Context. The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S. Methods. UW Medicine developed a strategy to implement a palliative care response for a multihospital health care system that incorporates conventional capacity, contingency capacity, and crisis capacity. The strategy was developed by our palliative care programs with input from the health care system leadership. Results. In this publication, we share our multifaceted strategy to implement high-quality palliative care in the context of the COVID-19 pandemic that incorporates conventional, contingency, and crisis capacity and focuses on the areas of the hospital caring for the most patients: the emergency department, intensive care units, and acute care services. The strategy focuses on key content areas, including identifying and addressing goals of care, addressing moderate and severe symptoms, and supporting family members. Conclusion. Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.

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Context: Given the relatively novel technique of tissue flossing is currently lacking in the research literature despite some positive findings in preliminary studies, the modality clearly requires further research. Current evidence suggests that band flossing results in performance improvements and may also be an effective method in injury prevention. Objective: Previous research has shown that tissue flossing may result in increased ankle range of motion, jump, and sprinting performance in recreational athletes. The present study aims to extend on this research, within an elite athlete sample. Design: Counterbalanced, cross-over design with experimental and control trials, separated by 1 week. Setting: University laboratory. Participants: Fourteen professional male rugby union athletes (mean [SD]: age 23.9 [2.7] y). Intervention: Application of a floss band to both ankles (FLOSS) for 2 minutes or without flossing of the ankle joints (CON) on 2 separate occasions. Main Outcome Measures: A weight-bearing lunge test, a countermovement jump test, and a 20-m sprint test at pre and at 5 and 30 minutes post application of the floss band or control. Results: There were no statistically significant interactions between treatment (FLOSS/CON) and time for any of the measured variables (P > .05). Effect size analysis revealed small benefits for FLOSS in comparison with CON for countermovement performance 5 minutes post (d = 0.28) and for 10-m (d = −0.45) and 15-m (d = −0.24) sprint time 30 minutes post. Conclusion: Findings from the current study suggest minimal benefits of tissue flossing when applied to the ankle joint in elite athletes for up to 30 minutes following their application.

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To characterise physiological responses to competing in an international rugby sevens tournament played in hot/humid conditions, core temperature (T c ) and T c predictors were collected from 11 elite men's rugby sevens athletes competing in the Oceania sevens tournament in Suva, Fiji. T c , body mass change, sweat electrolytes, playing minutes, total running distance, high speed running distance (HSD), psychrometric wet bulb temperature and exertional heat illness symptoms were collected pre, during and post games. Linear mixed-models were used to assess the effect of T c predictors on post-game T c , along with differences in T c across measurement periods. Compared to baseline on both tournament days, mean T c was higher during all between game (recovery) measures (all d >1.30, p <0.01). On both tournament days, eight athletes reached a post-game T c >39.0°C, with several athletes reaching >39.0°C during warm-ups. Mean post-game T c was related to playing minutes, total running distance, HSD, and post warm-up T c (all p < 0.01). The T c during warm-ups and games regularly exceeded those demonstrated to be detrimental to repeated sprint performance (> 39°C). Warm-up T c represents the easiest predictor of post-game T c to control via time/intensity modulation and the use of appropriate pre-and per-cooling strategies. Practitioners should be prepared to modulate warm-ups and other heat preparation strategies based on likely environmental conditions during hot/humid tournaments.