The constant work rate critical power protocol overestimates ramp incremental exercise performance

Abstract

Purpose

The parameters of the power-duration relationship (i.e., the critical power, CP, and the curvature constant, W′) may theoretically predict maximal performance capability for exercise above the CP. The CP and Wʹ are associated with the parameters of oxygen uptake ( \({\dot{\text{V}}}\) O₂) kinetics, which can be altered by manipulation of the work-rate forcing function. We tested the hypothesis that the CP and Wʹ derived from constant work-rate (CWR) prediction trials would overestimate ramp incremental exercise performance.

Methods

Thirty subjects (males, n = 28; females, n = 2) performed a ramp incremental test, and 3–5 CWR prediction trials for the determination of the CP and Wʹ. Multiple ramp incremental tests and corresponding CP and Wʹ estimates were available for some subjects such that in total 51 ramp test performances were predicted.

Results

The ramp incremental test performance (729 ± 113 s) was overestimated by the CP and Wʹ estimates derived from the best (751 ± 114 s, P < 0.05) and worst (749 ± 111 s, P < 0.05) individual fits of CWR prediction trial data. The error in the prediction was inversely correlated with the magnitude of the Wʹ for the best (r = −0.56, P < 0.05) and worst individual fits (r = −0.36, P < 0.05).

Conclusions

The overestimation of ramp incremental performance suggests that the CP and Wʹ derived from different work-rate forcing functions, thus resulting in different \({\dot{\text{V}}}\) O₂ kinetics, cannot be used interchangeably. The present findings highlight a potential source of error in performance prediction that is of importance to both researchers and applied practitioners.

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Ada County Paramedics ABC PSA

According to Ada County Paramedics call 911 call volume records, there were 15 infant sleep-related deaths since 2010, which is roughly two infant deaths each year.

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Ada County Paramedics ABC PSA

According to Ada County Paramedics call 911 call volume records, there were 15 infant sleep-related deaths since 2010, which is roughly two infant deaths each year.

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Substance abuse programs: What EMTs and paramedics need to know

Don Prince is a former fire chief, firefighter and EMS provider. He's also a recovering alcoholic, which is why he's a former fire chief, no longer a fire department member and not providing EMS care. In an article Prince wrote:

"One of the biggest things I could not let go of was my embarrassment, disappointment in myself and shame of having to resign my position as chief and my membership after almost 17 years of being a part of something that meant so much to me and for which I was not willing or able to make a choice to correct in order to try and save. Drinking was more important than my career and family at that time. I now see that if I had addressed my addiction years ago and sought the help that was offered to me none of this would have happened [1]."

Some EMS providers just like the patients they serve struggle with alcoholism and addiction. The daily stress of EMS work, as well as some cultural norms, may cause some EMS providers to unwind with friends and colleagues in situations where alcohol flows freely.

Research on alcohol use in EMS and fire
Science defines binge drinking as five or more servings for men or four or more servings for women. The definition is based on blood alcohol content — that consuming that many drinks within two hours typically raises BAC to 0.08 g/dL or higher [2].

In a study, funded by a grant from Federal Emergency Management Agency's Research and Development, firefighters were asked about their alcohol use. Data was collected from 656 male firefighters from 24 departments in the Missouri Valley region [3].

• Of the firefighters surveyed, 85 percent of career and 71 percent of volunteer firefighters reported drinking alcohol in the past 30 days.
• Approximately half of career and volunteer firefighters reported binge drinking in the past month.
• Career firefighters reported drinking 10 days per month, which is about half their off-duty days in most departments.
• Volunteer firefighters reported drinking an average of 12 days a month.

So, how do firefighters compare to the general male population in the United States" According to the 2013 National Survey on Drug Use and Health, 62 percent of males reported consuming alcohol in the past month — significantly lower than the fire service [4].

In 2010, the Centers for Disease Control and Prevention published data on binge drinking from more than 176,000 males. They found that 23 percent of males reported binge drinking in the month previous — half the rate of binge drinking reported in the fire service research [5].

We also know from anecdotal news reports, social media sharing and personal observation that EMS providers and firefighters seek solitude in the privacy of their own home in the company of a bottle of wine, beer or spirits. For a handful of addicts, the access to patient and agency medications can lead to a downward spiral of narcotics abuse, addiction and theft.

Substance treatment programs
The goal of substance abuse treatment is to stop drug or alcohol abuse and allow addicts to lead active lives in their family, workplace and community. One continual challenge, however, is keeping patients in treatment long enough for them to achieve this goal. That is why finding the right treatment for a person's specific needs is critical.

Drug abuse treatment is not one size fits all. Treatment outcomes depend on the [7]:

• Extent and nature of the person's problems
• Appropriateness of treatment
• Availability of additional services such as after-care
• Quality of interaction between the person and his or her treatment providers

To help addicts find appropriate care, the National Institute on Drug Abuse created a brief guide that asks five questions to answer when searching for a treatment program [8]:

1. Does the program use treatments backed by scientific evidence"
2. Does the program tailor treatment to the needs of each patient"
3. Does the program adapt treatment as the patient's needs change"
4. Is the duration of treatment sufficient"
5. How do 12-step or similar recovery programs fit into drug addiction treatment"

Information resources on drug and alcohol addiction
The Substance Abuse and Mental Health Services Administration is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

One of SAMHSA's programs is the National Registry of Evidence-based Programs and Practices, a repository and review system designed to provide the public with reliable information on mental health and substance abuse interventions. All interventions in the registry have met NREPP's minimum requirements for review. The programs' effects on individual outcomes have been independently assessed and rated by certified NREPP reviewers [9].

The Joint Commission is an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States. The Joint Commission accreditation and certification of substance abuse treatment centers is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards [10].

Addiction treatment programs
A variety of treatment options are available. Some treatment programs serve a diverse patient population while others focus their efforts on the specific characteristics of public safety personnel.

The Watershed is an addiction treatment program, licensed by the Florida Department of Children and Families, Substance Abuse Program Office and accredited by the Better Business Bureau. The Watershed also maintains Gold Seal accreditation through The Joint Commission. The Watershed has provided inpatient addiction, detoxification and rehabilitation services for over 14 years and successfully treated over 35,000 people [11].

The Watershed Addiction Treatment Programs website includes a wealth of resource including links for treatment programs in each of the 50 U.S. states.

In just three years, the Brattleboro Retreat Uniformed Service Program in Vermont has helped about 1,200 uniformed service professionals deal with issues including stress, substance abuse, trauma and depression [12]. Participants come to Brattleboro from throughout the United States, as well as military bases in Europe.

The Brattleboro Uniformed Service Program is a rigorous, brief — average stay is 10 days — partial hospitalization program for active or retired members of a uniformed service, such as police, fire, corrections, military and emergency medical service. Its structured and supervised psychotherapy program focuses on rapid clinical change, reduction of symptoms and stabilization and transitioning to outpatient service providers [13].

American Addiction Centers owns and operates adult drug and alcohol treatment and rehabilitation facilities nationwide. AAC has treatment facilities located in California, New Jersey, Florida, Texas, Nashville and Las Vegas [14].

The Rosecrance Florian Program for firefighters and paramedics incorporates occupational factors into the treatment process. The program's director is an active-duty Battalion Chief/EMT with more than 25 years of experience with the Chicago Fire Department. Operational medical control is provided by a board-certified psychiatrist and addictionologist who is trained and experienced in treating firefighters and paramedics for co-occurring disorders [15].

Do your research
Don Prince, the former fire chief, took his new "lease on life" as a recovering alcoholic and sought training and education from The Addictions Academy to become a Certified Recovery Coach and Interventionist through. The Addictions Academy is one of the nation's leading and accredited centers for individuals seeking training and certification in the fields of addiction treatment services, recovery/sober coaching and intervention.

During my e-mail exchange with Prince, he expressed the need for EMS providers looking for substance abuse treatment options to be cautious. "I would like to share with you my opinion of what the truth is as far as what is out there for one of us who needs help. It is not a very good situation given the current state of the substance abuse industry." [16].

Regarding some residential treatment facilities, Prince wrote, "The idea that a majority of the providers are in it to save lives and help you is not their primary intended mission. That comes secondary to filling beds and making a profit. What suffers is the quality of care during your stay at a facility and, even more importantly, is the lack of aftercare when you leave and get home and back on the job."

According to Prince, 80 percent of people leaving an addiction treatment center relapse within the first year of discharge. Nine out of ten of the addicts who relapse do so within their first 90 days after discharge. "Working with a Recovery Coach can significantly reduce the likelihood of relapse during this crucial period," wrote Prince. "Recovery Coaching is often the missing link, bridging the gap between an individual leaving a treatment center and maintaining long term sobriety."

References
1. Prince, D. Fighting the Devil Within. [Available: On-line] http://ift.tt/2fj3rlF"trk=mp-reader-card

2. FireRescue1. Firefighters and alcohol, what the data says. http://ift.tt/2ePVZLS

3. Ibid.

4. Ibid.

5. Ibid.

6. National Institute on Drug Abuse (NIDA/NIH). Anyone Can Become Addicted to Drugs. YouTube. https://youtu.be/SY2luGTX7Dk

7. National Institute on Drug Abuse. Seeking Drug Abuse Treatment: Know What to Ask. http://ift.tt/24uY7io

8. Ibid.

9. Substance Abuse and Mental Health Services Administration. National Registry of Evidence-based Programs and Practices. http://ift.tt/1SIOoyj

10. The Joint Commission. About The Joint Commission. http://ift.tt/1kWWHXK

11. The Watershed Addiction Treatment Programs. Frequently Asked Questions. http://ift.tt/2ePXb1W

12. Brattleboro Retreat. Uniformed Service Program. http://ift.tt/2fj7vC8

13. New England Psychologist. Program helps service professionals. http://ift.tt/2ePZNgm

14. American Addiction Centers. Frequently Asked Questions. http://ift.tt/2fj3wph

15. Rosecrance Florian Program. Firefighter & Paramedic Substance Abuse Treatment Program. http://ift.tt/2ePZa6r

16. Prince, D. Personal Communication via LinkedIn. April 14, 2016.

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When EMS calls leave you with a feeling of emptiness

By Anonymous Paramedic, Sacramento, Calif.

Some days it's a lot to handle. It's a hard thing to describe. I've never been one for talking about my feelings. The more important it is, the more powerful the feeling, the less I will say about it. The best I can do is to say that it is a feeling of crushing emptiness.

There is always a lot of talk about how this job can effect us. People die while we try to keep them from doing so. That is definitely a humbling feeling. I have worn other people's blood on my skin. I have heard the last words of people I have just met. I have felt my paradigm shift, and my ego crumble when I realize that I cannot help my patient and I do not know why.

I have experienced many of the stereotypical, harrowing experiences associated with this profession. I do not mean to underestimate the effects that those experiences can have on us, but for me personally it feels a little self-aggrandizing.

Those are the stories people expect.

When someone sees me staring into space, lost in my thoughts, it's easy for them to imagine those things running through my mind. I wish that were the case.

Make no mistake, I am struggling.

This job does eat away at me every day. There have been days that the toll is taken in one fell swoop, with a fast-paced, high pressure, traumatizing call.

Most days that isn't the case. Most days I don't have such a convenient target to point at when those feelings hit me. Most days it comes down like a light rain all around me.

There is no big wave. There is no crashing and breaking. Just a slow, steady rain, soaking into everything.

I see death every day, but it doesn't always make for a thrilling story. I see elderly patients over and over, slightly worse each day. I see demanding, high maintenance patients who really only called because they needed someone to talk to, someone to focus on them for a while. I see patients ashamed of themselves. Ashamed of their size, their appearance, or their hygiene. Ashamed that they need us. I see so much sadness. Not the potent sadness of an acute pain or loss. Not the sadness that allows for catharsis. I see a chronic sadness. Less a sharp stab, more a dull ache. A sadness that I don't realize is there until I begin to bend under the weight. Now I'm left searching for the source.

I do look back on certain calls and feel the twinge of the intense feelings that they evoked. I feel regret. I feel guilt. I feel incompetent. At least I feel a sense of understanding. I can understand the hurt of those calls. I can paint a picture in my mind. I can quantify the pain.

Those are not the thoughts running through my mind when I am lost in it all. Instead, I am left here wondering what is causing this. Why am I feeling this way" Why do the highs seem so much lower than they used to be" When did my life become the sum of so many minor injuries"

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When EMS calls leave you with a feeling of emptiness

By Anonymous Paramedic, Sacramento, Calif.

Some days it's a lot to handle. It's a hard thing to describe. I've never been one for talking about my feelings. The more important it is, the more powerful the feeling, the less I will say about it. The best I can do is to say that it is a feeling of crushing emptiness.

There is always a lot of talk about how this job can effect us. People die while we try to keep them from doing so. That is definitely a humbling feeling. I have worn other people's blood on my skin. I have heard the last words of people I have just met. I have felt my paradigm shift, and my ego crumble when I realize that I cannot help my patient and I do not know why.

I have experienced many of the stereotypical, harrowing experiences associated with this profession. I do not mean to underestimate the effects that those experiences can have on us, but for me personally it feels a little self-aggrandizing.

Those are the stories people expect.

When someone sees me staring into space, lost in my thoughts, it's easy for them to imagine those things running through my mind. I wish that were the case.

Make no mistake, I am struggling.

This job does eat away at me every day. There have been days that the toll is taken in one fell swoop, with a fast-paced, high pressure, traumatizing call.

Most days that isn't the case. Most days I don't have such a convenient target to point at when those feelings hit me. Most days it comes down like a light rain all around me.

There is no big wave. There is no crashing and breaking. Just a slow, steady rain, soaking into everything.

I see death every day, but it doesn't always make for a thrilling story. I see elderly patients over and over, slightly worse each day. I see demanding, high maintenance patients who really only called because they needed someone to talk to, someone to focus on them for a while. I see patients ashamed of themselves. Ashamed of their size, their appearance, or their hygiene. Ashamed that they need us. I see so much sadness. Not the potent sadness of an acute pain or loss. Not the sadness that allows for catharsis. I see a chronic sadness. Less a sharp stab, more a dull ache. A sadness that I don't realize is there until I begin to bend under the weight. Now I'm left searching for the source.

I do look back on certain calls and feel the twinge of the intense feelings that they evoked. I feel regret. I feel guilt. I feel incompetent. At least I feel a sense of understanding.  I can understand the hurt of those calls. I can paint a picture in my mind. I can quantify the pain.

Those are not the thoughts running through my mind when I am lost in it all. Instead, I am left here wondering what is causing this. Why am I feeling this way? Why do the highs seem so much lower than they used to be? When did my life become the sum of so many minor injuries?

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Carcinoma ovary with carcinoma cervix - A rare case of synchronous malignancy

2016-10-27T04-43-16Z
Source: The Southeast Asian Journal of Case Report and Review
Ashwini Arvind Natekar, Gautam Kr Mandal, Subhasis Basu.
Synchronous malignancies of genital tract are rare. Case report We report a case of carcinoma ovary with incidentally diagnosed carcinoma cervix. The patient had undergone total abdominal hysterectomy with bilateral salpingo-opherectomy with omentectomy and pelvic lymph node dissection for a right ovarian tumor which was reported as borderline malignancy on frozen section. On histological examination the ovarian malignancy was diagnosed as borderline papillary serous carcinoma. The cervix section showed in situ squamous cell carcinoma. Pelvic lymph nodes and omentum were free of tumor. The postoperative period was uneventful and the patient has no signs of malignancy on follow up till date. Conclusion Synchronous malignancies are associated with better prognosis with surgical resection being the treatment of choice. Since synchronous malignancies are rare it has to be reported.


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