What is the topic of this review? This is the first review to look across the broad field of 'cold water immersion' and to determine the threats and benefits associated with it as both a hazard and a treatment. What advances does it highlight? The level of evidence supporting each of the areas reviewed is assessed. Like other environmental constituents, such as pressure, heat and oxygen, cold water can be either good or bad, threat or treatment, depending on circumstance. Given the current increase in the popularly of open cold water swimming, it is timely to review the various human responses to cold water immersion (CWI) and consider the strength of the claims made for the effects of CWI. As a consequence, in this review we look at the history of CWI and examine CWI as a precursor to drowning, cardiac arrest and hypothermia. We also assess its role in prolonged survival underwater, extending exercise time in the heat and treating hyperthermic casualties. More recent uses, such as in the prevention of inflammation and treatment of inflammation-related conditions, are also considered. It is concluded that the evidence base for the different claims made for CWI are varied, and although in most instances there seems to be a credible rationale for the benefits or otherwise of CWI, in some instances the supporting data remain at the level of anecdotal speculation. Clear directions and requirements for future research are indicated by this review.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

SummarySince the adverse consequences of accidental peri-operative hypothermia have been recognised, there has been a rapid expansion in the development of new warming equipment designed to prevent it. This is a review of peri-operative warming devices and a critique of the evidence assessing their performance. Forced-air warming is a common and extensively tested warming modality that outperforms passive insulation and water mattresses, and is at least as effective as resistive heating. More recently developed devices include circulating water garments, which have shown promising results due to their ability to cover large surface areas, and negative pressure devices aimed at improving subcutaneous perfusion for warming. We also discuss the challenge of fluid warming, looking particularly at how devices' performance varies according to flow rate. Our ultimate aim is to provide a guide through the bewildering array of devices on the market so that clinicians can make informed and accurate choices for their particular hospital environment.

Longer follow-up is necessary, and biomechanical and finite element studies are needed to show long-term efficacy of this technique, however, early results indicate that such a construct is feasible. Furthermore, depending on the general medical condition of the patient, immediate postoperative weight bearing is possible and reasonable.

Background. Many cancers, including melanoma, exclusively express constitutive proteasomes (cPs) and are unable to express immunoproteasomes (iPs). In contrast, mature DCs used for immunotherapy exclusively express iPs. Since proteasomes generate peptides presented by HLA class I molecules, we hypothesized that mature melanoma antigen-loaded DCs engineered to process antigens through cPs would be superior inducers of antimelanoma immunity in vivo.Methods. Subjects with metastatic melanoma were vaccinated with mature DCs transfected with RNAs encoding melanoma antigens MART1, MAGE-3, gp100, and tyrosinase. These DCs were derived from monocytes that were untransfected (Arm A; n = 4), transfected with control siRNA (Arm B; n = 3), or transfected with siRNAs targeting the 3 inducible iP subunits (Arm C; n = 5).Results. Vaccination stimulated antigen-specific T cell responses in all subjects, which peaked after 3-4 vaccinations, but remained elevated in Arm C subjects. Also in Arm C, circulating melanoma cell levels (as detected by quantitative PCR) fell, and T cell lytic activity against autologous melanoma was induced. In HLA-A2 + subjects, CD8 + T cells that bound tetramers loaded with cP-derived melanoma antigenic peptides were found in the peripheral blood only in Arm C subjects. Of 2 subjects with active disease (both in Arm C), one had a partial clinical response, while the other, who exhibited diffuse dermal and soft tissue metastases, had a complete response. Conclusion.These results suggest that the efficacy of melanoma DC-based immunotherapy is enhanced when tumor antigen-loaded DCs used for vaccination express cPs.Trial registration. Clinicaltrials.gov NCT00672542.Funding.

SummaryForced-air warming exhaust may disrupt operating theatre airflows via formation of convection currents, which depends upon differences in exhaust and operating room air temperatures. We investigated whether the floor-to-ceiling temperatures around a draped manikin in a laminar-flow theatre differed when using three types of warming devices: a forced-air warming blanket (Bair Hugger TM ); an over-body conductive blanket (Hot Dog TM ); and an under-body resistive mattress (Inditherm TM ). With forced-air warming, mean (SD) temperatures were significantly elevated over the surgical site vs those measured with the conductive blanket (+2.73 (0.7)°C; p < 0.001) or resistive mattress (+3.63 (0.7)°C ; p < 0.001). Air temperature differences were insignificant between devices at floor (p = 0.339), knee (p = 0.799) and head height levels (p = 0.573). We conclude that forced-air warming generates convection current activity in the vicinity of the surgical site. The clinical concern is that these currents may disrupt ventilation airflows intended to clear airborne contaminants from the surgical site. . However, patient warming systems also release excess heat into the operating theatre that may generate convection currents even within a laminar flow system. It is possible that convection currents could disrupt the intended ceilingto-floor theatre airflows and therefore impede the ventilation system's ability to clear contaminants from the surgical site.There are two distinct categories of patient warming technology, forced-air and conductive heating. Forcedair devices deliver a heated airflow to a disposable coverlet that vents the hot air over the patient's body [6]. Conductive heating devices employ an electrically heated pad in contact with the patient's body [7]. Both types of devices appear to be comparably effective for the prevention of accidental peri-operative hypothermia [8][9][10][11][12][13][14], although forced-air devices are less efficient in transferring the applied heat to the patient than conductive devices [15]. Therefore, we might expect forced-air devices to generate a greater excess heat load on the ventilation system.

Background: Anecdotal evidence suggests that outdoor swimming can improve mood. This feasibility study examined the mood and well-being in participants attending an outdoor swimming course. Methods: Profile of Mood States and Short Warwick-Edinburgh Mental Well-being Scale questionnaires were completed by participants on a 10-week introductory outdoor swimming course (61 swimmers) and 22 controls who sat on the beach. Questionnaires were completed before and after three sessions: the first session (pool based), their first outdoor swim (session 4) and their final outdoor swim (session 10). Results: Swimmers reported acute increases in positive subscales (Esteem and Vigour, P < .001) and reductions in negative subscales (Tension, Anger, Depression, and Confusion and Total Mood Disturbance [TMD], P < .001, d = 1.1-1.7). TMD was also reduced between sessions (P < .001, d = 0.08). Well-being also increased during the course in swimmers (P < .001, d = 3.7) and controls (P = .019, d = 0.2). Greater reductions in TMD (P < .001, d = 0.8-2.5) and increases in well-being were observed in swimmers than controls (P = .034, r = .23). Conclusions: Novice outdoor swimmers participating in a 10-week introductory outdoor swimming course had acute and chronic reductions in negative mood, increases in well-being and acute increases in positive mood. Controls mood scores fluctuated and were similar at the start and end of the course, whereas well-being scores improved Abbreviations: POMS, Profile of Mood States; SWEMWBS, Short Warwick-Edinburgh Mental Well-being Scale; TMD, Total Mood Disturbance This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

No abstract