Military civilian partnerships: International proposals for bridging the Walker Dip.

The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict. As the operational tempo of the conflicts in Afghanistan and Iraq has declined, concerns have arisen regarding whether US military surgeons are prepared to meet the demands of future conflicts. This problem is not unique to the US military, and allied nations have taken creative steps to address the Walker Dip in their own surgical communities.

Management of Suspected Fluid Balance Issues in Participants of Wilderness Endurance Events.

Dehydration and exercise-associated hyponatremia (EAH) are both relatively common conditions during wilderness endurance events. Whereas dehydration is treated with fluids, EAH is appropriately managed with fluid restriction and a sodium bolus but can worsen with isotonic or hypotonic fluids. Therefore, caution is recommended in the provision of postevent rehydration in environments where EAH is a potential consideration because accurate field assessment of hydration status can be challenging, and measurement of blood sodium concentration is rarely possible in the wilderness.

Etiological Foundation for Practical Strategies to Prevent Exercise-Related Foot Blisters.

This work outlines the etiological factors for exercise-related foot blisters and the pertinent prevention strategies related to these causes. Blisters result from shear forces within the epidermis causing cell necrosis. The extent of skin shear is influenced by friction at the skin and other interfaces, various skin characteristics, bony movement, and the shear modulus of the foot ware.

The influence of hydration state on thermoregulation during a 161-km ultramarathon.

It is advised that individuals should avoid losing >2% of their body mass during exercise in order to prevent hyperthermia. This study sought to assess whether a loss of >2% body mass leads to elevations in core temperature during an ultramarathon. Thirty runners agreed to take part in the study.

Does oral buffered sodium supplementation reduce nausea and vomiting during an ultramarathon?

This work examines whether nausea or vomiting during an ultramarathon are due to a fluid or electrolyte imbalance, and if these symptoms can be reduced through the use of buffered sodium supplements. Starters (n = 376) of a 161.3-km ultramarathon underwent body weight measurements, 74.

Is Sodium Supplementation Necessary to Avoid Dehydration During Prolonged Exercise in the Heat?

The primary purpose of this work was to gain further insight into the need for sodium supplementation for maintenance of appropriate hydration during prolonged exercise under hot conditions. Participants of a 161-km ultramarathon (ambient temperature reaching 39° C) underwent body weight measurements immediately before, during, and after the race, and completed a postrace questionnaire about supplemental sodium intake and drinking strategies during 4 race segments. The postrace questionnaire was completed by 233 (78.

Factors associated with telemonitoring use among patients with chronic heart failure.

Background In adults with chronic heart failure (HF; defined as people with previously diagnosed left ventricular dysfunction) telemonitoring randomized controlled trials (RCTs) failed to consistently demonstrate improved clinical outcomes. We aimed to examine if patient and HF characteristics are associated with device preferences and use. Methods Using a cross-sectional, multicenter, international design, ambulatory and hospitalized adults with HF in Ohio, California, and Denmark viewed a six-minute video of telemonitoring configurations (tablet, smart phone, and key fob) and completed questionnaires.

Nausea is associated with endotoxemia during a 161-km ultramarathon.

This study explored possible contributing factors to gastrointestinal distress, including endotoxemia, hyperthermia, dehydration and nutrition, during a 161-km ultramarathon. Thirty runners participated in the study and 20 finished the race. At three checkpoints and the finish, runners were interviewed to assess the incidence and severity of 12 gastrointestinal symptoms and to determine dietary intake.

Does Acute Kidney Injury From an Ultramarathon Increase the Risk for Greater Subsequent Injury?

Objective: Examine whether the acute kidney injury (AKI) commonly observed among ultramarathon participants places the individual at risk for subsequent AKI of worse magnitude.

Design: Observational.

Setting: Western States Endurance Run.

Injuries and Health Considerations in Ultramarathon Runners.

Ultramarathon runners are a relatively small and unique group of distance runners with somewhat different medical issues than other distance runners. This article outlines some of those differences so that clinicians caring for these runners in the clinic or at competitions might be better prepared.

Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data.

Unlabelled: Chronic neuropathic pain, the most frequent condition affecting the peripheral nervous system, remains underdiagnosed and difficult to treat. Inhaled cannabis may alleviate chronic neuropathic pain. Our objective was to synthesize the evidence on the use of inhaled cannabis for chronic neuropathic pain.

Muscle Cramping During a 161-km Ultramarathon: Comparison of Characteristics of Those With and Without Cramping.

Background: This work sought to identify characteristics differing between those with and without muscle cramping during a 161-km ultramarathon.

Methods: In this observational study, race participants underwent body weight measurements before, during, and after the race; completed a post-race questionnaire about muscle cramping and "near" cramping (controllable, not reaching full-blown cramping), drinking strategies, and use of sodium supplementation during four race segments; and underwent a post-race blood draw for determination of serum sodium and blood creatine kinase (CK) concentrations.

Results: The post-race questionnaire was completed by 280 (74.

Case Study: Symptomatic Exercise-Associated Hyponatremia in an Endurance Runner Despite Sodium Supplementation.

Symptomatic exercise-associated hyponatremia (EAH) is known to be a potential complication from overhydration during exercise, but there remains a general belief that sodium supplementation will prevent EAH. We present a case in which a runner with a prior history of EAH consulted a sports nutritionist who advised him to consume considerable supplemental sodium, which did not prevent him from developing symptomatic EAH during a subsequent long run. Emergency medical services were requested for this runner shortly after he finished a 17-hr, 72-km run and hike in Grand Canyon National Park during which he reported having consumed 9.

Three cases of severe hyponatremia during a river run in Grand Canyon National Park.

We present 3 cases of severe hyponatremia occurring on a commercially guided river rafting trip on the Colorado River in Grand Canyon National Park. All 3 women appeared to have been overhydrating because of concern about dehydration and required evacuation within 24 hours of each other after the staggered onset of symptoms, which included fatigue and emesis progressing to disorientation or seizure. Each was initially transferred to the nearest hospital and ultimately required intensive care.

An investigation of ultramarathon-associated visual impairment.

Objective: The purpose of this study was to investigate the characteristics under which ultramarathon-associated visual impairment occurs and to seek to identify its physiological basis and risk factors.

Methods: Through an online questionnaire, distributed worldwide, we obtained information from 173 self-identified ultramarathon runners who had experienced visual impairment during an ultramarathon. We attempted to characterize this vision impairment-its symptoms, duration, and the conditions under which it occurs.

Sodium Supplementation and Exercise-Associated Hyponatremia during Prolonged Exercise.

Purpose: This work examines whether sodium supplementation is important in prevention of hyponatremia during continuous exercise up to 30 h and whether any distinguishing characteristics of those developing hyponatremia could be identified.

Methods: Participants of the 161-km Western States Endurance Run underwent body weight measurements before, during, and after the race, completed a postrace questionnaire about drinking strategies and use of sodium supplementation during four race segments, and underwent analysis of postrace serum sodium concentration.

Results: The postrace questionnaire was completed by 74.

Wilderness Medical Society practice guidelines for treatment of exercise-associated hyponatremia: 2014 update.

Exercise-associated hyponatremia (EAH) is defined by a serum or plasma sodium concentration below the normal reference range of 135 mmol/L that occurs during or up to 24 hours after prolonged physical activity. It is reported to occur in individual physical activities or during organized endurance events conducted in austere environments in which medical care is limited and often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to ensure a positive outcome.

Comparison of body composition techniques before and after a 161-km ultramarathon using DXA, BIS and BIA.

The low cost, ease of application and portability of bioelectrical impedance analysis (BIA) and spectroscopy (BIS) devices make them attractive tools for measuring acute changes in body composition before and after exercise, despite potential limitations from active compartmental fluid shifts. The primary study aim was to evaluate use of dual energy x-ray absorptiometry (DXA) against BIA and BIS in measurements of percent body fat (%BF) and percent total body water (%TBW) before and after prolonged endurance exercise. 10 runners were measured pre-race and at race finish.