Modulation of cold-induced shivering activity by intermittent and continuous voluntary suppression.

This investigation assessed the physiological effects of voluntary suppression of shivering thermogenesis in response to whole body cooling. Eleven healthy volunteers underwent passive air cooling (10°C), across three visits: NO_SUP, where participants allowed their body to freely regulate against the cold; FULL_SUP, where participants constantly suppressed shivering; INT_SUP, where participants intermittently suppressed shivering (5 min phases), interspersed with 5 min free regulation. Shivering was assessed via electromyography (EMG), mechanomyography (MMG), and whole body oxygen uptake (V̇o2), whereas body temperature and heat exchange were assessed via skin temperature, rectal temperature, and heat flux sensors. A 29% increase was observed in shivering onset time in the FULL_SUP trial compared with NO_SUP (P = 0.032). Assessing shivering intensity, EMG activity decreased by 29% (P = 0.034), MMG activity decreased by 35% (P = 0.031), whereas no difference was observed in V̇o2 (P = 0.091) in the FULL_SUP trial compared with NO_SUP. Partitioning the no-suppression and suppression phases of the INT_SUP trial, acute voluntary suppression significantly decreased V̇o2 (P = 0.001), EMG (P < 0.001), and MMG (P = 0.012) activity compared with the no-suppression phases. Shivering activity was restored in the no-suppression phases, equivalent to that in the NO_SUP trial (P > 0.3). No difference was observed in thermal metrics between conditions up to 60 min (P > 0.4). Humans can both constantly and periodically suppress shivering activity, leading to a delay in shivering onset and a reduction in shivering intensity. Following suppression, regular shivering is resumed.

Dietary nitrate supplementation increases nitrate and nitrite concentrations in human skin interstitial fluid.

Acute dietary nitrate (NO3-) supplementation can increase [NO3-], but not nitrite ([NO2-]), in human skeletal muscle, though its effect on [NO3-] and [NO2-] in skin remains unknown. In an independent group design, 11 young adults ingested 140 mL of NO3--rich beetroot juice (BR; 9.6 mmol NO3-), and 6 young adults ingested 140 mL of a NO3--depleted placebo (PL). Skin dialysate, acquired through intradermal microdialysis, and venous blood samples were collected at baseline and every hour post-ingestion up to 4 h to assess dialysate and plasma [NO3-] and [NO2-]. The relative recovery rate of NO3- and NO2- through the microdialysis probe (73.1% and 62.8%), determined in a separate experiment, was used to estimate skin interstitial [NO3-] and [NO2-]. Baseline [NO3-] was lower, whereas baseline [NO2-] was higher in the skin interstitial fluid relative to plasma (both P < 0.001). Acute BR ingestion increased [NO3-] and [NO2-] in the skin interstitial fluid and plasma (all P < 0.001), with the magnitude being smaller in the skin interstitial fluid (e.g., 183 ± 54 vs. 491 ± 62 µM for Δ[NO3-] from baseline and 155 ± 190 vs. 217 ± 204 nM for Δ[NO2-] from baseline at 3 h post BR ingestion, both P ≤ 0.037). However, due to the aforementioned baseline differences, skin interstitial fluid [NO2-] post BR ingestion was higher, whereas [NO3-] was lower relative to plasma (all P < 0.001). These findings extend our understanding of NO3- and NO2- distribution at rest and indicate that acute BR supplementation increases [NO3-] and [NO2-] in human skin interstitial fluid.

An examination of five theoretical foundations associated with localized thermosensory testing.

PURPOSE: To assess five theoretical foundations underlying thermosensory testing using local thermal stimuli. METHODS: Thermal sensation, discomfort and the confidence of thermal sensation scores were measured in 9 female and 8 male volunteers in response to 17 physical contact temperature stimuli, ranging between 18-42 °C. These were applied to their dorsal forearm and lateral torso, across two sessions. RESULTS: Thermal sensation to physical temperature relationships followed a positive linear and sigmoidal fit at both forearm (r2 = 0.91/r2 = 0.91, respectively) and lateral torso (r2 = 0.90/ r2 = 0.91, respectively). Thermal discomfort to physical temperature relationships followed second and third-order fits at both forearm (r2 = 0.33/r2 = 0.34, respectively) and lateral torso (r2 = 0.38/r2 = 0.39, respectively) test sites. There were no sex-related or regional site differences in thermal sensation and discomfort across a wide range of physical contact temperatures. The median confidence of an individual's thermal sensation rating was measured at 86%. CONCLUSION: The relation between thermal sensation and physical contact temperature was well described by both linear and sigmoidal models, i.e., the distance between the thermal sensation anchors is close to equal in terms of physical temperatures changes for the range studied. Participants rated similar thermal discomfort level in both cold and hot thermal stimuli for a given increase or decrease in physical contact temperature or thermal sensation. The confidence of thermal sensation rating did not depend on physical contact temperature.

Independent and combined impact of hypoxia and acute inorganic nitrate ingestion on thermoregulatory responses to the cold.

PURPOSE: This study assessed the impact of normobaric hypoxia and acute nitrate ingestion on shivering thermogenesis, cutaneous vascular control, and thermometrics in response to cold stress. METHOD: Eleven male volunteers underwent passive cooling at 10 °C air temperature across four conditions: (1) normoxia with placebo ingestion, (2) hypoxia (0.130 FiO2) with placebo ingestion, (3) normoxia with 13 mmol nitrate ingestion, and (4) hypoxia with nitrate ingestion. Physiological metrics were assessed as a rate of change over 45 min to determine heat loss, and at the point of shivering onset to determine the thermogenic thermoeffector threshold. RESULT: Independently, hypoxia expedited shivering onset time (p = 0.05) due to a faster cooling rate as opposed to a change in central thermoeffector thresholds. Specifically, compared to normoxia, hypoxia increased skin blood flow (p = 0.02), leading to an increased core-cooling rate (p = 0.04) and delta change in rectal temperature (p = 0.03) over 45 min, yet the same rectal temperature at shivering onset (p = 0.9). Independently, nitrate ingestion delayed shivering onset time (p = 0.01), mediated by a change in central thermoeffector thresholds, independent of changes in peripheral heat exchange. Specifically, compared to placebo ingestion, no difference was observed in skin blood flow (p = 0.5), core-cooling rate (p = 0.5), or delta change in rectal temperature (p = 0.7) over 45 min, while nitrate reduced rectal temperature at shivering onset (p = 0.04). No interaction was observed between hypoxia and nitrate ingestion. CONCLUSION: These data improve our understanding of how hypoxia and nitric oxide modulate cold thermoregulation.

Reliability and validity of methods in the assessment of cold-induced shivering thermogenesis.

PURPOSE: To compare two analytical methods for the estimation of the shivering onset inflection point, segmental regression and visual inspection of data, and to assess the test-retest reliability and validity of four metrics of shivering measurement; oxygen uptake (V̇O2), electromyography (EMG), mechanomyography (MMG) and bedside shivering assessment scale (BSAS). METHODS: Ten volunteers attended three identical experimental sessions involving passive deep-body cooling via cold water immersion at 10 °C. V̇O2, EMG, and MMG were continuously assessed, while the time elapsed at each BSAS stage was recorded. Metrics were graphed as a function of time and rectal temperature (Tre). Inflection points for intermittent and constant shivering were visually identified for every graph and compared to segmental regression. RESULTS: Excellent agreement was seen between segmental regression and visual inspection (ICC, 0.92). All measurement metrics presented good-to-excellent test-retest reliability (ICC's > 0.75 and 0.90 respectively), with the exception of visual identification of intermittent shivering for V̇O2 measurement (ICC, 0.73) and segmental regression for EMG measurement (ICC, 0.74). In the assessment of signal-to-noise ratio (SNR), EMG showed the largest SNR at the point of shivering onset followed by MMG and finally V̇O2. CONCLUSIONS: Segmental regression provides a successful analytical method for identifying shivering onset. Good-to-excellent reliability can be seen across V̇O2, EMG, MMG, and BSAS, yet given the observed lag times, SNRs, along with known advantages/disadvantaged of each metric, it is recommended that no single metric is used in isolation. An integrative, real-time measure of shivering is proposed.

A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training.

It is well known that physical activity and exercise is associated with a lower risk of a range of morbidities and all-cause mortality. Further, it appears that risk reductions are greater when physical activity and/or exercise is performed at a higher intensity of effort. Why this may be the case is perhaps explained by the accumulating evidence linking physical fitness and performance outcomes (e.g. cardiorespiratory fitness, strength, and muscle mass) also to morbidity and mortality risk. Current guidelines about the performance of moderate/vigorous physical activity using aerobic exercise modes focuses upon the accumulation of a minimum volume of physical activity and/or exercise, and have thus far produced disappointing outcomes. As such there has been increased interest in the use of higher effort physical activity and exercise as being potentially more efficacious. Though there is currently debate as to the effectiveness of public health prescription based around higher effort physical activity and exercise, most discussion around this has focused upon modes considered to be traditionally 'aerobic' (e.g. running, cycling, rowing, swimming etc.). A mode customarily performed to a relatively high intensity of effort that we believe has been overlooked is resistance training. Current guidelines do include recommendations to engage in 'muscle strengthening activities' though there has been very little emphasis upon these modes in either research or public health effort. As such the purpose of this debate article is to discuss the emerging higher effort paradigm in physical activity and exercise for public health and to make a case for why there should be a greater emphasis placed upon resistance training as a mode in this paradigm shift.

The Double Mandibular Osteotomy for Vascular and Tumor Surgery of the Parapharyngeal Space.

PURPOSE: The purposes of this study are to describe our experience using a double mandibular osteotomy for access to the parapharyngeal space in vascular and tumor surgery and to report on the outcomes and complications of this procedure. PATIENTS AND METHODS: We designed and implemented a case series to review the medical records of all patients treated with a double mandibular osteotomy for parapharyngeal space access from 1994 to 2016. Patient demographic characteristics, indications for the procedure, outcomes, and complications were recorded. RESULTS: A total of 17 patients underwent a double mandibular osteotomy procedure for access to the parapharyngeal space during the study period. There were 7 men (41%) and 10 women (59%) comprising the cohort. The average age was 57 years (range, 29 to 75 years). The follow-up period ranged from 6 to 98 months (mean, 40 months), and 7 patients (41%) were tobacco users at the time of surgery. The most common indication was high internal carotid artery stenosis (n = 6) followed by carotid body paraganglioma (n = 3). Average blood loss was 186 mL, and there were no deaths during the study period. Eight postoperative complications were noted in 7 patients (41%). No procedures were aborted or compromised because of inadequate parapharyngeal space access. All patients showed clinical and radiographic signs of healing of the osteotomy sites. CONCLUSION: The double mandibular osteotomy provides adequate access to the parapharyngeal space for effective tumor removal and high carotid surgical intervention with acceptable patient morbidity and complications.

Nitrate ingestion blunts the increase in blood pressure during cool air exposure: a double-blind, placebo-controlled, randomized, crossover trial.

Cold exposure increases blood pressure (BP) and salivary flow rate (SFR). Increased cold-induced SFR would be hypothesized to enhance oral nitrate delivery for reduction to nitrite by oral anaerobes and to subsequently elevate plasma [nitrite] and nitric oxide bioavailability. We tested the hypothesis that dietary nitrate supplementation would increase plasma [nitrite] and lower BP to a greater extent in cool compared with normothermic conditions. Twelve males attended the laboratory on four occasions. Baseline measurements were completed at 28°C. Subsequently, participants ingested 140 mL of concentrated nitrate-rich (BR; ∼13 mmol nitrate) or nitrate-depleted (PL) beetroot juice. Measurements were repeated over 3 h at either 28°C (Norm) or 20°C (Cool). Mean skin temperature was lowered compared with baseline in PL-Cool and BR-Cool. SFR was greater in BR-Norm, PL-Cool, and BR-Cool than PL-Norm. Plasma [nitrite] at 3 h was higher in BR-Cool (592 ± 239 nM) versus BR-Norm (410 ± 195 nM). Systolic BP (SBP) at 3 h was not different between PL-Norm (117 ± 6 mmHg) and BR-Norm (113 ± 9 mmHg). SBP increased above baseline at 1, 2, and 3 h in PL-Cool but not BR-Cool. These results suggest that BR consumption is more effective at increasing plasma [nitrite] in cool compared with normothermic conditions and blunts the rise in BP following acute cool air exposure, which might have implications for attenuating the increased cardiovascular strain in the cold.NEW & NOTEWORTHY Compared with normothermic conditions, acute nitrate ingestion increased plasma [nitrite], a substrate for oxygen-independent nitric oxide generation, to a greater extent during cool air exposure. Systolic blood pressure was increased during cool air exposure in the placebo condition with this cool-induced blood pressure increase attenuated after acute nitrate ingestion. These findings improve our understanding of environmental factors that influence nitrate metabolism and the efficacy of nitrate supplementation to lower blood pressure.

The Influence of Weight Bias on Processes and Outcomes in Negotiation.

In two studies, using a mix of samples, we examined the influence of weight bias on behaviors in competitive, potentially high stakes situations. As predicted, weight bias directed focal actors' treatment of counterparts in a negotiation. Negotiators made lower value offers to overweight counterparts relative to average-weight counterparts. In addition, overweight counterparts also received more negative messages over the course of their negotiation and were evaluated less favorably after the negotiation than average-weight counterparts.

When Less Is More: How Complexity Impacts Goal Setting, Judgment Accuracy, and Deals in Negotiation.

In two studies, we examine how objective complexity-in terms of numbers of negotiable issues-affects negotiators' aspirations, perceptions, actions, and ultimately, the quality of agreements they reach. We hypothesized and found that when negotiators had a greater number of issues to resolve, they were less ambitious for their own outcomes and developed less accurate insights into their partners' interests.

The nitric oxide dependence of cutaneous microvascular function to independent and combined hypoxic cold exposure.

Hypoxic modulation of nitric oxide (NO) production pathways in the cutaneous microvasculature and its interaction with cold-induced reflex vasoconstriction, independent of local cooling, have yet to be identified. This study assessed the contribution of NO to nonglabrous microvasculature perfusion during hypoxia and whole body cooling with concomitant inhibition of NO synthase [NOS; via NG-nitro-l-arginine methyl ester (l-NAME)] and the nitrite reductase, xanthine oxidase (via allopurinol), two primary sources of NO production. Thirteen volunteers were exposed to independent and combined cooling via water-perfused suit (5°C) and normobaric hypoxia ([Formula: see text], 0.109 ± 0.002). Cutaneous vascular conductance (CVC) was assessed across four sites with intradermal microdialysis perfusion of 1) lactated Ringers solution (control), 2) 20 mmol l-NAME, 3) 10 µmol allopurinol, or 4) combined l-NAME/allopurinol. Effects and interactions were assessed via four-way repeated measures ANOVA. Independently, l-NAME reduced CVC (43%, P < 0.001), whereas allopurinol did not alter CVC (P = 0.5). Cooling decreased CVC (P = 0.001), and the reduction in CVC was consistent across perfusates (~30%, P = 0.9). Hypoxia increased CVC (16%, P = 0.01), with this effect abolished by l-NAME infusion (P = 0.04). Cold-induced vasoconstriction was blunted by hypoxia, but importantly, hypoxia increased CVC to a similar extent (39% at the Ringer site) irrespective of environmental temperature; thus, no interaction was observed between cold and hypoxia (P = 0.1). l-NAME restored vasoconstriction during combined cold-hypoxia (P = 0.01). This investigation suggests that reflex cold-induced cutaneous vasoconstriction acts independently of NO suppression, whereas hypoxia-induced cutaneous vasodilatation is dependent on NOS-derived NO production.NEW & NOTEWORTHY When separated from local cooling, whole body cooling elicited cutaneous reflex vasoconstriction via mechanisms independent of nitric oxide removal. Hypoxia elicited cutaneous vasodilatation via mechanisms mediated primarily by nitric oxide synthase, rather than xanthine oxidase-mediated nitrite reduction. Cold-induced vasoconstriction was blunted by the opposing effect of hypoxic vasodilatation, whereas the underpinning mechanisms did not interrelate in the absence of local cooling. Full vasoconstriction was restored with nitric oxide synthase inhibition.

Influence of third party expertise on disputants' reactions to mediation.

When people cannot resolve their conflicts, they often turn to a third party, called a mediator, for help. What guides disputants' choice of mediators is the present focus. Two kinds of mediator's expertise were compared, which might affect disputants' judgment of mediators and their recommendations--process expertise and content expertise. The mediator's particular content expertise about the details of the dispute appeared to be irrelevant if the mediator was considered to be an expert in the process of conflict resolution. When mediators were seen as process experts, disputants viewed them as more credible and were more favorably disposed toward engaging their services. These judgments extended to the mediators' recommendations. Those recommendations offered by process expert mediators were viewed as higher quality and were judged more favorably. When the mediator was perceived as lacking process expertise, disputants' perceptions of how well the mediator understood the particular details of the dispute increased their evaluations of the mediator and the mediator's recommendation.

Intra-Subject Variability of 5 km Time Trial Performance Completed by Competitive Trained Runners.

Time-trials represent an ecologically valid approach to assessment of endurance performance. Such information is useful in the application of testing protocols and estimation of sample sizes required for research/magnitude based inference methods. The present study aimed to investigate the intra-subject variability of 5 km time-trial running performance in trained runners. Six competitive trained male runners (age = 33.8 ± 10.1 years; stature = 1.78 ± 0.01 m; body mass = 69.0 ± 10.4 kg, [Formula: see text]O2max = 62.6 ± 11.0 ml·kg·min-1) completed an incremental exercise test to volitional exhaustion followed by 5 x 5 km time-trials (including a familiarisation trial), individually spaced by 48 hours. The time taken to complete each trial, heart rate, rating of perceived exertion and speed were all assessed. Intra-subject absolute standard error of measurement and the coefficient of variance were calculated for time-trial variables in addition to the intra-class correlation coefficient for time taken to complete the time-trial. For the primary measure time, results showed a coefficient of variation score across all participants of 1.5 ± 0.59% with an intra-class correlation coefficient score of 0.990. Heart rate, rating of perceived exertion and speed data showed a variance range between 0.8 and 3.05%. It was concluded that when compared with related research, there was observed low intra-subject variability in trained runners over a 5 km distance. This supports the use of this protocol for 5 km time-trial performance for assessment of nutritional strategies, ergogenic aids or training interventions on endurance running performance.

Biomechanical Evaluation of a Growth-Friendly Rod Construct.

BACKGROUND: Distraction-type rods mechanically stabilize the thorax and improve lung growth and function by applying distraction forces at the rib, spine, pelvis, or a combination of locations. However, the amount of stability the rods provide and the amount the thorax needs is unknown. METHODS: Five freshly frozen and thawed cadaveric thoracic spine specimens were tested for lateral bending, flexion/extension, and axial rotation in displacement control (1°/sec) to a load limit of ±5 Nm for five cycles after which a growth-friendly unilateral rod was placed in a simulated rib-to-lumbar attachment along the right side. The specimens were tested again in the same modes of bending. From the seven Optotrak Orthopedic Research Pin markers (Northern Digital Inc., Waterloo, Ontario, Canada) inserted into the top potting to denote T1, and the right pedicles at T2, T4, T5, T8, T9, and T11 and the Standard Needle Tip Pressure Transducers (Gaeltech, Isle of Skye, Scotland) inserted into the T4/T5 and T8/T9 discs, motion, stiffness, and pressure data were calculated. Parameters from the third cycle of the intact case and the construct case were compared using two-tailed paired t tests with 0.05 as the level of significance. RESULTS: With the construct attached, the T1-T4 segment showed a 30% increase in neutral zone stiffness during extension (p = .001); the T8-T12 segment experienced a 63% reduction in the in-plane range of motion during flexion (p = .04); and the T8/T9 spinal motion unit had a significant decrease of 24% in elastic zone stiffness during left axial rotation (p = .04). CONCLUSIONS: It is clear the device as tested here does not produce large biomechanical changes, but the balance between providing desired changes while preventing complications remains difficult.

Negotiators' bargaining histories and their effects on future negotiation performance.

In 2 studies the authors show that the quality of deals negotiators reach are significantly influenced by their previous bargaining experiences. As predicted, negotiators who reached an impasse on a prior negotiation were more likely either to impasse in their next negotiation or to reach deals of low joint value compared to those who had reached an initial agreement. Notably, the impact of past performance on subsequent deals was just as strong for negotiators who changed partners on the 2nd occasion. Results highlight the role of bargaining histories as significant predictors of negotiation behavior. Moreover, they suggest that, at least in some cases, negotiations should be conceptualized as interrelated exchanges rather than separable incidents.

The impact of 12†weeks walking football on health and fitness in males over 50†years of age.

AIM: To describe and characterise anthropometrical and fitness changes following a 12-week walking football programme in individuals over the age of 50 years. METHODS: Following ethical approval, 10 male participants (mean (SD): age 66 (7) years) with a range of comorbidities completed a 12-week walking football programme, consisting of a single 2 h training session each week. Body mass, fat mass, fat free mass, maximal oxygen consumption, maximal heart rate, exercise time to exhaustion and isometric hand-grip strength, were assessed at baseline and immediately following the intervention. Week-0-12 intervention differences were determined using means (95% CIs) and t tests; effect sizes were calculated using Cohen's d (0.2 small, 0.5 medium, 0.8 large). RESULTS: 12 weeks walking football significantly reduced body fat mass (week 0, 27.4 (9.0) kg versus week 12, 24.4 (8.9) kg, p=<0.05, d=1.0) and reduced percentage body fat (week 0, 30.3 (8.2) % versus week 12, 27.5 (8.5) %, p=<0.05, d=1.0). A significant increase in time to volitional exhaustion during increamental exercise (week 0, 545 (102) s versus week 12, 603 (102) s, p=<0.05, d=0.7) was observed without any change in peak blood lactate. Non-significant differences with medium effect sizes were seen for a reduction whole body mass, increase in lean body mass and a reduction in body mass index. CONCLUSIONS: This investigation suggests the potential efficacy of walking football as a public health intervention, even in populations presenting a range of comorbidities, with future research investigating its move to scale.

Beetroot juice does not enhance altitude running performance in well-trained athletes.

We hypothesized that acute dietary nitrate (NO3(-)) provided as concentrated beetroot juice supplement would improve endurance running performance of well-trained runners in normobaric hypoxia. Ten male runners (mean (SD): sea level maximal oxygen uptake, 66 (7) mL·kg(-1)·min(-1); 10 km personal best, 36 (2) min) completed incremental exercise to exhaustion at 4000 m and a 10-km treadmill time-trial at 2500 m simulated altitude on separate days after supplementation with ∼7 mmol NO3(-) and a placebo at 2.5 h before exercise. Oxygen cost, arterial oxygen saturation, heart rate, and ratings of perceived exertion (RPE) were determined during the incremental exercise test. Differences between treatments were determined using means [95% confidence intervals], paired sample t tests, and a probability of individual response analysis. NO3(-) supplementation increased plasma nitrite concentration (NO3(-), 473 (226) nmol·L(-1) vs. placebo, 61 (37) nmol·L(-1), P < 0.001) but did not alter time to exhaustion during the incremental test (NO3(-), 402 (80) s vs. placebo 393 (62) s, P = 0.5) or time to complete the 10-km time-trial (NO3(-), 2862 (233) s vs. placebo, 2874 (265) s, P = 0.6). Further, no practically meaningful beneficial effect on time-trial performance was observed as the 11 [-60 to 38] s improvement was less than the a priori determined minimum important difference (51 s), and only 3 runners experienced a "likely, probable" performance improvement. NO3(-) also did not alter oxygen cost, arterial oxygen saturation, heart rate, or RPE. Acute dietary NO3(-) supplementation did not consistently enhance running performance of well-trained athletes in normobaric hypoxia.