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.

Body mapping of regional sweat distribution in young and older males.

PURPOSE: Given the pressing impact of global warming and its detrimental effect on the health of older populations, understanding age-related changes in thermoregulatory function is essential. Age differences in regional sweat distribution have been observed previously, but given the typically small measurement areas assessed, the development of whole body sweat maps for older individuals is required. Therefore, this study investigated age-related differences in regional sweat distribution in a hot environment (32 °C/50%RH) in young and older adults, using a body mapping approach. METHODS: Technical absorbent pads were applied to the skin of 14 young (age 24 ± 2 years) and 14 older (68 ± 5 years) males to measure regional sweat rate (RSR) at rest (30 min) and during exercise (30 min), at a fixed heat production (200 W m-2). Gastrointestinal (Tgi) and skin temperature (Tsk), heart rate, thermal sensation, and thermal comfort were also measured. RESULTS: Whole body sweat maps showed that despite equal heat production, healthy older males had significantly lower gross sweat loss (GSL) than the young and significantly lower RSR at almost all body regions at rest and at the hands, legs, ankles, and feet during exercise. The lower sweat loss in the older group coincided with a greater increase in Tgi and a consistently higher Tsk at the legs, despite subjectively feeling slightly cooler than younger individuals. CONCLUSION: These findings support the evidence of age-related deterioration in both autonomic and subjective responses in the heat and highlight the lower extremities as the most affected body region.

Sweat distribution and perceived wetness across the human foot: the effect of shoes and exercise intensity.

This study investigates foot sweat distribution with and without shoes and the relationship between foot sweat distribution and perceived wetness to enhance guidance for footwear design. Fourteen females performed low-intensity running with nude feet and low- and high-intensity running with shoes (55%VO2max and 75%VO2max, respectively) on separate occasions. Right foot sweat rates were measured at 14 regions using absorbent material applied during the last 5 min of each work intensity. Perceptual responses were recorded for the body, foot and four foot regions. Foot sweat production was 22% greater nude (p < .001) and with shoes did not increase with exercise intensity (p = .14). Highest sweat rates were observed at the medial ankle and dorsal regions; lowest sweat rates at the toes. Perceptions of wetness and foot discomfort did not correspond with regions of high sweat production or low skin temperature but rather seemed dominated by tactile interactions caused by foot movement within the shoe. Practitioner summary: This study provides a detailed view of foot sweat distribution for female runners with and without shoes, providing important guidance for sock and footwear design. Importantly, perceptions of wetness and foot discomfort did not correspond with areas of high sweat production. Instead tactile interactions between the foot, sock/shoe play an important role. Abbreviations: VO2max: maximal oxygen consumption; HR: heart rate; RH: relative humidity; GSL: gross sweat loss; Nude-I1: without socks and shoes, low intensity running; Shod-I1: with socks and shoes, low intensity running; Shod-I2: with socks and shoes, high intensity running.

Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns.

OBJECTIVE: The aim of this study was to characterize parental decision-making regarding delivery room resuscitation for infants born extremely prematurely or with potentially lethal congenital anomalies. METHODS: This was a qualitative multicenter study. We identified English-speaking parents at 3 hospitals whose infants had died as a result of extreme prematurity or lethal congenital anomalies in 1999-2005. Parents were interviewed about their prenatal decision-making. Maternal medical charts were reviewed for documented discussions regarding delivery room resuscitation. Subject enrollment was stopped when saturation of themes was achieved. RESULTS: Twenty-six mothers of infants were interviewed. All parents wanted to participate to some degree in decisions regarding delivery room resuscitation. Few parents recalled discussing options for delivery room resuscitation with physicians, and even fewer recalled being offered the option of comfort care, even when these discussions were documented in the medical chart. Parents did not report physicians' predictions of morbidity and death to be central to their decision-making. Religion, spirituality, and hope guided decision-making for most parents. Some parents felt that they had not made any decisions regarding resuscitation and instead "left things in God's hands." These parents typically were documented by staff members to "want everything done." CONCLUSIONS: The values that parents find most important during decision-making regarding delivery room resuscitation may not be addressed routinely in prenatal counseling. Parents and physicians may have different interpretations of what is discussed and what decisions are made. Future work should investigate whether physicians can be trained to address effectively parents' values during the decision-making process and whether addressing these values may improve physician-parent communication and lead to better postdecision outcomes for parents.