Rhodiola rosea as an adaptogen to enhance exercise performance: a review of the literature.

Rhodiola rosea (RR) is a plant whose bioactive components may function as adaptogens, thereby increasing resistance to stress and improving overall resilience. Some of these effects may influence exercise performance and adaptations. Based on studies of rodents, potential mechanisms for the ergogenic effects of RR include modulation of energy substrate stores and use, reductions in fatigue and muscle damage and altered antioxidant activity. At least sixteen investigations in humans have explored the potential ergogenicity of RR. These studies indicate acute RR supplementation (∼200 mg RR containing ∼1 % salidroside and ∼3 % rosavin, provided 60 min before exercise) may prolong time-to-exhaustion and improve time trial performance in recreationally active males and females, with limited documented benefits of chronic supplementation. Recent trials providing higher doses (∼1500 to 2400 mg RR/d for 4­30 d) have demonstrated ergogenic effects during sprints on bicycle ergometers and resistance training in trained and untrained adults. The effects of RR on muscle damage, inflammation, energy system modulation, antioxidant activity and perceived exertion are presently equivocal. Collectively, it appears that adequately dosed RR enhances dimensions of exercise performance and related outcomes for select tasks. However, the current literature does not unanimously show that RR is ergogenic. Variability in supplementation dose and duration, concentration of bioactive compounds, participant characteristics, exercise tests and statistical considerations may help explain these disparate findings. Future research should build on the longstanding use of RR and contemporary clinical trials to establish the conditions in which supplementation facilitates exercise performance and adaptations.

Validation of the Oxford WebQ Online 24-Hour Dietary Questionnaire Using Biomarkers.

The Oxford WebQ is an online 24-hour dietary questionnaire that is appropriate for repeated administration in large-scale prospective studies, including the UK Biobank study and the Million Women Study. We compared the performance of the Oxford WebQ and a traditional interviewer-administered multiple-pass 24-hour dietary recall against biomarkers for protein, potassium, and total sugar intake and total energy expenditure estimated by accelerometry. We recruited 160 participants in London, United Kingdom, between 2014 and 2016 and measured their biomarker levels at 3 nonconsecutive time points. The measurement error model simultaneously compared all 3 methods. Attenuation factors for protein, potassium, total sugar, and total energy intakes estimated as the mean of 2 applications of the Oxford WebQ were 0.37, 0.42, 0.45, and 0.31, respectively, with performance improving incrementally for the mean of more measures. Correlation between the mean value from 2 Oxford WebQs and estimated true intakes, reflecting attenuation when intake is categorized or ranked, was 0.47, 0.39, 0.40, and 0.38, respectively, also improving with repeated administration. These correlations were similar to those of the more administratively burdensome interviewer-based recall. Using objective biomarkers as the standard, the Oxford WebQ performs well across key nutrients in comparison with more administratively burdensome interviewer-based 24-hour recalls. Attenuation improves when the average value is taken over repeated administrations, reducing measurement error bias in assessment of diet-disease associations.

Validity of an online 24-h recall tool (myfood24) for dietary assessment in population studies: comparison with biomarkers and standard interviews.

BACKGROUND: Online dietary assessment tools can reduce administrative costs and facilitate repeated dietary assessment during follow-up in large-scale studies. However, information on bias due to measurement error of such tools is limited. We developed an online 24-h recall (myfood24) and compared its performance with a traditional interviewer-administered multiple-pass 24-h recall, assessing both against biomarkers. METHODS: Metabolically stable adults were recruited and completed the new online dietary recall, an interviewer-based multiple pass recall and a suite of reference measures. Longer-term dietary intake was estimated from up to 3 × 24-h recalls taken 2 weeks apart. Estimated intakes of protein, potassium and sodium were compared with urinary biomarker concentrations. Estimated total sugar intake was compared with a predictive biomarker and estimated energy intake compared with energy expenditure measured by accelerometry and calorimetry. Nutrient intakes were also compared to those derived from an interviewer-administered multiple-pass 24-h recall. RESULTS: Biomarker samples were received from 212 participants on at least one occasion. Both self-reported dietary assessment tools led to attenuation compared to biomarkers. The online tools resulted in attenuation factors of around 0.2-0.3 and partial correlation coefficients, reflecting ranking intakes, of approximately 0.3-0.4. This was broadly similar to the more administratively burdensome interviewer-based tool. Other nutrient estimates derived from myfood24 were around 10-20% lower than those from the interviewer-based tool, with wide limits of agreement. Intraclass correlation coefficients were approximately 0.4-0.5, indicating consistent moderate agreement. CONCLUSIONS: Our findings show that, whilst results from both measures of self-reported diet are attenuated compared to biomarker measures, the myfood24 online 24-h recall is comparable to the more time-consuming and costly interviewer-based 24-h recall across a range of measures.

Nutrition and the circadian system.

The human circadian system anticipates and adapts to daily environmental changes to optimise behaviour according to time of day and temporally partitions incompatible physiological processes. At the helm of this system is a master clock in the suprachiasmatic nuclei (SCN) of the anterior hypothalamus. The SCN are primarily synchronised to the 24-h day by the light/dark cycle; however, feeding/fasting cycles are the primary time cues for clocks in peripheral tissues. Aligning feeding/fasting cycles with clock-regulated metabolic changes optimises metabolism, and studies of other animals suggest that feeding at inappropriate times disrupts circadian system organisation, and thereby contributes to adverse metabolic consequences and chronic disease development. 'High-fat diets' (HFD) produce particularly deleterious effects on circadian system organisation in rodents by blunting feeding/fasting cycles. Time-of-day-restricted feeding, where food availability is restricted to a period of several hours, offsets many adverse consequences of HFD in these animals; however, further evidence is required to assess whether the same is true in humans. Several nutritional compounds have robust effects on the circadian system. Caffeine, for example, can speed synchronisation to new time zones after jetlag. An appreciation of the circadian system has many implications for nutritional science and may ultimately help reduce the burden of chronic diseases.

A critical analysis of undergraduate students' cultural immersion experiences.

PURPOSE: This paper is concerned with the impact of an international health promotion experience on the understanding of culture among university students. Such immersion experiences are often cited as a strategy to prepare nurses for culturally appropriate practice. We describe students' epistemic movements over time with respect to cultural perspectives prior to, during and after a field study in Malawi. DESIGN: Data were collected at three time points from students in undergraduate nursing (n = 14) and non-nursing (n = 8) programs at a Canadian university. Two essays narrating participants' understanding of culture were submitted by consenting class members. A subgroup of nine participants (four nursing students, five from other disciplines) completed a third narrative following a subsequent field study course in Malawi. METHOD: Using narrative analysis, themes and structures in the participants' writing were identified and located within a constructivist or essentialist paradigm of cultural understanding. FINDINGS: Overwhelmingly, students' narratives were initially portrayed and informed by an essentialist understanding of culture. Later narratives demonstrated varying degrees of epistemic movement towards more constructivist viewpoints. Narratives that initially exhibited constructivist characteristics tended to display strengthened convictions in that paradigm. CONCLUSION: We challenge the claim that an international immersion experience immediately transforms participants into cultural experts; our evidence suggests that students experienced existential growth, but their understanding of culture did not change as a result of their brief stay in a different cultural context. Cultural immersion is a phenomenon that requires more critical analysis and systematic investigation to determine how such experiences contribute to learning about culture among nursing students.

The Future of Shift Work: Circadian Biology Meets Personalised Medicine and Behavioural Science.

Shift work is commonplace in modern societies, and shift workers are predisposed to the development of numerous chronic diseases. Disruptions to the circadian systems of shift workers are considered important contributors to the biological dysfunction these people frequently experience. Because of this, understanding how to alter shift work and zeitgeber (time cue) schedules to enhance circadian system function is likely to be key to improving the health of shift workers. While light exposure is the most important zeitgeber for the central clock in the circadian system, diet and exercise are plausible zeitgebers for circadian clocks in many tissues. We know little about how different zeitgebers interact and how to tailor zeitgeber schedules to the needs of individuals; however, in this review we share some guidelines to help shift workers adapt to their work schedules based on our current understanding of circadian biology. We focus in particular on the importance of diet timing and composition. Going forward, developments in phenotyping and "envirotyping" methods may be important to understanding how to optimise shift work. Non-invasive, multimodal, comprehensive phenotyping using multiple sources of time-stamped data may yield insights that are critical to the care of shift workers. Finally, the impact of these advances will be reduced without modifications to work environments to make it easier for shift workers to engage in behaviours conducive to their health. Integrating findings from behavioural science and ergonomics may help shift workers make healthier choices, thereby amplifying the beneficial effects of improved lifestyle prescriptions for these people.

Longer sleep is associated with lower BMI and favorable metabolic profiles in UK adults: Findings from the National Diet and Nutrition Survey.

Ever more evidence associates short sleep with increased risk of metabolic diseases such as obesity, which may be related to a predisposition to non-homeostatic eating. Few studies have concurrently determined associations between sleep duration and objective measures of metabolic health as well as sleep duration and diet, however. We therefore analyzed associations between sleep duration, diet and metabolic health markers in UK adults, assessing associations between sleep duration and 1) adiposity, 2) selected metabolic health markers and 3) diet, using National Diet and Nutrition Survey data. Adults (n = 1,615, age 19-65 years, 57.1% female) completed questions about sleep duration and 3 to 4 days of food diaries. Blood pressure and waist circumference were recorded. Fasting blood lipids, glucose, glycated haemoglobin (HbA1c), thyroid hormones, and high-sensitivity C-reactive protein (CRP) were measured in a subset of participants. We used regression analyses to explore associations between sleep duration and outcomes. After adjustment for age, ethnicity, sex, smoking, and socioeconomic status, sleep duration was negatively associated with body mass index (-0.46 kg/m2 per hour, 95% CI -0.69 to -0.24 kg/m2, p < 0.001) and waist circumference (-0.9 cm per hour, 95% CI -1.5 to -0.3cm, p = 0.004), and positively associated with high-density lipoprotein cholesterol (0.03 mmol/L per hour, 95% CI 0.00 to 0.05, p = 0.03). Sleep duration tended to be positively associated with free thyroxine levels and negatively associated with HbA1c and CRP (p = 0.09 to 0.10). Contrary to our hypothesis, sleep duration was not associated with any dietary measures (p ≥ 0.14). Together, our findings show that short-sleeping UK adults are more likely to have obesity, a disease with many comorbidities.

Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences, and Countermeasures.

Circadian (∼24-hour) timing systems pervade all kingdoms of life and temporally optimize behavior and physiology in humans. Relatively recent changes to our environments, such as the introduction of artificial lighting, can disorganize the circadian system, from the level of the molecular clocks that regulate the timing of cellular activities to the level of synchronization between our daily cycles of behavior and the solar day. Sleep/wake cycles are intertwined with the circadian system, and global trends indicate that these, too, are increasingly subject to disruption. A large proportion of the world's population is at increased risk of environmentally driven circadian rhythm and sleep disruption, and a minority of individuals are also genetically predisposed to circadian misalignment and sleep disorders. The consequences of disruption to the circadian system and sleep are profound and include myriad metabolic ramifications, some of which may be compounded by adverse effects on dietary choices. If not addressed, the deleterious effects of such disruption will continue to cause widespread health problems; therefore, implementation of the numerous behavioral and pharmaceutical interventions that can help restore circadian system alignment and enhance sleep will be important.

Normal plasma free amino acid values in adults: the influence of some common physiological variables.

We measured plasma free amino acids in ten healthy adults (five males, five females, ages 26 to 54 years), at four times of day, under two dietary protocols. The design allowed us to measure the effects of some common physiological variables on the metrical distributions (mean, SD, skewness, kurtosis) of 80 values (in most cases), for each of 20 amino acids. Analysis of variance indicates that individuals in a "public" population possess "private" phenotypes for 18 plasma amino acids under typical external experiences; the exceptions were aspartate and taurine. The collective infradiem variation rarely exceeded 50% of the nadir value for any amino acid. We conclude that genotype is an important determinant of plasma amino acid phenotype in normal persons, and that there is striking homeostasis of plasma amino acid values in human adults adapted to normal daily activity.

Plasma free amino acid values in normal children and adolescents.

We measured plasma free amino acids in 52 children (mean age 8 years) and 80 adolescents (mean age 16 years); conditions of diet and time of day were similar in the two groups. The protocols allowed us to compare their interindividual variation with values previously reported by us for adults. In children, the values for all but seven amino acids were normally distributed; in adolescents there were only six exceptions. Effects of age were apparent: values for only two amino acids were higher in children than adolescents. Values were significantly lower for ten amino acids in children v adolescents and for 11 amino acids in younger children (1 to 6 years) v older children (7 to 12 years). An effect of sex was apparent for five amino acids in adolescents; such differences were not apparent in children. All differences were quasicontinuous and occurred within the global distributions that define values for plasma amino acids in normal children and adolescents. Two artifacts (choice of anticoagulant and delay in deproteinization) affected values for taurine and cystine, respectively.

Need for coronary artery bypass grafting in Newfoundland and Labrador: the impact of increased demand.

BACKGROUND: In the past decade, growth of coronary revascularization in Canada has been substantial. It was hypothesized that as coronary angiography (CA) rates increased, referral for necessary coronary artery bypass grafting (CABG) would also increase, and include patients with multivessel disease and class I to III angina who required elective surgery. Furthermore, it was proposed that the number of CABG surgeries needed would increase at a similar rate to that of CA. METHODS: An incident cohort of patients who received CA in 1998/1999 was identified, and the group referred for CABG was followed. Clinical characteristics, appropriateness and necessity scores using specific criteria, and waiting times were evaluated and compared with a similar cohort from 1994/1995. Utilization data for coronary revascularization procedures from 1994 to 2002 were reviewed. RESULTS: Between 1994/1995 and 1998/1999, the number of CAs per year increased by 37%. The inappropriateness rate for CA was 4% in 1998/1999. The proportion of patients diagnosed with critical coronary artery disease increased from 68% in 1994/1995 to 74% in 1998/1999. The number referred for CABG increased by 48%, and the number for percutaneous transluminal coronary angioplasty (PTCA) increased by 137%. The increase in the number referred for CABG was attributable to the increase in the number of patients with less severe symptoms who required delayed elective CABG. The necessity rate for CABG in the referred group was 94% in 1994/1995 and 95% in 1998/1999. A further 91 patients were identified who needed CABG but did not receive it, 86% of whom had PTCA. From 1999 to 2002, the annual growth rate in those referred for CABG was higher than the growth rate for CA. CONCLUSIONS: With the growth in CA, the rate of discovery of high risk coronary anatomy actually increased. Growth in CABG volume was attributable to growth in the need for elective surgery in patients with class I to III angina. The rate of CABG increased disproportionately to the rate of CA, despite higher rates of PTCA with stenting. It is likely that the demand for CABG will continue to rise steadily, as expansion of angiography occurs, and may be higher than expected from the growth in CA.

Pore structure and sorption properties of silica aerogels studied by magnetic resonance imaging and pulsed-field gradient spectroscopy.

Magnetic resonance imaging (MRI) has provided direct visualization of gaseous xenon and methane in the void spaces of aerogels, offering unique information and insights into the pore structure and molecular diffusivities of occluded sorbates. Nuclear magnetic resonance (NMR) pulsed-field gradient (PFG) techniques were used to characterize exchange and diffusive motion of sorbed xenon gas at equilibrium. PFG measurements showed evidence of anisotropic diffusion; nominal self-diffusivity coefficients of xenon on the order of D = 10(-7) m2/s were determined. Based on a mathematical relationship for the restricted diffusion of gases in confined environments, an expression for estimating the mean free path was derived, from which the average pore size could be obtained from the extrapolated value of the diffusion coefficient to low xenon pressures.

Patients' explanatory models for heart failure and COPD exacerbations.

Although there is extensive information on the disease aspect of heart failure (HF) and chronic obstructive pulmonary disease (COPD), the illness aspect of these diseases has received limited attention. This limitation in our knowledge is of concern because these diseases are increasing in incidence and prevalence and contributing to the premature morbidity and mortality of thousands of persons. This naturalistic inquiry study was undertaken to describe the explanatory models (EMs) of persons hospitalized for HF (n = 30) or COPD (n = 30) exacerbations. In semistructured interviews, participants offered descriptions of the etiology, cause, and effects of their disease exacerbations and identified interventions that they believed would have helped prevent their hospitalizations or helped them to live better at home. The findings provide a basis for understanding the EMs of persons with HF or COPD as an initial step in making health care more relevant.

Patients' perceptions of their experiences with ESRD and hemodialysis treatment.

A grounded theory methodology was used to explore patients' experiences with end-stage renal disease (ESRD) and hemodialysis. The emerging theory suggests that a "new sense of self" is an emotional/psychological state that fluctuates with the evolving meanings of illness and treatment and perceived quality of supports. The findings indicate that when confronted with this new way of being in the world, the individual becomes cognizant of an uncertain future, continued dependence on life-sustaining technology and the expertise of health care providers, and the demands on and sacrifices incurred by significant others. All aspects of patients' experiences with ESRD and hemodialysis treatment must be considered if health care providers are to facilitate positive health outcomes.

Elderly male spouses as caregivers--toward an understanding of their experience.

Male caregivers have difficulty assuming personal and household responsibilities; they seem to cope by focusing on the caregiving tasks and projects, establishing daily routines, and carving out their own territory in the home. To facilitate effective interventions, nurses should ascertain the elderly male spouse's meaning of caregiving. This would enable practitioners to foster the caregiver's strengths and provide support in those areas where burden or difficulties are experienced. Husbands as caregivers were more likely than wives to seek the help of formal providers and receive more informal support. Male caregivers tend to not participate in support groups. Before making a referal, nurses should ensure the group is geared to the special needs of the man.

Issues for consideration when choosing a qualitative data management system.

A primary issue in conducting qualitative research is the time required for data analysis. Qualitative research can be costly, since data analysis is generally labour intensive and our time factors into money. There is, unfortunately, no magic formula for hastening the conceptual tasks associated with qualitative analysis, yet effective qualitative data management systems (QDMS) expedite the mechanical tasks, those tasks associated with storing and retrieving qualitative data. Rapid and smooth data management increases the time one can allot to data analysis. Although computer QDMS are increasingly recommended for their time-saving potential in relation to data management, some significant issues associated with the adoption of a computer versus a manual QDMS have not yet been fully explored. The purpose of this paper is to present major issues researchers should consider in choosing a computer or a manual QDMS. These issues include availability and accessibility, comfort, appropriateness, efficiency, thoroughness and contextualization.

Protective care-receiving: the active role of care-recipients.

Historical and contemporary conceptualizations of caregiving have not addressed the active role of care recipients within caregiver-care-recipient relationships. Using an interpretive synthesis method, the authors developed the concept of protective care-receiving from three qualitative studies of different groups of care receivers (older adults with chronic illnesses, persons with AIDS, and persons in treatment for active cancer). This paper describes the focus of care recipients' protective care-receiving efforts, the goals they hoped to achieve, and the strategies they used to assist themselves in attaining their goals. Examples of their efforts and strategies are illustrated with quotations from the data. These findings extend what is known about care recipients' selfcare activities. Moreover, the findings reveal a new dimension in the role of care recipients--protective care given by care recipients to their professional care providers, family and friend caregivers, and other care recipients. The concept of protective care-receiving advances our understanding of caregiving relationships and presents researchers with the opportunity to investigate the complex encounter between caregiver and care recipient. Recognizing and facilitating care recipients' protective care-receiving is an ethical imperative for a 'caring' profession such as nursing.