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6 °C, p  less then  0.01), none of rectal temperature (38.0 ± 0.3 vs. 37.9 ± 0.4 °C, p = 0.30), local sweat rate (1.0 ± 0.3 vs. 0.9 ± 0.4 mg cm-2 min-1, p = 0.28), cutaneous blood flow (283 ± 116 vs. 287 ± 105 PU, p = 0.90), mean power output (206 ± 37 vs. 205 ± 41 W, p = 0.87) or total work completed (371 ± 64 vs. 369 ± 70 kJ, p = 0.77) showed any difference between environments during the work trial. 1-PHENYL-2-THIOUREA However, all perceptual measures (perceived exertion, thermal discomfort, thermal sensation, skin wettedness, pleasantness, all p  less then  0.05) were affected detrimentally during MOD compared to MILD. CONCLUSION In a warm and compensable environment, dry-bulb temperature did not influence high-intensity cycling performance when vapor pressure was maintained, whilst the perceptual responses were affected.PURPOSE The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS)  of 3 using video laryngoscopy versus direct laryngoscopy. METHODS A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. RESULTS The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p  less then  0.001). CONCLUSION Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.PURPOSE Peripheral nerve blockade (PNB) is a useful tool for pain control in the perioperative period. However, there are significant concerns about the use of PNBs following acute orthopaedic trauma due to the theoretical risk of masking acute compartment syndrome (ACS). This study aims to systematically review the effects of PNBs on diagnosis of ACS following long bone fractures. METHODS A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Six studies, all of which were single-patient case reports, met criteria for inclusion in this review. Two studies reported a delay in diagnosis of ACS in the setting of PNB use, while four studies did not. CONCLUSIONS Due to the low incidence of ACS, there is a paucity of literature available on ACS following PNB use in the setting of orthopedic trauma. There is no consensus in the literature about the safety of PNB use in the setting of acute long bone fractures, and this review could draw no conclusions from the literature, as the level of evidence is limited to case reports. PNBs should be administered to orthopedic trauma patients only in strictly controlled research environments, and surgeons should be highly cautious about using PNBs for orthopedic long bone fractures, particularly in cases at increased risk for developing ACS.BACKGROUND Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates’ self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS Joint training in the DSTC-DATC courses improved candidates’ perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.Taking 109 gymnosperm species in China as a case, the uncertainty and risk of losing habitat areas of gymnosperm species under future climate conditions were investigated via representative concentration pathways climate change scenarios, fuzzy set classifications and Monte Carlo techniques. Under nonrandom climate change scenarios, the richness of 109 species increased in the partial locations of northwestern and northeastern China and declined in the partial locations of eastern and central and southeastern China; the numbers of species that losing less then 20%, 20-40%, 40-60%, 60-80%, and over 80% of their current habitat areas were ~33-49, 36-40, 11-24, 7-9, and 2-8, respectively; ~99-105 species occupied over 80% of their total suitable areas and ~4-9 species occupied 60-80% their total suitable areas. Under random climate change scenarios, the number of species that losing various level of the habitat areas declined with enhancing probability; with a probabilities of over 0.6, the numbers of species that losing less then 20%, 20-40%, 40-60%, 60-80% and over 80% of their current habitat areas were ~19-28, 3-19, 0-3, 1-2, and 9-14, respectively, and the numbers of species that occupying ~20%, 20-40%, 40-60%, 60-80%, and over 80% of their total suitable areas were ~9-14, 4-11, 2-6, 1-3, and 34-45, respectively.