Native American Student Achievement in Minnesota

This report includes information about Native American students' graduation rates in Minnesota schools, legislative gains that are helping Native Americans to succeed, profiles of successful schools, and professional development training activities to help teachers work more effectively with Native American parents and students

PHYSICAL HEALTH CHECKS IN SERIOUS MENTAL ILLNESS: A PROGRAMME OF RESEARCH IN SECONDARY CARE

Background The physical health of people with serious mental illness [SMI] represents a significant public health challenge. It is estimated that they have a mortality rate two to three times greater than in the general population and the mortality gap is widening. Although suicide makes a significant contribution, cardiovascular disease [CVD] is the primary cause of death. A higher than expected prevalence of physical comorbidities in people with SMI has been identified in almost every system organ class [SOC] of the body with considerable overlap between them. This indicates multiple genetic, environmental, psychological, social, behavioural and system (of care) risk factors. A lower than expected incidence of comorbidities in the health records of people with SMI in primary and secondary care in the United Kingdom [UK] points to considerable under-diagnosis and treatment and presents an opportunity for intervention. There remains a paucity of evidence to support interventions that can be successfully implemented to make a difference to physical health outcomes in this vulnerable population. The SMI Health Improvement Profile [HIP] was developed by the author and two colleagues as a complex but pragmatic intervention to target physical wellbeing in SMI through the existing role of the mental health nurse in secondary care. The HIP Programme (the HIP and HIP training) is intended to support the mental health nurse working with people with SMI to undertake a structured health check and negotiate and implement an individualised physical health care plan as a result. Aim The aim of this research is to enable mental health nurses in secondary care to address the physical health needs of people with SMI by implementing a nurse-led structured physical health check and care planning process. Methods This project used a programme of research to evaluate the impact of the HIP Programme on care processes and patient outcomes that included: 1. A systematic review of the efficacy of educational interventions for healthcare professionals. 2. Description of the development of the HIP Programme and a pilot study to test the clinical utility and effectiveness of the HIP Programme in 31 patients in a nurse-led outpatient clinic. 3. A clinical audit of the use of the HIP in 108 patients. 4. A cluster RCT of the HIP Programme across four National Health Service [NHS] sites. 5. A process observation in a subsample of patient and nurse participants from the cluster randomised controlled trial. 6. Evaluation of evidence of impact from national and international dissemination of the HIP and the HIP Programme. Results 1. The systematic review identified that there was no evidence examining how to train healthcare professionals to deliver a structured health check for people with serious mental illness [SMI]. 2. The pilot study identified that the HIP was acceptable to people with SMI and healthcare professionals and that two mental health nurses could successfully implement the HIP following brief training. 3. The audit showed that it was possible to identify comorbidities in people with SMI using the structured health check in secondary care and that change in health behaviours and outcomes was possible. 4. The cluster RCT in community mental health teams across four NHS sites demonstrated no difference in health outcomes between HIP Programme and Treatment As Usual [TAU] patients at 12 months. Despite acceptable levels of patient attrition in the trial, rates of implementation of the HIP by nurse participants was very low. 5. The process evaluation highlighted the complexity of the processes we were trying to change. Barriers included service redesign and resource issues coupled with the time taken to complete the HIP and care plan. Nurse participants reported that they did not work with the same patients with SMI for long enough to follow through a (12 month) plan of physical health checks and intervention. There was a perception of structured physical health checks and care as a (new) extension to an already pressured role where mental health risk assessment and management takes priority over physical health risk. 6. The HIP is being used widely in practice but this is largely in inpatient services. Where it has been repeated at 12 months, improvements in some metabolic parameters have been seen. Discussion The need for better care for the physical health of people with SMIs is evident. This program of research developed a package of training and tool to support a structured health check and care planning process for people with SMI in secondary care. The cluster RCT did not demonstrate benefit on patient (quality of life) outcomes. Substantial structural barriers prevented the patients from receiving the intervention from the mental health nurses involved in the trial, despite the positive attitude of the nurse participants towards the importance of a physical health care role. Despite this disappointing finding the intervention is being used in practice across the United Kingdom [UK] and internationally with demonstrated benefits, including the achievement of commissioning targets for health screening and signs of improvement in some outcomes where it has been used in the same person over time. This programme of research demonstrates the challenge of conducting useful RCTs in rapidly changing service environments in the NHS. Future research should develop the intervention beyond the nurse and patient dyad to target the system barriers and levers to implementation

Neuropoietin activates STAT3 independent of LIFR activation in adipocytes

Neuropoietin (NP) is a member of the gp130 cytokine family that is closely related to cardiotrophin-1(CT-1) and shares functional and structural features with other family members, including ciliary neurotrophic factor (CNTF) and cardiotrophin-like cytokine (CLC). Studies have shown that NPcan play a role in the development of the nervous system, as well as affect adipogenesis and fat cell function. However, the signaling mechanisms utilized by NP in adipocytes have not been examined. In our present studies, we demonstrate that NP-induced activation of STAT3 tyrosine phosphorylation is independent of leukemia inhibitory factor receptor (LIFR) phosphorylation and degradation. Although it is widely accepted thatNPsignals via the LIFR, our studies reveal that NP results in phosphorylation of gp130, but not LIFR. These observations suggest that the profound effects that NP has on adipocytes are not mediated via LIFR signaling. © 2010 Elsevier Inc

Transcriptional factors that promote formation of white adipose tissue

Adipocytes are highly specialized cells that play a major role in energy homeostasis in vertebrate organisms. Excess adipocyte size or number is a hallmark of obesity, which is currently a global epidemic. Obesity is a major risk factor for the development of type II diabetes (T2DM), cardiovascular disease, and hypertension. Obesity and its related disorders result in dysregulation of the mechanisms that control the expression of metabolic and endocrine related genes in adipocytes. Therefore, understanding adipocyte differentiation is relevant not only for gaining insight into the pathogenesis of metabolic diseases, but also for identifying proteins or pathways which might be appropriate targets for pharmacological interventions. Significant advances towards an understanding of the regulatory processes involved in adipocyte differentiation have largely been made by the identification of transcription factors that contribute to the adipogenic process. It is important to note that the developmental origin of white and brown fat is distinct and different precursor cells are involved in the generation of these different types of adipose tissue (reviewed in Lefterova and Lazar, 2009; Seale et al., 2009). Several transcription factors, notably PPARγ, several members of the C/EBP and KLF families, STAT5, and SREBP-1c, have been shown to have significant roles in promoting adipogenesis. More comprehensive reviews on negative and positive regulators of adipogenesis have been published in the past year (reviewed in Christodoulides et al., 2009; Lefterova and Lazar, 2009). Though many proteins are known to negatively regulate adipogenesis, including Wnts, KLFs, the E2F family of transcription factors, CHOP, Delta-interacting protein A, ETO/MTG8, and members of the GATA and forkhead transcription factor families, this review will focus on transcription factors that positively impact the development of white adipose tissue. © 2009 Elsevier Ireland Ltd. All rights reserved

The gp130 receptor cytokine family: Regulators of adipocyte development and function

Gp130 cytokines are involved in the regulation of numerous biological processes, including hematopoiesis, immune response, inflammation, cardiovascular action, and neuronal survival. These cytokines share glycoprotein 130 as a common signal transducer in their receptor complex and typically activate STAT3. Most gp130 cytokines have paracrine or endocrine actions, and their levels can be measured in circulation in rodents and humans. In recent years, various laboratories have conducted studies to demonstrate that gp130 cytokines can modulate adipocyte development and function. Therefore, these studies suggest that some gp130 cytokines may be viable anti obesity therapeutics. In this review, we will summarize the reported effects of gp130 cytokines on adipocyte differentiation and adipocyte function. In addition, the modulation of gp130 cytokines in conditions of obesity, insulin resistance, and Type 2 diabetes will be presented. © 2011 Bentham Science Publishers Ltd

The impacts of altered floodplain-hydrology of the lower Roanoke river on tree regeneration and floodplain forest composition

Tree regeneration in floodplain forests is broadly determined by the ability of species to tolerate the flood regime at a given location. River regulation affects all aspects of the flood regime, but the effect is not linear across the floodplain or over time. This study assesses regeneration patterns in relation to the inundation regime at small scales across a broad extent in order to anticipate trajectories of forest change. This research is a case study of the lower Roanoke River, a regulated brownwater river on the North Carolina Coastal Plain, but the results presented here have broad applications. The first two chapters assess the combined effects of flood control and hydropower generation on the flood inundation regime. These changes are then mapped across the floodplain as an index of hydrologic stress. Next, I document variation in tree species regeneration dynamics over time and with respect to hydrologic setting. I then relate seedling dynamics to year-to-year variation in inundation patterns, and develop simple models to predict potential trajectories over time. There is a spatial and temporal gradient in flooding that is primarily driven by flood control, but also to some extent by hydropower production. For much of the active floodplain, flood frequency has been reduced, but when floods occur they are much longer in duration. Flood timing was found to have the greatest effect on regeneration. Flooding early in the growing season had a positive effect whereas mid-growing-season flooding had a significant negative effect. The analysis presented here projects that if the survival rates of any given year, or a random ordering of years were to continue, few if any seedlings would recruit into the sapling layer. The abundance of small stems declined over 14 years providing support for this prediction. Species that are prolific seeders, widely dispersed and have a broad tolerance range dominate the seedling layer as their regeneration strategy improves the probability of success in this stochastic environment. Without changes in dam operations it is likely that tree density and diversity will decline and that the floodplain will be become dominated by a few opportunistic species.Doctor of Philosoph

Modeled seasonality of glacial abrupt climate events

Greenland ice cores, as well as many other paleo-archives from the northern hemisphere, recorded a series of 25 warm interstadial events, the so-called Dansgaard-Oeschger (D-O) events, during the last glacial period. We use the three-dimensional coupled global ocean-atmosphere-sea ice model ECBILT-CLIO and force it with freshwater input into the North Atlantic to simulate abrupt glacial climate events, which we use as analogues for D-O events. We focus our analysis on the Northern Hemisphere. The simulated events show large differences in the regional and seasonal distribution of the temperature and precipitation changes. While the temperature changes in high northern latitudes and in the North Atlantic region are dominated by winter changes, the largest temperature increases in most other land regions are seen in spring. Smallest changes over land are found during the summer months. Our model simulations also demonstrate that the temperature and precipitation change patterns for different intensifications of the Atlantic meridional overturning circulation are not linear. The extent of the transitions varies, and local non-linearities influence the amplitude of the annual mean response as well as the response in different seasons. Implications for the interpretation of paleo-records are discusse