Thomas batchelor

Thomas Batchelor FdSc Marine Sport Science - Project 2012/04/20

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The effects of cold water immersion on the body’s ability to perform

dexterity tasks that can aid survival.

Falmouth Marine School, Thomas D. Batchelor, 2012

Raising awareness for the hazard of a man overboard situation in cold water seas.

Thomas D. Batchelor

Carinthia Weston Road Totland Bay Isle of Wight

PO29 0HA 07792312602

[email protected]


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ABSTRACT

Cold water immersion is a very real hazard for all water users in Britain; it can kill regardless

of how competent one is as a swimmer as it is not hypothermia that causes the most fatalities, but is

in fact drowning due to the colds effect on the body’s muscles. Sever cold will restrict the muscles

ability to function, and as a result, swimming becomes an impossible task. However, it is also clear

that drowning is often the main cause of death following cold water immersion, as opposed to

hypothermia. There is a general consensus of naivety, from the general public, when it comes to just

how dangerous cold water immersion is, especially seeing as forty percent of drowning victims are

children aged less than four years old; making drowning the second most common cause of

accidental death amongst children (Orlowski, 1987).

This experiment used a selection of asymptomatic students of 16-25 to investigate the

body’s ability to perform dexterity tasks, when subject to cold water immersion, that can aid

survival; using a VHF radio or signal flare. It was completed in a controlled environment, with the

participants volunteering to be subject to mild hypothermia throughout the experiment. The subject

would therefore witness first hand, how hard it is for the body to function when subject to such

intense cold; especially in the hands or fingers.

The results showed that the time taken to complete a safety task increased and became

more difficult as the subject spent nearer 5 minutes in water of 10 degrees Celsius. This would mean

that there is a limited amount of time that one can spend immersed in cold water before it is not

only just their fingers that stop functioning with ease, but also larger body parts responsible for

keeping one afloat or swimming after a man overboard situation.

Conclusions

The practical applications of the data gathered from this experiment are of course marine

industry or maritime linked. They are to educate water users of the dangers of cold water


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immersion, to provide safety advice and basic survival knowledge to the general public on water

safety, to further educate professionals in the marine sector of the general perception to cold water

immersion awareness and to assist in the risk assessment of situations where cold water immersion

is a very real hazard. For example, to reiterate the importance of a personal flotation device in aiding

cold water immersion survival, especially at water sport centres across the country.

Keywords: Hypothermia. Cold Water Immersion. Cold Water Shock. Dexterity Tasks


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INTRODUCTION

H0. There will be no significant difference between time spent immersed in cold water and time

taken to complete dexterity task.

H1. There will be a significant difference between time spent immersed in cold water and time taken

to complete dexterity task.

A study conducted by the RNLI in 2008 brought to reality the very real hazard of death by

drowning in the United Kingdom (UK), and the main harsh reality of the matter was that

“approximately 1,500 people drown in the UK per year” however, the worrying statistic was that

only “25% of these drowning occur at sea”. This means that up to 75% of reported drowning did in

fact occur in water situated in land; areas like lakes, rivers, reservoirs etc; the ideal locations where

water sport centres thrive best as businesses in the UK. Such are the threats of cold water

immersion at these locations, that ignorance to water safety is thoroughly unacceptable; as such,

the importance of this study is indeed relevant when considering a practical application to help

promote water safety to the general public and marine industry; water safety such as flotation

devices for inexperienced water goers and properly completed risk assessments for water sport

centres. Wissler (2003) also stresses the importance of personal flotation devices (PFD’s) and goes

on to say that flotation is an absolute requirement for survival; these ideas are backed up by

Higenbottam (1995) and Jacobs (2008).

The alternate hypothesis, “There will be a significant difference between time spent

immersed in cold water and time taken to complete dexterity task”, can be further developed to

state that the cold water immersion will decrease the overall body temperature and thus making

muscular movement more difficult to complete. This increase in difficulty to move whilst immersed

can be significantly linked with finer, dexterous movement, such as; moving ones fingers to use a

VHF radio to signal for help in a man overboard situation, or sinking of a craft etc. It is fact that the


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areas of the body situated furthest away from the core are the first to lose heat and the first be

subject to slow blood flow carrying oxygenated blood to working muscles. It is deemed necessary for

the core to have the majority of the oxygenated blood sent to it, so to keep vital organs safe and

surrounding muscles working to keep generating heat. However, as fingers, toes, arms, ears, nose

and legs are the first parts of the body to start feeling cold (Tipton, 1989) and that it is in fact these

parts of the body, especially hands, legs and arms that play the majority gross muscle movers in

swimming, or staying afloat, it is clear to see just how bad of an effect cold water can have in

restricting muscle movement.

There are many survival tips that the marine industry are aware of and have produced,

however, as far as survival tips for the general public go, it is naively considered a specialist situation,

when statistics prove that death by cold water immersion is a far too common occurrence which can

be avoided and prevented. Cheung et al (2003) provides advice to any victim of cold water

immersion to reduce the danger affiliated with the cold water shock; by controlling their breathing

for the first 3-5 minutes prior to attempting escape, the strain on the cardiac muscle and the effect

from the aspiratory gasp with relation to aspiration of fluid into the lungs are controlled. This study

will hopefully bring to light just how quickly cold water immersion can restrict the body’s ability to

function and as such result in chances of survival being drastically reduced.


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METHODS

Experimental approach to the problem

To simulate how the body reacts in cold water immersion, firstly a body of water in a

controlled environment must be attained, this body of water must be safe and have no additional

variables that may reduce the validity of the test or any such results gathered from the test.

To test the hypothesis, a tank of water (1meter wide x 1 meter deep x 7 meters long) was

filled with water with a temperature of 10 degrees Celsius as this would be a controlled environment

with absolutely no risk of drowning for the participant as long as safety cover was at hand to assess

the subject’s welfare conditions. The extended duration of time spent in the cold water would result

in the subject experiencing all changes and body adaptations that a person who has actually fallen

into cold water would feel; all except possibly the factor of fear, which would be eliminated for the

purpose of a valid, ethical and controlled test.

The simple dexterity task would then be used as the physical indicator on how much the

body is affected by cold water immersion, which would then be measured and analysed alongside

the scientific reading of the subject’s actual body temperature. By controlling all outside variable

that a person would experience in a real cold water immersion situation, such as wind chill, water

current and the presence of swimming, it is a clearer indication on how cold water alone effects the

body’s functioning ability and just how little variables are needed to place someone in a life and

death situation. In addition, clearer recommendations can be made regarding safety awareness that

takes into account how long the body can resist the cold up to the point where the subject in

succumbed to the cold no longer has the ability to move body parts.

Subjects

“Table 1” shows the list of asymptomatic students from Falmouth Marine School, within the

ages of 18 to 24 of both sexes that had consent to participate in the experiment. All willingly signed


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a consent form and were allowed to withdraw from the experimentation process at any point, no

subject had any medical condition that may interfere with the results and no subject had any

practise in the dexterity task, used as the main test of cold water restriction on the body, before the

experiment, so performance enhancing by practise could not occur at the initial stages of testing.

Table 1

Participant Number Name Sex Age Height (CM) Weight (KG) BMI

1 Benjamin Tun Pe M 21 167.64 63 22.42 kg/m2 (Normal)

2 Leon Vessey M 19 177 72 22.98 kg/m2 (Healthy weight)

3 Josh Neely M 19 181 65 19.84 kg/m2 (Healthy weight)

4 Katie Buddoch F 18

5 Josh Burgon M 21

6 Tom Greaves M 19

7 Georgia Thompson F 18

8 Edward Jones M 18

9 Richard Smith M 18

10 Callum Knight M 18

11 Chris Garbet M 18

12 Thomas Batchelor M 19 182.88 73 21.83 kg/m2 (Healthy weight)

13 Alex Sawdon M 19

14 William West M 24 179.4 75 23.30 kg/m2 (Normal)

15 William Stitson M 20 162.4 69.85 21.48 kg/m2 (Healthy weight)

16 Daniel Flint M 22

17 Craig Stearman M 21

18 Elliot Shilling M 19


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Equipment List

Water tank (7m x 1m x 1m) filled with water of 10 degrees Celsius

Indoor location (protected from the wind) with an air temperature of 14 degrees Celsius

“Vicks” Digital Thermometer for oral use

Deactivated handheld VHF Radio

Stopwatch x2

Swimming costumes (standard swimming apparatus, shorts for males, bikini’s for females)

“Gull” water proof overalls trousers

“Gull” water proof overalls jacket

Towel

Dry clothing

First aid kit

Foil Blankets

Procedures

1. Subject to get changed into swimming clothing

2. Subject to get changed into waterproof overalls

3. Subject’s body temperature to be measured using the digital thermometer

4. Subject to be briefed for a second time (initial brief is stated on consent form) on to what

the experiment is and what they will experience:

i. Participant will enter the water, fully immersing themselves in the water,

then to lie on their back in the water for 5 minutes. They will then be asked

to complete the dexterity test on the 1 minute, 3 minute and 5 minute

marker, before they can exit the water slowly and safely.

5. Subject is given practical tutorial on how to conduct initial dexterity test

i. Press the channel 16 button


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ii. Adjust the squelch

iii. Press and hold the communication button and say the following phrase in a

clear and concise manner:

iv. “Coastguard Coastguard Coastguard”

6. Subject is to stand on the side of the tank and enter the water quickly so as to submerse for

a brief moment of time, to simulate falling overboard into the water.

7. Subject the lays on their back in the water with VHF in hand

8. Timing begins as soon as the subjects head is under the water. Timing to last 5 minutes.

9. Subject remains in water for one minute with hands fully immersed in water

10. Body temperature to be taken orally after one minute of immersion is reached

11. Result to be recorded

12. Subject is told to complete VHF dexterity task and timed

13. Time of task to be recorded

14. Subject is then to rate on a scale of 1 to 10 (1=easy & 10=difficult) how easy it was to

perform task.

15. Rating to be recorded

16. Points 10 through to 15 are repeated on the 3 minute mark and on the 5 minute mark

17. Throughout experiment, first aider is to monitor visual signs of hypothermia

18. Subject is also to be reminded throughout the test that they can exit the water at any time

19. After the results for the 5 minute data is recorded the subject may exit water by simply

standing up and stepping out of the tank slowly and carefully with assistance if needed.

20. Drying and reheating precautionary measures are then given to the subject to help slowly

warm up the body

21. This whole process is then repeated for all 18 participants that volunteered for the

experiment.


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Statistical analysis

The data gathered from the above experiment will be statistically analysed using a T-test

with a significance level of 0.05 being used. The mean age of the group will be calculated, along with

the mean body temperature and time taken to complete dexterity task for the control, at 1 minute

in the water, 3 minutes and 5 minutes. The means will serve as a more ecologically valid and less

generalised sample group data. Furthermore, it makes the statistical analysis using a T-test more

relevant to reach a significance level.


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RESULTS

Table 2 shows the results of the participants’ body temperature, in degrees Celsius, for the

control and over 5 minutes immersed in cold water. The hypothesis would predict that the longer

spent in the water, the lower the body temperature will drop; however, due to the nature of the

experiment and the time spent in the water, the participant’s body temperature would not decrease

to a number around the severe mark as stated by Kernshaw (2002), which is that “any persons

immersed in cold water...if reaching a body temperature read out of 24-26 degrees Celsius then

death is going to occur”. Kernshaw’s justification of cold is as follows:

37 °C (99 °F) - Normal body temperature (which varies between about 36–37.5 °C (97–100

°F))

36 °C (97 °F) - Mild to moderate shivering (body temperature may drop this low during

sleep). May be a normal body temperature.

35 °C (95 °F) - (Hypothermia) is less than 35 °C (95 °F) - Intense shivering, numbness and

bluish/grayness of the skin. There is the possibility of heart irritability.

34 °C (93 °F) - Severe shivering, loss of movement of fingers, blueness and confusion. Some

behavioral changes may take place.

33 °C (91 °F) - Moderate to severe confusion, sleepiness, depressed reflexes, progressive loss

of shivering, slow heart beat, shallow breathing. Shivering may stop. Subject may be

unresponsive to certain stimuli.

32 °C (90 °F) - (Medical emergency) Hallucinations, delirium, complete confusion, extreme

sleepiness that is progressively becoming comatose. Shivering is absent (subject may even

think they are hot). Reflex may be absent or very slight.

31 °C (88 °F) - Comatose, very rarely conscious. No or slight reflexes. Very shallow breathing

and slow heart rate. Possibility of serious heart rhythm problems.


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28 °C (82 °F) - Severe heart rhythm disturbances are likely and breathing may stop at any

time. Patient may appear to be dead.

24–26 °C (75–79 °F) or less - Death

Due to the nature of this experiment however, the mean body temperature for the group did

not reach lower than 35.9°C, with lowest single results not dropping under 35.2°C; this means that

all participants were safe as long as safety cover was at hand to assess the mild hypothermic

conditions that some subjects may have been subdued to.

Table 3 shows the time taken to complete the VHF signal call (dexterity task) and what was

expected from the hypothesis was that as time immersed in cold water increases, so would the time

taken to complete the dexterity task. This part of the experiment was the key factor in looking at

how the body’s functioning ability is affected by the cold. It is then given a qualitative backing from

table 4 which shows the subjects own personal assessment of the conditions they are experiencing

and their analysis of their own performance on the task.


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Table 2

Participant no. Body Temperature (⁰C)

Control 1min 3min 5min 1 36.4 36.4 36.3 36.2 2 36.2 36.2 36.1 36 3 36.7 36.5 36.4 36.2 4 36.4 35.8 35.6 35.4 5 36.4 36.4 36.3 35.8 6 36.8 36.4 36.1 36 7 36.9 35.3 35.3 35.2 8 36.5 36.5 36.3 36.1 9 36.4 35.9 35.5 35.3

10 36.1 35.3 36.1 35.9 11 36.5 36.2 35.9 35.8 12 36.4 36.2 36.1 35.8 13 36.1 35.9 35.8 35.6 14 36.5 36.2 36.1 36.1 15 36.4 36.3 36.2 36.0 16 36.6 36.4 36.4 36.4 17 36.6 36.4 36.1 36.1 18 36.2 36.2 36.1 35.7

Mean 36.5 36.1 36.0 35.9

34

34.5

35

35.5

36

36.5

37

37.5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Bo

dy

Tem

pe

ratu

re (

Ce

lciu

s)

Participants

Body Temperature Results

Control

1min

3min

5min

Figure 1


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Table 3

Participant no. Time taken for VHF Task (S.MS)

Control 1min 3min 5min 1 2.97 3.22 3.88 4.57 2 1.93 2.84 2.89 2.98 3 2.44 2.15 2.78 2.91 4 2.19 2.47 2.5 3 5 1.97 2.69 2.81 2.99 6 1.53 2.18 2.5 2.99 7 2.57 2.03 3.19 3.5 8 2.05 2.68 3.13 2.48 9 2.66 3.44 4.08 4.47

10 2.37 3.69 4.34 4.66 11 2.69 2.72 3 3.09 12 1.67 2.7 3.09 4 13 2.68 2.69 2.25 2.58 14 2.75 2.35 2.16 2.35 15 2.21 3.23 2.8 2.81 16 2.59 2.6 3.22 2.25 17 2.59 2.94 3.09 2.35 18 2.84 3.7 2.68 2.63

Mean 2.372222 2.795556 3.021667 3.145

Figure 2

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Tim

e T

ake

n (

Seco

nd

s)

Participants

Time Taken to Complete VHF Task

Control

1min

3min

5min


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Table 4

Participant no. Own Performance rating (n/10)

Control 1min 3min 5min 1 3 5 6 3 2 2 5 8 2 3 2 3 5 2 4 2 3 4 2 5 2 4 6 2 6 1 4 5 1 7 3 5 8 3 8 2 6 8 2 9 3 6 9 3

10 3 6 7 3 11 1 4 6 1 12 2 4 8 2 13 1 4 6 1 14 2 5 5 2 15 2 5 7 2 16 2 6 7 2 17 2 5 6 2 18 2 5 7 2

Mean 2.055556 4.722222 6.555556 2.055556

Figure 3

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Rat

ing

1-1

0

Participant

Self Assesment of Performance

1min

3min

5min


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DISCUSSION

The results show that the mean body temperature of each participant decreased from

36.5°C to 35.9°C, this is definitely a case for the longer the amount of time spent in the cold water,

the more the body’s temperature will decrease, thus resulting in the subject entering more

dangerous stages of hypothermia. The participants that showed the lowest body temperature at the

end of the 5 minute immersion were subjects 4, 7 and 9; who coincidently are the two female

participants and the youngest male participant. The remaining participants showed a much better

result of around 36°C; this is evidence for males, with a larger body composition being able to keep

thermoregulation at a steadier pace than females with smaller body compositions and less muscle

mass. The results of the three lowest body temperatures can be seen against the three highest body

temperatures in figure 4, figure 4 shows that there is a noticeable difference between the top three

temperatures and the bottom three temperatures, which means that body composition, sex and age

may be the most likely factors to keeping a steady thermoregulatory heat loss. Interestingly

however, it is the female participant (participant 7) who starts with the highest body temperature

before entering the water; who then ends up with lowest body temperature. The sever loss of heat

may be due to what is known as the cold water shock; Wissler (2003) reports that in a fraction of

accidental immersions, death may occur quickly owing to cold water shock due to the stressed

character of the casualty.


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Figure 4

The mean time taken for the completion of the dexterity task, starting at control and ending

after 5 minutes of immersion, increased from 02:37 (SS:MS) to 03:14 (SS:MS), this increase in time

positively backs up the hypothesis that the muscles are being hindered by the effects that the cold

water is presenting. Figure 5 shows the three participants that completed the task the quickest at

the end of their 5 minute immersion against the participants that took the longest times; this shows

that participants 1, 9 and 12 noticed a more significant effect, or succumbed to the cold in a more

noticeable manner, in their body’s ability to complete the dexterity task. Whereas, participants 14,

16 and 17 managed to keep their fingers moving in a more efficient way as the cold was setting in.

The three slowest participants all showed a constant increase in time, which shows that the cold was

indeed having an effect as time went on; however, the results for the three fastest showed

interesting anomalies in the data. Participant 14 shows a decrease in time from the control to the 3rd

minute, then an increase up to the 5th minute, which suggests that the cold did indeed affect this

participant after extended immersion; however, the reasoning for the decrease in time at the start

of the experiment could be the practise effect, which means that the participant knew what to

34

34.5

35

35.5

36

36.5

37

37.5

Control 1min 3min 5min

Bo

dy

Tem

pe

ratu

re (

cels

ius)

Time

Three Highest Body Temperatures against Three Lowest Temperatures

4

7

9

1

3

16


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expect, kinaesthetically, in terms of the dexterity task. In relation to participants 16 and 17, the

practise effect has also seemed to have occurred during the 5th minute however, which definitely

suggests that the cold had not affected their fingers in the same physiological way that it did for the

slowest participants.

Figure 5

After using “mini tab” for the statistical analysis of my data means, there is definitely a

significant difference between the relationship of body temperature and time taken to complete the

dexterity task. This means that the null hypothesis can be rejected and that the time spent

immersed in cold water will in fact increase the time taken to complete the dexterity task. In

addition, it proves that cold water has a sufficiently dangerous effect on the body’s functioning

ability, which can of course result in drowning and hypothermia. After an analysis of these results, it

is surprising to see just how short the amount of time a subject needs to spend in cold water,

deemed an average water temperature for most of the bodies of water in the United Kingdom,

before noticeable effects are seen.

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Control 1min 3min 5min

Tim

e T

ake

n (

seco

nd

s)

Time Stage

Three Longest Task Completions against Three Shortest Task Completions

1

9

12

14

16

17


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From assessing the results, the recommendations that can be made for all practical

applications are that cold water immersion should be avoided at all costs, unless professional

measures are taken, e.g. wearing a winter wetsuit and a personal flotation device. As far as a man

over board situation is concerned, it is a reasonable action to suggest that all maritime or marine

professionals in the industry should be wearing personal flotation devices when the threat of cold

water immersion is a very real hazard, due to the short amount of time needed for the body’s

functioning to succumb to the cold, and drowning to become a reality.

403020100

Body Tempera

Time taken f

the mean of Time taken f (p < 0.05).

The mean of Body Tempera is significantly different from

> 0.50.10.050

NoYes

P = 0.000

3020100

results of the test.

samples. Look for unusual data before interpreting the

-- Distribution of Data: Compare the location and means of

that the true difference is between 32.745 and 33.813.

the difference from sample data. You can be 95% confident

-- CI: Quantifies the uncertainty associated with estimating

level of significance.

-- Test: You can conclude that the means differ at the 0.05

Sample size 4 4

Mean 36.113 2.8336

95% CI (35.73, 36.49) (2.2927, 3.3745)

Standard deviation 0.23936 0.33993

Statistics Body Tempera Time taken f

33.279

(32.745, 33.813)

Distribution of Data

Compare the data and means of the samples.

Do the means differ?

95% CI for the Difference

Does the interval include zero?

Difference between means*

95% CI

* The difference is defined as Body Tempera - Time taken f.

Comments

2-Sample t Test for the Mean of Body Tempera and Time taken f

Summary Report


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4321

30

20

10

4321

0.83402, you would have a 90% chance.

60% chance of detecting the difference. If they differed by

If the true means differed by 0.56216, you would have a

For alpha = 0.05 and sample sizes = 4:

100%

0.83402

90%

0.56216

60%< 40%

Data in Worksheet OrderInvestigate outliers (marked in red).

0.56216 60.0

0.63319 70.0

0.71690 80.0

0.83402 90.0

Difference Power

sample sizes of 4?

What difference can you detect with your

Body Tempera Time taken f

Power

What is the chance of detecting a difference?

sample sizes.

Power is a function of the sample sizes and the standard deviations. To detect a difference smaller than 0.71690, consider increasing the


Diagnostic Report

!

Data

Unusual There are no unusual data points. Unusual data can have a strong influence on the results.

Normality

checked with small samples, you should use caution when interpreting the test results.

distributed, the p-value may be inaccurate with small samples. Because normality cannot be reliably

Because the sample sizes are less than 15, normality can be an issue. If the data are not normally

Size

Sample The sample is sufficient to detect a difference between the means.

Check Status Description


Report Card


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flow during auxiliary heating in the cold. Journals of Applied Physiology; 95: 758-770

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Dexterity Following Short-Term Hand and Forearm Immersion in 10⁰C Water.

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