Employment Considerations for People who have Diabetes

This brochure on Diabetes and the Americans with Disabilities Act (ADA) is one of a series on human resources practices and workplace accommodations for persons with disabilities edited by Susanne M. Bruyère, Ph.D., CRC, SPHR, Director, Program on Employment and Disability, School of Industrial and Labor Relations – Extension Division, Cornell University. Cornell University was funded in the early 1990’s by the U.S. Department of Education National Institute on Disability and Rehabilitation Research as a National Materials Development Project on the employment provisions (Title I) of the ADA (Grant #H133D10155). These updates, and the development of new brochures, have been funded by Cornell’s Program on Employment and Disability, the Pacific Disability and Business Technical Assistance Center, and other supporters

Nutrient Timing: A Garage Door of Opportunity?

Nutrient timing involves manipulation of nutrient consumption at specific times in and around exercise bouts in an effort to improve performance, recovery, and adaptation. Its historical perspective centered on ingestion during exercise and grew to include pre- and post-training periods. As research continued, translational focus remained primarily on the impact and outcomes related to nutrient consumption during one specific time period to the exclusion of all others. Additionally, there seemed to be increasing emphasis on outcomes related to hypertrophy and strength at the expense of other potentially more impactful performance measures. As consumption of nutrients does not occur at only one time point in the day, the effect and impact of energy and macronutrient availability becomes an important consideration in determining timing of additional nutrients in and around training and competition. This further complicates the confining of the definition of “nutrient timing” to one very specific moment in time at the exclusion of all other time points. As such, this review suggests a new perspective built on evidence of the interconnectedness of nutrient impact and provides a pragmatic approach to help frame nutrient timing more inclusively. Using this approach, it is argued that the concept of nutrient timing is constrained by reliance on interpretation of an “anabolic window” and may be better viewed as a “garage door of opportunity” to positively impact performance, recovery, and athlete availability

Effects of a 4-Week Heart Rate Variability Biofeedback Intervention on Psychological and Performance Variables in Student-Athletes: A Pilot Study

PURPOSE: To examine the effects of a 4-week biofeedback intervention on coherence, psychological, and performance variables in collegiate student-athletes. METHODS: Thirteen student-athletes were randomly assigned to the intervention (one weekly biofeedback session for 4-weeks) or control group (no sessions). Data were collected at pre and post-intervention using weekly averaged coherence scores, psychological measures for depression, arousal, stress, resiliency, and performance outcome measures. RESULTS: A 3 (Time) x 4 (Week average) repeated measures ANOVA was independently conducted to examine differences between time and weekly coherence average for coherence scores. No significant differences were found for “at rest”, pre, or post-practice coherence scores. A 2 (treatment group) x 4 (Week) repeated measures ANOVAs were independently conducted to examine differences between treatment groups and week average for performance, resilience, and recovery. Significant differences were found for performance by time (p = .029). For the psychological variables, 2 (treatment group) X 2 (Time) repeated measures ANOVAs were independently conducted to examine differences between treatment group and time for CESD, AD-ACL, CSSS, and the ASSQ sleep score and no significant differences were found. CONCLUSIONS: Overall the biofeedback intervention did not improve coherence, psychological, or performance variables between the groups. While the biofeedback intervention did not show significant changes in this pilot study, there is potential for future research to address male participants and a change in timing during the season

Customising user-friendly technology for achieving safer homes : a process of interaction

Den demografiske utviklingen i Norge og Europa viser at andelen eldre i befolkningen stadig øker. Utviklingen genererer et behov for større ressurser til helse og omsorgssektoren, samtidig presser kravet til nye eller proaktive tjenester seg frem. Innovasjonen tryggere hjem konseptet er utgangspunktet for denne studien. Tryggere hjem konseptet er utviklet med elektronisk styring, tilsyn og kommunikasjons funksjoner som er videreutviklet fra smarthusteknologi. Slik teknologi gir mulighet for styring av ulike funksjoner som kommunikasjon mellom bolig og tjenesteytere samt aktivt eller passivt tilsyn i boligen. Caset i oppgaven består av tre hovedaktører. Privat produktutvikler som har utviklet tryggere hjem konseptet. Konseptet er delvis integrert som et pilotprosjekt ved omsorgsboliger, i Nord-Odal kommune som er den andre aktøren. Brukerne som har kjøpt leiligheter som omsorgsboliger er den tredje aktøren. Oppgaven har som mål å belyse hvilke forhold ved rammebetingelsene og ved samhandlingen aktørene vektlegger som hemmende eller fremmende for produktutvikling i tryggere hjem konseptet. Aktørene plasseres inn i et systemisk innovasjonsperspektiv, der produktinnovasjonen og den potensielle prosessinnovasjonen ved tryggere hjem konseptet, er del av et innovasjonssystem. Fokus på åpne eller lukkede grenser mellom aktørene i systemet er helt sentralt for å kunne definere graden av samhandling. Kvalitativ metode danner grunnlaget for innhenting av data hos aktørene ved bruk av semi-strukturerte intervjuer. Data drøftes ved å presentere funn inn i ulike sammenhenger for å synliggjøre rammebetingelser og forhold ved samhandling slik de oppfattes av aktørenes. Disse sammenhengene relaterer seg til faktorer som påvirker adaptasjon av innovasjoner, økonomiske og organisatoriske forutsetninger, motivasjon, insitamenter, kommunikasjon, læring og policy learning. Vi har identifisert to interessegrupper blant aktørene. En gruppe på operativt nivå i pleie- og omsorgssektoren og en gruppe hos daglig ledelse i Tryggere hjem AS. Disse interessegruppene har ulike målsettinger knyttet til tryggere hjem konseptet. Både leverandøren og operativt nivå i kommunens omsorgstjeneste har begge god intern samhandling og et bevisst forhold til utvikling. Det innebærer et sterkt fokus på å ta i bruk nye metoder i forbindelse med innføringen av nye hjelpemidler og tilpassning av tjenester til brukerne. Begge aktører lærer gjennom samhandling med eksterne samarbeidspartnere, men de har ingen samhandling knyttet til utvikling av tryggere hjem konseptet. Kommunikasjonen knyttet til utviklingen av innovasjonen er i lite grad koordinert mellom de ulike aktørene, og internt i organisasjonen hos den enkelte aktør. Funn viser at alle aktørene oppfatter at det eksisterer store svakheter ved kommunikasjonen slik den var ved prosjekteringen av boligene og gjennom initiering samt implementering av tryggere hjem konseptet. Det synes å være mange barrierer som skal brytes for at tryggere hjem konseptet kan realiseres i sin helhet med både tilsyn, styring og kommunikasjonsløsninger. De ulike forhold ved rammebetingelsene og ved samhandlingen er samlet til hinder for åpning av grensene mellom aktørene. Det er allikevel muligheter for en videre produktutvikling i tryggere hjem konseptet ved at aktører på operativt nivå i kommunen og hos leverandøren, ønsker et samarbeid hvor brukernes omsorgsbehov kartlegges. Slik kartlegging er også utgangspunkt for tilpassning av teknologi til brukerne. Leverandøren og bruker kan som produktutvikler og kunde samhandle om utviklingen av styringselementene i tryggere hjem konseptet på tross av de funn som viser at det er vanskelig å bryte ned grensene mellom aktørene

Eight weeks of supplementation with a multi-ingredient weight loss product enhances body composition, reduces hip and waist girth, and increases energy levels in overweight men and women

Background: Numerous natural products are marketed and sold claiming to decrease body weight and fat, but few undergo finished product-specific research demonstrating their safety and efficacy. Objective: To determine the safety and efficacy of a multi-ingredient supplement containing primarily raspberry ketone, caffeine, capsaicin, garlic, ginger and Citrus aurantium (Prograde Metabolism™ [METABO]) as an adjunct to an eight-week weight loss program. Methods: Using a randomized, placebo-controlled, double-blind design, 70 obese but otherwise healthy subjects were randomly assigned to METABO or a placebo and underwent 8 weeks of daily supplementation, a calorie restricted diet, and exercise training. Subjects were tested for changes in body composition, serum adipocytokines (adiponectin, resistin, leptin, TNF-α, IL-6) and markers of health including heart rate and blood pressure. Results: Of the 45 subjects who completed the study, significant differences were observed in: body weight (METABO -2.0% vs. placebo -0.5%, P < 0.01), fat mass (METABO -7.8 vs. placebo -2.8%, P < 0.001), lean mass (METABO +3.4% vs. placebo +0.8%, P < 0.03), waist girth (METABO -2.0% vs. placebo -0.2%, P < 0.0007), hip girth (METABO -1.7% vs. placebo -0.4%, P < 0.003), and energy levels per anchored visual analogue scale (VAS) (METABO +29.3% vs. placebo +5.1%, P < 0.04). During the first 4 weeks, effects/trends for maintaining elevated serum leptin (P < 0.03) and decreased serum resistin (P < 0.08) in the METABO group vs. placebo were also observed. No changes in systemic hemodynamics, clinical blood chemistries, adverse events, or dietary intake were noted between groups. Conclusions: METABO administration is a safe and effective adjunct to an eight-week diet and exercise weight loss program by augmenting improvements in body composition, waist and hip girth. Adherence to the eight-week weight loss program also led to beneficial changes in body fat in placebo. Ongoing studies to confirm these results and clarify the mechanisms (i.e., biochemical and neuroendocrine mediators) by which METABO exerts the observed salutary effects are being conducted. Keywords: Dietary supplement; Raspberry ketone; Adipokine; Body composition; Fat loss; Capsaici

Electronic structure of intentionally disordered AlAs/GaAs superlattices

We use realistic pseudopotentials and a plane-wave basis to study the electronic structure of non-periodic, three-dimensional, 2000-atom (AlAs)_n/(GaAs)_m (001) superlattices, where the individual layer thicknesses n,m = {1,2,3} are randomly selected. We find that while the band gap of the equivalent (n = m = 2) ordered superlattice is indirect, random fluctuations in layer thicknesses lead to a direct gap in the planar Brillouin zone, strong wavefunction localization along the growth direction, short radiative lifetimes, and a significant band-gap reduction, in agreement with experiments on such intentionally grown disordered superlattices.Comment: 10 pages, REVTeX and EPSF macros, 4 figures in postscript. e-mail to [email protected]

Effects of variations in resistance training frequency on strength development in well-trained populations and implications for in-season athlete training : a systematic review and meta-analysis

In-season competition and tournaments for team sports can be both long and congested, with some sports competing up to three times per week. During these periods of time, athletes need to prepare technically, tactically and physically for the next fixture and the short duration between fixtures means that, in some cases, physical preparation ceases, or training focus moves to recovery as opposed to progressing adaptations. The aim of this review was to investigate the effect of training frequency on muscular strength to determine if a potential method to accommodate in-season resistance training, during busy training schedules, could be achieved by utilizing shorter more frequent training sessions across a training week. A literature search was conducted using the SPORTDiscus, Ovid, PubMed and Scopus databases. 2134 studies were identified prior to application of the following inclusion criteria: (1) maximal strength was assessed, (2) a minimum of two different training frequency groups were included, (3) participants were well trained, and finally (4) compound exercises were included within the training programmes. A Cochrane risk of bias assessment was applied to studies that performed randomized controlled trials and consistency of studies was analysed using I as a test of heterogeneity. Secondary analysis of studies included Hedges' g effect sizes (g) and between-study differences were estimated using a random-effects model. Inconsistency of effects between pre- and post-intervention was low within-group (I  = 0%), and moderate between-group (I  ≤ 73.95%). Risk of bias was also low based upon the Cochrane risk of bias assessment. Significant increases were observed overall for both upper (p ≤ 0.022) and lower (p ≤ 0.008) body strength, pre- to post-intervention, when all frequencies were assessed. A small effect was observed between training frequencies for upper (g ≤ 0.58) and lower body (g ≤ 0.45). Over a 6-12-week period, there are no clear differences in maximal strength development between training frequencies, in well-trained populations. Such observations may permit the potential for training to be manipulated around competition schedules and volume to be distributed across shorter, but more frequent training sessions within a micro-cycle rather than being condensed into 1-2 sessions per week, in effect, allowing for a micro-dosing of the strength stimuli

Practitioner perceptions regarding the practices of soccer substitutes.

Despite empirical observations suggesting that practitioners value the use of substitutions during soccer match-play, limited research has sought to substantiate such claims. This study used online surveys to assess the perceptions of practitioners within professional soccer about the use and practices of substitutes. Thirty-three practitioners completed one of two surveys (each requiring both open and closed questions to be answered), depending upon whether their primary role related mostly to tactical ('tactical practitioners'; n = 7) or physical ('physical practitioners'; n = 26) aspects of player/team management. Thematic content analysis of responses identified four higher-order themes: 'impact of substitutions', 'planning and communication', 'player preparation and recovery' and 'regulations'. Eighty-five percent of practitioners believed that substitutes are important in determining success during soccer match-play, with the primary justification being the perceived ability of such players to provide a physical and/or tactical impact. However, contextual factors such as the match situation, timing of introduction, and players undergoing adequate pre-pitch-entry preparation, may be important for realising such aims. Although many practitioners believed that there was a need for substitutes to engage in bespoke non-match-day preparations and recovery strategies that differ from starting players, logistical considerations, such as scarcity of resources, often limit their scope. Notwithstanding, 96% of respondents indicated that substitutes frequently perform extra conditioning sessions to account for deficits in high-speed running loads compared with players exposed to a longer period of match-play. Substitutes' pre-match warm-ups are typically led by team staff, however practitioners reported providing varying levels of input with regards to the practices adopted between kick-off and pitch-entry. Uncertainty exists as to the efficacy of current pre-pitch-entry practices, and 100% of practitioners highlighted 'preparatory strategies' as at least a 'moderately important' direction for future research. This study presents novel insights and highlights areas that are considered future research priorities amongst those working in the field

International society of sports nutrition position stand: energy drinks and energy shots

Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of energy drink (ED) or energy shot (ES) consumption on acute exercise performance, metabolism, and cognition, along with synergistic exercise-related performance outcomes and training adaptations. The following 13 points constitute the consensus of the Society and have been approved by the Research Committee of the Society: Energy drinks (ED) commonly contain caffeine, taurine, ginseng, guarana, carnitine, choline, B vitamins (vitamins B1, B2, B3, B5, B6, B9, and B12), vitamin C, vitamin A (beta carotene), vitamin D, electrolytes (sodium, potassium, magnesium, and calcium), sugars (nutritive and non-nutritive sweeteners), tyrosine, and L-theanine, with prevalence for each ingredient ranging from 1.3 to 100%. Energy drinks can enhance acute aerobic exercise performance, largely influenced by the amount of caffeine (\u3e 200 mg or \u3e3 mg∙kg bodyweight [BW−1]) in the beverage. Although ED and ES contain several nutrients that are purported to affect mental and/or physical performance, the primary ergogenic nutrients in most ED and ES based on scientific evidence appear to be caffeine and/or the carbohydrate provision. The ergogenic value of caffeine on mental and physical performance has been well-established, but the potential additive benefits of other nutrients contained in ED and ES remains to be determined. Consuming ED and ES 10-60 minutes before exercise can improve mental focus, alertness, anaerobic performance, and/or endurance performance with doses \u3e3 mg∙kg BW−1. Consuming ED and ES containing at least 3 mg∙kg BW−1 caffeine is most likely to benefit maximal lower-body power production. Consuming ED and ES can improve endurance, repeat sprint performance, and sport-specific tasks in the context of team sports. Many ED and ES contain numerous ingredients that either have not been studied or evaluated in combination with other nutrients contained in the ED or ES. For this reason, these products need to be studied to demonstrate efficacy of single- and multi-nutrient formulations for physical and cognitive performance as well as for safety. Limited evidence is available to suggest that consumption of low-calorie ED and ES during training and/or weight loss trials may provide ergogenic benefit and/or promote additional weight control, potentially through enhanced training capacity. However, ingestion of higher calorie ED may promote weight gain if the energy intake from consumption of ED is not carefully considered as part of the total daily energy intake. Individuals should consider the impact of regular coingestion of high glycemic index carbohydrates from ED and ES on metabolic health, blood glucose, and insulin levels. Adolescents (aged 12 through 18) should exercise caution and seek parental guidance when considering the consumption of ED and ES, particularly in excessive amounts (e.g. \u3e 400 mg), as limited evidence is available regarding the safety of these products among this population. Additionally, ED and ES are not recommended for children (aged 2-12), those who are pregnant, trying to become pregnant, or breastfeeding and those who are sensitive to caffeine. Diabetics and individuals with preexisting cardiovascular, metabolic, hepatorenal, and/or neurologic disease who are taking medications that may be affected by high glycemic load foods, caffeine, and/or other stimulants should exercise caution and consult with their physician prior to consuming ED. The decision to consume ED or ES should be based upon the beverage’s content of carbohydrate, caffeine, and other nutrients and a thorough understanding of the potential side effects. Indiscriminate use of ED or ES, especially if multiple servings per day are consumed or when consumed with other caffeinated beverages and/or foods, may lead to adverse effects. The purpose of this review is to provide an update to the position stand of the International Society of Sports Nutrition (ISSN) integrating current literature on ED and ES in exercise, sport, and medicine. The effects of consuming these beverages on acute exercise performance, metabolism, markers of clinical health, and cognition are addressed, as well as more chronic effects when evaluating ED/ES use with exercise-related training adaption