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Journal of Strength and Conditioning... Feb 2021Knechtle, B, Stjepanovic, M, Knechtle, C, Rosemann, T, Sousa, CV, and Nikolaidis, PT. Physiological responses to swimming repetitive "Ice Miles." J Strength Cond Res...
Knechtle, B, Stjepanovic, M, Knechtle, C, Rosemann, T, Sousa, CV, and Nikolaidis, PT. Physiological responses to swimming repetitive "Ice Miles." J Strength Cond Res 35(2): 487-494, 2021-"Ice Mile" swimming (i.e., 1,608 m in water of below 5° C) is becoming increasingly popular. Since the foundation of the International Ice Swimming Association (IISA) in 2009, official races are held as World Cup Races and World Championships. Ice swimming was a demonstration sport at the 2014 Winter Olympics in Sochi, Russia. This case study aimed to identify core body temperature and selected hematological and biochemical parameters before and after repeated "Ice Miles." An experienced ice swimmer completed 6 consecutive Ice Miles within 2 days. Three Ice Miles adhered to the strict criteria for the definition of Ice Miles, whereas the other 3 were very close (i.e., 5.2, 6.1, and 6.6° C) to the temperature limit. Swimming times, changes in core body temperatures, and selected urinary and hematological parameters were recorded. The athlete showed after each Ice Mile a metabolic acidosis (i.e., an increase in lactate and TCO2; a decrease in base excess and HCO3-) and an increase in blood glucose, cortisol, and creatine kinase concentration. The decrease in pH correlated significantly and negatively with the increase in cortisol level, indicating that this intense exercise causes a metabolic stress. The change in core body temperature between start and finish was negatively associated with metabolic acidosis. The increase in creatine kinase suggests skeletal muscle damages due to shivering after an Ice Mile. For athletes and coaches, swimming in cold water during Ice Miles leads to a metabolic acidosis, which the swimmer tries to compensate with a respiratory response. Considering the increasing popularity of ice swimming, the findings have practical value for swimmers and practitioners (e.g., coaches, exercise physiologists, and physicians) working with them because our results provide a detailed description of acute physiological responses to repeated swimming in cold conditions. These findings are of importance for athletes and coaches for National Championships and World Championships in Ice Swimming following the IISA rules.
Topics: Athletes; Cold Temperature; Humans; Ice; Russia; Swimming
PubMed: 29878984
DOI: 10.1519/JSC.0000000000002690 -
International Journal of Cardiology Oct 2023
Topics: Humans; Sarcopenia; Cachexia; Heart Failure; Muscle, Skeletal; Walking
PubMed: 37364716
DOI: 10.1016/j.ijcard.2023.131131 -
Research Square Mar 2023Playgrounds have features that benefit visitors, including opportunities to engage in outdoor physical activity. We surveyed 1350 adults visiting 60 playgrounds across...
Playgrounds have features that benefit visitors, including opportunities to engage in outdoor physical activity. We surveyed 1350 adults visiting 60 playgrounds across the U.S. in Summer 2021 to determine if distance to the playground from their residence was associated with weekly visit frequency, length of stay, and transportation mode to the site. About 2/3 of respondents living within ½ mile from the playground reported visiting it at least once per week compared with 14.1% of respondents living more than a mile away. Of respondents living within ¼ mile of playgrounds, 75.6% reported walking or biking there. After controlling for socio-demographics, respondents living within ½ mile of the playground had 5.1 times the odds (95% CI: 3.68, 7.04) of visiting the playground at least once per week compared with those living further away. Respondents walking or biking to the playground had 6.1 times the odds (95% CI: 4.23, 8.82) of visiting the playground at least once per week compared with respondents arriving via motorized transport. For public health purposes, city planners and designers should consider locating playgrounds ½ mile from all residences. Distance is likely the most important factor associated with playground use.
PubMed: 36993744
DOI: 10.21203/rs.3.rs-2697497/v1 -
Neurorehabilitation and Neural Repair Aug 2023Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements. (Clinical Trial)
Clinical Trial
BACKGROUND
Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements.
OBJECTIVE
To investigate (1) the time course of steady-state balance in terms of postural stability and inter-limb symmetry, and (2) longitudinal associations with lower limb motor recovery in the first 3 months poststroke.
METHODS
Forty-eight hemiparetic subjects (age: 58.9 ± 16.1 years) were evaluated at weeks 3, 5, 8, and 12 poststroke. Motor impairments concerned the Fugl-Meyer assessment (FM-LE) and Motricity Index total score (MI-LE) or ankle item separately (MI-ankle). Postural stability during quiet 2-legged stance was calculated as the net center-of-pressure area (COP) and direction-dependent velocities (COP and COP). Dynamic control asymmetry (DCA) and weight-bearing asymmetry (WBA) estimated inter-limb symmetries in balance control and loading. Linear mixed models determined (1) time-dependent change and (2) the - and -subject associations between motor impairments and postural stability or inter-limb symmetry.
RESULTS
Time-dependent improvements were significant for FM-LE, MI-LE, MI-ankle, COP, COP, and COP, and tended to plateau by week 8. DCA and WBA did not exhibit significant change. -subject analyses yielded significant regression coefficients for FM-LE, MI-LE, and MI-ankle scores with COP, COP, and COP up until week 8, and with WBA until week 12. -subject regression coefficients of motor recovery with change in COP, COP, COP, DCA, or WBA were generally non-significant.
CONCLUSIONS
Postural stability improved significantly in the first 8 weeks poststroke, independent of lower limb motor recovery at the most affected side subjects. Our findings suggest that subjects preferred to compensate with their less affected side, making metrics reflecting inter-limb asymmetries in balance invariant for change early poststroke.: Clinicaltrials.gov. unique identifier NCT03728036.
Topics: Adult; Aged; Humans; Middle Aged; Linear Models; Lower Extremity; Motor Disorders; Weight-Bearing
PubMed: 37596887
DOI: 10.1177/15459683231186983 -
PloS One 2022Sustainable Last-Mile Delivery (LMD) is one of the key phases in city logistics. Micro-hubs in cities are new emerging solutions for an easier and viable last-mile...
Sustainable Last-Mile Delivery (LMD) is one of the key phases in city logistics. Micro-hubs in cities are new emerging solutions for an easier and viable last-mile delivery process. The important question in smart and modern cities is the determination of the best micro-hub location for the LMD. This paper solves the micro-hub location selection for sustainable LMD using the multi-criteria decision-making (MCDM) techniques. The main reason for solving the micro-hub location selection is to make the last-mile delivery process in Pardubice as easier and effortless as possible. The Best-Worst Method (BWM), Criteria Importance Through Intercriteria Correlation (CRITIC) method, and Weighted Aggregated Sum Product Assessment (WASPAS) method are coupled to solve the micro-hub location selection for sustainable LMD. First, five criteria and alternatives are identified and discussed with the experts. Second, the hybrid criteria importance is determined by combining the BWM and CRITIC methods. Third, the obtained hybrid weights are integrated within the WASPAS method to rank the micro-hub locations. The findings of the Hybrid BWM-CRITIC-WASPAS model show the Alternative 2 ("Hůrka") as the best possible location for Pardubice in the context of the LMD. In addition, a comparative analysis with some of the existing MCDM approaches is conducted for the same problem and its results show a high level of matching with the applied hybrid BWM-CRITIC-WASPAS method, which means that Alternative 2 ("Hůrka") is strongly recommended as a micro-hub location for sustainable LMD in Pardubice.
Topics: Cities; Humans; Weight Gain
PubMed: 35789231
DOI: 10.1371/journal.pone.0270926 -
JAMA Network Open Jan 2023Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing...
IMPORTANCE
Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth.
OBJECTIVE
To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery.
DESIGN, SETTING, AND PARTICIPANTS
An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021.
MAIN OUTCOMES AND MEASURES
The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract-level median hourly wages were used.
RESULTS
The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile.
CONCLUSIONS AND RELEVANCE
In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.
Topics: Humans; Female; COVID-19; Cost Savings; Pandemics; Telemedicine; Ambulatory Care; Neoplasms
PubMed: 36626174
DOI: 10.1001/jamanetworkopen.2022.50211 -
The Journal of Law, Medicine & Ethics :... Sep 2020Health reform debate understandably focuses on large system design. We should not omit attention to the "last mile" problem of physician payment theory. Achieving...
Health reform debate understandably focuses on large system design. We should not omit attention to the "last mile" problem of physician payment theory. Achieving fundamental goals of integrative, patient-centered primary care depends on thoughtful financial support. This commentary describes the nature and importance of innovative primary care payment programs.
Topics: Health Care Reform; Insurance, Health, Reimbursement; Practice Patterns, Physicians'; Primary Health Care
PubMed: 33021174
DOI: 10.1177/1073110520958871 -
Eye (London, England) Jun 2019
Topics: Artificial Intelligence; Clinical Decision-Making; Diabetic Retinopathy; Disease Management; Female; Humans; Male; Middle Aged; Ophthalmology; Telemedicine
PubMed: 30622289
DOI: 10.1038/s41433-018-0324-8 -
Expert Review of Pharmacoeconomics &... 2023
Topics: Humans; Uncertainty; Decision Making
PubMed: 37539711
DOI: 10.1080/14737167.2023.2245138 -
The Chinese Journal of Physiology Aug 2017Ice Mile swimming (1608 m in water of below 5 °Celsius) is becoming increasingly popular. This case study aimed to identify body core temperature and selected...
Ice Mile swimming (1608 m in water of below 5 °Celsius) is becoming increasingly popular. This case study aimed to identify body core temperature and selected haematological and biochemical parameters before and after repeated Ice Miles. An experienced ice swimmer completed three consecutive Ice Miles within 15 h. Swim times, body core temperatures, and selected urinary and haematological parameters were recorded. Body core temperature reached its maximum between 5, 8 and 15 min after immersion (37.7°C, 38.1°C, and 38.0°C, respectively). The swimmer suffered hypothermia during the first Ice Mile (35.4°C) and body core temperature dropped furthermore to 34.5°C during recovery after the first Ice Mile. He developed a metabolic acidosis in both the first and the last Ice Mile (pH 7.31 and pH 7.34, respectively). We observed hyperkalaemia ([K⁺] > 5.5 mM) after the second Ice Mile (6.9 mM). This was followed by a drop in [K⁺] to3.7 mM after the third Ice Mile. Anticipatory thermogenesis (i.e. an initial increase of body core temperature after immersion in ice cold water) seems to be a physiological response in a trained athlete. The results suggest that swimming in ice-cold water leads to a metabolic acidosis, which the swimmer compensates with hyperventilation (i.e. leading to respiratory alkalosis). The shift of serum [K⁺] could increase the risk of a cardiac arrhythmia. Further studies addressing the physiology and potential risks of Ice Mile swimming are required to substantiate this finding.
Topics: Acidosis; Arrhythmias, Cardiac; Body Temperature; Humans; Hypothermia; Ice; Male; Middle Aged; Potassium; Sodium; Swimming
PubMed: 28847139
DOI: 10.4077/CJP.2017.BAF467