Inflammatory Markers in Pediatric Obesity: Health and Physical Activity Implications

The prevalence of childhood obesity has recently peaked in the USA with ~17% of children considered obese. With the increase in adiposity that occurs with weight gain, a persistent low-grade inflammatory state is created. The most commonly studied inflammatory markers associated with obesity are the cytokines, tumor necrosis factor α and interleukin-6, and the acute-phase reactant, C-reactive protein. Understanding the relation between adiposity and inflammation is an important concept because these inflammatory markers influence insulin sensitivity, glucose metabolism, and atherosclerosis, ultimately leading to impaired health. In addition to obesity, physical inactivity is associated with elevated inflammatory markers. The literature, however, is inconsistent as to whether the association between physical activity and inflammation is independent of adiposity. In some obese children, physical fitness appears to circumvent the increase in inflammatory markers that are associated with obesity. The purpose of this review is to examine the relation between adiposity and inflammatory markers, including potential health implications and the impact of physical activity. We exposed a dearth of literature in understanding the interaction between obesity and physical activity on inflammatory markers, especially in children because their anthropometrics change. This review highlights the necessity for further research to better understand the complexity of the chronic inflammatory state associated with obesity

Does Exercise Decrease Pain via Conditioned Pain Modulation in Adolescents?

Purpose: Pain relief after exercise, exercise-induced hypoalgesia (EIH), is established across the lifespan. Conditioned pain modulation (CPM: pain inhibits pain) may be a mechanism for EIH. Methods: In 55 adolescents, pressure pain thresholds were measured before and after exercise (deltoid, quadriceps, and nail bed) and during CPM at the nail bed and deltoid test stimulus sites. The relationship between EIH and CPM was explored. Results: EIH occurred at deltoid and quadriceps; CPM occurred at nail bed and deltoid. CPM and EIH correlated at deltoid; adolescents with greater CPM experienced greater pain relief after exercise. At this site, CPM predicted 5.4% of EIH. Arm lean mass did not add a significant effect. Peak exercise pain did not influence EIH. Adolescents with none, minimal, moderate, or severe peak exercise pain experienced similar EIH. Conclusions: A potential relationship exists between CPM and EIH in adolescents. Pediatric physical therapists should consider the CPM response when prescribing exercise as a pain management tool

Shape Memory Alloy Actuator and Fluid Sampler Development for Extreme Environments

Due to the high temperature, high pressure environments of deep-sea boreholes, using conventional electronics to capture temperature-specific water samples may be unreliable or even impossible. In this project, we introduce the use of shape memory alloys as thermal sensors to trigger an actuator to take a water sample at a specified temperature. A custom sampler that can interface with a variety of developed triggers was also designed and fabricated for use in deep-sea boreholes. All of the developed triggers are modular and designed for ease-of-use by users on a drillship with limited tools and equipment. The shape memory alloys used in these triggers vary in shape and activation temperatures, ranging from 80°C to 170°C. This thesis presents the development of the sampler as well as several of the trigger designs. Two of the trigger designs utilizing four different shape memory alloys were fabricated and tested in-house before deployment on IODP Expedition 385T

Does Weight Status Impact Metabolic Health in Adolescents When Controlling for Physical Fitness?

Purpose: To determines whether adolescents who are fit with overweight/obesity are similar in their metabolic profile to adolescents who are fit and normal weight. Methods: Adolescents participated in 3 sessions: (1) resting vitals and anthropometrics; (2) maximal aerobic treadmill test () to determine physical fitness; and (3) dual-energy x-ray absorptiometry and fasting laboratory draw for analysis of insulin, glucose, high-density lipoprotein, triglycerides, and C-reactive protein. Results: Of the 30 fit adolescents who are normal weight and 16 adolescents who are fit and overweight/obese (OW/OB), metabolic syndrome was apparent in 1 adolescent who are normal weight and 4 adolescents who are OW/OB. Metabolic syndrome severity was positively associated with body mass index, waist circumference, total body fat, insulin resistance, and C-reactive protein but inversely associated with peak relative, but not lean . Conclusions: Despite good physical fitness, adolescents who are OW/OB demonstrated greater metabolic syndrome than adolescents who are normal weight. Future intervention research is necessary to explore the relation between physical fitness and metabolic syndrome

Pain Response after Maximal Aerobic Exercise in Adolescents across Weight Status

Introduction Pain reports are greater with increasing weight status, and exercise can reduce pain perception. It is unknown, however, whether exercise can relieve pain in adolescents of varying weight status. The purpose of this study was to determine whether adolescents across weight status report pain relief after high-intensity aerobic exercise (exercise-induced hypoalgesia (EIH)). Methods Sixty-two adolescents (15.1 ± 1.8 yr, 29 males) participated in the following three sessions: 1) pressure pain thresholds (PPT) before and after quiet rest, clinical pain (McGill Pain Questionnaire), and physical activity levels (self-report and ActiSleep Plus Monitors) were measured, 2) PPT were measured with a computerized algometer at the fourth finger’s nailbed, middle deltoid muscle, and quadriceps muscle before and after maximal oxygen uptake test (V˙O2max Bruce Treadmill Protocol), and 3) body composition was measured with dual-energy x-ray absorptiometry. Results All adolescents met criteria for V˙O2max. On the basis of body mass index z-score, adolescents were categorized as having normal weight (n = 33) or being overweight/obese (n = 29). PPT increased after exercise (EIH) and were unchanged with quiet rest (trial × session, P = 0.02). EIH was similar across the three sites and between normal-weight and overweight/obese adolescents. Physical activity and clinical pain were not correlated with EIH. Overweight/obese adolescents had similar absolute V˙O2max (L·min−1) but lower relative V˙O2max (mL·kg−1·min−1) compared with normal-weight adolescents. When adolescents were categorized using FitnessGram standards as unfit (n = 15) and fit (n = 46), the EIH response was similar between fitness levels. Conclusions This study is the first to establish that both overweight and normal-weight adolescents experience EIH. EIH after high-intensity aerobic exercise was robust in adolescents regardless of weight status and not influenced by physical fitness

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New Nurse Reality Shock & Early Burnout: Can Role Transition Education Received During New Nurse Residency Positively Affect Satisfaction?

Newly licensed nurses are at incredibly high risk for reality shock leading to early burnout which results in many of them resigning their positions or leaving nursing altogether. Common feelings leading to reality shock often involve exhaustion, cynicism, depersonalization, decreased self-efficacy, and decreased job satisfaction. The result of early burnout presents significant financial strain and quality concerns for our already struggling healthcare systems. In the 1960s and early 1970s, Marlene Kramer brought her research regarding newly licensed nurses and their experience of “reality shock” to publication. Kramer felt strongly that reality shock was a key factor that led newly licensed nurses to leave the profession. More than 40 years later, newly licensed nurses continue to experience the same problems when trying to transition into their roles.The purpose of this project was to examine whether participation in a nurse residency program that actively addressed reality shock and early burnout reduced the incidence of emotional exhaustion, cynicism, depersonalization, and increased newly licensed nurse’s sense of personal accomplishment and self-efficacy within the first year of practice. Kramer’s “Reality Shock” theory (1974) and Boychuk-Dunscher’s “Process of Becoming” theory (2008) was the theoretical framework used as a basis for the educational intervention content. The Maslach Burnout Inventory Human Services Survey for Medical Personnel was utilized to assess exhaustion, cynicism, depersonalization, and personal accomplishment among newly licensed nurses. Demographic questions were asked at the beginning of the survey. Questions related to the COVID-19 pandemic were also included as it was recognized that participation in the care of patients during the COVID-19 crisis may have added stressors that would not have been otherwise present. The setting was an education and training center located in Las Vegas, Nevada, that provides centralized education services and a nurse residency program for newly licensed nurses in a seven-hospital system. Forty-five newly licensed nurses completed the initial online demographic survey, COVID-19 survey, and MBI survey. Descriptive statistics using frequency distributions were used to characterize sampled demographics and participant’s perception of providing care to patients with COVID-19 during the pandemic. Twenty-six newly licensed nurses completed the educational intervention discussing reality shock and early burnout via a digital learning management system. The educational intervention and surveys were available for 4 months. Twenty-six participants completed the same online MBI survey following completion of the educational intervention. A paired samples t-test was used to analyze data obtained from the pre- and post-intervention surveys. The educational intervention was successful in achieving its overall objectives, but the incidence of burnout did not improve as much as hoped, perhaps due to the unexpected added stress of a nationwide pandemic. Increasing organizational awareness of new nurse reality shock and early burnout through the project contributed positively to development of initiatives to assess and address burnout within the healthcare organization. A system wide retention committee was formed to address engagement and assess and address early burnout of newly licensed nurses within the first year of practice. Raising the awareness of organizational leadership regarding reality shock and early burnout will help support ongoing retention efforts. It is suggested that in the future, in person educational sessions be added to supplement the presentation which will enhance ongoing efforts to assist newly licensed nurses to feel understood and supported through their transition to practice. When they feel they are well supported in their respective clinical work settings, retention occurs