Nielsen. Influence of body temperature on the development of fatigue during prolonged exercise in the heat. J. Appl. Physiol. 86(3): 1032-1039, 1999.-We investigated whether fatigue during prolonged exercise in uncompensable hot environments occurred at the same critical level of hyperthermia when the initial value and the rate of increase in body temperature are altered. To examine the effect of initial body temperature [esophageal temperature (T es ) ϭ 35.9 Ϯ 0.2, 37.4 Ϯ 0.1, or 38.2 Ϯ 0.1 (SE)°C induced by 30 min of water immersion], seven cyclists (maximal O 2 uptake ϭ 5.1 Ϯ 0.1 l/min) performed three randomly assigned bouts of cycle ergometer exercise (60% maximal O 2 uptake) in the heat (40°C) until volitional exhaustion. To determine the influence of rate of heat storage (0.10 vs. 0.05°C/min induced by a water-perfused jacket), four cyclists performed two additional exercise bouts, starting with T es of 37.0°C. Despite different initial temperatures, all subjects fatigued at an identical level of hyperthermia (T es ϭ 40.1-40.2°C, muscle temperature ϭ 40.7-40.9°C, skin temperature ϭ 37.0-37.2°C) and cardiovascular strain (heart rate ϭ 196-198 beats/min, cardiac output ϭ 19.9-20.8 l/min). Time to exhaustion was inversely related to the initial body temperature: 63 Ϯ 3, 46 Ϯ 3, and 28 Ϯ 2 min with initial T es of ϳ36, 37, and 38°C, respectively (all P Ͻ 0.05). Similarly, with different rates of heat storage, all subjects reached exhaustion at similar T es and muscle temperature (40.1-40.3 and 40.7-40.9°C, respectively), but with significantly different skin temperature (38.4 Ϯ 0.4 vs. 35.6 Ϯ 0.2°C during high vs. low rate of heat storage, respectively, P Ͻ 0.05). Time to exhaustion was significantly shorter at the high than at the lower rate of heat storage (31 Ϯ 4 vs. 56 Ϯ 11 min, respectively, P Ͻ 0.05). Increases in heart rate and reductions in stroke volume paralleled the rise in core temperature (36-40°C), with skin blood flow plateauing at T es of ϳ38°C. These results demonstrate that high internal body temperature per se causes fatigue in trained subjects during prolonged exercise in uncompensable hot environments. Furthermore, time to exhaustion in hot environments is inversely related to the initial temperature and directly related to the rate of heat storage. hyperthermia; skin blood flow; heart rate; stroke volume IT IS WELL DOCUMENTED that endurance can be impaired in hot compared with temperate climates (10,12,28) and that time to exhaustion is influenced by alterations of the initial body temperature (1,22,32,39). The attainment of a critically high level of body temperature has been proposed as the main factor limiting endurance performance in hot environments (7,28). The observation that trained subjects working at 60% of peak O 2 uptake (V O 2 peak ) in the heat [40°C, 10% relative humidity (RH)] for 9-12 consecutive days improved exercise performance from 48 to 80 min but fatigued at a core temperature of 39.7°C appears to support this notion (28). This large improvement in exercise time t...

(1) Objective: To assess hospital medication costs and staff time between One-Stop Dispensing (OSD) and the Traditional Medication System (TMS), and to evaluate patient perspectives on OSD. (2) Methods: The study was conducted at Hvidovre Hospital, University of Copenhagen, Denmark in an elective gastric surgery and acute orthopedic surgery department. This study consists of three sub-studies including adult patients able to self-manage medication. In Sub-study 1, staff time used to dispense and administer medication in TMS was assessed. Medication cost and OSD staff time were collected in Sub-study 2, while patient perspectives were assessed in Sub-study 3. Medication costs with two days of discharge medication were compared between measured OSD cost and simulated TMS cost for the same patients. Measured staff time in OSD was compared to simulated staff time in TMS for the same patients. Patient satisfaction related to OSD was evaluated by a questionnaire based on a five-point Likert scale (‘very poor’ (1) to ‘very good’ (5)). (3) Results: In total, 78 elective and 70 acute OSD patients were included. Overall, there was no significant difference between OSD and TMS in medication cost per patient ($2.03 [95% CI −0.57–4.63]) (p = 0.131). Compared with TMS, OSD significantly reduced staff time by an average of 12 min (p ≤ 0.001) per patient per hospitalization. The patients’ satisfaction for OSD was high with an average score of 4.5 ± 0.7. (4) Conclusion: There were no differences in medication costs, but staff time was significantly lower in OSD and patients were overall satisfied with OSD.

In recent years, it has become increasingly important to understand the global circulation of healthcare innovations in nations’ attempts to solve contemporary health challenges. This article is a systematic review and meta-ethnography–inspired analysis that explores the global circulation of health-related standards, protocols, procedures, and regulations, or what we term health-promoting infrastructures (HPIs). The notion of HPIs is defined as built networks that allow for the circulation of health expertise with the intention of promoting solutions that address global health problems. We conducted systematic searches in six relevant electronic databases and ended up with a set of 13 studies. The review shows that it takes arduous work to prepare and facilitate the travel of HPIs and to mold them into meaningful local forms. In conclusion, we argue that HPIs can helpfully be thought of as scripted forms, which are globally available in always sited efforts to address specific problems.