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Purpose: Training characteristics such as duration, frequency, and intensity can be manipulated to optimize endurance performance, with an enduring interest in the role of training-intensity distribution to enhance training adaptations. Training intensity is typically separated into 3 zones, which align with the moderate-, heavy-, and severe-intensity domains. While estimates of the heavy- and severe-intensity boundary, that is, the critical speed (CS), can be derived from habitual training, determining the moderate-heavy boundary or first threshold (T1) requires testing, which can be costly and time-consuming. Therefore, the aim of this review was to examine the percentage at which T1 occurs relative to CS., Results: A systematic literature search yielded 26 studies with 527 participants, grouped by mean CS into low (11.5 km·h-1; 95% CI, 11.2-11.8), medium (13.4 km·h-1; 95% CI, 11.2-11.8), and high (16.0 km·h-1; 95% CI, 15.7-16.3) groups. Across all studies, T1 occurred at 82.3% of CS (95% CI, 81.1-83.6). In the medium- and high-CS groups, T1 occurred at a higher fraction of CS (83.2% CS, 95% CI, 81.3-85.1, and 84.2% CS, 95% CI, 82.3-86.1, respectively) relative to the low-CS group (80.6% CS, 95% CI, 78.0-83.2)., Conclusions: The study highlights some uncertainty in the fraction of T1 relative to CS, influenced by inconsistent approaches in determining both boundaries. However, our findings serve as a foundation for remote analysis and prescription of exercise intensity, although testing is recommended for more precise applications.

This paper summarizes historical asbestos exposure data collected during the handling of short-fiber chrysotile asbestos that was used as an additive to drilling fluid in oil and gas exploration. A total of 1171 industrial hygiene (IH) personal and area air samples were collected and analyzed from more than 20 drilling rigs between 1972 and 1985. The dataset consists of 1097 short-term samples (<240 min) with more than 80% having sample durations less than 30 min. Average airborne fiber concentrations measured during asbestos handling activities ranged from 0.62 f/cc to 3.39 f/cc using phase-contrast microscopy (PCM). An additional 14 samples were considered long-term samples (>240 min) and there were 60 samples with no reported sample duration. Eight-hour time-weighted average (8-h TWA) results, calculated using short-term samples, along with long-term samples greater than 240 min, did not exceed contemporaneous Occupational Safety and Health Administration (OSHA) permissible exposure limits (PELs). This analysis fills a data gap in the evaluation of asbestos exposures from the use of drilling mud additives (DMAs) that contained chrysotile asbestos., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Ramboll is an environmental and health consulting firm that assists clients on a range of matters including assessing chemical exposures and risks in occupational and environmental settings to various stakeholders including law firms, government agencies, and industry clients. The writing and production of the article was undertaken at the authors’ expense. Four of the authors (MH, JE, RA, and EA) have testified on behalf of defendants in asbestos litigation matters, including defendants related to DMAs. No client or defendant in litigation requested that this work be performed, nor reviewed this paper prior to its publication.

Background: Hearing loss (HL) is associated with adverse cognitive, mental, and physical health outcomes. There is evidence that across age groups HL is more prevalent in people with schizophrenia than the general population. Given that people with schizophrenia may already be vulnerable to cognitive and psychosocial disability, we sought to examine how hearing ability relates to concurrent levels of cognitive, mental and daily functioning., Methods: Community-dwelling adults with schizophrenia (N = 84) ages 22-50 completed pure tone audiometry assessments. Hearing threshold (in decibels) was defined as the lowest detectable pure tone at 1000 Hz. Pearson correlation was used to test the hypothesis that higher hearing thresholds (worse hearing) would be significantly associated with poorer performance on the Brief Assessment of Cognition in Schizophrenia (BACS). Additional analyses explored the relationships between audiometric threshold and functional capacity measured with the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and symptoms severity rated on the Positive and Negative Syndrome Scale (PANSS)., Results: Hearing threshold was inversely and significantly correlated with the BACS composite score (r = -0.27, p = 0.017). This relationship was reduced but remained significant after controlling for age (r = -0.23, p = 0.04). Hearing threshold was not associated with VRFCAT or psychiatric symptom measures., Conclusions: While schizophrenia and HL are independently associated with cognitive impairment, the magnitude of impairment in this sample was greater among those with poorer hearing. Findings warrant further mechanistic study of the relationship between hearing impairment and cognition and have implications for addressing modifiable health risk factors for higher morbidity and mortality in this vulnerable population., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2023. Published by Elsevier B.V.)

Early auditory processing (EAP) deficits are prevalent in schizophrenia and linked to disturbances in higher order cognition and daily functioning. Treatments that target EAP have the potential to drive downstream cognitive and functional improvements, but clinically feasible means to detect EAP impairment are lacking. This report describes the clinical feasibility and utility of using the Tone Matching (TM) Test to assess EAP in adults with schizophrenia. Clinicians were trained to administer the TM Test as part of a baseline cognitive battery to inform choice of cognitive remediation (CR) exercises. Only if the TM Test indicated EAP impairment, were the recommended CR exercises to include EAP training. Results indicated clinicians included the TM Test in all baseline assessments and identified 51.72% as EAP impaired. There were significant positive relationships between TM Test performance and cognitive summary scores, confirming instrumental validity. All clinicians found the TM Test useful for CR treatment planning. CR participants with impaired EAP spent significantly more training time on EAP exercises compared to CR participants with intact EAP (20.11% vs 3.32%). This study found that it is feasible to use the TM Test in community clinics and the test was perceived as clinically useful for personalizing treatment., Competing Interests: Declaration of Competing Interest DCJ holds equity in Glytech, AASI and NRX pharma. He has served as a consultant for SK Life Sciences, Biogen, Boehringer Ingelheim, Autifony and Anavex. He has received research support from Cerevance. He holds intellectual property for use of NMDAR agonists in treatment of schizophrenia; NMDAR antagonists for treatment of depression; neurophysiological measures for detection of amyloid deposition; and parcel-guided approaches to brain stimulation. AM serves as a consultant at Boehringer Ingelheim and Sumitomo and receives royalties from Oxford University Press. Other authors report no potential COI., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: The authors characterized hearing loss among individuals diagnosed as having schizophrenia to inform provision of routine behavioral health services to this population., Methods: Audiometry data collected between October 2019 and December 2021 from 84 community-dwelling adults with schizophrenia and 81 age-matched participants without the condition were analyzed. Rates of hearing loss were identified within groups and across age decades (20-50 years). Hearing threshold and rates of hearing loss were compared between groups., Results: Participants with schizophrenia had significantly higher mean hearing thresholds (p=0.006), indicating worse hearing. This difference remained significant after controlling for age (p=0.01). A significantly larger proportion of participants with schizophrenia had mild hearing loss (24%) compared with age-matched participants (6%) (p = 0.002), with higher rates of mild hearing loss observed across all ages., Conclusions: Screening for and detection of hearing loss among adults with schizophrenia may be an unmet need. Hearing loss is a treatable source of cognitive and psychosocial disability, warranting scalable assessment and intervention practices.

Aim: This study characterised the decoupling of internal-to-external workload in marathon running and investigated whether decoupling magnitude and onset could improve predictions of marathon performance., Methods: The decoupling of internal-to-external workload was calculated in 82,303 marathon runners (13,125 female). Internal workload was determined as a percentage of maximum heart rate, and external workload as speed relative to estimated critical speed (CS). Decoupling magnitude (i.e., decoupling in the 35-40 km segment relative to the 5-10 km segment) was classified as low (< 1.1), moderate (≥ 1.1 but < 1.2) or high (≥ 1.2). Decoupling onset was calculated when decoupling exceeded 1.025., Results: The overall internal-to-external workload decoupling experienced was 1.16 ± 0.22, first detected 25.2 ± 9.9 km into marathon running. The low decoupling group (34.5% of runners) completed the marathon at a faster relative speed (88 ± 6% CS), had better marathon performance (217.3 ± 33.1 min), and first experienced decoupling later in the marathon (33.4 ± 9.0 km) compared to those in the moderate (32.7% of runners, 86 ± 6% CS, 224.9 ± 31.7 min, and 22.6 ± 7.7 km), and high decoupling groups (32.8% runners, 82 ± 7% CS, 238.5 ± 30.7 min, and 19.1 ± 6.8 km; all p < 0.01). Compared to females, males' decoupling magnitude was greater (1.17 ± 0.22 vs. 1.12 ± 0.16; p < 0.01) and occurred earlier (25.0 ± 9.8 vs. 26.3 ± 10.6 km; p < 0.01). Marathon performance was associated with the magnitude and onset of decoupling, and when included in marathon performance models utilising CS and the curvature constant, prediction error was reduced from 6.45 to 5.16%., Conclusion: Durability characteristics, assessed as internal-to-external workload ratio, show considerable inter-individual variability, and both its magnitude and onset are associated with marathon performance., (© 2022. The Author(s).)

New Findings: What is the topic of this review? Biological and methodological factors associated with the variable changes in cardiorespiratory fitness in response to endurance training. What advances does it highlight? Several biological and methodological factors exist that each contribute, to a given extent, to response variability. Notably, prescribing exercise intensity relative to physiological thresholds reportedly increases cardiorespiratory fitness response rates compared to when prescribed relative to maximum physiological values. As threshold-based approaches elicit more homogeneous acute physiological responses among individuals, when repeated over time, these uniform responses may manifest as more homogeneous chronic adaptations thereby reducing response variability., Abstract: Changes in cardiorespiratory fitness (CRF) in response to endurance training (ET) exhibit large variations, possibly due to a multitude of biological and methodological factors. It is acknowledged that ∼20% of individuals may not achieve meaningful increases in CRF in response to ET. Genetics, the most potent biological contributor, has been shown to explain ∼50% of response variability, whilst age, sex and baseline CRF appear to explain a smaller proportion. Methodological factors represent the characteristics of the ET itself, including the type, volume and intensity of exercise, as well as the method used to prescribe and control exercise intensity. Notably, methodological factors are modifiable and, upon manipulation, alter response rates to ET, eliciting increases in CRF regardless of an individual's biological predisposition. Particularly, prescribing exercise intensity relative to a physiological threshold (e.g., ventilatory threshold) is shown to increase CRF response rates compared to when intensity is anchored relative to a maximum physiological value (e.g., maximum heart rate). It is, however, uncertain whether the increased response rates are primarily attributable to reduced response variability, greater mean changes in CRF or both. Future research is warranted to elucidate whether more homogeneous chronic adaptations manifest over time among individuals, as a result of exposure to more homogeneous exercise stimuli elicited by threshold-based practices., (© 2021 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Cognitive remediation (CR) is an evidence-based therapy used to improve cognition in people with schizophrenia. However, it often requires multiple in-person clinic sessions per week, which can limit scalability. This mixed methods study considered the feasibility and acceptability of a hybrid approach, which allowed for half the sessions to be conducted remotely as homework, without the clinician present. Individuals with schizophrenia were randomized to either all in-clinic or hybrid conditions and completed questionnaires and individual interviews about their experience. CR clinicians provided feedback in complement. Because of limited access to technology, most Hybrid CR participants had to come to clinic to access computers and often sought clinician support to do their homework. Participants in the two conditions were equally satisfied per the Client Satisfaction Questionnaire, and the majority reported perceived benefit and enjoyment. Both CR participants and clinicians identified access to technology as a barrier to program feasibility, while availability of clinician support positively impacted acceptability. Suggestions to improve CR highlighted adopting a flexible approach to providing CR that accounts for participant access to technology, potential benefit from peer interaction, and need for clinician support., (Copyright © 2021. Published by Elsevier B.V.)

Objective: To evaluate the ability of internal thoracic impedance (ITI) monitors to predict cardiogenic pulmonary edema in patients at risk., Design and Setting: Prospective, controlled multicenter study., Patients: We examined 328 consecutive patients admitted for cardiac conditions. Of these 265 patients aged 27-83 years with no clinical signs of pulmonary edema, extracardiac respiratory failure or pacemakers comprised the study cohort., Intervention: Monitoring of the lung's electrical impedance was used for predicting cardiogenic pulmonary edema since accumulation of blood and fluid decreases impedance values., Measurements and Results: Impedance of the lung is the main feature of ITI measured by the RS-207 monitor: decreased ITI prior to the clinical signs of cardiogenic pulmonary edema was used as the prediction criterion. The clinical signs used for confirmation of its prediction were dyspnea, cyanosis, pulmonary rales, crepitations, arterial hypoxemia, and radiographic evidence of pulmonary congestion in chest radiographs. Clinicians were blinded to the results of ITI measurements and radiologists were blinded to both ITI and clinical data. Thirty-seven patients developed cardiogenic pulmonary edema while being monitored. ITI decreased by more than 12% of baseline in all of them; this occurred at 30 min or longer (26 patients) and at 60 min or longer (11 patients) before the appearance of clinical signs. ITI fell by less then 10.1% of baseline in all 228 patients who did not develop the edema., Conclusion: Monitoring ITI is suitable for early prediction of cardiogenic pulmonary edema, before the appearance of the clinical signs.

Background: Acute heart failure (AHF) evolves through two phases. In the first phase, there is interstitial congestion with no clinical sign of edema (preclinical phase); the second, during which lung alveoli begin to fill with fluid, manifests as clinically overt alveolar edema. Treatment of AHF at its preclinical phase can alleviate its clinical impact. Presently, there is no technique that detects the interstitial phase of AHF. We used a device based on a new method of lung bioimpedance measurement. The device measures internal thoracic impedance (ITI), which nearly equals inherent lung bioimpedance. This method can detect small changes in lung fluid that occur during the interstitial stage of AHF., Aim: The objective of this study was to assess the feasibility and efficacy of the said new method in detecting preclinical AHF., Methods: Internal thoracic impedance and pertinent clinical parameters were monitored for 72 h in 403 patients hospitalized for an acute coronary syndrome without evidence of AHF at study entry., Results: Seventy patients developed AHF during monitoring. Internal thoracic impedance decreased in these patients by 16.4% (95% CI=-12.2% to -20.6%; P<.0001) from the baseline level at 44+/-15.1 min prior to the onset of lung rales. The other 333 patients had no clinical sign of AHF, and their ITI declined only by 4.5% (95% CI=2.5% to -11.5%; P=.3) compared with the baseline level., Conclusion: The new method for ITI measurement is sufficiently sensitive in detecting AHF at its preclinical stage. An ITI decrease of more than 12% heralds the appearance of clinically overt AHF and, thus, allows earlier therapy.

Nicotine patches are commonly used by people who try to quit smoking. Because high doses of nicotine may increase heart rate and potentiate cardiac arrhythmia or ischemia, its use in patients with coronary artery disease was investigated. The objective was to assess the cardiovascular safety of nicotine patches in patients with coronary artery disease (CAD) who try to quit smoking. The study was conducted in a double-blind, placebo-controlled, randomized fashion over a 2-week period. One hundred and six patients with CAD who wished to stop smoking and were taking part in a smoking cessation program were included. Fifty-two patients received nicotine patches (Nicotinell) and 54 received placebo patches. The cardiovascular effects of nicotine patches were assessed by repeated ambulatory ECG monitoring (AEM) and exercise testing. There were no changes in the resting heart rate and in the systolic or diastolic blood pressure between the screening and the two phases of the study in both the Nicotinell and placebo groups. Repeated 48-hour AEM revealed that there were no significant changes in the number and duration of ischemic episodes in both groups. There was no change in the frequency of atrial or ventricular arrhythmias. Exercise duration and time to 1-mm ST-segment depression increased in both groups during the double-blind treatment phase. More patients in the Nicotinell group claimed tobacco abstinence compared with the placebo group (27% vs. 13%). The use of nicotine patches did not cause aggravation of myocardial ischemia or arrhythmia in coronary patients and therefore can be used as a method to promote smoking cessation in this high-risk group.

Facial nerve paralysis developed in a man with tumor-stage mycosis fungoides (MF). Mastoidectomy disclosed that MF had involved the mastoid and middle ear. Meningeal lymphoma, confirmed by the finding of Sézary cells in the CSF, was subsequently established. Autopsy disclosed MF lymphoma in the leptomeninges, medulla, spinal cord, and cranial nerves. A unique feature was the formation of a communicating hydrocephalus. Case reports of 23 patients with MF of the CNS, including 21 autopsies, are reviewed. Practically all had tumor-stage or erythrodermic MF. Atypical mononuclear cells were found ante mortem in the CSF in eight patients. In contrast to other CNS lymphomas, bone marrow involvement was uncommon. Cranial, especially facial, nerve paralyses were often premonitory signs of meningeal lymphomas. Patients with MF having such symptoms should have cytologic examination of the CSF.