Whole body sweat rate prediction: indoor treadmill and cycle ergometer exercise.

This article describes the development and validation of accurate whole body sweat rate prediction equations for individuals performing indoor cycle ergometer and treadmill exercise, where power output can be measured or derived from simple inputs. For cycle ergometry, 112 trials (67 participants) were used for model development and another 56 trials (42 participants) for model validation. For treadmill exercise, 171 trials (67 participants) were used for model development and another 95 trials (63 participants) for model validation. Trials were conducted over a range of dry-bulb temperature (20°C to 40°C), relative humidity (14% to 60%), and exercise intensity (∼40% to 85% of peak aerobic power) conditions, which were matched between model development and model validation. Whole body sweat rates were measured, and proprietary prediction models were developed (accounting for all relevant biophysical factors) and then validated. For model validation, mean absolute error for predicted sweating rate was 0.01 and 0.02 L·h-1 for cycle and treadmill trials, respectively. The 95% confidence intervals were modest for cycle ergometer (+0.25 and -0.22 L·h-1) and treadmill exercise (+0.33 and -0.29 L·h-1). The accounted for variance between predicted and measured values was 92% and 78% for cycle and treadmill exercise, respectively. Bland-Altman analysis indicated that zero and one predicted value exceeded the a priori acceptable level of agreement (equivalent to ±2% of total body mass in 3 h) for cycle and treadmill exercise, respectively. There were fewer trials with female subjects, but their values did not differ from those expected for males. This is the foremost study to develop and validate whole body sweat rate prediction equations for indoor treadmill and cycle ergometer exercise of moderate to high intensity. These prediction equations are publicly available for use (https://sweatratecalculator.com).NEW & NOTEWORTHY This study presents the development of new proprietary whole body sweat rate prediction models for people exercising indoors on a cycle ergometer or treadmill using simple input parameters and delivered through a publicly available online calculator: https://sweatratecalculator.com. In an independent validation group, the predictive models for both indoor cycling and treadmill exercise were accurate across moderate to high exercise intensities in temperate to hot conditions. These equations will enable individualized hydration management during physical training and exercise physiology experiments.

Whole body sweat rate prediction: outdoor running and cycling exercise.

Our aim was to develop and validate separate whole body sweat rate prediction equations for moderate to high-intensity outdoor cycling and running, using simple measured or estimated activity and environmental inputs. Across two collection sites in Australia, 182 outdoor running trials and 158 outdoor cycling trials were completed at a wet-bulb globe temperature ranging from ∼15°C to ∼29°C, with ∼60-min whole body sweat rates measured in each trial. Data were randomly separated into model development (running: 120; cycling: 100 trials) and validation groups (running: 62; cycling: 58 trials), enabling proprietary prediction models to be developed and then validated. Running and cycling models were also developed and tested when locally measured environmental conditions were substituted with participants' subjective ratings for black globe temperature, wind speed, and humidity. The mean absolute error for predicted sweating rate was 0.03 and 0.02 L·h-1 for running and cycling models, respectively. The 95% confidence intervals for running (+0.44 and -0.38 L·h-1) and cycling (+0.45 and -0.42 L·h-1) were within acceptable limits for an equivalent change in total body mass over 3 h of ±2%. The individual variance in observed sweating described by the predictive models was 77% and 60% for running and cycling, respectively. Substituting measured environmental variables with subjective assessments of climatic characteristics reduced the variation in observed sweating described by the running model by up to ∼25%, but only by ∼2% for the cycling model. These prediction models are publicly accessible (https://sweatratecalculator.com) and can guide individualized hydration management in advance of outdoor running and cycling.NEW & NOTEWORTHY We report the development and validation of new proprietary whole body sweat rate prediction models for outdoor running and outdoor cycling using simple activity and environmental inputs. Separate sweat rate models were also developed and tested for situations where all four environmental parameters are not available, and some must be subsequently estimated by the user via a simple rating scale. All models are freely accessible through an online calculator: https://sweatratecalculator.com. These models, via the online calculator, will enable individualized hydration management for training or recreational cycling or running in an outdoor environment.

A Subdural Hygroma Necessitating a Subdural-Peritoneal Shunt in a Pediatric Patient Following Total Cranial Vault Remodeling Surgery.

Sagittal synostosis is a common non-syndromic synostosis treated with open or endoscopic cranial vault remodeling. Early intervention is recommended to avoid restricted brain growth, increased intracranial pressure, and resultant developmental delay. Common complications such as failure or reconstruction, cerebrospinal fluid leak, blood loss, and stroke are well-reported in the literature. Here, we present a rare case of the development of a subdural hygroma following cranial vault remodeling in a seven-month-old male, necessitating the insertion of a subdural-peritoneal shunt.

Creation of a pharmacy leadership certificate program for pharmacists and pharmacy technicians using an innovative, low-cost framework.

PURPOSE: To describe the creation of a statewide leadership training program for practicing pharmacists and pharmacy technicians. The 2 overarching goals were to (1) enable learners to develop foundational leadership skills that could be used at their place of work or would enable them to take on a new or advanced role and (2) help foster sustainability within our state pharmacy society through incorporation of the learners on committees and projects, bringing awareness to board member roles and functions. Overall, the program's mission was to empower practicing pharmacists and pharmacy technicians to take on leadership roles within their organization and the state pharmacy society. SUMMARY: Leadership training for pharmacists and pharmacy technicians can be variable, elusive, and costly. We provide our experiences in establishing a 1-year leadership certificate program affiliated with the state pharmacy society. In the first 4 years, a total of 15 program fellows have graduated, with 8 more set to finish in September 2022. Since completion of the program, a majority of the graduates have taken on new leadership positions (65% have accepted new leadership positions and 35% have been elected to state pharmacy society board positions). CONCLUSION: Implementation of a statewide pharmacy leadership program provided a low-cost, high-value option to develop local leaders, in affiliation with a state pharmacy society.

Accuracy of Algorithm to Non-Invasively Predict Core Body Temperature Using the Kenzen Wearable Device.

With climate change increasing global temperatures, more workers are exposed to hotter ambient temperatures that exacerbate risk for heat injury and illness. Continuously monitoring core body temperature (TC) can help workers avoid reaching unsafe TC. However, continuous TC measurements are currently cost-prohibitive or invasive for daily use. Here, we show that Kenzen's wearable device can accurately predict TC compared to gold standard TC measurements (rectal probe or gastrointestinal pill). Data from four different studies (n = 52 trials; 27 unique subjects; >4000 min data) were used to develop and validate Kenzen's machine learning TC algorithm, which uses subject's real-time physiological data combined with baseline anthropometric data. We show Kenzen's TC algorithm meets pre-established accuracy criteria compared to gold standard TC: mean absolute error = 0.25 °C, root mean squared error = 0.30 °C, Pearson r correlation = 0.94, standard error of the measurement = 0.18 °C, and mean bias = 0.07 °C. Overall, the Kenzen TC algorithm is accurate for a wide range of TC, environmental temperatures (13-43 °C), light to vigorous heart rate zones, and both biological sexes. To our knowledge, this is the first study demonstrating a wearable device can accurately predict TC in real-time, thus offering workers protection from heat injuries and illnesses.

Caffeine alters thermoregulatory responses to exercise in the heat only in caffeine-habituated individuals: a double-blind placebo-controlled trial.

To assess the impact of acute caffeine ingestion on thermoregulatory responses during steady-state exercise under moderate heat stress conditions in caffeine-habituated and nonhabituated individuals. Twenty-eight participants [14 habituated (HAB) (4 females) and 14 nonhabituated (NHAB) (6 females)] cycled at a fixed metabolic heat production (7 W·kg-1) for 60 min on two separate occasions 1 h after ingesting 1) 5 mg·kg-1 caffeine (CAF) or 2) 5 mg·kg-1 placebo (PLA), in a double-blinded, randomized, and counterbalanced order. Environmental conditions were 30.6 ± 0.9°C, 31 ± 1% relative humidity (RH). The end-exercise rise in esophageal temperature (ΔTes) from baseline was greater with CAF in the HAB group (CAF = 0.88 ± 0.29°C, PLA = 0.62 ± 0.34°C, P < 0.001), but not in the NHAB group (CAF = 1.00 ± 0.42°C, PLA = 1.00 ± 0.39°C, P = 0.94). For a given change in mean body temperature, rises in % of maximum skin blood flow were attenuated with CAF on the forearm (P = 0.015) and back (P = 0.021) in the HAB group, but not in the NHAB group (P ≥ 0.65). Dry heat loss was similar in the HAB (CAF = 31 ± 5 W·m-2, PLA = 33 ± 7 W·m-2) and NHAB groups (CAF = 31 ± 3 W·m-2, PLA 30 ± 4 W·m-2) (P ≥ 0.37). There were no differences in whole body sweat losses in both groups (HAB: CAF = 0.59 ± 0.15 kg, PLA = 0.56 ± 0.17 kg, NHAB:CAF = 0.53 ± 0.19 kg, PLA 0.52 ± 0.19 kg) (P ≥ 0.32). As the potential for both dry and evaporative heat loss was uninhibited by caffeine, we suggest that the observed ΔTes differences with CAF in the HAB group were due to alterations in internal heat distribution. Our findings support the common practice of participants abstaining from caffeine before participation in thermoregulatory research studies in compensable conditions.NEW & NOTEWORTHY We provide empirical evidence that acute caffeine ingestion exerts a thermoregulatory effect during exercise in the heat in caffeine-habituated individuals but not in nonhabituated individuals. Specifically, caffeine habituation was associated with a greater rise in esophageal temperature with caffeine compared with placebo, which appears to be driven by a blunted skin blood flow response. In contrast, no thermoregulatory differences were observed with caffeine in nonhabituated individuals. Caffeine did not affect sweating responses during exercise in the heat.

Primary care collaborative practice in quality improvement: Description of an interprofessional curriculum.

PURPOSE: An innovative quality improvement (QI)-focused interprofessional training curriculum for pharmacy residents and other healthcare trainees is described. SUMMARY: Effective interprofessional collaboration and the ability to carry out QI initiatives are important skills for all healthcare trainees to develop when they are in training. To cultivate those skills, in 2011 a Veterans Affairs medical center in Idaho implemented a unique yearlong interprofessional curriculum for healthcare trainees, including postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residents, physician trainees in internal medicine, nurses, and psychologists. The curriculum has both didactic and experiential components. After attending a series of 1-hour workshops early in the academic year, trainees are assigned to interprofessional teams and work for the remainder of the year to complete QI projects. Over 100 trainees have participated in the interprofessional QI curriculum, with the majority of trainee projects based in the primary care setting. Pharmacy residents were involved in 62% of the projects completed in the 6 academic years ending with the 2016-17 year. CONCLUSION: Establishing an interprofessional QI curriculum allowed pharmacy residents in PGY1 and PGY2 programs to collaborate with other members of the healthcare team. Benefits include QI skills development, a greater understanding of QI initiatives at the institution, stronger relationships with other healthcare trainees and mentors, and improvements to patient care and safety and facility performance.

Robust in vitro affinity maturation strategy based on interface-focused high-throughput mutational scanning.

Development of protein therapeutics or biosensors often requires in vitro affinity maturation. Here we report a robust affinity engineering strategy using a custom designed library. The strategy consists of two steps beginning with identification of beneficial single amino acid substitutions then combination. A high quality combinatorial library specifically customized to a given binding-interface can be rapidly designed by high-throughput mutational scanning of single substitution libraries. When applied to the optimization of a model antibody Fab fragment, the strategy created a diverse panel of high affinity variants. The most potent variant achieved 2110-fold affinity improvement to an equilibrium dissociation constant (Kd) of 3.45 pM with only 7 amino acid substitutions. The method should facilitate affinity engineering of a wide variety of protein-protein interactions due to its context-dependent library design strategy.

Cadmium-induced decrease in RUNX2 mRNA expression and recovery by the antioxidant N-acetylcysteine (NAC) in the human osteoblast-like cell line, Saos-2.

Exposure to cadmium poses a threat to human health, including increased susceptibility to developing the bone disease osteoporosis. Despite its recognized importance as an environmental toxin, little is known about how cadmium directly impacts bone-forming osteoblasts. We previously reported that cadmium induces apoptosis in human osteoblast-like Saos-2 cells. In this work, we hypothesize that cadmium exposure induces oxidative stress which leads to decreased RUNX2 mRNA expression and increased apoptotic death, and predict that the antioxidant NAC mitigates the damaging effects of cadmium. Oxidative stress is implicated in osteoporosis; furthermore the osteoblast transcriptional factor RUNX2 is reported to play a protective role against osteoporosis in postmenopausal women. Cells treated with 10 microM CdCl2 exhibited signs of oxidative damage including depletion in glutathione, increased reactive oxygen species formation, and enhanced lipid peroxidation. RUNX2 mRNA expression, by RT-PCR, was significantly reduced after exposure to 10 microM CdCl2. Pretreatment with the antioxidant NAC (1mM) prevented cadmium-induced decrease in RUNX2 mRNA and protected cells from apoptotic death. This study provides insight into the mechanisms underlying cadmium-induced osteotoxicity. In addition, this study distinguishes itself by identifying RUNX2 as a target for heavy metal-induced osteotoxicity.