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Cold water swimming seems to have a positive effect on insulin metabolism, although here too, the effect appears to be sex-specific [3,56]. In a field study, 30 cold water swimmers were examined for six months with regard to body composition and insulin sensitivity . The chilled water swimmers were overweight compared to a control group and had a higher percentage of body fat with differences between the sexes. For female and swimmers with lower body fat percentage, there was an increased insulin sensitivity as well as a reduction in insulin secretion and resistance .
The lungs contract in the first few seconds followed by uncontrollable hyperventilating and loss of breathing control . The heart rate, and blood pressure and cardiac output increase rapidly increase with simultaneous peripheral vasoconstriction [4,80]. The dynamic response is initiated by peripheral cold receptors, peaking approximately 30 seconds after exposure and adapting over about two minutes . The initial shock and loss of breathing control is where the swimmer is at greatest risk of drowning and death is it requires very little aspirated water to initiate the drowning process . Experienced winter swimmers become more resistant to the cold shock reaction through conditioning and progressive adaptation of the body to the cold regularly and with increasing frequency and gradual lowering of temperatures . It is crucial to adapt and acclimatize to the initial shock response as it is particularly hazardous, accounting for the majority of cold water immersion deaths .
However, it can be assumed that the drop in core body temperature in ice swimmers is less rapid than in pool swimmers with more subcutaneous fat [40,43]. Overweight people who are acclimatized to the cold water and have the appropriate experience are more likely to tolerate a longer stay in the cold water than people with little body fat tissue and those who are not acclimatized [40,79,102,103]. An experienced, overweight ice swimmer with a BMI > 35 kg/m2 and 45% body fat never became hypothermic, even after several stays in ice-cold water . Keatinge et al.  described a case of an Icelandic fisherman who survived in the ice-cold water, in part due more adipose tissue. After his boat sank and his two colleagues drowned within 10 min, he swam back to the shore in the 5 C cold sea, taking him approximately 6 hours to complete .
An important aspect is the aspect of swimming intensity (e.g., in %VO2max) to maintain body core temperature while swimming in cold water (e.g., 10 C) [109,110]. A cold-water swimmer covered a total swim distance of 15 km in water of 9.9 C while swimming at a mean speed of 2.48 km/h . The swimming speed of 2.48 km/h was equal to 0.69 m/s which corresponds to 70%VO2max .
After a person is immersed in cold water, a cold shock reaction occurs that causes an uncontrollable heavy breathing (gasp). This is followed by a cold-induced hyperventilation  with a longer period of time with high-frequency breathing [63,69]. With prolonged exposure to cold, the respiratory rate is very high and it is assumed that the increased ventilation leads to progressive inefficiency when swimming  and respiratory muscle fatigue . Inexperienced cold water swimmers could benefit from a graded and progressive cold water acclimatization program, in combination with mental training to improve control over the respiratory portion of the cold shock response . Although it is possible to improve the initial cold shock response, drowning may still occur. Uncontrollable hyperventilation triggered by the acute exposure to cold leads to a reduction in cerebral blood flow with the result of disorientation and loss of consciousness .
The Government of the Philippines (GPH) actively seeks foreign investment to promote economic development. The Philippine investment landscape has some noteworthy advantages, such as its free trade zones, including the Philippine Economic Zone Authority (PEZA). Certain industries have experienced impressive growth in recent years, especially those that leverage educated, English-speaking Philippine labor.
The Foreign Investment Negative List is actually two lists, which outline sectors that are restricted or limited in terms of foreign investment under the 1991 Foreign Investment Act. The Foreign Investment Act also requires the Philippine government to publish an updated negative list every two years to reflect changes in law; the eighth negative list was promulgated in February 2010. This relatively long list of foreign investment limitations contribute to the poor Philippine record in attracting foreign investment. List A enumerates investment sectors and activities for which foreign equity participation is restricted by mandate of the Constitution and specific laws. List B enumerates areas where foreign ownership is restricted or limited (generally at 40 percent) for reasons of national security, defense, public health, safety, and morals. The restrictions stem from a constitutional provision permitting Congress to reserve to Philippine citizens certain areas of investment and limit foreign participation in public utilities or their operation. No mechanism exists for a waiver under the negative lists.
The insurance industry is open to 100 percent foreign ownership, with a sliding scale of minimum capital requirements depending on the degree of foreign ownership. As a general rule, only the state-owned Government Service Insurance System (GSIS) may provide coverage for government-funded projects. Build-Operate-Transfer (BOT) projects and privatized government corporations must secure insurance and bonding from GSIS, at least proportional to GPH interests.
The Build-Operate-Transfer (BOT) Law provides the legal framework for large infrastructure projects and other types of government contracts. Franchises in railways or urban rail mass transit systems, electricity distribution, water distribution, and telephone systems may only be awarded to enterprises with at least 60 percent Philippine ownership. U.S. firms have won contracts under the law and similar arrangements, mostly in the power generation sector. However, more active foreign participation under BOT and similar arrangements can be frustrated by legal administration problems, including: weaknesses in planning, tendering, and executing private sector infrastructure projects; regulatory and legal challenges to collecting and/or increasing tolls and fees; and lingering ambiguities about the level of guarantees and other support provided by the government.
The Philippine Mining Act of 1995 allows a foreign entity full ownership of a company involved in large-scale exploration, development, and utilization of mineral resources, as arranged through Financial and Technical Assistance Agreements with the Philippine government.
The Central Bank has worked over the past five years to relax and streamline the Philippine foreign exchange (forex) regulatory framework and help stem the rapid appreciation of the peso. There are no restrictions on the full and immediate transfer of funds associated with foreign investments, foreign debt servicing, or payment of royalties, lease payments, and similar fees.
Central Bank regulations spell out specific requirements for foreign exchange purchases. There is no mandatory foreign exchange surrender requirement imposed on export earners and other foreign exchange earners such as overseas workers. The Central Bank follows a market-determined exchange rate policy, with scope for intervention targeted mainly at smoothing excessive foreign exchange volatility.
Investment disputes can take years for parties to reach final settlement. A number of GPH actions in recent years have raised questions over the sanctity of contracts in the Philippines and have clouded the investment climate. Recent high-profile cases include the GPH-initiated review and renegotiation of contracts with independent power producers, court decisions voiding allegedly tainted and disadvantageous BOT agreements, and challenges to the extent of foreign participation in large-scale natural resource exploration activities, such as mining.
Many foreign investors describe the inefficiency and uncertainty of the judicial system as a significant disincentive for investment. The judiciary is constitutionally independent of the executive and legislative branches and faces many problems, including understaffing and corruption. The GPH is pursuing judicial reform with support from foreign donors, including the U.S. Government, the Asian Development Bank, and the World Bank.
The Philippines is not a signatory to the WTO Agreement on Government Procurement. The Government Procurement Reform Act of 2003 requires the public sector to procure goods, supplies, and consulting services from enterprises that are at least 60 percent Filipino-owned and infrastructure services from enterprises with at least 75 percent Filipino interest. Although Philippine law outlines objective criteria for selection of a single portal electronic procurement system, U.S. and other foreign companies continue to raise concerns about irregularities in government procurement and inconsistent implementation. 59ce067264