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Ian Wickham. Topic last updated on October at Username: Password: Remember Me? Lost Password I want to Sign-Up. Ski Forum Index Avalanche Safety. I found this video very instructive - it will come to mind whenever I see an attractive powder-slope The text posted below the video deserves to be read through too. Very strange and disconcerting to see and hear someones life potentially ebbing away via a camera ,and the shear gibbering wreck he was reduced to by the adreneline and emotions once rescued. A sobering lesson indeed, after a heavy snowfall leave the virgin stuff be in these conditions if it is warm and sunny,leave it for a couple of days to give the snow a chance to settle, and ski it early ish before the sun has got on it and changed the relationship between the layers has always been my thinking A very lucky chap I got halfway through and thought I'd been watching for 10mins, I checked it was less than 3. How ever long must it have felt for him? The key is not just to carry a transceiver but to know how to use it. It's amazing how many people carry them but have only a very limited knowledge of how to use one. Amongst other things it explains some techniques which guides there use to get a better estimate of whether or not snow is safe for off-piste activity. They said that in damp-snow avalanches such as we often see in Europe, the event is violent enough to litterally destroy any person caught in its path. They looked very serious when they spoke That video is totally scary. I have skied the Backcountry for 34 years without an AvaLung. I am buying one this weekend. SkiRite wrote: One last point: When skiing chutes at Alagna I noticed no one, including the guides, used self-arrest grips. When skiing the 'fall-you-die' descents they help a lot - if you do fall. Does anyone on this forum use self-arrest grips besides me. Would like to hear from you about your likes, dislikes? Do you use one or two. J2Ski Sites for Close. Apartments Chalets Hotels Packages Close.

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Alagna Valsesia where can I buy cocaine

By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. To browse Academia. Neurocognitive functions are affected by high altitude, however the altitude effects of acclimatization and repeated exposures are unclear. Seventeen control subjects A novel modified JAYA algorithm for heat exchanger optimization, In general, algorithm modification is changing or alternating some aspects of the original algorithms with improving their performances. This work aims to introduce and implement a novel modified Jaya algorithm MJ to optimize fins and tube heat exchangers. The objective functions used in the current work are to minimize total cost and maximize effectiveness. Each of the four algorithms optimized the heat exchanger at three different values of population size, which are 25, 50, and , and three different numbers of runs, 20, 40, and 80, to determine the optimal solution. MJ performs better than GWO at low and medium populations,25 and International Journal of Behavioral Medicine, Valverde y K. Journal of emerging technologies and innovative research, Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Uiaa medcom neurological disorders V Corrado I Angelini. The cerebral etiology of high-altitude cerebral edema and acute mountain sickness Peter Hackett. Effects of dexamethasone and high terrestrial altitude on cognitive performance and affect Paul Rock. Osama M Elmardi. DOI: SB profiles and cognitive function at high altitude. High Alt. In this study we investigated the effect of high altitude on neurocognitive function and SB release. Increased SB release has been hypothesized to signify a loss of integrity in the blood—brain barrier BBB. Seven healthy volunteers trekked to Capanna Regina Margherita m above sea level in the Monte Rosa massif. During ascent and descent, five test events were undertaken; participants underwent neurocognitive testing, Lake Louise scoring LLS , and blood sampling to measure levels of SB. Moreover, an observed correlation between SB and a lower score on neurocognitive tests suggests that the pathogenetic mechanisms may be linked. The study indicates that a decline in cognitive function is associated with symptoms of AMS. The presentation of HACE can range from subclinical manifestations to symptoms of severe, and sometimes lethal, cerebral dysfunction. The milder manifestations include a persistent headache and nausea; more severe symptoms include ataxia, drowsiness, and confusion Hackett and Roach, ; Hackett and Roach, The pathophysiology of HACE remains poorly understood, but it is assumed that cerebral edema plays an important role, most probably by increasing the permeability of the BBB Rodway et al. SB is a predominantly astroglial protein with several intra- and extracellular functions, and it is normally present in serum at low concentrations Donato, ; Donato, The concentration of SB in serum increases, however, after a stroke or an event of global ischemia Missler et al. Recreational summer and winter mountain sports frequently expose active tourists to altitudes above m, and sometimes up to m. Exposure to altitudes above m can produce symptoms of acute mountain sickness AMS of varying severity Harris et al. Exposure to altitudes above m can lead to potentially lethal forms of altitude illness, such as high altitude pulmonary edema HAPE and high altitude cerebral edema HACE. Various studies have reported a 0. Radiology, Akureyri Hospital, Akureyri, Iceland. It has also been shown to increase during sports, such as football, breath-hold diving, boxing, running, ice hockey, and basketball Otto et al. In high altitude research, SB has, to our knowledge, only been evaluated in hypoxia in a hypobaric chamber Bailey et al. It has not been measured in individuals exposed to hypoxia at high altitudes. It can therefore be hypothesized that this level of hypoxia could lead to cerebral ischemia and dysfunction, thus raising the serum concentration of SB. Several studies of trekkers and mountaineers have shown that cognitive function decreases with increasing altitude Abraini et al. However, no attempt has been made to correlate a cognitive decline with any other measure of cerebral status. The aim of this study was to investigate the cerebral function of mountaineers during an ascent to Capanna Regina Margherita at m in the Monte Rosa massif, using a computerized neurocognitive test package together with a standardized AMS score and serial measurements of SB concentration in serum. Material and Methods Subjects After approval from the local ethics committee at Lund University Lund, Sweden , seven healthy volunteers were included age 42 to 51 in the study. All participants resided at less than m above sea level and did not travel to high altitude for at least 3 months prior to the expedition. The participants were physicians with at least 5 yr of alpine experience, and all were given full insight into the study protocol. Participants had no history of cardiac, cerebrovascular, or respiratory disease, although three participants developed AMS during an ascent to Mt. Kilimanjaro m in Experimental protocol The study was performed from a base camp in AlagnaValsesia, Italy m , and in the Monte Rosa massif to m. All participants arrived at Alagna-Valsesia on day 0. High altitude acclimatization was performed on day 1. Participants trekked to the Rifugio Vigevano m , slept over, and then trekked back down to Alagna-Valsesia on day 2 Fig. The expedition started on day 3, with baseline tests at m marking the first event. The participants then took the lift to Passo Salati m and trekked to Rifugio Gnifetti m , where test 2 was performed. After a brief overnight sleep, the group trekked to Capanna Regina Margherita m on day 4, where test 3 was performed before noon. Participants then descended to Rifugio Gnifetti m , where test 4 was conducted in the afternoon, followed by a further descent to Rifugio Vigevano m , where they slept overnight Fig. On day 5, the group took the lift down to Alagna-Valsesia m , where the final test 5 was performed upon arrival. At every testing point, venous blood samples were collected, and pulse rate and oxygen saturation were measured. In addition, participants performed neurocognitive tests and answered the Lake Louise questionnaire. The participants were allowed to rest, eat, and rehydrate for 30 min before testing and sampling began. Schematic presentation of study design with approximate relative time for events. Both the run-in and acclimatization together with the study period are described. The solid line shows the altitude profile, and the circles denote test points. The triangles show where neurocognitive NP testing was performed connected triangles show the aggregated baseline for neurocognitive testing. The black box denotes SB sampling, Lake Louise, physiological parameters. Neurocognitive testing was performed in a quiet, solitary environment without interruption. To familiarize the participants with the test, they performed training tests on day 1 both in Alagna-Valsesia m and at Rifugio Vigevano m. A third practice test was performed on day 2, which was grouped with the test on the first sampling point on day 3, as a baseline for the neurocognitive tests. The test battery took approximately 25 min to perform for each participant. From the test data, the program calculated neurocognitive performance in the following cognitive domains: memory, psychomotor speed, reaction time, processing speed, cognitive flexibility, and executive function. A deterioration in a domain yields a lower score all domains except reaction time. Scores for reaction time decrease with improvement, since time is measured. Participants filled out the scoring sheets, which were complemented with clinical assessment by other members of the team. Serum was separated by centrifugation for 10 min at rpm. Blood from the first sampling point was centrifuged within 1 h and frozen. At the other sampling points, the blood samples were kept cold using a Styrofoam box filled with snow until the group returned to Alagna, where the blood samples were centrifuged and frozen. Data analysis The neurocognitive test results revealed a clear learning effect over time, despite the two practice tests performed before the study began. The learning effect was controlled for by fitting a line for each individual between the baseline and last test test event 5 and subtracting the slope from the results on an individual basis. For comparison of results from baseline, the Friedman repeated measures analysis of variance on ranks was first performed and, if significant, a Wilcoxon matched pairs test was performed against baseline value. For correlations between outcome variables, univariate linear regression analyses were performed. All but one participant had an increase in SB levels at the higher altitudes and m when compared to baseline. Self-assessments by LLS yielded an increase from a mean 0. SB levels at different test events. Lake Louise scoring at the different test events. No significant correlation was found between SB points 2, 3, and 4 compared with baseline, with a concomitant decrease in oxygen saturation, with 6. When the participants returned to Alagna, pulse and saturation returned to baseline levels. The barometric pressures measured , , , , and hPa millibars , respectively, at the different sampling points. Cognitive function yielded no significant changes from baseline in any of the measured domains. Pulse lower curve and oxygen saturation upper curve at the different test events. Relative change in cognitive function after individual adjustment for the learning effect. Discussion The study was designed to evaluate the effect of light to moderate symptoms of AMS or HACE on cognitive function and to relate it to changes of SB in serum in a group ascending from to m. The principal findings of the study were an increase in SB levels, particularly during the first stages of the ascent, and an association between symptoms of AMS measured by LLS and a decline in certain neurocognitive functions above m. An increase in SB in individuals exposed to high altitudes has not been previously reported. The exact mechanism Table 1. However, for a cerebral protein to be released into the circulation, it is assumed that the integrity of the BBB has been compromised. One way to do this is to induce hypoxia Belayev et al, ; Witt, These observations suggest that the integrity of the BBB could be involved in the SB release observed in our study. SB is released in several other hypoxic conditions. For example, it has been documented that SB protein is released in obstructive sleep apnea, voluntary apnea, and cardiac arrest Rosen et al. Our findings contrast with those of Bailey and colleagues , where subjects were exposed to hypoxia in a hypobaric chamber and no SB release was observed. At least two differences in the protocol could help Table 2. Figures within parentheses show a trend in the opposite direction, e. Figures denote r values, and figures within parentheses show a trend in the opposite direction, e. First, we studied subjects actually trekking up to a high altitude, where oxygen demand increased and oxygen pressure decreased. Second, we used a different assay that is more sensitive to SB levels below 0. Still, the specificity of SB as a brain marker has been questioned, and a discussion of this specificity is warranted. SB is a phylogenetically old protein and is found in all mammal species and in several organs in varying concentrations. For instance, muscle cells and adipocytes have a relatively high concentration of SB. This has been shown to affect serum concentrations of SB during special circumstances such as autotransfusion of blood after surgery, trauma, and food deprivation Jonsson et al. In sports, one report of increased SB levels in professional swimmers after a race suggests that there could be an extracerebral release without a trauma Dietrich et al. Still, the brain is the biggest pool of SB in the human body Jonsson, , and a wide selection of studies has shown a clear and positive correlation between SB and brain damage. For instance, increased SB levels have been observed in sports when some sort of trauma is induced, for example, in ice hockey, boxing, soccer, basketball, and running Otto et al. SB has also been found in the circulation in situations where subjects have been exposed to mental stress Hanin, ; Scaccianoce et al. Moreover, SB is seen after focal and global cerebral ischemia, such as stroke and cardiac arrest Missler et al. Extracerebral origin of SB cannot be excluded in this study owing to the lack of a control group. However, one interesting observation in this study indicates that we did not measure SB from extracerebral tissues. The highest levels of SB were found at test event 2, at m on day 1 of the ascent. On this day the greatest ascent was made, m, compared to m on day 2 of the ascent. In addition, day 1 a lift ride and 1-h trek was not as physically demanding as day 2 a 3-h trek up and 3-h trek down. From Fig. Therefore, SB release seems to be related more to the rapid decrease in partial O2 pressure, rather than to the actual O2 pressure or the intensity of the physical exercise. To summarize, although an extracerebral contamination cannot be excluded, much of our findings are in favor of a cerebral release of SB. If this is the case, several mechanisms could have played a role in the opening of the BBB and release of SB. In this setting, the most plausible explanation is a decrease in partial O2 pressure, leading to mild hypoxia and SB release, indicating that a mild and prolonged hypoxia may lead to SB release. We performed computerized neurocognitive tests to measure subtle functional changes in different cognitive domains of the brain. Computerized tests have proved effective for this purpose Gualtieri and Johnson, ; Gualtieri and Johnson, and could therefore be used in a standardized manner in mountain huts. Despite our effort to standardize the procedure, repeated neurocognitive tests have inherent problems with test—retest reliability, practice effects, sensitivity, and specificity Abraini et al. We attempted to control for the practice effect by performing two training runs before the baseline test. Moreover, the tests were performed at different times of day and after varying hours of sleep, which could affect results. In this setting, it would be virtually impossible to standardize tests in this aspect. Examining the results of cognitive function Fig. However, the statistical analysis did not reveal any significant changes. Despite the small number of participants in the study, a significant correlation between Lake Louise score and cognitive function was found. In 2 of 6 domains, there was a significant correlation at and m. Moreover, in 15 of 18 correlations, the trend was in the hypothesized direction; that is, with an increased Lake Louise score, there was a concomitant deterioration in cognitive function. However, with the small number of participants it is hard to draw any conclusions regarding which cognitive domains are most vulnerable in the setting of mild hypoxia. The lack of a significant correlation between SB release and cognitive impairment is of interest. We had previously hypothesized that SB would increase during an opening of the BBB and that the opening would lead to the subsequent development of cerebral edema, which in turn would be reflected by transient cognitive dysfunction. In this chain of events, several other factors could interact, such as electrolyte and fluid balance in the participants. Given the low statistical power and individual variability, it is not surprising that we did not find any strong correlation between the two. However, in parallel with the Lake Louise scores and cognitive function, 15 of 18 correlations performed showed a trend in the expected direction and thus warrant further research. To further explore this hypothesis, the number of individuals should be increased. Extended cognitive testing might also be of value. Some implications of this study are worth considering. The environment above m is potentially dangerous, irrespective of season and weather, and correct decision making is imperative. If there is a decline in cognitive function, such as cognitive flexibility and executive function, at these altitudes, the ability to make correct decisions may be impaired, and awareness of this may be of benefit to individuals traveling to these altitudes. The current study only suggests such impairment in participants who developed symptoms of AMS. Consequently, awareness of symptoms and the insight that decision making may be impaired should caution mountain tourists. We advise the use of mountain guides at these and higher altitudes. In conclusion, we have demonstrated an increase in serum levels of SB during an ascent from to m. At the same time, participants showed clinical signs of altitude sickness, which also were associated with a decline in cognitive function. This study indicates that rapid ascent to high altitudes can stimulate a release of SB into the circulation, which may precede the development of cognitive dysfunction and the onset of AMS. Acknowledgments We would like to thank mountain guide Armin Fisher from Alagna-Valsesia for his expertise and commitment on and off the mountain. Computer software and lab analysis were funded by grants from the Crafoord foundation and state funds in Sweden. Clothing for the study was sponsored in part by N, Reykjavik, Iceland. The other costs were incurred by the participants. Hackett P. High-altitude illness. High altitude cerebral edema. Hanin I. The Gulf War, stress and a leaky blood—brain barrier. Harris M. High-altitude medicine. Honigman B. Acute mountain sickness in a general tourist population at moderate altitudes. Jonsson H. SB and cardiac surgery: possibilities and limitations. Restorative Neurol. Sbeta after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome. SB as a predictor of size and outcome of stroke after cardiac surgery. Kapural M. Serum Sbeta as a possible marker of blood—brain barrier disruption. Brain Res. Kramer A. Cognitive function at high altitude. Missler U. S protein and neuron-specific enolase concentrations in blood as indicators of infarction volume and prognosis in acute ischemic stroke. Netto C. Serum SB protein is increased in fasting rats. Otto M. Boxing and running lead to a rise in serum levels of SB protein. Sports Med. Pavlicek V. Cognitive and emotional processing at high altitude. Space Environ. Roach R. The Lake Louise acute mountain sickness scoring system. Rodway G. Highaltitude-related disorders. Part I: pathophysiology, differential diagnosis, and treatment. Heart Lung. Part II: prevention, special populations, and chronic medical conditions. Roeggla G. How can acute mountain sickness be quantified at moderate altitude? Royal Soc. Rosen H. Increased serum levels of the S protein are associated with hypoxic brain damage after cardiac arrest. Scaccianoce S. Relationship between stress and circulating levels of SB protein. Disclosure The authors have no conflicts of interest or financial ties to disclose. References Abraini J. Cognitive performance during a simulated climb of Mount Everest: implications for brain function and central adaptive processes under chronic hypoxic stress. Pflugers Arch. Andersson J. Increased serum levels of the brain damage marker SB after apnea in trained breath-hold divers. Bailey D. Free radical-mediated damage to barrier function is not associated with altered brain morphology in high-altitude headache. Blood Flow Metab. Belayev L. Quantitative evaluation of blood—brain barrier permeability following middle cerebral artery occlusion in rats. Astroglial protein S is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humans. Braga C. SB and NSE serum levels in obstructive sleep apnea syndrome. Sleep Med. Collie A. Computerised cognitive assessment of athletes with sports related head injury. Dietrich M. Increase in serum SB protein level after a swimming race. Donato R. Functional roles of S proteins, calciumbinding proteins of the EF-hand type. Intracellular and extracellular roles of S proteins. Microscience Res. Einav S. Serum SB levels after meningioma surgery: a comparison of two laboratory assays. BMC Clin. Gallagher S. North Am. Gualtieri C. Neurocognitive testing supports a broader concept of mild cognitive impairment. Alzheimers Dis. Other Dementia. Reliability and validity of a computerized neurocognitive test battery. CNS Vital Signs. High-altitude pulmonary edema. High altitude cerebral edema and acute mountain sickness: a pathophysiology update. Serum concentrations of two biochemical markers of brain tissue damage SB and neurone specific enolase are increased in elite female soccer players after a competitive game. Stalnacke B. Playing ice hockey and basketball increases serum levels of SB in elite players: a pilot study. Sport Med. Unden J. Raised serum SB levels after acute bone fractures without cerebral injury. Wagner D. Reliability and utility of a visual analog scale for the assessment of acute mountain sickness. Watson P. Witt K. Effects of hypoxia-reoxygenation on rat blood— brain barrier permeability and tight junctional protein expression. Heart Circ. La comunicazione non verbale Andrian Ciobanu. Smart Library System utkarsh chandra. Kazuistyka: Naturalny przebieg stwardnienia rozsianego - opis przypadku Tomasz Berkowicz. Locandina Cepoc Genova Roberta Braccia. De Blasi-G. Stabile eds. ISBN: Gianluca del Noce. Robust pose invariant face recognition using coupled latent space discriminant analysis Dr. Abhishek Sharma.

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