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PubMed1992

Expedition stress and personality change.

There have been few attempts to investigate the widespread assumption that short-term challenges can have beneficial effects on personality. An expedition to India organized by the British Schools Exploring Society provided such an opportunity. The Gordon Personal Profile Inventory showed that the expedition was associated with increased ascendancy, emotional stability, sociability and responsibility, and decreased cautiousness. Women tended to benefit more than men. The results suggest that the expedition was associated with positive personality changes, though other explanations of the findings cannot be ruled out.

Adolescent↗
PubMed2003

Peripheral responses to cold: case studies from an Arctic expedition.

OBJECTIVE: An Arctic expedition provided an opportunity to examine the interaction between cold injury and peripheral acclimatization. The conditions were similar to those during which acclimatization has been demonstrated, yet they were also conducive to development of peripheral cold injury. METHODS: Extremity digit temperatures were measured during 30-minute peripheral cold-water (4 degrees C) immersion (CWI) in 2 explorers (R.G. and T.L.) before and after a 109-day Arctic ski trek (average T(air) = -21 degrees C). This self-supported trek involved carrying heavy backpacks (up to 45 kg) and hauling sleds (approximately 100 kg). RESULTS: During the expedition, the explorers' hands did not sustain frostbite, but their feet developed moderate trench foot. Unexpectedly, both men exhibited lower mean finger temperatures during CWI after the expedition in right and left hands (R.G. by 0.9 degrees C and 0.2 degrees C; T.L. by 1.8 degrees C and 1.1 degrees C), suggesting peripheral acclimatization was impaired. In contrast, mean toe temperatures during CWI were warmer in both right and left feet for T.L. (by 3.6 degrees C and 2.3 degrees C) and in the left foot for R.G. (by 1.3 degrees C) postexpedition. There was no change in R.G.'s right toe mean temperature. CONCLUSIONS: We speculate that prolonged heavy load carriage may have impaired blood flow or nerve conduction in the hands and inhibited acclimatization. Our data also suggest that despite incidence of moderate trench foot, acclimatization can still occur after resolving this injury.

Acclimatization↗
PubMed2004

To air is human: altitude illness during an expedition length adventure race.

OBJECTIVE: To calculate the incidence and prevalence of altitude illness (acute mountain sickness [AMS], high altitude pulmonary edema, and high altitude cerebral edema) during an expedition length adventure race and to determine factors contributing to its development as well as identify cases requiring medical treatment, withdrawal from the event, or both. METHODS: The Primal Quest Expedition Length Adventure Race was held in Colorado in July 2002. Sixty-two coed teams of four participated in the event. It began at an altitude of over 9500 feet, ascended to an altitude over 13,500 feet with a cumulative elevation gain of 69,400 feet, of which 40,000 feet occurred in the first 12 hours of the event. There was 138,800 total feet of altitude change during the event. All racers underwent a prerace medical assessment 24 hours before the start of the race and completed an Environmental Systems Questionnaire version 3-R (ESQ 3-R). Onsite medical staff provided treatment during the event. A standard medical encounter form was used to record all patient encounters including a presumed diagnosis and disposition. RESULTS: At the start of the race, the prevalence of altitude illness was 4.5%. The incidence of altitude illness requiring medical treatment during the race was 14.1% (AMS, 33 [13.3%]; high altitude pulmonary edema, 2 [.81%]) resulting in 4 (14.3%) of the 28 medical withdrawals from the race. There was no correlation between home altitude, prerace ESQ scores, and successful completion of the race. CONCLUSIONS: Altitude illness occurs among participants in expedition length adventure races and contributes significantly to withdrawal from the event.

Adult↗
PubMed2004

Morbidity and determinants of health on youth expeditions.

OBJECTIVE: To document the prevalence of illness and injury on youth expeditions and analyze specific determinants of health. METHODS: Two thousand nine hundred fifteen people, aged 15 to 18 years, traveled with a commercial company, World Challenge Expeditions Ltd, between June and September 2001. Adult team leaders were required to keep medical cards for each person. This study is a retrospective analysis of these medical cards. RESULTS: Completed medical cards were available for 2402 people (82%). There were no medical problems in 36% of people. Illness or injury was reported by 64% (mean, 2.0 medical problems per person). Of the medical problems, 6% were defined as serious, and 1% were admitted to the hospital. One fatality occurred. The five most prevalent medical problems were diarrhea (22%), nausea and vomiting (20%), cold or sore throat (11%), headache (11%), and trauma (10%). Girls reported 19% more medical problems than the boys reported. Gastrointestinal illness was significantly increased at high altitude. Illness and injury were most prevalent in South America and least prevalent in Australasia. CONCLUSIONS: Our results demonstrate that in young people traveling to remote parts of the world, illness and injury are common. Serious incidents are rare; however, the death of one person does highlight the dangers present. This study may help risk assessment for young people considering taking part in an expedition.

Adolescent↗
PubMed2000

Effects of different stay durations on attentional performance during two mountain expeditions.

BACKGROUND: Hypoxia-induced deficits in intellectual performance are linked to the altitude level reached, the speed of the ascent and the time spent at high altitude. This study analyzes attentional changes during adaptation to two different types of stay at high altitude on two different expeditions: one involving a 16-d trip between 2,000 m and 5,600 m, followed by a 2-d ascent to 6,440 m and back again; the other, a 21-d stay at 6,542 m. We tested the hypothesis that, at similar high altitudes, decrements in attentional performance would only occur during a long duration stay. METHODS: Indexes for attentional performance were calculated for two experimental groups under normoxia before the climb, under acute and chronic hypoxia during the climb, and under normoxia after the climb. They were compared for two control groups tested only under normoxia. RESULTS: The altitude stay was found to have an effect on the 6,542 m group when compared with the controls. Group performance differed at 2 d and 21 d after their arrival at 6,542 m and after their return to normoxia. When all the test administrations were pooled together for this expedition we noted an interaction between the level of difficulty of the task and the experimental and control groups: namely the difference between the groups was greater for the difficult task than it was for the easy task. No effect was found for the other expedition (at 5,600 m) when the group tested was compared with the controls. CONCLUSION: For a 21-d stay at an altitude of 6,542 m with the same ascent protocol as a group climbing to a lower altitude (16 d between 2,000 m and 5,600 m followed by a 2 d ascent to 6,440 m and back again), subjects appeared to suffer from attentional performance deficits which persisted for several days after the subjects returned to normoxic conditions.

Acclimatization↗
PubMed1989

Changes in cardiac and respiratory function of Antarctic Research Expedition members--preliminary report.

Cardiac and respiratory functions were estimated in 16 Chinese Antarctic Research Expedition members (Third expedition) before and after spending three months in the Antarctic. No significant changes were found in ECG examination. In cardiac function test, prolonged LVET and abbreviated PEP were found. PEP/LVET decreased significantly. Respiratory ventilation function examination showed an increase in FEV1 and FEV25 and a decrease in ERC. Results showed that cardiac and respiratory functions remained almost unchanged in the Expedition members. It is also suggested that a physiological compensation may have occurred in these members' cardiac functions either in the Antarctic or during the return sea voyage.

Antarctic Regions↗
PubMed1985

Assessment of immunological responsiveness in members of International Biomedical Expedition to the Antarctic 1980/81.

Analysis of immune responsiveness was performed in members of the IBEA during a controlled trial of acclimatization with cold baths and during the subsequent 71 day period of Antarctic isolation. Several parameters of humoral and cellular immunity were assessed. No differences were found for those individuals who underwent cold-acclimatization in the first phase of the expedition. On the ice-cap all members showed slight elevation of their immunoglobulins, the increase in IgA reaching significance (p less than 0.05). Values returned to normal on returning to Sydney. Enhanced reactivity to the mycobacterium antigen purified protein derivative (PPD) was found on the ice-cap with 4 individuals becoming positive and remaining so on returning to Sydney. There was no obvious exposure to mycobacterium during the expedition but it is recommended that in future expeditions all PPD negative individuals be vaccinated with BCG.

Adaptation, Physiological↗
PubMed1996

Lung diffusion capacity, oxygen uptake, cardiac output and oxygen transport during exercise before and after an himalayan expedition.

Studies were made of pulmonary diffusion capacity and oxygen transport before and after an expedition to altitudes at and above 4900 m. Maximum power (Pmax) and maximal oxygen uptake (VO2max) were measured in 11 mountaineers in an incremental cycle ergometer test (25W.min-1) before and after return from basecamp (30 days at 4900 m or higher). In a second test, cardiac output (Qc) and lung diffusion capacity of carbon monoxide (DL,cg) were measured by acetylene and CO rebreathing at rest and during exercise at low, medium and submaximal intensities. After acclimatization, VO2max and Pmax decreased by 5.1% [from 61.0 (SD 6.2) to 57.9 (SD 10.2) ml.kg-1, n.s.] and 9.9% [from 5.13 (SD 0.66) to 4.62 (SD 0.42) W.kg-1, n.s.], respectively. The maximal cardiac index and DL,cg decreased significantly by 15.6% [14.1 (SD 1.41) 1.min-1.m-2 to 11.9 (SD 1.44)1.min-1.m-2, P < 0.05] and 14.3% [85.9 (SD 4.36) ml.mmHg-1. min-1 to 73.6 (SD 15.2) ml.mmHg-1.min-1, P < 0.05], respectively. The expedition to high altitude led to a decrease in maximal Qc, oxygen uptake and DL,cg. A decrease in muscle mass and capillarity may have been responsible for the decrease in maximal Qc which may have resulted in a decrease of DL,cg and an increase in alveolar-arterial oxygen difference. The decrease in DL,cg especially at lower exercise intensities after the expedition may have been due to a ventilation-perfusion mismatch and changes in blood capacitance. At higher exercise intensities diffusion limitation due to reduced pulmonary capillary contact time may also have occurred.

Acclimatization↗
PubMed1986

The physical characteristics of the members during the International Biomedical Expedition to the Antarctic.

Twelve male medical scientists formed the International Biomedical Expedition to the Antarctic (IBEA). Their physical characteristics and maximum oxygen uptakes (VO2max) were measured in association with three series of thermal tolerance tests in Sydney, twice before and once after going to the Antarctic. In the Antarctic they lived in tents and spent 15 days travelling by motor toboggan. Their body mass (BM) and skinfold thickness (SFT) were measured four times during the 69 days the expedition spent in the field. The characteristics of the group were (ranges): age 26-52 years, height 1680-1889 mm, BM 58.5-103.4 kg, fatness 16-34% BM and VO2max 33-49 ml X kg-1 X min-1. In the Antarctic 9 men lost between 0.7 and 5.5 kg (mean 2.7 kg) of BM with a decrease in SFT, whilst 2 men increased BM by 1.2 and 1.9 kg without change in SFT. One man retired early from the expedition. BM and SFT were regained and physical fitness lost during the return voyage to Australia. Consequently there was no difference in average SFT between the pre- and post-Antarctic laboratory tests, but BM was greater after the Antarctic implying gains in fat free mass. VO2max was lower in the final laboratory tests than in the tests before Antarctica.

Acclimatization↗
PubMed2004

Effect of a high-altitude expedition to a Himalayan peak (Pumori, 7,161 m) on plasma and erythrocyte antioxidant profile.

The effects of a high-altitude exposure were studied in six mountaineers who spent 3 weeks at an altitude range between 5,250 and 7,161 m after 1 week in an acclimatization trek (2,800-5,250 m). Blood drawn from the antecubital vein was collected at sea level 1 day before and 1 day after the expedition to analyse some haematological variables [haemoglobin (Hb), haematocrit (Htc) and red blood cell (RBC) count], erythrocyte antioxidant enzyme activity [superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (Gr)] and membrane fatty acid profile [mono-unsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), saturated fatty acids (SFA), trans fatty acids (TRANS)]. Moreover, total antioxidant status (TAS), thiobarbituric acid reactive substances (TBARS), thiol protein groups (SH), SOD, GPx and Gr were measured in plasma. High-altitude exposure induced polycythaemia, with significant increases in RBC count (5.26%), Hb concentration (4.83%) and Htc (6.26%). Furthermore, a significant increase in plasma TBARS, SOD and Gr was observed after the expedition, whereas SH, TAS and GPx decreased. Erythrocyte glutathione-cycle-related antioxidant enzyme activity was upregulated, whereas SOD activity was maintained after the expedition. In addition, despite the unchanged (MUFA+PUFA)/SFA ratio, the membrane erythrocyte fatty acid content showed a significant increase in PUFAs and a decrease in TRANS, suggesting enhanced membrane fluidity. In conclusion, it seems that high-altitude exposure, besides quantitative variations in RBC expression, induced plasma oxidative stress and damage, and significant changes in erythrocyte components, namely in antioxidant enzyme activity and membrane fatty acid profile that might modify RBC functionality.

Adaptation, Physiological↗
PubMed1993

Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol.

A prospective study that compared a traditional emergency department (ED) triage protocol with an expedited protocol was conducted to determine if minimizing the subjectivity of nursing triage would result in more efficient management of adult patients presenting with nontraumatic chest pain. The traditional protocol triaged 382 patients into 1 of 5 categories of acuity. The expedited study group (418 patients) were triaged as usual but subsequently were treated as if they were triage category 1 or 2 (medical evaluation within 15 minutes of arrival). Traditional triage led to 40% of acute myocardial infarction (AMI) patients being triaged into inappropriately low-acuity categories. The expedited protocol resulted in significant improvement in the following intervals: ED arrival to triage, triage to cubicle, ED arrival to cubicle, ED arrival to electrocardiogram (ECG) ordered, ED arrival to ECG available, ED arrival to physician evaluation, and ED arrival to decision to thrombolyse. Study patients with non-AMI cardiac chest pain and AMI cardiac chest pain were evaluated by a physician an average of 12 minutes and 8 minutes after ED arrival, respectively. Delays in interdepartmental processes, such as ECG-technician responsiveness, thrombolysis protocol fulfillment and thrombolytic agent delivery, negated benefits derived from improvements in internal processes. Effective coordination of the numerous processes involved in the initial ED management of adult patients with nontraumatic chest pain is required to make thrombolytic therapy for AMI within 30 minutes of patient arrival a routinely achievable goal.

Adult↗
PubMed2006

Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion.

BACKGROUND: In patients undergoing transesophageal echocardiography-guided cardioversion, we evaluated the use and safety of an expedited in-hospital anticoagulation regimen that incorporates shorter-than-standard durations of precardioversion intravenous unfractionated heparin and postcardioversion bridging therapy with a low-molecular-weight heparin. METHODS: Adult patients who underwent successful transesophageal echocardiography-guided cardioversion for atrial fibrillation or atrial flutter between May 2000 and August 2003 were classified into 2 groups by duration of intravenous unfractionated heparin therapy (<24 h or > or =24 h) before transesophageal echocardiography and cardioversion. Safety end points evaluated included all-cause death, stroke or other thromboembolic events, and major bleeding complications within 1 month after successful cardioversion. RESULTS: The study population of 386 patients included 199 (52%) who received expedited intravenous unfractionated heparin (<24 h; minimum duration, <4 h) and 193 patients (50%) who were discharged on low-molecular-weight heparin therapy. The adverse event rates at 1-month follow-up were not significantly different between the 2 unfractionated heparin patient groups, and the rate of stroke among patients dismissed on low-molecular-weight heparin was less than 1%. No adverse events occurred among patients who received intravenous unfractionated heparin for less than 12 hours and who were dismissed on low-molecular-weight heparin bridging therapy. CONCLUSIONS: The use of an expedited heparin anticoagulation regimen in patients with atrial fibrillation or atrial flutter undergoing transesophageal echocardiography-guided cardioversion appears to be safe. Cardioversion can be performed as early as a few hours after initiation of intravenous unfractionated heparin, and bridging therapy with a low-molecular-weight heparin can be used after cardioversion until the international normalized ratio is therapeutic.

Aged↗
PubMed2006

Acute stroke care at rural hospitals in Idaho: challenges in expediting stroke care.

CONTEXT: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. PURPOSE: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. METHODS: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. FINDINGS: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. CONCLUSIONS: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays.

Clinical Protocols↗
PubMed1988

University of Edinburgh veterinary expeditions: 1966 to 1986.

Since 1966, teams of new graduates from the Royal (Dick) School of Veterinary Studies have organised eight veterinary research expeditions to Africa, tropical America and the Seychelles. The expeditions are now a regular feature of the school's activities. It is now possible to look back, learn and advise on future expeditions regarding timing, research and funding.

Animals↗
PubMed2006

An expedited code stroke protocol is feasible and safe.

BACKGROUND AND PURPOSE: Stroke recovery critically depends on timely reperfusion. In July 2003, we set a benchmark onset-to-treatment time of < or =2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe. METHODS: The expedited protocol includes: Benchmark onset-to-treatment within 2 hours; in-person triage of all code stroke patients; unmixed tissue plasminogen activator at the bedside during evaluation; no delays pending coagulation tests, chest x-ray, or stool guiac unless specifically indicated; and no delays pending formal CT interpretation or written consent. RESULTS: Between July 2003 and June 2005, we evaluated 781 patients and treated 103 of 781 (13.2%) with intravenous recombinant tissue plasminogen activator within 3 hours. Of these, we treated 49 of 103 (47.6%) within 2 hours of symptom onset, and 54 of 103 (52.4%) between 2 and 3 hours. The overall risk of symptomatic intracerebral hemorrhage was 4 of 103 (3.9%; 95% CI, 1.1%, 9.6%), and not significantly different from 6.4% (P=0.42). The hemorrhage risks in those treated within 2 hours of symptom onset and those treated between 2 and 3 hours were not significantly different from each other or from 6.4%. CONCLUSIONS: The expedited code stroke protocol is feasible and appears safe. Further study is warranted to confirm its safety and determine whether it results in better clinical outcomes.

Adult↗
PubMed1998

Partitioned weight loss and body composition changes during a mountaineering expedition: a field study.

Weight loss and changes in body composition are recognized phenomena associated with high-altitude mountaineering expeditions. Attempts to partition the weight loss between fat mass (FM) and fat-free mass (FFM) have been inconclusive. Therefore, five male subjects, average age 40.0 +/- 5.5 years, were studied prior to, during, and following a 21-day expedition between 2200 m and 4300 m on Mt. McKinley, Alaska. Pre- to postexpedition body composition changes were determined by densitometry, skinfold thickness (12 sites), body girth measurements (14 sites), and cross-sectional area from magnetic resonance imaging (MRI) (three sites). Data analysis by Student's t-test (p < 0.05(1) tail) indicated decreases in body weight (4.2 +/- 2.8 kg, 220 g/day, 5.4% of initial weight), total skinfold thickness (10.8%), total body girth (2.8%), and percentage of fat by densitometry (15%). Total cross-sectional area of the three MRI slices (upper arm + thigh + calf) decreased 4.7%, muscle area decreased 9.1%, and fat area decreased 3.9%. The three methods used to partition the weight loss between FM and FFM did not agree: 77% FM vs 23% FFM by densitometry, 25% FM vs 75% FFM by skinfolds, and 38% FM vs 62% FFM by MRI. Energy intake (3640 +/- 1250 kcal/day) was negatively correlated (Pearson r > 0.88(2) tail) with losses in weight (r = -0.89), skinfolds (r = -0.93), and girths (r = -0.88), ie the greater the intake the less the decline. Therefore, insufficient energy intake appeared primarily responsible for the weight loss and changes in body composition during the expedition.

Absorptiometry, Photon↗
PubMed2003

When epilepsy may have changed history: Antônio Moreira César as the commander of the third expedition in the war of Canudos.

Colonel Antônio Moreira César, the Commander of the third Expedition against Canudos (1896-1897), nicknamed "head-chopper", was considered an implacable military man, a synonym of ferocity and extreme brutality against his adversaries. Therefore, he was nominated the Commander of an expedition considered almost invincible. Since his 30's he presented epileptic seizures, which increased in frequency and severity on his way to Canudos. After several well-documented episodes and probably considering himself the winner in anticipation, he ordered a premature and almost ingenuous attack against Canudos. His misjudging is attributed to the effect of successive seizures. He was shot and killed on the very first day of that battle and his expedition had a horrible and unexpected end. Based on the descriptions of his biographer we discuss the nature of his disease probably characterized by focal seizures with elementary and complex visual hallucinations followed by language deficits and episodes of complex partial seizures and secondary generalization and its role in this episode of Brazilian history.

Brazil↗
PubMedDate not supplied

A study of the incidence of accidents occurring during an Arctic expedition: another important aspect of travel medicine?

The number of expeditioners and independent adventure travelers to remote and physically demanding areas is increasing. Recent evidence suggests that trauma and accidents (resulting mainly from road traffic accidents and drowning) are the primary cause of mortality in travelers rather than infectious diseases.1,2 The risks and potential hazards faced on an expedition are likely to be different from those encountered by other travelers. An extensive literature search revealed little data concerning the incidence and nature of accidents on expeditions, or concerning the young adventure traveler. The objective of this study was to determine the frequency and type of accidents that occurred on a 6-week summer arctic expedition, undertaken by "young explorers" and their leaders. This information will be valuable in order to identify potential risks as part of the pretravel risk assessment, and consequently improve the medical briefing and training of expeditioners and adventure travelers.

Accidents↗