated tau accumulation in Alzheimer’s disease. One drug, flubendazole, is a potent inducer of autophagy initiation and flux by affecting acetylated and dynamic microtubules in a reciprocal way. Disruption of dynamic microtubules by flubendazole results in mTOR deactivation and dissociation from lysosomes leading to TFEB (transcription factor EB) nuclear translocation and activation of autophagy. By inducing microtubule acetylation, flubendazole activates JNK1 leading to Bcl-2 phosphorylation, causing release of Beclin1 from Bcl-2-Beclin1 complexes for autophagy induction, thus uncovering a new approach to inducing autophagic flux that may be applicable in disease treatment