Supporting health professional educators in the workplace: A scoping review.

PURPOSE: Clinical educators frequently request additional support for educating pre-qualification health professions students despite having access to professional development programs to build education knowledge and skills. The breadth of 'additional support' options remains unclear. The aim of this review is to explore what is known about support options for health professional educators in the workplace through the lens of learning organisations. MATERIALS AND METHODS: A scoping review was conducted searching Ovid Medline, CINAHL, ProQuest and PsycINFO electronic databases from 1 January 2005 up to 21 October 2020 for studies that identified support strategies for clinical educators of pre-qualification students in the workplace. Relevant data were charted, summarised thematically and synthesised with reference to support type and implementation level. RESULTS: Fifty relevant records related to medicine, nursing and allied health clinical education were included. Twelve support themes and five cross-cutting support categories were identified across four implementation levels of healthcare systems. CONCLUSIONS: A diversity of support for clinical educators beyond professional development was identified. Future research combined with leadership and commitment from the healthcare and education sectors is needed to better understand the applicability, efficacy and resourcing of any newly integrated support to ensure it is sustainable and improves clinical educator capability.

Evidence for Protein Leverage in Children and Adolescents with Obesity.

OBJECTIVE: The aim of this study was to test the protein leverage hypothesis in a cohort of youth with obesity. METHODS: A retrospective study was conducted in a cohort of youth with obesity attending a tertiary weight management service. Validated food questionnaires revealed total energy intake (TEI) and percentage of energy intake from carbohydrates (%EC), fats (%EF), and proteins (%EP). Individuals with a Goldberg cutoff ≥ 1.2 of the ratio of reported TEI to basal metabolic rate from fat-free mass were included. A subgroup had accelerometer data. Statistics included modeling of percentage of energy from macronutrients and TEI, compositional data analysis to predict TEI from macronutrient ratios, and mixture models for sensitivity testing. RESULTS: A total of 137 of 203 participants were included (mean [SD] age 11.3 [2.7] years, 68 females, BMI z score 2.47 [0.27]). Mean TEI was 10,330 (2,728) kJ, mean %EC was 50.6% (6.1%), mean %EF was 31.6% (4.9%), and mean %EP was 18.4% (3.1%). The relationship between %EP and TEI followed a power function (L coefficient -0.48; P < 0.001). TEI was inversely associated with increasing %EP. In the subgroup with < 60 min/d of moderate to vigorous physical activity (n = 48), lower BMI z scores were associated with higher %EP and moderate %EC. CONCLUSIONS: In youth with obesity, protein dilution by either carbohydrates or fats increases TEI. Assessment of dietary protein may be useful to assist in reducing TEI and BMI in youth with obesity.

Maternal inheritance of BDNF deletion, with phenotype of obesity and developmental delay in mother and child.

Childhood obesity is a significant world health problem. Understanding the genetic and environmental factors contributing to the development of obesity in childhood is important for the rational design of strategies for obesity prevention and treatment. Brain-derived neurotrophic factor (BDNF) plays an important role in the growth and development of the central nervous system, there is also an evidence that BDNF plays a role in regulation of appetite. Disruption of the expression of this gene in a child has been previously reported to result in a phenotype of severe obesity, hyperphagia, impaired cognitive function, and hyperactivity. We report a mother and child, both with micro-deletions encompassing the BDNF gene locus, who both have obesity and developmental delay, although without hyperactivity. This report highlights the maternal inheritance of a rare genetic cause of childhood obesity.

Resistance exercise increases NF-κB activity in human skeletal muscle.

Intense resistance exercise causes a significant inflammatory response. NF-κB has been identified as a prospective key transcription factor mediating the postexercise inflammatory response. The purpose of this study was to determine whether a single bout of intense resistance exercise regulates NF-κB signaling in human skeletal muscle. Muscle biopsy samples were obtained from the vastus lateralis of five recreationally active, but not strength-trained, males (21.9 ± 1.3 yr) prior to, and at 2 and 4 h following, a single bout of intense resistance exercise. A further five subjects (4 males, 1 female) (23 ± 0.89 yr) were recruited as a nonexercise control group to examine the effect of the muscle biopsy protocol on key markers of skeletal muscle inflammation. Protein levels of IκBα and phosphorylated NF-κB (p65), as well as the mRNA expression of inflammatory myokines monocyte chemoattractant protein 1 (MCP-1), IL-6, and IL-8 were measured. Additionally, NF-κB (p65) DNA binding to the promoter regions of MCP-1, IL-6, and IL-8 was investigated. IκBα protein levels decreased, while p-NF-κB (p65) protein levels increased 2 h postexercise and returned to near-baseline levels by 4-h postexercise. Immunohistochemical data verified these findings, illustrating an increase in p-NF-κB (p65) protein levels, and nuclear localization at 2 h postexercise. Furthermore, NF-κB DNA binding to MCP-1, IL-6, and IL-8 promoter regions increased significantly 2 h postexercise as did mRNA levels of these myokines. No significant change was observed in the nonexercise control group. These novel data provide evidence that intense resistance exercise transiently activates NF-κB signaling in human skeletal muscle during the first few hours postexercise. These findings implicate NF-κB in the transcriptional control of myokines known to be central to the postexercise inflammatory response.

The role of eicosanoids in the brain.

The brain contains two main polyunsaturated fatty acids (PUFA), arachidonic acid (AA) and docosahexaenoic acid (DHA). These PUFA are located almost exclusively in the sn2-position of phosphoglycerides which are found in the neural cell membranes. Liberation of these PUFA from the phosphoglycerides occurs via the action of specific phospholipases (PLA2). Free AA can be metabolised by cyclooxygenases to prostaglandins and thromboxane, while both AA and DHA can be metabolised by lipoxygenases to form hydroxy derivatives and leukotrienes. AA is also metabolised to lipoxins via the 5-lipoxygenase pathway. The eicosanoids formed play important roles in neural function including sleep induction (PGD2), long term potentiation, spatial learning and synaptic plasticity (PGE2), resolution of inflammation (lipoxins) and anti-inflammatory and neuroprotective bioactivity (dihydroxy-docosatriene, neuroprotectin D1, formed from DHA). COX-inhibitors have been shown to reduce oxidative stress and cognitive impairment. Additionally, drugs which are used to treat depression have been shown to reduce the turnover of AA to PGE2 in the brain. Diets deficient in omega 3 PUFA lead to reduced DHA in the brain and increased turnover of AA to eicosanoids, an effect which is overcome by restoring the omega 3 PUFA to the diet. In neural trauma and neurodegenerative diseases, there is a dramatic rise in the levels of AA-derived eicosanoids. In contrast, DHA-derived compounds can prevent neuroinflammation. Clearly, the eicosanoids are very important for the normal functioning of the brain, while the PUFA themselves are important in membrane structure and function.