{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T23:31:09Z","timestamp":1785022269301,"version":"3.55.0"},"reference-count":33,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100013232","name":"Stiftelsen Norsk Luftambulanse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013232","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Hypothermia increases mortality among trauma patients. It is difficult to identify hypothermia in conscious patients due to the limited availability of diagnostic equipment yielding accurate measurements. Shivering is a symptom associated with hypothermia, and it serves as a parameter for clinical staging of hypothermia. Because shivering is part of the body's response to counteract hypothermia, the resulting thermogenic effect and expected cooling rates in shivering individuals warrant further investigation. This study aimed to describe core temperature trajectories in a setting of cold air, mild wind, and wet clothing, simulating a clinically relevant prehospital scenario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Fifteen healthy volunteers were dressed in wet clothing and placed in a windy climate chamber set at 5.0\u00b0C for 3\u2005h. Core temperature was measured using an esophageal probe (\n                      <jats:italic toggle=\"yes\">\n                        T\n                        <jats:sub>eso<\/jats:sub>\n                      <\/jats:italic>\n                      ) and an ingestible capsule (\n                      <jats:italic toggle=\"yes\">\n                        T\n                        <jats:sub>cap<\/jats:sub>\n                      <\/jats:italic>\n                      ). Shivering was estimated based on oxygen consumption (VO\n                      <jats:sub>2<\/jats:sub>\n                      ) and by objective observations of the participants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The temperature reductions from baseline were 0.25\u00b0C for\n                      <jats:italic toggle=\"yes\">\n                        T\n                        <jats:sub>eso<\/jats:sub>\n                      <\/jats:italic>\n                      (95% CI, 0.06\u20130.44\u00b0C,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.014) and 0.11\u00b0C for\n                      <jats:italic toggle=\"yes\">\n                        T\n                        <jats:sub>cap<\/jats:sub>\n                      <\/jats:italic>\n                      (95% CI, \u22120.13\u20130.34\u00b0C,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.36). Initially, participants exhibited a significant increase in temperature. The cooling rate in the climate chamber was 0.17\u00b0C\u00b7h\n                      <jats:sup>\u20131<\/jats:sup>\n                      (\n                      <jats:italic toggle=\"yes\">\n                        T\n                        <jats:sub>eso<\/jats:sub>\n                      <\/jats:italic>\n                      ). VO\n                      <jats:sub>2<\/jats:sub>\n                      corresponded with objective observations of shivering and was inversely related to\n                      <jats:italic toggle=\"yes\">\n                        T\n                        <jats:sub>eso<\/jats:sub>\n                      <\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Healthy individuals exposed to the described windy, wet, and cold conditions with only light clothing retained a normal core temperature for 3 h. The heat-producing mechanism of shivering is considered to be a significant contributing factor; therefore, a lack of shivering in patients in cold environments should be considered a warning sign for hypothermia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10806032251378099","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T19:02:33Z","timestamp":1761332553000},"page":"161-168","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Minor Decrease of Core Temperature in Shivering Volunteers Over a 3-Hour Exposure to Cold, Wet, and Windy Conditions"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7899-1056","authenticated-orcid":false,"given":"Ane M.","family":"Helland","sequence":"first","affiliation":[{"name":"University of Bergen"},{"name":"Haukeland University Hospital"},{"name":"Norwegian Air Ambulance Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8717-8554","authenticated-orcid":false,"given":"Sigurd","family":"Mydske","sequence":"additional","affiliation":[{"name":"University of Bergen"},{"name":"Haukeland University Hospital"},{"name":"Norwegian Air Ambulance Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Assmus","sequence":"additional","affiliation":[{"name":"Norwegian Air Ambulance Foundation"},{"name":"Haukeland University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guttorm","family":"Bratteb\u00f8","sequence":"additional","affiliation":[{"name":"University of Bergen"},{"name":"Haukeland University Hospital"},{"name":"Norwegian Air Ambulance Foundation"},{"name":"Haukeland University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein","family":"Wiggen","sequence":"additional","affiliation":[{"name":"Norwegian Air Ambulance Foundation"},{"name":"SINTEF Digital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haakon K.","family":"Kvidaland","sequence":"additional","affiliation":[{"name":"Haukeland University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8yvind","family":"Thomassen","sequence":"additional","affiliation":[{"name":"University of Bergen"},{"name":"Haukeland University Hospital"},{"name":"Norwegian Air Ambulance Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2700.185276"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.shk.0000169726.25189.b1"},{"issue":"4","key":"e_1_3_4_4_2","article-title":"Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update","volume":"30","author":"Dow J","year":"2019","unstructured":"Dow J, Giesbrecht GG, Danzl DF, Brugger H, Sagalyn GB, Walpoth B, et al. Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update. 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