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Purpose: To develop and validate a questionnaire to evaluate caffeine consumption habits in adults. Methods: A caffeine habits and consumption questionnaire (CaffCo) was developed in three stages. ...

Background: Caffeine, which is found in a number of foods and beverages, elicits a variety of physiological responses, some of which are considered favorable such as improved alertness and reductio...

Background: To compare three saliva collection methods for examining salivary biomarkers in males and females at rest and exercise. Methods: Whole saliva was collected using drool method (unstimulated, UWS), mastication (stimulated, SWS) or using cotton-buds placed around the mouth (unstimulated, Bud) from 8males and 12females. Samples were analysed for flow rate, osmolality, sodium, potassium, chloride, secretory salivary immunoglobulin A (SIgA), α-amylase activity and cortisol during both rest and exercise in a randomised crossover design. Results: SWS and Bud methods were consistently more reliable than UWS, and Bud had the greatest reliability across all measures. Significant variations between all methods existed for total osmolality, sodium and SIgA concentrations; between UWS and SWS methods for flow rate and α-amylase activity, and between UWS and Bud methods for potassium. SWS most consistently replicated UWS patterns of analyte responses to exercise for both males and females and showed good agreement with UWS for cortisol. Both SWS and Bud data reflected the inverse α-amylase/cortisol relationship seen in UWS. Conclusion: SWS was better able to replicate results measured from UWS, between rest and exercise and between males and females. SWS and Bud methods can be used to inform comparisons between rest and exercise and males and females

Caffeine-related health incidents in New Zealand have escalated over the last two decades. In order to reduce the risk of substance-related harm, it is important to understand the consumers’ motivations for its use. This is especially true for tertiary students who are presumed to be at a higher risk due to seeking out caffeine’s well-known cognitive benefits as well as the targeted marketing of such products to young adults. This study examined the habits and motivations for caffeine consumption in tertiary students in New Zealand. A previously validated caffeine consumption-habits (CaffCo) questionnaire was administered online to 317 tertiary students (n = 169 females), aged ≥16 years. Of the 99.1% of participants who regularly consumed caffeine, coffee (76.3%) tea (71.6%) and chocolate (81.7%) consumption were the most prevalent. Motivations for caffeinated-product consumption differed according to caffeine source. Tea was consumed for the warmth and taste, coffee was consumed to stay awake and for warmth, and chocolate, for the taste and as a treat. Marketing was not identified by participants as influencing their consumption of caffeinated products. Knowledge of motivations for caffeine consumption may assist in identifying strategies to reduce caffeine intake in those New Zealand tertiary students who regularly consume amounts of caffeine that exceed safe level.

During World War II, Britain, the United States and the Soviet Union had thriving domestic gardening movements. Actively promoted by their governments, gardening was supposed to supplement diets and nourish the patriotic spirit. In the Soviet Union, however, gardening was much more than a patriotic duty; it was often a matter of survival, the primary means of supplementing near starvation bread rations. Amidst incomparable, catastrophic wartime conditions, the huge Soviet gardening movement was distinguished by the speed with which it was implemented and taken up, predominantly by women. Based on original archival and published sources, this article examines in depth the Soviet wartime legislative framework, material resources and propaganda that promoted individual kitchen gardens. The article analyzes the way the state organized and promoted individualist, small-scale urban horticulture – a politically risky initiative given that it conflicted with the Stalinist model of large-scale, industrialized agriculture – and argues that in promoting gardening self-sufficiency, the Soviet socialist state shifted much of its responsibilities for food production onto its citizenry. The article not only aims to shed new light on the crucial role gardening played in feeding a famished citizenry but also the distinctive way in which Soviet propaganda, in giving voice to the psychological satisfaction of gardening, tapped into women’s commitments to the family, in intimate alignment with patriotic, home front defence of the Soviet Motherland.

Background Racism is a key determinant of the health of Indigenous Australians that may explain the unremitting gap in health and socioeconomic outcomes between Indigenous and non-Indigenous Australians. We quantified the population-based prevalence of experiences of racism of Indigenous adults in the Australian state of Victoria and investigated whether this was independent of social determinants and lifestyle risk factors. Methods We combined data from the 2011, 2012 and 2014 Victorian Population Health Surveys to obtain a sample size of 33,833 Victorian adults, including 387 Indigenous adults. The survey is a cross-sectional, population-based, computer-assisted telephone interview survey conducted annually. Using logistic regression, experiences of racism was the dependent variable and Indigenous status the primary independent variable of interest. Secondary independent variables included age, sex, rurality, socioeconomic status, social capital, and lifestyle risk factors. Results Indigenous Victorian adults were four times more likely than their non-Indigenous counterparts to have experienced racism in the preceding 12 months; odds ratio (OR) = 4.3 (95% confidence interval (CI): 3.2–5.8). Controlling for social determinants and lifestyle risk factors attenuated, but did not eliminate, the association between experiences of racism and Indigenous status; OR = 3.1 (95% CI: 2.2–4.3). The social determinants of age and social trust made the largest contribution to the attenuation of the association. Education also had a large impact on the association, but in the opposite direction, suggesting that a low level of education may be protective against experiences of racism. When the non-Indigenous comparison group consisted of adults of mainly Anglo-Celtic origin, Indigenous adults were seven times more likely (OR = 7.2; 5.3–9.7) to have experienced racism. Conclusions Racism directed against Indigenous Victorians is significant and cannot be ascribed to any specific attributes such as socioeconomic status or lifestyle risk factors. We argue that a human rights-based approach to policy-making for the elimination of systemic and interpersonal racism offers an opportunity and viable alternative to current policy-making, that continues to be dominated by a paternalistic approach that reinforces racism and the resulting inequities. Please note Throughout this document, the term Indigenous is taken to include people of Aboriginal and Torres Strait Islander descent. While not our preferred term, Indigenous is used in preference to Aboriginal and Koori as not all Indigenous people living in Victoria are Aboriginal or Koori. We recognise that, with the exception of the term ‘Koori’, these terms are Eurocentric having been imposed upon a people of many nations with distinct languages and cultures. The use of such terms is akin to referring to the peoples of the continent of Europe as ‘Europeans’.

Metabolic syndrome (MetS) is a group of metabolic abnormalities, which together lead to increased risk of coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM), as well as reduced quality of life. Dietary nitrate, betalains and anthocyanins may improve risk factors for MetS and reduce the risk of development of CHD and T2DM. Beetroot is a rich source of dietary nitrate, and anthocyanins are present in high concentrations in blackcurrants. This narrative review considers the efficacy of beetroot and blackcurrant compounds as potential agents to improve MetS risk factors, which could lead to decreased risk of CHD and T2DM. Further research is needed to establish the mechanisms through which these outcomes may occur, and chronic supplementation studies in humans may corroborate promising findings from animal models and acute human trials.

Adverse effects associated with excessive caffeine consumption combined with increasing numbers and availability of caffeine-containing products are causes for concern. Tertiary students may be at increased risk of consuming excessive amounts of caffeine due to seeking caffeinated products with well-known wakefulness effects and cognitive benefits. This study explored caffeine consumption habits of New Zealand tertiary students (317, ≥16-years) using a previously validated caffeine consumption habits (CaffCo) questionnaire. Most (99.1%) regularly consumed caffeinated products, especially chocolate, coffee and tea, with coffee, tea and energy drinks contributing most to total caffeine intake. Median estimated caffeine intake was 146.73 mg·day−1, or 2.25 mg·kgbw−1·day−1. Maximum and minimum intakes were 1988.14 mg·day−1 (23.51 mg·kgbw−1·day−1) and 0.07 mg·day−1 (0.02 mg·kgbw−1·day−1), respectively. One-third (34.4%) of caffeine consumers ingested caffeine above the adverse effect level (3 mg·kgbw−1·day−1) and 14.3% above the safe limit (400 mg·day−1). Most caffeine consumers (84.7%), reported experiencing at least one ‘adverse symptom’ post-caffeine consumption, of which 25.7% reported effects leading to distress or negatively impacting their life. Experiencing ‘adverse symptoms’ did not, however, curtail consumption in the majority of symptomatic participants (~77%). Public health initiatives directed at tertiary students may be important to reduce potential caffeine-related harm.

This paper presents an overview of the current status of the Virtual Atomic and Molecular Data Centre (VAMDC) e-infrastructure, including the current status of the VAMDC-connected (or to be connected) databases, updates on the latest technological development within the infrastructure and a presentation of some application tools that make use of the VAMDC e-infrastructure. We analyse the past 10 years of VAMDC development and operation, and assess their impact both on the field of atomic and molecular (A&amp, M) physics itself and on heterogeneous data management in international cooperation. The highly sophisticated VAMDC infrastructure and the related databases developed over this long term make them a perfect resource of sustainable data for future applications in many fields of research. However, we also discuss the current limitations that prevent VAMDC from becoming the main publishing platform and the main source of A&amp, M data for user communities, and present possible solutions under investigation by the consortium. Several user application examples are presented, illustrating the benefits of VAMDC in current research applications, which often need the A&amp, M data from more than one database. Finally, we present our vision for the future of VAMDC.

In this chapter, we briefly compare and contrast the cadences of the renaissance with those of later periods. After discussing various types of cadences, including “cadenze fuggite” (evaded cadences) common in renaissance music, we use examples from the pieces presented in Chapters 7–10 to show how a musician can give more structure and meaning to the music by highlighting these musical punctuation marks.

The renaissance modes are defined and explained in Chapter 11. The expressive character of the different modes is discussed, and we consider what twenty-first-century musicians can do to harness the power that the modes apparently had for renaissance listeners. The accompanying table presents the modes in notation, highlighting the species of fourths and fifths that make up each mode, and also the final and cadence tones.

Caffeine is ubiquitous, available in a variety of sources, and used in social settings. As more children are routinely consuming caffeine, it is important to consider young people specifically rath...

Palaeogeography is the representation of the past surface of the Earth. It provides the spatial context for investigating how the Earth evolves through time, how complex processes interact and the juxtaposition of spatial information. In hydrocarbon exploration, palaeogeographies have been used to map and investigate the juxtaposition, distribution and quality of play elements (source, reservoir, seal and trap), as boundary conditions for source-to-sink analysis, climate modelling and lithofacies retrodiction, but most commonly as the backdrop for presentations and montages. This paper demonstrates how palaeogeography has been and can be used within an exploration workflow to help mitigate exploration risk. A comprehensive workflow for building palaeogeographies is described which is designed to provide a standard approach that can be applied to a range of tasks in exploration and academia. This is drawn from an analysis of the history of palaeogeography and how it has been applied to exploration in the past and why. Map applications, resolution and content depend on where in the exploration and production (E&P) cycle the map is used. This is illustrated here through three case studies, from the strategic decisions of global new ventures exploration to the more detailed basin and petroleum analyses of regional asset teams evaluating basins and plays. Through this, the paper also addresses three commonly asked questions: (1) How can I use palaeogeography in my workflow? (2) How reliable are the maps? (3) How do I build a palaeogeography?

Background Saliva is a useful diagnostic tool for analysis in sports, exercise and nutrition research, as collection is easy and non-invasive and it contains a large number of analytes affected by a range of physiological and pathological stressors and conditions. This study examined key salivary electrolytes and stress and immune markers in males and females at rest and during exercise. Methods Unstimulated whole saliva from 20 healthy, recreationally active participants (8 males and 12 females) was analysed for flow rate, osmolality, sodium (Na+), potassium (K+), chloride (Cl−), secretory immunoglobulin A (SIgA), α-amylase activity and cortisol during both rest and moderate intensity (70% peak power) cycling exercise in a randomised crossover design. Each trial lasted 60 min and sampling was carried out at 15 and 45 min after the start of the trial. Saliva was collected using the gold-standard drool method; participants were required to provide at least 1 mL sample over 2 or 3-min period. Results Females showed a greater response to steady-state exercise stress than males, with significant increases in osmolality (P < 0.001), α-amylase activity (P = 0.001) and secretion rate (P = 0.023) and SIgA secretion rate (P = 0.023), with trends for an increase in K+ (P = 0.053) and decrease in Cl− (P = 0.067). There were no differences between rest and exercise for any salivary analytes in males. In addition, females showed a trend for higher levels of cortisol than males at both rest (P = 0.099) and exercise (P = 0.070), as well as a higher heart rate (P < 0.001) and greater ratings of perceived exertion (P < 0.001) during the exercise trial. The coordination of the two stress response pathways (α-amylase vs cortisol) was positive in males (r = 0.799; P = 0.017) yet negative in females (r = −0.475; P = 0.036). Conclusions Males and females show a markedly different response to steady-state exercise stress as measured in unstimulated whole saliva.

Adolescents are vulnerable to the effects of excess caffeine intake and the European Food SafetyAuthority recommend adolescents limit caffeine intake to 3 mg·kg−1·day−1 [...]

Acute and short-term supplementation with nitrate-rich (NO3−) beetroot juice has been shownto improve cardiovascular health and function in healthy adults [...]

Nitrate-rich beetroot juice supplementation has been shown to improve cardiovascular and cognitive function in younger and older adults via increased nitric oxide production. However, it is unclear whether the level of effects differs between the two groups. We hypothesized that acute supplementation with nitrate-rich beetroot juice would improve cardiovascular and cognitive function in older and younger adults, with the potential for greater improvements in older adults. Thirteen younger (18&ndash, 30 years) and 11 older (50&ndash, 70 years) adults consumed either 150 mL of nitrate-rich beetroot juice (BR, 10.5 mmol nitrate) or placebo (PL, 1 mmol nitrate) in a double-blind, crossover design, 2.25 h prior to a 30-min treadmill walk. Plasma nitrate and nitrite concentrations, blood pressure (BP), heart rate (HR), cognitive function, mood and perceptual tests were performed throughout the trial. BR consumption significantly increased plasma nitrate (p &lt, 0.001) and nitrite (p = 0.003) concentrations and reduced systolic BP (p &lt, 0.001) in both age groups and reduced diastolic BP (p = 0.013) in older adults. Older adults showed a greater elevation in plasma nitrite (p = 0.038) and a greater reduction in diastolic BP (p = 0.005) following BR consumption than younger adults. Reaction time was improved in the Stroop test following BR supplementation for both groups (p = 0.045). Acute BR supplementation increased plasma nitrite concentrations and reduced diastolic BP to a greater degree in older adults, whilst systolic BP was reduced in both older and younger adults, suggesting nitrate-rich BR may improve cardiovascular health, particularly in older adults due to the greater benefits from reductions in diastolic BP.

SETTING: The Inuit community of Rigolet experiences greater rates of self-reported acute gastrointestinal illness (AGI) compared to southern Canada. INTERVENTION: A whiteboard video tool was collaboratively developed by Rigolet youth, community members, the research team and key regional stakeholders to share public health recommendations for reducing the risk of AGI. The video debuted in Rigolet at a community event in August 2016 and was later provided online for community members and local and regional health departments. Interviews and focus group discussions were used to evaluate the ability of the video to communicate public health information to community members in Rigolet. OUTCOMES: Community and government viewers reported that the whiteboard video was novel and engaging. Evaluation participants believed the video was suitable for promoting Inuit health because of the use of locally relevant visuals and narrative, which reflect Inuit art and storytelling traditions. Furthermore, participants indicated that the video co-development process was critical to ensuring community relevance of the video. Short-term outcome results suggest the video can reinforce health knowledge and potentially encourage behavioural change. IMPLICATIONS: The results suggest this whiteboard video was an effective tool to share information and could increase intention to change behaviours to reduce the risk of AGI in Rigolet. While tools like the whiteboard video are gaining popularity, the participatory approach was used to develop the video, and its use in an Inuit context illustrates its innovation and novelty. This tool may be a useful health promotion tool among Indigenous communities in Canada.

Background: Caffeine-related health incidents in New Zealand have escalated over the last twodecades. [...]

Background: To investigate age-related effects of acute dietary nitrate (NO3−) supplementationon cardiovascular responses, cognition and mood. [...]

Scope Markers of oxidative and psychological stress are elevated during high intensity exercise. Additionally, when energy intake does not match expenditure, women who actively participate in sports and exercise are at risk of developing menstrual dysfunction, infertility and osteoporosis. Vitamin C is known to reduce exercise-induced stress. Here we investigate the efficacy of consuming vitamin C from SunGoldTM kiwifruit compared to in isolation, in ameliorating exercise-induced stress in recreationally active women. Method/results 10 eumenorrheic women were recruited in this crossover study and attended 3 exercise and 1 rest trial. In the exercise trials, participants consumed: 300 mg vitamin C from kiwifruit or drink, or had a placebo drink, followed by 30-min exercise on a cycle ergometer at 60% power. During rest visit, participants sat quietly and consumed a placebo drink. Salivary uric acid (oxidative stress) and cortisol (psychological stress) was measured before and immediately after exercise for 2 hours. Both vitamin C and kiwifruit reduced exercise-induced uric acid, immediately after exercise. Vitamin C drink continued to decrease uric acid for a further 30 minutes and slightly attenuated exercise-induced cortisol. Conclusion Consuming liquid vitamin C prior to high intensity cycling appears more effective than eating kiwifruit, in ameliorating exercise-induced stress in recreationally active women of reproductive age. This article is protected by copyright. All rights reserved.

Objectives: To identify factors associated with outcomes following rotational atherectomy (RA). Background: RA is an effective way to mechanically modify heavily calcified lesions before stenting; however its outcomes are not well defined. Methods and Results: Retrospective evaluation of all patients who underwent RA in three large UK centers (Leeds General Infirmary (LGI), Royal Infirmary of Edinburgh (RIE) and University Hospital of North Staffordshire (UHNS)) from March 2005 to January 2013. Five hundred and eighteen patients had RA with median follow-up period of 22 months. About 68.3% were male, 28.7% had DM and 34.6% were treated because of ACS. Stents were deployed in 97.3% of the patients while 30.7% of the procedures were performed transradially. Maximum burr was ≤1.75 mm in 85.5% and the mean SYNTAX score was 19.5 ± 11.6. Peri-procedural complications occurred in 6.4% and vascular access complications in 1.9%. Outcomes in the follow-up period were: MACE 17.8%, cardiac death 7.1%, MI 11.7%, TVR 7.5%, all-cause death 13.7%, definite stent thrombosis (ST) 1.4% and stroke 2.9%. Patients with intermediate and high SYNTAX scores were more likely to suffer MACE, cardiac death, MI, all-cause death and ST. Patients with a SYNTAX score >32 were also more likely to have a peri-procedural complication. Multiple logistic regression analysis showed that the presence of PVD (P = 0.026, OR = 2.0), DM (P = 0.008, OR = 2.1), ACS presentation (P = 0.011, OR = 2.1) and SYNTAX score ≥23 (P = 0.02, OR = 1.9) had a significant association with MACE. Conclusions: RA is safe and effective, with high rate of procedural success and relatively low incidence of MACE. PVD, DM, ACS presentation and SYNTAX score were significant predictors for MACE. © 2016 Wiley Periodicals, Inc.

Transgender includes patients at various stages of their journey. It is important that providers care for transgender patients with a culturally sensitive approach, awareness, and competent skill. There are new terms to learn. There may be mental health issues or substance use issues. Hormone therapy can have an impact on a person's health. As a primary care provider, it is important to be alert to these potential issues, addressing the patient's individual needs. In this study we discuss the transgender patient and outline basic care and issues that can arise in a primary care setting.

Resistance and endurance exercise increases net muscle protein breakdown but can also enhance muscle protein synthesis. However, exercise needs to interact with protein ingestion to promote muscle mass, improve exercise recovery, and improve performance. Whey protein (WP) is a high-quality protein that contains all essential amino acids and is especially abundant in leucine, the key amino acid signaler underpinning anabolism and performance. Although eating a balanced meal may negate the need for supplements, adding WP supplements to the diet may confer additional benefits to athletes. The aim of this chapter is to: (1) detail reasons why WP is superior to other proteins for sports and exercise; (2) examine the effect of WP intake on performance, increasing muscle mass, and enhancing muscle repair; (3) investigate issues relating to timing of ingestion, dosage, and coingestion with other bioactives; (4) describe the effects on different user groups; and (5) discuss potential mechanisms of action.

Background. Gymnemic acids, from the plant Gymnema sylvestre (GS), selectively suppress taste responses to sweet compounds without affecting the perception of other taste elements. The aim of this study was to investigate the effect of consuming a GS-containing mint on the desire to consume high-sugar sweet foods directly thereafter. Methods. This study utilized a single-blind, crossover design comparing the consumption of a mint (dissolving tablet) containing 4 mg of gymnemic acids with an isocaloric placebo in 56 healthy young men and women. Participants were given samples of their favourite chocolate (varied between 14&ndash, 18 g, energy varied between 292&ndash, 370 kJ) and were directed to rate on their hunger on 100-mm visual analogue scales 30 s prior to consuming high-sugar sweet food (chocolate). They then consumed the GS mint or placebo mint and rated their perceived pleasantness and desire for more chocolate on separate visual analogue scales immediately following consumption of the high-sugar sweet food before being offered up to five additional servings (and asked to rate hunger, pleasantness and desire to eat more chocolate between each ingestion period). Results. The number of chocolate bars eaten decreased by 0.48 bars (21.3%) within a 15-min period of consumption of the GS mint (p = 0.006). Desire to eat more of the high-sugar sweet food (p = 0.011) and pleasantness of the high-sugar sweet food (p &lt, 0.001) was reduced after GS mint intake. Those who reported having a &lsquo, sweet tooth&rsquo, had a greater reduction in the pleasantness of chocolate (p = 0.037) and desire to eat more (p = 0.004) after consuming the GS mint for the first serving of a high-sugar sweet food following the mint. Conclusion. Consuming gymnema-containing mints compared to placebo significantly reduced the quantity of chocolate eaten mainly due to a decrease in the desire and pleasantness of consuming it.

Caffeine use is widespread among athletes following its removal from the World Anti-Doping Agency banned list, with approximately 75% of competitive athletes using caffeine. While literature supports that caffeine has a small positive ergogenic effect for most forms of sports and exercise, there exists a significant amount of inter-individual difference in the response to caffeine ingestion and the subsequent effect on exercise performance. In this narrative review, we discuss some of the potential mechanisms and focus on the role that genetics has in these differences. CYP1A2 and ADORA2A are two of the genes which are thought to have the largest impact on the ergogenicity of caffeine. CYP1A2 is responsible for the majority of the metabolism of caffeine, and ADORA2A has been linked to caffeine-induced anxiety. The effects of CYP1A2 and ADORA2A genes on responses to caffeine will be discussed in detail and an overview of the current literature will be presented. The role of these two genes may explain a large portion of the inter-individual variance reported by studies following caffeine ingestion. Elucidating the extent to which these genes moderate responses to caffeine during exercise will ensure caffeine supplementation programs can be tailored to individual athletes in order to maximize the potential ergogenic effect.

Caffeine is a widely used ergogenic aid with most research suggesting it confers the greatest effects during endurance activities. Despite the growing body of literature around the use of caffeine as an ergogenic aid, there are few recent meta-analyses which quantitatively assess the effect of caffeine on endurance exercise. To summarise studies which have investigated the ergogenic effects of caffeine on endurance time-trial performance and to quantitatively analyse the results of these studies to gain a better understanding of the magnitude of caffeine’s ergogenic effect on endurance time-trial performance. A systematic review was carried out on randomised placebo-controlled studies investigating the effects of caffeine on endurance performance and a meta-analysis was conducted to determine the ergogenic effect of caffeine on endurance time-trial performance. 44 studies met the inclusion criteria and were included in the meta-analysis. Caffeine has a small but evident effect on endurance performance when taken in moderate doses (3–6 mg·kg−1) as well as an overall improvement following caffeine compared to placebo in mean power output (2.92 ± 2.18%; Effect Size = 0.22 ± 0.15) and time-trial completion time (2.26 ± 2.60%; Effect Size = 0.28 ± 0.12). However, differences in responses to caffeine ingestion have been shown, with two studies reporting slower time-trial performance while five studies reported lower mean power output during the time-trial. Caffeine can be used effectively as an ergogenic aid when taken in moderate doses, such as during sports when a small increase in endurance performance can lead to significant differences in placements as athletes are often separated by small margins.

Caffeine is a widely used ergogenic aid with most research suggesting it confers the greatest effects during endurance activities. Despite the growing body of literature around the use of caffeine as an ergogenic aid, there are few recent meta-analyses that quantitatively assess the effect of caffeine on endurance exercise. To summarise studies that have investigated the ergogenic effects of caffeine on endurance time-trial performance and to quantitatively analyse the results of these studies to gain a better understanding of the magnitude of the ergogenic effect of caffeine on endurance time-trial performance. A systematic review was carried out on randomised placebo-controlled studies investigating the effects of caffeine on endurance performance and a meta-analysis was conducted to determine the ergogenic effect of caffeine on endurance time-trial performance. Forty-six studies met the inclusion criteria and were included in the meta-analysis. Caffeine has a small but evident effect on endurance performance when taken in moderate doses (3–6 mg/kg) as well as an overall improvement following caffeine compared to placebo in mean power output (3.03 ± 3.07%; effect size = 0.23 ± 0.15) and time-trial completion time (2.22 ± 2.59%; effect size = 0.41 ± 0.2). However, differences in responses to caffeine ingestion have been shown, with two studies reporting slower time-trial performance, while five studies reported lower mean power output during the time–trial. Caffeine can be used effectively as an ergogenic aid when taken in moderate doses, such as during sports when a small increase in endurance performance can lead to significant differences in placements as athletes are often separated by small margins.

OBJECTIVES There is a marked propensity for patients with acetaminophen-induced acute liver failure to develop sepsis, which may culminate in multiple organ failure and death. Toll-like receptors sense pathogens and induce inflammatory responses, but whether this is protective or detrimental in acetaminophen-induced acute liver failure remains unknown. DESIGN, SETTING, AND PATIENTS We assessed Toll-like receptor expression on circulating neutrophils and their function in 24 patients with acetaminophen-induced acute liver failure and compared with 10 healthy controls. INTERVENTIONS Neutrophil Toll-like receptor 2, -4, and -9 expression and cytokine production and function were studied ex vivo at baseline and following stimulation with lipopolysaccharide, oligodeoxynucleotides, ammonium chloride, and interleukin-8. To examine the influence of acetaminophen-induced acute liver failure plasma and endogenous DNA on Toll-like receptors-9 expression, healthy neutrophils were incubated with acetaminophen-induced acute liver failure plasma with and without deoxyribonuclease-I. MEASUREMENTS AND MAIN RESULTS Circulating neutrophil Toll-like receptor 9 expression was increased in acetaminophen-induced acute liver failure on day 1 compared with healthy controls (p = 0.0002), whereas Toll-like receptor 4 expression was decreased compared with healthy controls (p < 0.0001). Toll-like receptor 2 expression was unchanged. Neutrophil phagocytic activity was decreased, and spontaneous oxidative burst increased in all patients with acetaminophen-induced acute liver failure compared with healthy controls (p < 0.0001). Neutrophil Toll-like receptor 9 expression correlated with plasma interleukin-8 and peak ammonia concentration (r = 0.6; p < 0.05) and increased with severity of hepatic encephalopathy (grade 0-2 vs 3/4) and systemic inflammatory response syndrome score (0-1 vs 2-4) (p < 0.05). Those patients with advanced hepatic encephalopathy (grade 3/4) or high systemic inflammatory response syndrome score (2-4) on day 1 had higher neutrophil Toll-like receptor 9 expression, arterial ammonia concentration, and plasma interleukin-8 associated with neutrophil exhaustion. Healthy neutrophil Toll-like receptor 9 expression increased upon stimulation with acetaminophen-induced acute liver failure plasma, which was abrogated by preincubation with deoxyribonuclease-I. Intracellular Toll-like receptor 9 was induced by costimulation with interleukin-8 and ammonia. CONCLUSION These data point to neutrophil Toll-like receptor 9 expression in acetaminophen-induced acute liver failure being mediated both by circulating endogenous DNA as well as ammonia and interleukin-8 in a synergistic manner inducing systemic inflammation, neutrophil exhaustion, and exacerbating hepatic encephalopathy.

In a randomised, double-blind, placebo-controlled crossover design, 10 females taking monophasic oral contraceptives completed 90 min intermittent treadmill-running 45 min after ingestion of 6 mg∙kg(-1) body mass anhydrous caffeine or artificial sweetener (placebo). Water (3 mL∙kg(-1)) was provided every 15 min during exercise. Venous blood samples were taken before, during and after exercise, as well as after sleep (~15 h post-ingestion), and levels of caffeine, paraxanthine, theobromine and theophylline were measured using high-performance liquid chromatography. Sleep quality was assessed using the Leeds Sleep Evaluation Questionnaire. Plasma caffeine concentration peaked 100 min after ingestion. Caffeine clearance was 0.95±0.14 mL·min(-1)·kg(-1) while the elimination half-life of caffeine was 17.63±8.06 h. Paraxanthine and theophylline levels were significantly elevated at 15 h with no significant change in theobromine. Sleep latency and subsequent quality of sleep was impaired following caffeine supplementation (P

Supplementation with nitrate (NO3−)-rich beetroot juice has been shown to improve exercise performance and cardiovascular (CV) responses, due to an increased nitric oxide (NO) availability. However, it is unclear whether these benefits are greater in older adults who have an age-related decrease in NO and higher risk of disease. This systematic review examines 12 randomised, crossover, control trials, investigating food-based NO3− supplementation in older adults and its potential benefits on physiological and cognitive performances, and CV, cerebrovascular and metabolic health. Four studies found improvements in physiological performance (time to exhaustion) following dietary NO3− supplementation in older adults. Benefits on cognitive performance were unclear. Six studies reported improvements in CV health (blood pressure and blood flow), while six found no improvement. One study showed improvements in cerebrovascular health and two found no improvement in metabolic health. The current literature indicates positive effects of dietary NO3− supplementation in older adults on physiological performance, with some evidence indicating benefits on cardiovascular and cerebrovascular health. Effects on cognitive performance were mixed and studies on metabolic health indicated no benefit. However, there has been limited research conducted on the effects of dietary NO3− supplementation in older adults, thus, further study, utilising a randomised, double-blind, control trial design, is warranted.

Executive functioning is the ability to plan, strategize, organize, and focus on details. Impaired executive functioning plays a significant role in behavior disturbances. Lack of inhibition, impaired abstract reasoning, thought perseverance, rigidity in routine, and lack of insight disrupt social skills and daily life. Autism and schizophrenia present some similar behaviors, including impaired executive functioning, often resulting in pharmacological management as many healthcare professionals receive limited training in executive functioning. Non-pharmacological tools used in autism for behavior management include functional behavioral analysis and social scripting, which help to identify causes of behavior and teach more appropriate behavioral responses. Described here is an educational program for healthcare workers in a long-term care skilled nursing facility, to help them understand the basis for behaviors in individuals with impaired executive function, to use these same tools for behavioral modification techniques, and to help patients learn more appropriate social skills. Program evaluation suggested the educational program was successful in increasing the staff's knowledge and comfort level in addressing the behavioral issues that arise with this population and staff also reported less use of medication as first-line treatment for behavioral issues.

There is growing evidence that Aboriginal peoples often experience healthcare inequalities due to racism. However, research exploring the healthcare experiences of Aboriginal peoples who use illicit substances is limited, and research rarely accounts for how multiple accounts of stigma intersect and contribute to the experiences of marginalized populations. Our research aimed to explore the healthcare experiences of Aboriginal peoples who use illicit drugs and or illicit alcohol (APWUID/A) living in Vancouver's inner city. Using Indigenous methodologies, a community research team comprised of APWUID/A led the study design, data collection and analysis. Peer-facilitated talking circles explored community members' experiences accessing healthcare services and patient-provider encounters. Using an intersectionality framework, our research demonstrated how healthcare inequalities among Aboriginal peoples are perpetuated by systemic racism and discrimination. Stigmatizing racial stereotypes were perceived to negatively influence individual attitudes and clinical practice. Participants' experiences of medical dismissal often resulted in disengagement from care or delay in care. The findings suggest healthcare providers must understand the structural and historical forces that influence racial disparities in healthcare and personal attitudes in clinical practice. Adequate clinical protocols for pain management within the context of illicit substance use are urgently needed. The valuation of Aboriginal peoples and cultures within healthcare is paramount to addressing the health gap between Aboriginal and non-Aboriginal Canadians.

The Virtual Atomic and Molecular Data Centre (VAMDC) Consortium is a worldwide consortium which federates atomic and molecular databases through an e-science infrastructure and an organisation to support this activity. About 90% of the inter-connected databases handle data that are used for the interpretation of astronomical spectra and for modelling in many fields of astrophysics. Recently the VAMDC Consortium has connected databases from the radiation damage and the plasma communities, as well as promoting the publication of data from Indian institutes. This paper describes how the VAMDC Consortium is organised for the optimal distribution of atomic and molecular data for scientific research. It is noted that the VAMDC Consortium strongly advocates that authors of research papers using data cite the original experimental and theoretical papers as well as the relevant databases.

Background: The Montreal Cognitive Assessment (MoCA) appears more sensitive to mild cognitive impairment (MCI) than the Mini-Mental State Examination (MMSE): over 50% of TIA and stroke patients with an MMSE score of ≥27 (‘normal’ cognitive function) at ≥6 months after index event, score Methods: The MMSE and MoCA were done on consecutive patients with TIA or stroke in a population-based study (Oxford Vascular Study) 6 months or more after the index event and on consecutive subjects enrolled in a memory research cohort (the Oxford Project to Investigate Memory and Ageing). Patients with moderate-to-severe cognitive impairment (MMSE score of Results: Of 207 stroke patients (mean age ± SD: 72 ± 11.5 years, 54% male), 156 TIA patients (mean age 71 ± 12.1 years, 53% male) and 107 memory research subjects (mean age 76 ± 6.6 years, 46% male), stroke patients had the lowest mean ± SD cognitive scores (MMSE score of 27.7 ± 1.84 and MoCA score of 22.9 ± 3.6), whereas TIA (MMSE score of 28.4 ± 1.7 and MoCA score of 24.9 ± 3.3) and memory subject scores (MMSE score of 28.5 ± 1.7 and MoCA score of 25.5 ± 3.0) were more similar. Rates of MoCA score of Conclusions: The MoCA demonstrated more differences in cognitive profile between TIA, stroke and memory research subjects without major cognitive impairment than the MMSE. The MoCA showed between-group differences even in those with normal MMSE and would thus appear to be a useful brief tool to assess cognition in those with MCI, particularly where the ceiling effect of the MMSE is problematic.

In response to “Letter: are there non-responders to the ergogenic effects of caffeine ingestion on exercise performance” by Grgic [...]

OBJECTIVE: To assess whether clozapine is likely to be more cost-effective than other second-generation antipsychotics (SGAs) in people with schizophrenia. METHODS: An integrated clinical and economic multicenter, rater-blind, randomized controlled trial (RCT) compared clozapine to the class of other SGAs, using the perspectives of the National Health Service, social support services, and patients. The practice setting was secondary and primary care in the United Kingdom; patients were followed for 1 year. Incremental cost-effectiveness ratios (ICERs), net benefit statistics, and cost acceptability curves were estimated. RESULTS: The ICER for clozapine was 33,240 pound per quality-adjusted life-year (QALY) (range 23,000-70,000 pound for the sensitivity analyses). The proportion of simulations when clozapine was more cost-effective than other SGAs reached 50% if decision-makers are prepared to pay 30,000 pound to 35,000 pound per QALY. This is at the top of the range of acceptable willingness-to-pay values per QALY implied by decisions taken by the National Institute for Health and Clinical Excellence (NICE). CONCLUSIONS: This study adds to a limited body of evidence comparing clozapine to other SGAs and is the first economic and clinical RCT to compare clozapine to the class of other SGAs using the lower cost of generic clozapine and a pragmatic trial design. Policy decisions by the NICE suggest that additional reasons would be needed to accept clozapine as effective and efficient if it had a high probability of having ICERs more than 35,000 pound per QALY. The results and limitations of the analysis suggest that there is still a need for further economic evaluation of clozapine.

Two days after castration, urinary free felinine plus N-acetylfelinine decreased 24% in male cats, but, by day 5, the concentration had not decreased to that routinely found in males that have been castrated for several months. In a second experiment, three groups of castrated adult male cats received different subcutaneous injections: control (carrier), testosterone, testosterone plus estradiol. A fourth group of intact adult female cats received a testosterone injection. Urine was collected and analysed for free felinine, N-acetylfelinine and 3-methylbutanolglutathione. Baseline blood testosterone and estradiol concentrations were low during the pre-period, but increased sharply after hormone injections. The concentration of all three urinary metabolites increased as a result of testosterone injections with estradiol not modulating the effect. The effect of testosterone was not gender dependent. The concentration of free felinine, N-acetylfelinine and 3-methylbutanolglutathione in the urine remained low in the placebo control group throughout the study. The relative molar contribution of free felinine to the total amount of felinine containing compounds increased due to testosterone treatment, while the contribution of 3-methylbutanolglutathione and N-acetylfelinine decreased. Testosterone increases free felinine, N-acetylfelinine and 3-methylbutanolglutathione excretion in castrated adult male and intact female cats, whereas estradiol does not modulate this effect.

Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards’ potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD’s access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.

This article describes the effective use of telemedicine for the urban adult patient. A successful pediatric telemedicine program was expanded to include care for adults. The pilot program resulted in high levels of patient satisfaction, decreased loss of work time, and decrease in inappropriate use of the emergency department.

We examined the influence of caffeine supplementation on cognitive performance and perceptual responses in female team-game players taking low-dose monophasic oral contraceptives of the same hormonal composition. Ten females (24 ± 4 years; 59.7 ± 3.5 kg body mass; 2-6 training sessions per week) took part in a randomised, double-blind, placebo-controlled crossover-design trial. A 90-min intermittent treadmill-running protocol was completed 60 min following ingestion of a capsule containing either 6 mg • kg(-1) anhydrous caffeine or artificial sweetener (placebo). Perceptual responses (ratings of perceived exertion (RPE), feeling scale (FS), felt arousal scale (FAS)), mood (profile of mood states (POMS)) and cognitive performance (Stroop test, choice reaction time (CRT)) were completed before, during and after the exercise protocol, as well as after ~12 h post exercise. Caffeine ingestion significantly enhanced the ratings of pleasure (P = 0.008) and arousal (P = 0.002) during the exercise protocol, as well as increased vigour (POMS; P = 0.007), while there was a tendency for reduced fatigue (POMS; P = 0.068). Caffeine ingestion showed a tendency to decrease RPE (P = 0.068) and improve reaction times in the Stroop (P = 0.072) and CRT (P = 0.087) tests. Caffeine supplementation showed a positive effect on perceptual parameters by increasing vigour and a tendency to decrease fatigue during intermittent running activity in female games players taking low-dose monophasic oral contraceptive steroids (OCS).

Nicole Markwick , Ryan McNeil , Solanna Anderson , Will Small , Thomas Kerr * a British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 – 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada b School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada c Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada

Despite various reform efforts, a persistent concern remains within education regarding the under-representation of women in non-traditional subject areas, such as science and engineering. As society is becoming increasingly technocratic, this article examines this issue in relation to Information Technology (IT), as a relatively new educational area. In doing so, I review some of the literature surrounding the gendering of this site and draw upon empirical findings from a study exploring the experiences of women in university computing courses. The aim of this article is to consider and critique the dominant paradigms that have been adopted, drawing upon constructions and understandings of subjectivity of educational theorists who offer alternative ways of approaching this issue. In this article I argue that to move forward we must disrupt and dismantle the gender binary that is so insidiously embedded in the discursive repertoire of the dominant paradigm of educational research and reform. A feminist post-structuralist approach, as employed by several educational theorists, offers opportunities for transcending such duality, while engaging more effectively with the lived experiences of individual women.

There is good evidence that clozapine is more efficacious than first-generation antipsychotic drugs in resistant schizophrenia. It is less clear if clozapine is more effective than the other second-generation antipsychotic (SGA) drugs. A noncommercially funded, pragmatic, open, multisite, randomized controlled trial was conducted in the United Kingdom National Health Service (NHS). Participants were 136 people aged 18–65 with DSM-IV schizophrenia and related disorders whose medication was being changed because of poor clinical response to 2 or more previous antipsychotic drugs. Participants were randomly allocated to clozapine or to one of the class of other SGA drugs (risperidone, olanzapine, quetiapine, amisulpride) as selected by the managing clinician. Outcomes were assessed blind to treatment allocation. One-year assessments were carried out in 87% of the sample. The intent to treat comparison showed no statistically significant advantage for commencing clozapine in Quality of Life score (3.63 points; CI: 0.46–7.71; p = .08) but did show an advantage in Positive and Negative Syndrome Scale (PANSS) total score that was statistically significant (–4.93 points; CI: −8.82 to −1.05; p = .013) during follow-up. Clozapine showed a trend toward having fewer total extrapyramidal side effects. At 12 weeks participants who were receiving clozapine reported that their mental health was significantly better compared with those receiving other SGA drugs. In conclusion, in people with schizophrenia with poor treatment response to 2 or more antipsychotic drugs, there is an advantage to commencing clozapine rather than other SGA drugs in terms of symptom improvement over 1 year.

Background: Despite randomized controlled trials (RCTs) being regarded as the gold standard for intervention research in mental health, there is a lack of guidance on the practicalities of setting up and conducting such trials in the NHS.Aims: To provide information for new clinical trials collated from the experiences of carrying out the NCCHTA-funded CUtLASS trial (reported in an HTA Monograph entitled “Randomised controlled trials of conventional versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment”).Conclusions: The main practical considerations in clinical trials can be grouped into issues of Staffing, Trial Management and Data Management. Matters that impact on recruitment include the research question, the interest of clinicians in that question, the extent of clinical equipoise, and the provision of adequate reimbursement of service support costs associated with participation in the trial.

Objectives To examine clinicians' attitudes regarding the relative benefits and risks of conventional and atypical antipsychotic medication, and the perceived validity of the CUtLASS study. To examine the attitudes of participant clinicians' regarding the operation and administration, and the potential clinical impact of the findings. Method Two hundred and sixty-two clinicians were each sent an anonymous questionnaire, and invited to indicate whether they agreed or disagreed with each of to nine statements (from agree to disagree). Results Of the 112 clinicians who responded, 71% supported the CUtLASS study. Thirty-nine percent agreed with the statement that the clinical efficacy of atypicals was superior to conventional antipsychotics, while 27% disagreed and 34% were undecided. Thus, two-thirds of participating clinicians revealed no uncertainty on a key question being tested in the CUtLASS study. Further, the vast majority (97%) considered that atypicals were associated with less severe side effects. Conclusions In clinical studies, recruitment strategies relying on referrals from clinicians may find that some clinicians identify fewer patients than expected. This can lead to a relatively low yield of potential study subjects and possibly a selection bias. Surveys of clinicians approached to participate in clinical studies provide a potential mechanism to explore attitudes relevant to participant recruitment.