Football Practices in Hot Environments Impact Subsequent Days' Hydration.

ABSTRACT: Ashley, CD, Lopez, RM, and Tritsch, AJ. Football practices in hot environments impact subsequent days' hydration. J Strength Cond Res 38(1): 90-96, 2024-The impact of proper hydration to prevent exertional heat illness in American football has not been evaluated during high school preseason football practices in a hot environment (wet-bulb globe temperature = 31.3 ± 1.8° C). The purposes of this study were to examine the accuracy of urinary hydration measures to assess body mass (BM) changes and to examine carryover effects of consecutive practices by comparing postpractice with the next prepractice values. Before and after each of 7 outdoor practices, 31 male high school football players (age = 16 ± 1 years, height = 181.2 ± 12.0 cm, BM = 85.7 ± 19.1 kg, body mass index = 20.8 ± 1.8) provided a urine sample and were weighed to assess hydration. Sensitivity and specificity of urine color (Ucol) and urine-specific gravity (USG) to determine BM changes were determined using receiver operating characteristic (ROC) analysis. Paired samples t -tests assessed carryover effects between practices. Repeated-measures analysis of variance assessed carryover effects across practices. Significance was set at p < 0.05. Sensitivity and specificity for using Ucol or USG to determine BM changes was not significant. For Ucol, there was a carryover effect from practice numbers 2 to 3, 6 to 7 am , 7 am to 7 pm ( p < 0.001 for all), and 10 to 11 ( p = 0.004); most with less than 24 hours between practices. The %BM loss (%BML) was significantly greater ( p = 0.001 to 0.024) after 2-a-day practices. Effects of previous days' exercise in the heat, as evidenced by higher Ucol and %BL, are greater after 2-a-day practices, which occurred on later practice days. Athletes must replenish fluids during and between practices to remain euhydrated.

Type II hiatal hernias: do they exist or are they actually parahiatal hernias?

BACKGROUND: Type II hiatal hernias (HH) are characterized by a portion of the gastric fundus located above the esophageal hiatus adjacent to the esophagus while the gastroesophageal junction (GEJ) remains fixed below the esophageal hiatus. This type of HH has been called the "true" paraesophageal hernia (PEH) because the fundus appears to the side of the esophagus. In our experience, Type II HHs are occasionally identified on radiographic testing, however they are rarely, if ever, confirmed intraoperatively. This led to our question: Does Type II HH exist? METHODS: We searched for evidence of type II HH in three locations: 1. Retrospective review of all first-time PEH repairs (excluding Type I HHs and re-operative cases) performed at the University of Washington Medical Center from 1994 to 2021; 2. Operative videos available on YouTube and WebSurg websites; and 3. Abstracts from the SAGES annual meetings from 2005 to 2021. RESULTS: We found no evidence of Type II HH in any of our three searches. We performed 846 PEH repairs: 760 Type III, 75 Type IV, and 11 parahiatal. Upon website video review, we found only one possible type II hernia, though it too was likely a para-hiatal hernia. No video or case presentations of a type II HH were identified within SAGES annual meeting abstracts. CONCLUSION: Type II HHs do not exist as they are currently defined. Although uncommon, parahiatal hernia can easily be misinterpreted as Type II HH. We should consider changing the hiatal hernia classification system to prevent ongoing clinical confusion.

Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes.

OBJECTIVE: The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. DESIGN: Mixed-methods, cross-sectional survey. SETTING: Online. PATIENTS OR PARTICIPANTS: In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. INDEPENDENT VARIABLES: Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. MAIN OUTCOME MEASURES: The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. RESULTS: Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. CONCLUSIONS: Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.

Sleep Dysfunction in Adolescents With Prolonged Postconcussion Symptoms: A Reciprocal Coupling of Traumatic Brain Injury and Sleep-Related Problems.

CLINICAL SCENARIO: Concussions are often neglected injuries that affect children and adolescents. Two physiological responses to a concussion are an ionic flux and an increased indiscriminate release of glutamate, which leads to an increase of intracellular calcium and extracellular potassium. This can ultimately result in sleep dysfunction, which often occurs after concussion and has long been thought of as simply another concussion symptom. FOCUSED CLINICAL QUESTION: Does the likelihood of prolonged postconcussion symptoms increase with reported sleep-related problems (SRPs) in young athletes (8-18 y) compared to concussed young athletes without SRPs and healthy controls? SUMMARY OF KEY FINDINGS: Four cohort studies with level 2/3 evidence measured subjective and objective sleep dysregulations in concussed and healthy populations. Overall, there was a difference in subjective SRPs between concussed and healthy patients. This correlated with other studies where worse sleep scores during the acute phase of concussion and increased SRPs led to worse ImPACT scores in patients 3 to 12 months postconcussion and longer overall recovery. Objective sleep dysfunction measures were significantly worse in concussed patients than in healthy controls, but no significant difference existed in melatonin measures. CLINICAL BOTTOM LINE: There is strong evidence that sleep dysfunction is both a symptom of concussion as well as a causal factor of prolonged postconcussion symptoms. These studies show that sleep dysregulation is not always evident in objective measurements, leading to the strong possibility of a functional dysregulation of the sleep-wake cycle that is evident solely from subjective reports. STRENGTH OF RECOMMENDATION: While there are strong cohort studies researching the role of sleep in those with postconcussion symptoms, the nature of sleep studies prevents the production of strong, high-level evidence studies such as randomized control trials. Thus, there is level B evidence that the likelihood of prolonged postconcussion symptoms is increased by a higher amount of SRPs.

Thermoregulation and Hydration in Female American Football Players During Practices.

ABSTRACT: Lopez, RM, Ashley, CD, Zinder, SM, and Tritsch, AJ. Thermoregulation and hydration in female American football players during practices. J Strength Cond Res 35(9): 2552-2557, 2021-Little is known about hydration practices and thermoregulation in female tackle football players. The purpose of the study was to examine the thermoregulatory and hydration responses of female professional American football players. Fifteen females from the same tackle football team volunteered for this observational field study. Each subject was observed for 4 practices for the following measures: gastrointestinal temperature (TGI), maximum TGI, heart rate (HR), maximum HR (HRmax), fluid consumption, sweat rate, percent body mass loss (%BML), urine specific gravity (USG), urine color (Ucol), perceptual measures of thirst, thermal sensations, and rating of perceived exertion (RPE). Descriptive data (mean ± SD) were calculated for all measures. Main measures were analyzed using a repeated-measures analysis of variance. Trials took place during evening practices. Average TGI during practices was 38.0 ± 0.3° C while maximum TGI was 38.4 ± 0.3° C (n = 14). Average practice HR was 118 ± 11 b·min-1, while HRmax was 148 ± 13 b·min-1. Subjects arrived at practices with Ucol of 3 ± 1 and USG of 1.018 ± 0.007. Postpractice USG (1.022 ± 0.007) was significantly higher than prepractice across all days (p < 0.001). The average sweat rate across 4 practices was 0.6 ml·h-1. Average %BML was 0.3 ± 0.4%. Thirst and thermal sensations were moderate (4 ± 1 and 5 ± 1, respectively), while RPE was 11 ± 1. Female football players tended to have similar physiological responses to males. Although subjects seemed to adequately match their sweat losses with fluid consumed during practice, there was considerable variability in hydration indices and hydration habits, with some subjects experiencing hypohydration and others overestimating their fluid needs. Those working with this population should emphasize the need for hydration education and establish individualized hydration regimens.

Do Alternative Cooling Methods Have Effective Cooling Rates for Hyperthermia Compared With Previously Established CWI Cooling Rates?

Clinical Scenario: In the last few years, there have been several studies examining alternative cooling strategies in the treatment of exertional heat stroke (EHS). Morbidity and mortality with EHS are associated with how long the patient's core body temperature remains above the critical threshold of 40.5°C. Although cold-water immersion (CWI) is the gold standard of treatment when cooling a patient with EHS, more recent alternative cooling techniques have been examined for use in settings where CWI may not be feasible (ie, remote locations). Clinical Question: Do alternative cooling methods have effective core body temperature cooling rates for hyperthermia compared with previously established CWI cooling rates? Summary of Key Findings: The authors searched for studies using alternative cooling methods to cool hyperthermic individuals. To be included, the studies needed a PEDro score ≥6 and a level of evidence ≥2. They found 9 studies related to our focused clinical question; of these, 5 studies met the inclusion criteria. The cooling rates for hand cooling, cold-water shower, and ice-sheet cooling were 0.03°C/min, 0.08°C/min, and 0.06°C/min, respectively, whereas the tarp-assisted cooling with oscillation (TACO) method was the only method that had an acceptable cooling rate (range 0.14-0.17°C/min). Clinical Bottom Line: When treating EHS, if CWI is not available, the tarp-assisted cooling method may be a reasonable alternative. Clinicians should not use cold shower, hand cooling, or ice-sheet cooling if better cooling methods are available. Clinicians should always use CWI when available. Strength of Recommendation: Five level 2 studies with PEDro scores ≥6 suggest the TACO method is the only alternative cooling method that decreases core body temperature at a similar, though slower, rate of CWI. Hand cooling, cold showering, and ice-sheet cooling do not decrease core body temperature at an appropriate rate and should not be used in EHS situations if a modality with a better cooling rate is available.

Examining the Influence of Exercise Intensity and Hydration on Gastrointestinal Temperature in Collegiate Football Players.

DeMartini-Nolan, JK, Martschinske, JL, Casa, DJ, Lopez, RM, Stearns, RL, Ganio, MS, and Coris, E. Examining the influence of exercise intensity and hydration on gastrointestinal temperature in collegiate football players. J Strength Cond Res 32(10): 2888-2896, 2018-Debate exists regarding the influence of intensity and hydration on body temperature during American football. The purpose of this study was to observe body core temperature responses with changes in intensity and hydration. Twenty-nine male football players (age = 21 ± 1 year, height = 187 ± 9 cm, mass = 110.1 ± 23.5 kg, body mass index [BMI] = 31.3 ± 5.0, and body surface area [BSA] = 2.34 ± 0.27 m) participated in 8 days of practice in a warm environment (wet bulb globe temperature: 29.6 ± 1.6° C). Participants were identified as starters (S; n = 12) or nonstarters (n = 17) and linemen (L; n = 14) or nonlinemen (NL; n = 15). Variables of interest included core body temperature (T), hydration status, and physical performance characteristics as measured by a global positioning system. Intensity measures of average heart rate (138 ± 9 bpm), low-velocity movement (4.2 ± 1.7%), high-velocity movement (0.6 ± 0.6%), and average velocity (0.36 ± 0.10 m·s) accounted for 42% of the variability observed in T (38.32 ± 0.34° C, r = 0.65, p = 0.01). Hydration measures (percent body mass loss = -1.56 ± 0.80%, urine specific gravity [Usg] = 1.025 ± 0.006, and urine color [Ucol] = 6 ± 1) did not add to the prediction of T (p = 0.83). Metrics of exercise intensity accounted for 39% of the variability observed in maximum T (38.83 ± 0.42° C, r = 0.62, p = 0.02). Hydration measures did not add to this prediction (p = 0.40). Low-velocity movement, high-velocity movement, average velocity, BMI, and BSA were significantly different (p = 0.002, p < 0.001, p = 0.02, p < 0.001, p < 0.001, respectively) between L vs. NL. Heart rate and T were not different between L and NL (p > 0.05). Exercise intensity primarily accounted for the rise in core body temperature. Although L spent less time at higher velocities, T was similar to NL, suggesting that differences in BMI and BSA added to thermoregulatory strain.

Comparison of Two Fluid Replacement Protocols During a 20-km Trail Running Race in the Heat.

Lopez, RM, Casa, DJ, Jensen, K, Stearns, RL, DeMartini, JK, Pagnotta, KD, Roti, MW, Armstrong, LE, and Maresh, CM. Comparison of two fluid replacement protocols during a 20-km trail running race in the heat. J Strength Cond Res 30(9): 2609-2616, 2016-Proper hydration is imperative for athletes striving for peak performance and safety, however, the effectiveness of various fluid replacement strategies in the field setting is unknown. The purpose of this study was to investigate how two hydration protocols affect physiological responses and performance during a 20-km trail running race. A randomized, counter-balanced, crossover design was used in a field setting (mean ± SD: WBGT 28.3 ± 1.9° C). Well-trained male (n = 8) and female (n = 5) runners (39 ± 14 years; 175 ± 9 cm; 67.5 ± 11.1 kg; 13.4 ± 4.6% BF) completed two 20-km trail races (5 × 4-km loop) with different water hydration protocols: (a) ad libitum (AL) consumption and (b) individualized rehydration (IR). Data were analyzed using repeated measures ANOVA. Paired t-tests compared pre-race-post-race measures. Main outcome variables were race time, heart rate (HR), gastrointestinal temperature (TGI), fluid consumed, percent body mass loss (BML), and urine osmolality (Uosm). Race times between groups were similar. There was a significant condition × time interaction (p = 0.048) for HR, but TGI was similar between conditions. Subjects replaced 30 ± 14% of their water losses in AL and 64 ± 16% of their losses in IR (p < 0.001). Ad libitum trial experienced greater BML (-2.6 ± 0.5%) compared with IR (-1.3 ± 0.5%; p < 0.001). Pre-race to post-race Uosm differences existed between AL (-273 ± 146 mOsm) and IR (-145 ± 215 mOsm, p = 0.032). In IR, runners drank twice as much fluid than AL during the 20-km race, leading to > 2% BML in AL. Ad libitum drinking resulted in 1.3% greater BML over the 20-km race, which resulted in no thermoregulatory or performance differences from IR.

Plyometric Training Effects on Athletic Performance in Youth Soccer Athletes: A Systematic Review.

The purpose of this systematic review was to critically analyze the literature to determine the effectiveness of plyometric training on athletic performance in youth soccer athletes. A total of 7 studies were included in this review after meeting the following criteria: (a) used plyometric training programs to assess athletic performance, (b) subjects were soccer athletes aged preadolescent up to 17 years, and (c) were published from 2000 to January 2014. Study methods were assessed using the PEDro scale with scores ranging from 4 to 6. Results showed similarities and differences in methodologies and procedures among the included studies. Athletic performance consisting of kicking distance, speed, jumping ability, and agility significantly improved because of plyometric training interventions. The current evidence suggests that plyometric training should be completed 2 days per week for 8-10 weeks during soccer practice with a 72-hour rest period between plyometric training days. The initial number of foot contacts should be 50-60 per session and increase to no more than 80-120 foot contacts per session for this age group to prevent overuse injuries. A total of 3-4 plyometric training exercises should be performed 2-4 sets for 6-15 repetitions per training session. The evidence and the literature suggest that plyometric training for this age group should only be implemented using recommended safety guidelines such as those published by the Canadian Society for Exercise Physiology and the National Strength and Conditioning Association and under appropriate supervision by trained personnel.

Parity and short-term estradiol treatment utilizes similar cellular mechanisms to confer protection against breast cancer.

BACKGROUND: Protective effect of early pregnancy and short-term estrogen treatment (STET), against breast cancer is well established. The underlying mechanisms are not well understood. In this study, we compared the mammary gland cellular microenvironment influenced/induced by parity and STET alongside age-matched controls. METHODS: Parous, STET, and control rats were injected with N-methyl-N-nitrosourea at 15 weeks and monitored for the development of mammary cancer. A subset of 4 rats were killed five weeks post carcinogen treatment and mammary gland samples were isolated and subjected to molecular analysis. RESULTS: Our results demonstrated a reduction in cell survival, extracellular matrix associated proliferation, hormonal and growth factor receptor pathways in the experimental groups compared to control rats. Moreover, concomitant reductions in the EMT markers along with cell migration regulators were also observed in parous and STET groups. Hormonal receptor such as GHR, PR, ERα and growth factor receptors IGFR, EGFR and erbB2 were down regulated in the treatment groups. Further analysis revealed that parity and STET drastically reduced the expression, activation of JAK2 and nuclear localization of STATs. CONCLUSION: Parity and STET by targeting major cell signaling pathways involved in cell survival, cell migration and cell death reduces the mammary tumor promoting environment.

Thermoregulatory, cardiovascular, and perceptual responses to intermittent cooling during exercise in a hot, humid outdoor environment.

Decreasing core body temperature during exercise may improve exercise tolerance, facilitate acclimatization, and prevent heat illness during summer training. We sought to evaluate the effectiveness of intermittent superficial cooling on thermoregulatory, cardiovascular, and perceptual responses during exercise in a hot humid environment. We used a randomized, counterbalanced, repeated measures investigation with 2 conditions (control and cooling) during exercise and recovery outdoors on artificial turf in a hot, humid tropical climate in the sun (wet bulb globe temperature outdoors [WBGTo], 27.0 ± 0.8° C; range, 25.8-28.1° C) and in the shade (WBGTo, 25.4 ± 0.9° C; range, 24.3-26.8° C). Participants were 10 healthy males (age, 22.6 ± 1.6 years; height, 176.0 ± 6.9 cm; mass, 76.5 ± 7.8 kg; body fat, 15.6 ± 5.4%) who wore shorts and T-shirt (control) or "phase change cooling" vest (cooling) during 5-minute rest breaks during 60 minutes of intense American football training and conditioning exercises in the heat and 30 minutes of recovery in the shade. Throughout, we measured core (Tgi) and skin (Tchest) temperature, heart rate (HR), thermal and thirst sensations, and rating of perceived exertion. We found significant (p ≤ 0.001) hypohydration (-2.1%); for Tgi, we found no significant differences between conditions (p = 0.674) during exercise and progressive decreases during recovery (p < 0.001). For [INCREMENT]Tg,i we found no significant (p = 0.090) differences. For Tchest, we found significantly (p < 0.001) decreased skin temperature in the cooling condition (Tchest, 31.85 ± 0.43° C) compared with the control condition (Tchest, 34.38 ± 0.43° C) during exercise and significantly (p < 0.001) lower skin temperature in the cooling condition (Tchest, 31.24 ± 0.47° C) compared with the control condition (Tchest, 33.48 ± 0.47° C) during recovery. For HR, we found no significant difference (p = 0.586) between the conditions during exercise; however, we did find significantly (p < 0.001) lower HR during recovery. Thermal sensations were significantly (p = 0.026) decreased in the cooling (4.4 ± 0.2 points) compared with the control (5.0 ± 0.2 points) condition but not for other perceptual responses. The cooling effects of "phase change cooling" material were effective in reducing skin temperature but did not sufficiently reduce core body temperature or cardiovascular strain.

Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators.

BACKGROUND: Little is known about the adoption by athletic administrators (AAs) of exertional heat illness (EHI) policies, and the corresponding facilitators and barriers of such policies within high school athletics. This study describes the adoption of comprehensive EHI policies by high school AAs and explores factors influencing EHI policy adoption. HYPOTHESIS: We hypothesized that <50% of AAs would report adoption of an EHI policy, and that the most common facilitator would be access to an athletic trainer (AT), whereas the most common barrier would be financial limitations. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 466 AAs (82.4% male; age, 48 ± 9 years) completed a validated online survey to assess EHI prevention and treatment policy adoption (11 components), as well as facilitators and barriers to policy implementation. Access to athletic training services was ascertained by matching the participants' zip codes with the Athletic Training Locations and Services Project. Policy adoption, facilitators, and barriers data are presented as summary statistics (proportions, interquartile range (IQR)). A Welch t test evaluated the association between access to athletic training services and EHI policy adoption. RESULTS: Of the AAs surveyed, 77.9% (n = 363) reported adopting a written EHI policy. The median of EHI policy components adopted was 5 (IQR = 1,7), with only 5.6% (n = 26) of AAs reporting adoption of all policy components. AAs who had access to an AT (P = 0.04) were more likely to adopt a greater number of EHI-related policies, compared with those without access to an AT. An AT employed at the school was the most frequently reported facilitator (36.9%). CONCLUSION: Most AAs reported having written EHI policy components, and access to an AT resulted in a more comprehensive policy. CLINICAL RELEVANCE: Employment of an AT within high school athletics may serve as a vital component in facilitating the adoption of comprehensive EHI policies.

The Role of the Athletic Trainer in Providing Care to Transgender and Gender Diverse Patients: Considerations for Medical Affirmation - Part II.

Recently, there has been an increase in media attention surrounding transgender and gender-diverse (TGD) individuals between discriminatory legislation efforts and changing participation policies within organized sports. These changes and the historical lack of competence and education regarding the transgender patient population have resulted in sub-par patient care, and a misunderstanding of the athletic trainer's (AT) role within the healthcare and compliance systems. This literature review is the second part of a two-paper series and the objective of this paper was to educate ATs on the processes relevant to medical affirmation including compliance considerations regarding medical eligibility and to establish the AT's role. The gender affirmation framework includes social and legal components which are discussed in part one of this literature, and the medical component is thoroughly discussed in part two. AT's and all health care providers involved in the patient care of TGD individuals should work collaboratively on an interprofessional care team and have a general knowledge of the gender affirmation process including GAHT, surgical options, known risks and complications, and the general health needs of TGD patients. By being more knowledgeable, ATs are uniquely positioned to help reduce health and healthcare disparities as they are point-of-care providers as well as members of the interprofessional care team. Furthermore, ATs can use their knowledge to facilitate medical compliance and eligibility within the evolving policies of sporting organizations.

The Role of the Athletic Trainer in Treating Transgender and Gender Non-Conforming Patients: Foundational Knowledge and Disparities - Part I.

Transgender and Gender Diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts leading to numerous health and healthcare disparities that negatively impact wellbeing and access to quality healthcare.1 While in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purpose of the first part of this two-part narrative literature review is to 1) provide readers with foundational information and terminology, 2) explore relevant health and healthcare disparities, and 3) identify the role of the AT within an interprofessional care team treating TGD patients.

Distribution of upper limit of the prescriptive zone values for acclimatized and unacclimatized individuals.

Heat stress has an adverse impact on worker health and well-being, and the effects will increase with more frequent and severe heat events associated with global warming. Acclimatization to heat stress is widely considered to be a critical mitigation strategy and wet bulb globe temperature- (WBGT-) based occupational standards and guidelines contain adjustments for acclimatization. The purpose here was to 1) compare the mean values for the upper limit of the prescriptive zone (ULPZ, below which the rise in core temperature is minimal) between unacclimatized and acclimatized men and women; 2) demonstrate that the change in the occupational exposure limit (ΔOEL) due to acclimatization is independent of metabolic rate; 3) examine the relation between ΔOEL and body surface area (BSA); and 4) compare the exposure-response curves between unacclimatized and acclimatized populations. Empirically derived ULPZ data for unacclimatized participants from Pennsylvania State University (PSU) and acclimatized participants from University of South Florida (USF) were used to explore the difference between unacclimatized and acclimatized heat exposure limits. The findings provide support for a constant 3°C WBGT OEL decrease to account for unacclimatized workers. Body surface area explained part of the difference in ULPZ values between men and women. In addition, the pooled PSU and USF data provide insight into the distribution of individual values for the ULPZ among young, healthy unacclimatized and acclimatized populations in support of occupational heat stress guidelines.NEW & NOTEWORTHY Occupational exposure limit guidelines using wet bulb globe temperature (WBGT) distinguish between acclimatized and unacclimatized workers with about a 3°C difference between them. For the first time, empirical data from two laboratories provide support for acclimatization state adjustments. Using a constant difference rather than increasing differences with metabolic rate better describes the limit for unacclimatized participants. Furthermore, the lower upper limit of the prescriptive zone (ULPZ) values set forth for women do not relate to fitness level but are partly explained by their smaller body surface area (BSA). An examination of individual ULPZ values suggests that many unacclimatized individuals should be able to sustain safe work at the exposure limit for acclimatized workers.

Superficial cooling does not decrease core body temperature before, during, or after exercise in an American football uniform.

The purpose of this study was to identify the effects of superficial cooling on thermoregulatory responses while exercising in a hot humid environment while wearing an American football uniform. Nine male and female subjects wore a superficial cooling garment while in a cooling (CS) experimental condition or a no cooling (NCS) control condition during an exercise task consisting of warm-up (WU), exercise (EX), and recovery (R). The exercise task simulated an American football conditioning session with subjects wearing a full American football uniform and performing anaerobic and aerobic exercises in a hot humid environment. Subjects were allowed to drink water ad libitum during rest breaks. During the WU, EX, and R periods, core body temperature (T(c)) was measured to assess the effect of the cooling garment. Neither baseline resting before warm-up T(c) nor after warm-up T(c) was significantly different between trials. No significant differences in exercise T(c) between conditions were found. Time to return to baseline T(c) revealed no significant differences between the experimental and control conditions. The authors found that the volume of fluid consumed was 34% less in the experimental condition (711.1 ± 188.0 ml) compared with the control condition (1,077.8 ± 204.8 ml). The findings indicate that the cooling garment was not effective in blunting the rise in T(c) during warm-up, attenuating a rise in T(c) during intermittent exercise, or in increasing a return to baseline T(c) during a resting recovery period in a hot humid environment while wearing an American football uniform.

Relationship Between Pre- and Post-exercise Body Mass Changes and Pre-exercise Urine Color in Female Athletes.

Although studies use body mass changes or urine color to measure hydration status, the purpose of this study was to examine the relationship between pre-practice urine color and exercise body mass changes in female tackle football players. Twenty-six female American football players (Age: 29.9 ± 7.3 years; Height: 165.2 ± 2.6 cm; Weight: 83.8 ± 24.4 kg) volunteered. Fluid consumptions (FC) was measured during tackle football practices, while urine color (Ucol), and percent body mass loss (%BML) were taken before and after practices. Subjects were grouped by %BML: lost mass (LM), gained mass (GM), or no change (NC). A one-way ANOVA compared groups on Ucol and FC. There were differences across groups for pre-practice Ucol (P < 0.01) and FC (P < 0.01). GM had a higher pre-practice Ucol than LM (P < 0.01) and NC (P < 0.05) and consumed more fluid than LM (P < 0.01) and NC (P < 0.05). A stepwise linear regression examined the extent that Ucol and FC were related to %BML. When predicting BML, FC accounted for 45% of variance (P < 0.01). The addition of pre-practice Ucol increased predicted variance explained (R 2 change= 2.5%, P = 0032). Subjects who gained mass during practice arrived with elevated urine color (Ucol 5 ± 2), while those who lost mass arrived with pale urine color (Ucol 3 ± 2). Findings indicate those who arrived with an elevated urine color attempted to improve hydration status by consuming more fluid and gaining body mass during exercise.

Proper Recognition and Management of Exertional Heat Stroke in a High School Cross-Country Runner: A Validation Clinical Case Report.

A 14-year-old female high school cross- country runner (height = 154 cm, mass = 48.1 kg) with no history of exertional heat stroke (EHS) collapsed at the end of a race. An athletic trainer assessed the patient, who presented with difficulty breathing and then other signs of EHS (eg, confusion and agitation). The patient was taken to the medical area and draped with a towel, and a rectal temperature (Tre) of 106.9°F (41.6°C) was obtained. The emergency action plan was activated, and emergency medical services was called. The patient was submerged in a cold-water immersion tub until emergency medical services arrived (∼15 minutes; Tre = 100.1°F; cooling rate: 0.41°F.min-1[0.25°C.min-1]). At the hospital, the patient received intravenous fluids, and urine and blood tests were normal. She was not admitted and returned to running without sequelae. Following best practices, secondary school athletic trainers can prevent deaths from EHS by properly recognizing the condition and providing rapid cooling before transport.

Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma.

BACKGROUND: Treatment of open fractures remains a significant challenge in trauma care as these fractures are accompanied by extensive soft tissue damage, exposing the wound site to contaminants and increasing infection risk. Formation of biofilm, a capsule-like environment that acts as a barrier to treatment, is a primary mode by which infecting pathogens persist at the wound site. Therefore, a pressing need exists to identify irrigation methods that can disrupt biofilm and expose pathogens to treatment. This study aims to evaluate the antibiofilm wound lavage, Bactisure™, in comparison with saline for care of severe musculoskeletal wounds and elucidate potential effects on antibiotic treatment success. METHODS: UAMS-1 Staphylococcus aureus biofilms were formed in vitro and treated with Bactisure™ wound lavage or sterile normal saline, alone, or in combination with sub-biofilm inhibitory levels of vancomycin. Characterization methods included quantification of biofilm biomass, quantification of viable biofilm bacteria, and biofilm matrix imaging. For in vivo assessment, a delayed treatment model of contaminated open fracture was used wherein a critical-sized defect was created in a rat femur and wound site inoculated with UAMS-1. Following a 6 h delay, wounds were debrided, irrigated with lavage of interest, and antibiotic treatments administered. Bacterial enumeration was performed on bone and hardware samples after two weeks. RESULTS: An immediate reduction in biofilm biomass was observed in vitro following antibiofilm lavage treatment, with a subsequent 2- to 3- log reduction in viable bacteria achieved after 24 h. Furthermore, biofilms treated with antibiofilm lavage in combination with vancomycin exhibited a minor, but statistically significant, decrease in viable bacteria compared to irrigation alone. In vivo, a minor, not statistically significant, decrease in median bioburden was observed for the antibiofilm lavage compared to saline when used in combination with antibiotics. However, the percentage of bone and hardware samples with detectable bacteria was reduced from 50 to 38%. CONCLUSIONS: These results suggest that the antibiofilm wound lavage, Bactisure™, may hold promise in mitigating infection in contaminated musculoskeletal wounds and warrants further investigation. Here, we proposed multiple mechanisms in vitro by which this antibiofilm lavage may help mitigate infection, and demonstrate this treatment slightly outperforms saline in controlling bioburden in vivo.